Pervasive developmental disorder (PDD) is occasionally associated with medi
cally intractable complex partial seizures. The outcome of PDD was explored
in three males and two females who underwent epilepsy surgery at 32 months
to 8 years of age (mean = 4 years) after onset of epilepsy at 1 week to 21
months of age (mean = 11 months). Four children had temporal lobe resectio
ns (three right, one left; two for focal cortical dysplasia, and two for tu
mors), and one had a right temporoparieto-occipital resection (for focal co
rtical dysplasia), Each child underwent repeated evaluations by a pediatric
neuropsychologist and psychiatrist. Fourteen to 47 months (mean = 23 month
s) after operation, one child with persistent seizures had moderate develop
mental and behavioral improvement, three children (two seizure free, one wi
th rare staring spells) had mild developmental and behavioral improvement,
and the remaining child (seizure free) experienced a worsening of her PDD,
The four children with mild-to-moderate improvement in postoperative cognit
ive and behavioral development still demonstrated persistent delay. Cogniti
ve gains were confirmed by neuropsychologic testing in the oldest patient b
ut were not reflected in test results from the three younger children, who
had more modest improvement. The child with worsening of her PDD had cognit
ive and emotional deterioration to babbling, echolalia, aggressiveness, dec
reased social interaction, and increased mouthing of objects beginning seve
ral months postoperatively, These results suggest that families should be c
ounseled that PDD symptoms in children with focal epileptogenic lesions may
or may not improve after epilepsy surgery, even if the surgery is successf
ul with respect to seizure control. (C) 1999 by Elsevier Science Inc. All r
ights reserved.