Outcome trajectories after pediatric epilepsy surgery vary by biopsychosocial phenotypes

OBJECTIVE: The aims of this study were to examine whether there are distinct biopsychosocial phenotypes among children with drug-resistant epilepsy (DRE) and to determine whether these phenotypes are related to the longitudinal trajectories of child, parent, and family outcomes after epilepsy surgery compared to medical treatment. METHODS: This prospective cohort study recruited children with DRE aged 4-18 years who were evaluated for epilepsy surgery and their parents. Baseline clinical variables, child characteristics, parent depressive and anxiety symptoms, and family factors (household income, family demands, family resources, and satisfaction with family relationships) were used to identify distinct phenotypes using hierarchical k-means clustering. The trajectories of child health-related quality of life (HRQOL), parent depressive and anxiety symptoms, family resources, and satisfaction with family relationships over 2 years in the surgical and medical treatment groups were compared across the phenotypes using linear mixed models. RESULTS: There were 105 surgical and 197 medical patients. Three distinct biopsychosocial phenotypes were identified among children with DRE: the psychosocial vulnerability phenotype had the poorest psychological and social (family) functioning, the well functioning phenotype had substantially better clinical and psychosocial functioning, and the neurological burden phenotype demonstrated the highest seizure burden and intermediate psychosocial functioning. The most pronounced improvements in child HRQOL, parent emotional functioning, and family functioning over time were observed among those with psychosocial vulnerability, especially after epilepsy surgery. The well functioning and neurological burden phenotypes showed more limited change across most outcomes in both treatment groups. SIGNIFICANCE: Identifying biopsychosocial phenotypes may enhance prediction of child, parent, and family outcomes and identify children and families who could benefit from targeted interventions. Despite experiencing more psychosocial disadvantages, the psychosocial vulnerability phenotype demonstrated the largest improvement in outcomes following surgery, suggesting that surgical treatment has the potential to promote more equitable psychosocial outcomes, alongside clinical and HRQOL outcomes.