Epilepsy surgery in children with pervasive developmental disorder

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.