RESUMO
Children with epilepsy have a high rate of mood and behavior problems; yet few studies consider the emotional and behavioral impact of surgery. No study to date has been sufficiently powered to investigate effects of both side (left/right) and site (temporal/frontal) of surgery. One hundred patients (aged 6-16) and their families completed measures of depression, anxiety, and behavioral function as part of neuropsychological evaluations before and after surgery for pharmacoresistant epilepsy. Among children who had left-sided surgeries (frontal = 16; temporal = 38), there were significant interactions between time (pre to post-operative neuropsychological assessment) and resection site (frontal/temporal) on anhedonia, social anxiety, and withdrawn/depressed scales. Patients with frontal lobe epilepsy (FLE) endorsed greater pre-surgical anhedonia and social anxiety than patients with temporal lobe epilepsy (TLE) with scores normalizing following surgery. While scores on the withdrawn/depressed scale were similar between groups before surgery, the FLE group showed greater symptom improvement after surgery. In children who underwent right-sided surgeries (FLE = 20; TLE = 26), main effects of time (patients in both groups improved) and resection site (caregivers of FLE patients endorsed greater symptoms than those with TLE) were observed primarily on behavior scales. Individual data revealed that a greater proportion of children with left FLE demonstrated clinically significant improvements in anhedonia, social anxiety, and aggressive behavior than children with TLE. This is the first study to demonstrate differential effects of both side and site of surgery in children with epilepsy at group and individual levels. Results suggest that children with FLE have greater emotional and behavioral dysfunction before surgery, but show marked improvement after surgery. Overall, most children had good emotional and behavioral outcomes, with most scores remaining stable or improving.
RESUMO
It is well known that epilepsy patients often exhibit material-specific deficits in memory for verbal versus nonverbal material. However, it is also apparent that such deficits are not always discernible, and that numerous factors may potentially moderate the degree to which fractionation between verbal and nonverbal material is evident. Using confirmatory factor analysis, we compared the relative fit of one-factor (general) and two-factor (material-specific) models of memory in data from 330 patients with intractable seizure disorder. Data from verbal and nonverbal selective reminding tests, as well as Logical Memory and Visual Reproduction (immediate and delayed recall indices), were used in analyses. The one-factor model fit the data poorly in the full sample, whereas the two-factor model fit the data significantly better. We then assessed the invariance of these two models using multiple-group modeling across subsamples of patients with left versus right sided seizure focus, earlier versus later age of seizure onset, lower versus higher Full Scale IQ, fewer versus more years of education, younger versus older patients, and male versus female patients. In all cases, the two-factor model comprised of verbal and nonverbal memory factors fit the data better than a one-factor (general) model. These findings indicate robust consistency of verbal and nonverbal memory constructs in the epilepsy population, which remain viable in this patient group despite considerable heterogeneity in other respects.
