Lendt M, Helmstaedter C, Kuczaty S, Schramm J, Elger C E
University Hospital of Epileptology, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany.
J Neurol Neurosurg Psychiatry. 2000 Dec;69(6):739-44. doi: 10.1136/jnnp.69.6.739.
Epilepsy surgery has proved to be a successful intervention method to achieve freedom from seizures or seizure relief in children with pharmacoresistant epilepsy. Long term studies on operated children suggest that behavioural disorders, which are often seen before surgery, improve after surgery. However, the early postoperative development of behavioural problems has not been systematically evaluated.
Parents of 28 children with pharmacoresistant focal epilepsies completed the child behaviour checklist (CBCL) preoperatively and 3 months after surgery. Surgeries comprised 24 focal resections (13 temporal, 11 extratemporal), two hemispherectomies, and two callosotomies. Twenty eight conservatively treated children with comparable CBCL scores served as a control group. A repeated measurement multivariate analysis of variance (MANOVA) and a regression analysis were computed to compare the development of behaviour between both groups and to identify predictors of postoperative changes in behaviour.
Preoperatively 39% of the children exhibited significant behavioural problems, a further 11% were within the borderline range. The MANOVA disclosed a significant interaction between time of examination and group (F=2.23, p<0.05). The surgery group showed significant improvements on the scales "internalising problems", "externalising problems", "attention problems", and "thought problems". Behavioural problems in the control group, however, remained unchanged. No changes were seen in social problems in both groups. The significant predictor of total behavioural improvement was a good seizure outcome (R(2)=0.11, p<0.05). Age, sex, onset, and duration of epilepsy, the site of the focus, and changes in antiepileptic drug regimen did not influence changes in behaviour.
The data demonstrate an early improvement of behavioural problems after epilepsy surgery in children. The behavioural improvements can be assumed to result directly from the removal of the epileptic focus. They are not predictable on the basis of information available preoperatively, but depend on the seizure outcome.
癫痫手术已被证明是一种成功的干预方法，可使药物难治性癫痫患儿摆脱癫痫发作或减轻发作症状。对接受手术治疗的儿童进行的长期研究表明，术前常见的行为障碍在术后会有所改善。然而，术后早期行为问题的发展尚未得到系统评估。
28例药物难治性局灶性癫痫患儿的家长在术前及术后3个月完成了儿童行为量表（CBCL）。手术包括24例局灶性切除术（13例颞叶，11例颞外）、2例大脑半球切除术和2例胼胝体切开术。28例接受保守治疗且CBCL评分相当的儿童作为对照组。计算重复测量多变量方差分析（MANOVA）和回归分析，以比较两组行为的发展情况，并确定术后行为变化的预测因素。
术前，39%的患儿存在显著的行为问题，另有11%处于临界范围。MANOVA显示检查时间和组别之间存在显著交互作用（F = 2.23，p < 0.05）。手术组在“内化问题”“外化问题”“注意力问题”和“思维问题”量表上有显著改善。然而，对照组的行为问题保持不变。两组的社交问题均无变化。行为总体改善的显著预测因素是良好的癫痫发作结果（R(2)=0.11，p < 0.05）。年龄、性别、癫痫发作的起始和持续时间、病灶部位以及抗癫痫药物治疗方案的变化均未影响行为变化。
数据表明儿童癫痫手术后行为问题会早期改善。行为改善可认为是直接由于癫痫病灶的切除。这些改善无法根据术前可用信息预测，而是取决于癫痫发作结果。
