PSYCHIATRIC CO-MORBIDITY IN PEDIATRIC SURGICALLY TREATED TEMPORAL LOBE EPILEPSY

Objectives: Temporal Lobe Epilepsy (TLE) is associated with psychiatric co-morbidity particularly depression. Most reports describe adults. The objective of this study is to investigate psychiatric co-morbidity in children with surgically treated temporal lobe epilepsy.

Methods: Retrospective review of the medical records, neuroimaging and EEG data was done in children with temporal lobe epilepsy treated by surgical resection. The diagnosis of psychiatric morbidity was based on validated questionnaires and psychiatric assessments. DSM IV criteria were used for diagnosis of psychiatric disorders.

Results: The study population comprised 33 patients, 23 males (69%) and 10 females (31%), the median age at seizure onset was 8.5 years (range 3 months-15 years). The etiology was malformations of cortical development (7), mesial temporal lobe sclerosis (10), tumors (11), and other (5). 22/32 (69%) had psychiatric co-morbidity; depression was most common in 9 (27%). In 6 of the 9 depressions occurred pre-surgery only and all were seizure free (Engle Ia) following surgery. Three patients made a pre-surgery suicide attempt. In 2, depression persisted following surgery and seizure outcome was Engel Ib and IV respectively. In one patient, depression occurred post-surgery and this patient was seizure free. One patient had a schizophreniform psychosis and committed suicide. This patient had no improvement in seizure control. Anxiety occurred in 5 (15%), Oppositional Defiant Disorder in 4 (12%), and Obsessive Compulsive Disorder in 4 (12%). Autism was diagnosed in 4 (12%).

Conclusion: Psychiatric co-morbidity is very common in children with intractable temporal lobe epilepsy. Good surgical outcome was associated with improvement in depression. Psychiatric evaluation of children under evaluation for epilepsy surgery is extremely important.