Looking beyond seizure control: Psychiatric comorbidities after pediatric epilepsy surgery

Background: Approximately 30% of patients with epilepsy have drug-resistant seizures, and some may benefit from resective surgery, achieving seizure freedom in 60-70% of cases. However, long-term psychiatric outcomes in this population remain underexplored. Psychiatric disorders affect 20-30% of individuals with epilepsy and can significantly impair quality of life and complicate disease management. This study investigates anxiety, depression, Post-Traumatic Stress Disorder (PTSD) and behavior disorders in patients with drug-resistant focal epilepsy who underwent pediatric epilepsy surgery. Methods: We enrolled 104 pediatric patients (60,6% male) between June 2022 and September 2023 who underwent epilepsy surgery at Bambino Ges & ugrave; Children's Hospital (Rome, Italy). Psychiatric assessment included a battery of questionnaires and the K-SADS-PL interview, with diagnoses based on DSM-5-TR criteria. Results: Mean age at epilepsy onset was 6.4 +/- 4.41 years; mean age at surgery 9.2 +/- 4.94 years; and mean age at evaluation 13.3 +/- 4.86 years. Anxiety was identified in 27,4% (26/95), depression in 18,9% (18/95), PTSD in 13,6% (11/81), and behavior disorders in 13,5% (12/89) of patients. The psychiatric symptoms explored were significantly associated with female sex (anxiety p = 0.012; depression p = 0.019; PTSD p = 0.003) and with lack of seizure freedom (anxiety p = 0.030; PTSD p = 0.040). Among patients aged 8-16 years (n = 55/104), 83,6% (46/55) exhibited at least one psychiatric symptom, highlighting this as a vulnerable period. Conclusion: Our findings underscore the prevalence of anxiety, depression, PTSD, and behavior disorders after epilepsy surgery in pediatric patients. Early identification and continuous monitoring of psychiatric comorbidities are essential to improve long-term outcomes and quality of life.