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Psychopathology before and after temporal lobectomy for epilepsy

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Children with temporal lobe epilepsy (TLE) commonly exhibit psychopathology but children with severe TLE who are candidates for temporal lobectomy are even more likely to have a psychiatric disorder and many have more than one psychiatric diagnosis. A report from the Great Ormond Street Hospital for Children, London (

) includes 60 children who underwent temporal lobectomy between 1992 and 1998. Forty-three children (72%) had at least one psychiatric diagnosis before operation and 27 (45%) had more than one. The main psychiatric diagnoses preoperatively were disruptive behaviour disorder, not otherwise specified (DBD (NOS)), which affected 25 of 60 children; pervasive developmental disorder (PDD), 23 children; attention deficit hyperactivity disorder (ADHD), 14; and oppositional defiant disorder/conduct disorder (ODD/CD), 14. Five children had emotional disorders before operation. Of 57 children followed up after operation 25 had DBD (NOS) (five lost that diagnosis and five gained it), 21 had PDD, 13 ADHD, and 13 ODD/CD. Twelve had emotional disorder, ten for the first time. Overall, 72% had a psychiatric diagnosis before operation and 72% of those followed up had a psychiatric diagnosis after operation. Except for PDD, there was no significant relationship between psychiatric disorders and brain pathology, sex, seizure frequency, or postoperative seizure outcome. PDD was significantly associated with younger age of seizure onset, right sided temporal lobe lesions, and cognitive difficulties, and was non-significantly associated with male sex. Thirty-seven children had no or rare seizures after operation, nine had much fewer seizures, and 11 had an unchanged or worse seizure frequency. Psychiatric outcome after temporal lobectomy is uncertain, unrelated to seizure outcome, and needs to be discussed with parents during the preoperative work-up.

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