Psychopathology in children and adolescents with epilepsy: an investigation of predictive variables

Mental health and neurodevelopmental patient-reported outcome measures (PROMs) for children and young people with epilepsy: A systematic review

Children and young people with epilepsy are at higher risk of mental health disorders and atypical neurodevelopmental outcomes compared to the general population. It is essential to detect such comorbidities early in children with epilepsy and provide appropriate interventions, to improve clinical outcomes. We aimed to identify and evaluate the measurement properties of Patient-Reported Outcome Measures (PROMs) that have been validated specifically to measure mental health and neurodevelopmental outcomes in children and/or young people with epilepsy. We searched Embase, Medline, and PsycINFO in May 2023 for relevant studies. Mental health was defined as psychological symptoms (e.g., anxiety, depression, psychosis) and/or behavioural difficulties (e.g., conduct disorders). Neurodevelopmental outcomes included neurodevelopmental disorder traits such as attention-deficit hyperactivity disorder (ADHD) and autistic spectrum disorders. We assessed methodological quality using Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidance. Twelve papers were identified that psychometrically evaluated 13 relevant PROMs (two epilepsy-specific, eleven generic). The appraisal of the PROMs was limited by the availability of only one or two published articles for each, and incomplete psychometric evaluations in some cases. The tool demonstrating the strongest evidence was The Neurological Disorders Depression Inventory-Epilepsy for Youth. The ADHD Rating Scale-IV and The Paediatric Symptom Checklist -17 demonstrated good evidence in favour of at least two measurement properties. This review identified only a small number of mental health and neurodevelopmental PROMs evaluated specifically in paediatric epilepsy. There is a need for further validation of mental health and neurodevelopmental PROMs in children with epilepsy.

Impact of sociodemographic disadvantage on neurobehavioral outcomes in children with newly diagnosed seizures and their unaffected siblings over 36 months

OBJECTIVE

This study was undertaken to determine the short-term and longer term impact of sociodemographic disadvantage on the emotional-behavioral status of youths with new onset epilepsy and their unaffected siblings at the time of diagnosis and the subsequent 3 years.

METHODS

Three hundred twelve youths with newly diagnosed epilepsies and 223 unaffected siblings, aged 6-16 years, were independently assessed regarding their emotional and behavioral status by their parents and teachers at baseline, and at 18 at 36 months later; youths with seizures also completed self-report measures of depression, anxiety, and hostility at those three time points. A sociodemographic disadvantage score was computed for each family (children with newly diagnosed seizures and their siblings), and families were separated into four categories from most disadvantaged to least disadvantaged.

RESULTS

In both children and siblings, the least disadvantaged group exhibited the lowest level of neurobehavioral problems, whereas the most disadvantaged group showed a higher level of neurobehavioral problems across all the same behavior metrics. Findings remained stable and significant across all informants (parent, teacher, child) and across all time periods (throughout the 3-year period). Furthermore, both corrected and uncorrected linear regression analyses indicated that disadvantage was a more constant and stable predictor of behavioral and emotional problems over time compared to clinical seizure characteristics and abnormalities in magnetic resonance imaging and electroencephalographic testing.

SIGNIFICANCE

Sociodemographic disadvantage bears a strong relationship to youths with emotional and behavioral problems both at the time of diagnosis as well as prospectively. The relationship is robust and reflected in reports from multiple informants (parent, teacher, child self-report), evident in siblings as well, and possibly more explanatory than traditional clinical seizure variables. Future studies will be needed to determine whether this disadvantage factor is modifiable with early intervention.

Emotional and behavioral profiles of adolescents with epilepsy: Associations with parental perception of epilepsy-related stigma

PURPOSE

We evaluated self-reported psychopathology in adolescents with epilepsy (AWE) and determined which types of psychopathology were associated with the parental perception of stigma towards AWE.

METHODS

This was a cross-sectional, multicenter study of 289 adolescents aged 11 to 18 years. Psychopathology was evaluated using the Youth Self-Report scale, which consists of eight narrowband and three broadband syndrome scales. We analyzed the raw score and T-score of each syndrome scale. The parental perception of stigma was assessed using the modified three-item Epilepsy Stigma Scale.

RESULTS

Of the 289 AWE (180 boys and 109 girls), 18.3% had at least one emotional or behavioral problem in the clinical range. Social problems were the most common (10.0%), followed by attention problems (6.9%) and aggressive behaviors (4.2%). Externalizing problems (11.8%) were two times more common than internalizing problems (6.2%). Females and older AWE had a higher level of internalizing problems. Social problems were more common in girls (15.6%) than in boys (6.7%), whereas thought problems were more common in boys (3.9%) than in girls (0%). Epilepsy-related factors, especially antiseizure medication polytherapy, were significantly associated with various emotional and behavioral problems. A quarter of parents felt stigma towards their children with epilepsy. Male sex, antiseizure medication polytherapy, and longer duration of epilepsy were more likely to be associated with the parental perception of stigma. Parental perception of stigma was significantly associated with psychopathology in AWE, particularly externalizing problems and social problems.

CONCLUSIONS

Emotional and behavioral problems in AWE are common and vary depending on demographic, clinical, and parental factors. Early identification and proper management of these problems are crucial for decreasing comorbid psychopathology in AWE.

Impact of number of anti-seizure medications on long-term health-related quality of life in children with epilepsy: A prospective cohort study

PURPOSE

Health-related quality of life (HRQL) is compromised in children with epilepsy. We aimed to determine whether children diagnosed with epilepsy between ages 4-12 years who are exposed to a higher number of anti-seizure medication (ASM) over the first 2 years, have poorer HRQL 10 years after diagnosis.

METHODS

Data were obtained from 195 children enrolled in the Health-Related Quality of Life in Children with Epilepsy Study (HERQULES) in Canada. HRQL was measured using the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-55) completed by parents at baseline through to 10 years after diagnosis. The total number of ASM were reported by physicians four times in the first two years after diagnosis. Multivariable block-wise linear regression was used to assess the impact of ASM (categorized as none, one, or more than one), as well as clinical and family factors on children's HRQL 10 years after diagnosis.

RESULTS

Children had a mean age of 7.9 ± 2.3 years at diagnosis and 92 (47%) were female. Mean QOLCE at baseline and 10 years was 72.04±14 and 78.7±16,respectively. Clinically meaningful improvement in HRQL from the 2 to 10-year follow-up was detected in 35% of children, reported similarly across all ASM treatment categories (p = .38). The number of ASM prescribed in the first two years was associated with HRQL at the 10-year follow-up, however this association was not significant when adjusting for clinical characteristics, family factors, and HRQL at the two-year follow-up (p = .75). Our data showed that HRQL at 2 years was the only variable associated with better HRQL scores at 10 years (p = <.001).

CONCLUSION

In children with new onset epilepsy, exposure to a higher number of ASM, when accounting for clinical and family factors as well as HRQL at 2 years, is not independently associated with lower long-term HRQL. Early HRQL was found to be a good indicator of long-term HRQL, despite the number of ASMs prescribed.

Association between epilepsy and risk of depression: A meta-analysis

BACKGROUND

Recent studies provided inconsistent evidence for the association between epilepsy and risk of depression.

METHODS

We searched for articles published in the databases (Web of Science, Google Scholar and PubMed) and before December 2021. We used STATA 12.0 software to compute odds ratios (ORs)/relative risks (RRs) and their 95% confidence intervals (CIs).

RESULTS

The meta-analysis indicated that epilepsy was associated with an increased risk of depression with a random effects model (OR/RR = 2.05; 95% CI: 1.77-2.37, I² = 37.7%, p = 0.036). Subgroup studies indicated that epilepsy was associated with an increased risk of depression in both case-control and cohort studies (case-control studies: OR = 2.32; 95% CI: 1.91-2.82; cohort studies: RR = 1.71; 95% CI: 1.53-1.92). Subgroup studies indicated that epilepsy was associated with an increased risk of depression in Asian, African and Caucasian populations (Asian: OR/RR = 2.42; 95% CI: 1.48-3.95; African: OR/RR = 2.48; 95% CI: 1.88-3.28; Caucasian: OR/RR = 1.86; 95% CI: 1.60-2.15). Subgroup studies showed that epilepsy was associated with an increased risk of depression among adolescents and adults (adolescents: OR/RR = 2.54; 95% CI: 1.86-3.46; adults: OR/RR = 2.22; 95% CI: 1.79-2.75).

CONCLUSIONS

Epilepsy is at increased risk of depression comorbidity.

Assessment of the Frequency of Depressive Symptoms in Epileptic Children (Single Center Study)

Background

Epilepsy, the most common neurological disorder in children, may present with many psychiatric comorbidities, the most common of which is depression.

Aim of the Work

We evaluated the frequency of depressive symptoms in epileptic children, with regard to the possible association between depression and their demographic data or seizure-related variables.

Patients and Methods

This cohort study was conducted on 80 children (6-13 years old) diagnosed as idiopathic epilepsy and were regularly recruiting the pediatric neurology clinic at Minya University Children Hospital. The Structured Birleson Depression Scale Questionnaire was used for assessment of presence of depressive symptoms, and Quality Of Life in Epilepsy (QOLIE-31) score was used to assess quality of life in those patients.

Results

Depressive symptoms were found in 37.5% of enrolled patients. There were statistically significant differences between the patients with depressive symptoms and the other group regarding age (p=0.001), residence (p=0.006) and past history of mood disorders (p=0.03). Sleep disturbance was the highest predictor of depression in cases with depressive symptoms, detected in 90% of cases, followed by appetite disturbance in 86.6% of cases, while delusions and hallucinations were the lowest, detected in only 10% of cases. Both duration of epilepsy and frequency of seizures were significantly higher in cases with depressive symptoms than the other group (p=0.001) for both. QOLIE score was significantly lower in cases with depressive symptoms than the other group (p= 0.01 for all).

Conclusion

Depressive symptoms are common in epileptic children, and it is often challenging and underestimated. It should be screened during the management of such children. Early diagnosis and more comprehensive package of care for depression in epileptic children will enable them to have a better quality of life.

Mental Health of Adolescents With Epilepsy in Enugu, Nigeria: A Cross-Sectional Study

Adolescence is an important period, marked by significant changes in biological and psychosocial domains. Epilepsy is a chronic neurologic disorder associated with social stigma and prejudice. The etiology of depression in epilepsy appears to be a complex interplay between psychosocial and neurobiologic factors. This period may be too taxing for the adolescent with epilepsy to steer, as epilepsy can affect the development of independence by its social, educational, and mental health effects. The study aimed to compare the burden of depression in adolescents with epilepsy with the general population.One hundred forty-five adolescents with epilepsy and their classmates matched for age and gender were studied over a 9-month period. Zung Self-rating Depression Scale was used to determine the burden of depression in the study population.Among the subjects, 70 (48.3%) had scores in the depressive range to varying degrees compared to 38 (26.2%) controls. The difference in scores was significant (OR=2.628, P < .001). Among the population with positive scores, mild depression category was the commonest for both groups (40% and 22.8%, respectively). There was a statistically significant relationship between gender, seizure type, and depression, whereas there was no significant relationship between age, social class, number of antiepileptic drugs, seizure frequency in the last 12 months, and depression.Adolescents with epilepsy had higher rates of depression than the general population. Hence, there might be need for routine screening of adolescents with epilepsy for early detection and management of depression to improve their overall well-being and quality of life.

Longitudinal changes in emotional functioning following pediatric resective epilepsy surgery: 2-Year follow-up

OBJECTIVE

To examine longitudinal changes and predictors of depression and anxiety 2 years following resective epilepsy surgery, compared to no surgery, in children with drug-resistant epilepsy (DRE).

METHOD

This multicenter cohort study involved 128 children and adolescents with DRE (48 surgical, 80 nonsurgical; 8-18 years) who completed self-report measures of depression and anxiety at baseline and follow-up (6-month, 1-year, 2-year). Child demographic (age, sex, IQ) and seizure (age at onset, duration, frequency, site and side) variables were collected.

RESULTS

Linear mixed-effects models controlling for age at enrolment found a time by treatment by seizure outcome interaction for depression. A negative linear trend across time (reduction in symptoms) was found for surgical patients, irrespective of seizure outcome. In contrast, the linear trend differed depending on seizure outcome in nonsurgical patients; a negative trend was found for those with continued seizures, whereas a positive trend (increase in symptoms) was found for those who achieved seizure freedom. Only a main effect of time was found for anxiety indicating a reduction in symptoms across patient groups. Multivariate regressions failed to find baseline predictors of depression or anxiety at 2-year follow-up in surgical patients. Older age, not baseline anxiety or depression, predicted greater symptoms of anxiety and depression at 2-year follow-up in nonsurgical patients.

CONCLUSION

Children with DRE reported improvement in anxiety and depression, irrespective of whether they achieve seizure control, across the 2 years following surgery. In contrast, children with DRE who did not undergo surgery, but achieved seizure freedom, reported worsening of depressive symptoms, which may indicate difficulty adjusting to life without seizures and highlight the potential need for ongoing medical and psychosocial follow-up and support.

Psychiatric disorders among children and adolescents with active epilepsy in southwestern Uganda

INTRODUCTION

the study aimed to determine the prevalence of emotional, behavioral, developmental and psychosis related disorders among children and adolescents with active epilepsy aged 5 to 18 years in southwestern Uganda.

METHODS

we conducted a cross sectional study at one big urban hospital, two rural health centers and one rural special needs school. The disorders were assessed using an adapted parent version of the Child and Adolescent Symptom Inventory-5 (CASI-5).

RESULTS

one hundred and sixty-one participants were assessed, and 93 (57.8%) had at least one psychiatric disorder. Developmental disorders were the most prevalent at 39.8% (95%CI 32.11 - 47.39), followed by emotional disorders, 30.4% (95%CI 23.25-37.62), behavioral disorders, 7.5% (95%CI 3.35-11.55) and psychosis related disorders, 6.2% (95%CI 2.44 - 9.98). Thirty-nine participants (24.2%) had at least two psychiatric disorders. Developmental disorders were associated with younger age (aOR=0.86, p=0.001) and having epilepsy-related physical injuries and deformities (aOR=2.36, p=0.036). Emotional disorders (aOR=1.13, p=0.007) and psychosis related disorders (aOR=1.44, p=0.007) were associated with increasing age, whereas a family history of epilepsy was protective (aOR=0.22, p=0.042).

CONCLUSION

psychiatric disorders were highly prevalent among children and adolescents with epilepsy in southwestern Uganda; highlighting the need to integrate screening and management of these disorders into routine epilepsy care.

Examining relations between neuropsychological and clinical epilepsy-specific factors with psychopathology and adaptive skills outcomes in youth with intractable epilepsy

Pediatric epilepsy is a prevalent childhood neurological disorder. Youth with a diagnosis of medically uncontrollable or intractable epilepsy are at increased risk for poor neurocognitive and psychosocial functioning. To date, there is a paucity of clinical research examining and/or characterizing the relations of neuropsychological, clinical, and epilepsy-specific medical factors in clinical outcomes among youth with diagnosed intractable epilepsy. One hundred and twenty-six patients (6-20 years) with diagnosed intractable epilepsy and who were evaluated as part of a presurgical work-up and medical standard of care participated in a neuropsychological evaluation, including parent completion of the Behavior Assessment System for Children - Second Edition Parent Report Scale (BASC-2 PRS). Medical chart review was conducted to obtain demographic and epilepsy-specific information. Results indicated that an increase in the BASC-2 PRS Adaptive Symptoms Index T-Scores was associated with a decrease in the BASC-2 PRS Internalizing, Externalizing, and Behavioral Symptoms Index score. Additionally, the Wechsler (Wechsler Intelligence Scale for Children - Fourth Edition [WISC-IV], Wechsler Intelligence Scale for Children - Fifth Edition [WISC-V], Wechsler Adult Intelligence Scale - Fourth Edition [WAIS-IV]) Similarities z-score was associated with the BASC-2 PRS Externalizing Symptoms Index T-Score. No demographic or clinical medical factors remained in any of the three final models. Findings highlight the importance of verbal reasoning and adaptive functioning as protective factors in clinical outcomes among youth with diagnosed intractable epilepsy and may provide future direction for targeted interventions.

An Overview of Anxiety Disorders and Depression in Children with Epilepsy: A Literature Review

Comorbid psychiatric disorders in children with epilepsy have long been a subject of medical literature. Many studies conducted by pediatric neurologists, neurosurgeons, psychiatrists, and psychologists have revealed that psychiatric disorders, including anxiety disorders and depression, are frequently seen in children and adolescents with epilepsy. Due to various etiologies behind epilepsy, causes, manifestation, and treatment of anxiety and depression all have unique aspects. We think there are multiple reasons behind anxiety disorders and depression in children with epilepsy, varying from the physiological nature of the epilepsy itself to the environmental factors such as family, parenting, and social status. In this article, we aim to review the causes, risk factors, and management of anxiety disorders and depression in children with epilepsy.

Longitudinal trajectories of depression symptoms in children with epilepsy

AIM

To examine self- and proxy-reported symptoms of depression in children with epilepsy.

METHOD

This was a prospective longitudinal cohort study of children with epilepsy. Participants were treated at six Canadian tertiary-care centers and followed over 28 months with repeated assessments of child self-reported symptoms of depression using the Children's Depression Inventory Short-Form (CDI-S). Trajectories of symptoms of depression were estimated using linear mixed effects (LME) modeling.

RESULTS

At baseline, 477 children had complete data (mean age [SD] 11y 5mo [2y 1mo], range 7y 7mo-15y 1mo; 234 females, 243 males). Mean CDI-S T score at baseline was 45.7 (SD=7.5) and at 28 months was 44.9 (SD=8.2), both were within the 'average' range. Results from LME modeling revealed mean raw CDI-S score of 1.897, corrected for age 10 years (corresponding to T scores slightly below the normed mean of 50), with no significant change over three measurements (slope=-0.113, p=0.135), indicating that CDI-S scores were stable over 28 months. Children with high initial CDI-S scores had lower subsequent scores, as demonstrated by the correlation of -0.827 between intercept and slope (p<0.001). Parents reported comparable findings.

INTERPRETATION

Self- and proxy-reported symptoms of depression were generally low and stable over an extended follow-up period. Normalization of scores was seen upon repeated assessment, even in children with higher scores of symptoms of depression at one point. These findings speak to the value and importance of repeated assessment over time.

WHAT THIS PAPER ADDS

In children with epilepsy, self- and proxy-reported symptoms of depression were generally low and stable over 28 months. The trajectory of symptoms of depression was not associated with seizure severity, whether considering the frequency or type of seizures. Parents' reports of symptoms of depression were comparable to the children's self-evaluations.

Children and adolescents with epilepsy in rehabilitation centers: A French prospective transversal study

INTRODUCTION

The reason why some children and adolescent with epilepsy (CAWE) still challenge the "inclusive" educative policy needs to be explored.

METHODS/PATIENTS

We conducted a transversal study in French medical, social, and educative rehab centers (MSERCs) dedicated to CAWE to describe the profile of 263 centers-involved (CI)-CAWE. Centers-involved CAWE were prospectively followed from September 2012 to August 2013. Medical, social, and educative rehab centers were dichotomized according to their care-provider agreement (i.e., CAWE of "moderate" (M) vs. "severe" (S) conditions). Clinical factors known to impact clinical outcome and quality of life (QoL) in epilepsy and four disabling conditions at risk to impact school life (i.e., cognitive and psychiatric/behavioral disorders, risk of physical hazards (i.e., refractory seizures with unpredictable loss of tone and/or awareness), and one or more seizure/week) were evaluated. The electronic chart of the French collaborative database (namely GRENAT) was used for data collection allowing comparison with the profile of 731 "normally integrated and schooled" (NIS)-CAWE extracted from GRENAT and matching for generation (i.e., born between 1988 and 2006).

RESULTS

Centers-involved CAWE's profile was found, after adjustment, to be associated with clinical factors and disabling conditions reflecting the poorest clinical outcome and health-related quality of life (HR-QoL) (all p < 0.001). A cutoff of two disabilities/child highly discriminated NIS-CAWE vs. CI-CAWE. Centers-involved CAWE of S-MSERCs were the most severe (all p < 0.001), and the type of cognitive disability (i.e., intellectual disability (ID) vs. specific learning disorders (SLD)) highly paralleled the types of MSERCs (S vs. M). Using a parent-informant questionnaire, the number of disabilities/child was found to correlate with both the evaluation of the impact of epilepsy (r = 0.47, p < 0.001) and the HR-QoL (r = 0.37, p < 0.001). A satisfactory social life was reported (83.8%) even after S vs. M dichotomization (77.2% vs. 94.7%; p < 0.001).

CONCLUSION

Multiple disabilities rather than epilepsy per se challenge the inclusive educative policy. Evaluation of disabilities could be the missing bridge to optimize this policy and understand its limits.

Impact of resective surgery for pediatric drug-resistant epilepsy on emotional functioning

OBJECTIVE

The objective of the study was to evaluate emotional functioning following surgical and medical treatment in children with drug-resistant epilepsy (DRE; i.e., uncontrolled seizures despite treatment with ≥2 antiepileptic drugs [AED]).

METHOD

This prospective, longitudinal, multicenter study involved 128 children and adolescents (8-18 years) with DRE who were assessed for surgical candidacy; 48 went on to have surgery and 80 continued medical treatment. Participants completed child-validated self-report measures of anxiety and depression at baseline, 6, and 12 month follow-up. Standardized z-scores were calculated with higher scores indicative of greater symptoms.

RESULTS

At baseline, 16% and 22% of all patients reported elevated symptoms of depression and anxiety, respectively (i.e., z ≥ 1.00). Seizure freedom was higher in the surgical, compared with the medical, group at 6 (64 vs. 11%) and 12 month (77 vs. 24%) follow-up. Linear mixed effects models controlling for age found a main effect of time for both depression and anxiety; scores decreased over time for all patients. A main effect of seizure outcome was found for depression, but not anxiety; seizure freedom was associated with lower scores overall. There were no main effects of treatment or significant interactions. Multiple regression analyses found baseline mood predicted outcomes at 6 and 12 month follow-up; higher anxiety and depression scores at baseline were associated with higher scores at follow-up. Older age and greater number of AEDs at baseline was associated with higher depression scores at 12 month follow-up.

CONCLUSION

Overall, patients reported a reduction in anxiety and depressive symptoms over the first 12 months, irrespective of treatment, and baseline level of functioning was the best predictor of outcome. Despite more children achieving seizure freedom with surgery compared with medical treatment, surgery was not associated with better outcomes over time. It may be that changes in anxiety and depression require a longer time to emerge postsurgery; however, being seizure-free is associated with fewer depressive symptoms, irrespective of treatment type.

Evaluation of Symptoms of Depression and Anxiety in Adolescents with Epilepsy in a Tertiary-Level Medical Center in Serbia

Backgrounds

Even though epilepsy is the most common neurological disorder in adolescence; studies of adolescents with epilepsy are scarce.

Objective

To evaluate whether adolescents with epilepsy are more likely to develop anxiety and depressive symptoms than their healthy peers and to determine the relationship of depression and anxiety scores to epilepsy-related variables.

Settings and Design

Cross-sectional observational study.

Methods and Procedures

Ninety adolescents with epilepsy aged 13-19 years were compared with healthy controls using the Beck Depression Inventory II (BDI II) and the Stait Trait Anxiety Inventory (STAI) for assessment of depressive and anxiety symptoms. Within the study group, epilepsy-related variables were also determined using the stated measures.

Statistical Analysis Used

The independent sample t-test, One-Way ANOVA, Pearson's correlation coefficient.

Outcomes and Results

23.3% of the study group and 8.3% of the control group had mild to moderate depression. The mean BDI II score was significantly higher in the group of adolescents with epilepsy. Comparing the STAI scores, results on both STAI scales were higher in the study group. Regarding the epilepsy-related variables, a high frequency of seizures, symptomatic etiology and polytherapy showed strong associations with high depression and anxiety scores.

Conclusion and Implications

Symptoms of depression and anxiety are not uncommon among adolescents with epilepsy. BDI II and STAI may be used as screening tools to provide useful information to clinicians when assessing adolescents' mental status.

Autism, ADHD and parent-reported behavioural difficulties in young children with epilepsy

PURPOSE

To provide data on the prevalence of Autism Spectrum Disorder (ASD), Attention-Deficit/Hyperactivity Disorder (ADHD), and parent reported behaviour difficulties in young children with epilepsy, and to compare results with children with neurodisability (neurodevelopmental/neurological difficulties) without epilepsy.

METHOD

Children with epilepsy (1-7 years, n = 48) and children with neurodisability (1-7 years, n = 48) matched for gender, chronological and developmental age underwent psychological assessment. Parents completed measures of behaviour including the Strengths and Difficulties Questionnaire (SDQ). DSM-5 diagnoses of ASD and ADHD were made at consensus case conferences. Factors associated with child behaviour were analysed using linear regression.

RESULTS

Of the children with epilepsy, 18% met ASD criteria and 40% met ADHD criteria (corresponding figures in the non-epilepsy group were 41% and 27%). A large proportion (76%-78%) in both groups scored in the at-risk range on the SDQ and frequently had difficulties across multiple behavioural domains. Children with epilepsy had more concerns expressed regarding attention and mood. None of the epilepsy factors were significantly associated with scores on the behavioural measures.

SIGNIFICANCE

Young children with epilepsy had a very high level of parent reported behavioural difficulties and a high risk for ADHD and ASD highlighting the need for comprehensive multidisciplinary assessment. Behavioural concerns were not greater than for other children with non-epilepsy related neurodisability with the exception of attention and mood. Epilepsy related factors were not associated with child behaviour, suggesting that seizures per se do not confer a unique risk for behavioural difficulties.

The Impact of Pediatric Epilepsy on Children and Families: A Multicenter Cross-Sectional Study

Background and Objectives:

Epilepsy is considered one of the most prevalent causes of morbidity in children. The aim of this study is to determine how epilepsy impacts the lives of children with epilepsy and their families.

Methods:

A translated version of the “Impact of Pediatric Epilepsy Scale” (IPES) questionnaire was completed by the 80 mothers of children with epilepsy, recruited at three hospitals in Jeddah, Saudi Arabia This is a validated self-administered questionnaire used to assess the impact of epilepsy on the lives of the child and family, as well as the quality of life (QoL) of the child.

Results:

The mean age of children epilepsy was 6.32 years (SD = 3.22). The mean IPES score was 6.28 (SD = 8.42) and the mean child’s QoL was 2.85 (SD= 0.83). 87.5% of the mothers rated their child’s QoL as low. IPES score was significantly associated with cause of seizure (β=0.259; 95%-CI= 0.263 - 10.334; p = 0.039). Child’s QoL was significantly associated with frequency of seizure (β=0.251; 95%-CI= 0.016 - 0.568; p= 0.039) and child’s nationality (β=-0.270; 95%-CI -0.252, -0.013; p= 0.031).

Conclusions:

Pediatric epilepsy may have a greater impact on the lives of the child and the family when it is not comorbid with cerebral palsy. Quality of life tends to be lower for non-Saudi children, and children with more frequent seizures. Therefore, these groups may need more support in managing the impact that epilepsy has on their daily functioning and quality of life.

Sociocultural aspects and different types of stigmatization in epilepsy

This literature review deals with knowledge and beliefs about epilepsy and with the attitude of patients, relatives, and society as a whole towards epilepsy. It discusses the stigma that is associated with the  disease and has a strong impact on patients with epilepsy and their  families. The problems of stigma or related concepts in different countries are analyzed.

Young people with epilepsy have an increased risk of eating disorder and poor quality diet

Objective

To investigate whether adolescents with epilepsy are at increased risk of having self-reported eating disorder symptoms and poor quality diet compared to young people from the general population.

Methods

We used data from the Health Profile for Children and Youth in Akershus Study, a cross-sectional population-based study based on a voluntary self-reported questionnaire. There were 19,995 participants (response rate 85%) aged 13-19 years; 247 (1.2%) reported a lifetime diagnosis of epilepsy. Odds ratios (OR) and 95% confidence intervals (CI) for eating disorders, unhealthy diet, dieting, satisfaction with looks, and participation in sports were estimated by using a logistic regression model. All estimates were adjusted for single parents and poor family economy.

Results

Children and adolescents with epilepsy had more eating disorders than their peers (OR 1.8, CI 1.0-3.0, p = 0.03). They were less satisfied with their own appearance (OR 0.7, CI 0.5-0.9, p = 0.02), and they eat more unhealthily (OR 1.7, CI 1.3-2.2, p = 0.001). Males with epilepsy were more likely to have been dieting (OR 3.1, CI 1.2-7.9, p = 0.02) and less satisfied with their own appearance (OR 0.4, CI 0.3-0.7, p < 0.001). Females with epilepsy were more likely to eat unhealthily (OR 1.7, CI 1.1-2.5, p = 0.01).

Significance

Adolescents with epilepsy are at increased risk of having eating disorder symptoms. They eat less healthily and are less satisfied with their looks. Health workers should be aware of this and bring diet and lifestyle into the dialogue with young people with epilepsy.

Symptoms of anxiety and depression and family's quality of life in children and adolescents with epilepsy

INTRODUCTION

We studied children and adolescents with epilepsy (CAWE) and their families to evaluate symptoms of anxiety and depression, quality of life (QoL), and their correlations with epilepsy characteristics.

MATERIAL AND METHODS

The study included 326 (52.5% females) 8 to 18years old CAWE. Anxiety and depression were assessed with the "Self-administered psychiatric scales for children and adolescents" (SAFA), and family's QoL with the parents' report "Impact of Epilepsy on QoL" (IEQoL).

RESULTS

The CAWE exhibiting abnormal (T≥70) scores were 8.0% in the anxiety scale, 9.2% in the depression scale, and 4.6% in both scales. Social anxiety was the predominant anxiety symptom, while irritable mood and desperation were the most frequent symptoms of depression. Depressive symptoms were associated with parents' complaint of higher worries about the child's condition and future and lower well-being of the family. Severity and duration of the epilepsy and polypharmacy were independent from abnormal scores of anxiety and depression, but were associated with parents' worries about the child's condition and family's well-being.

CONCLUSIONS

Anxiety and depression in CAWE are independent from the characteristics of the disease but are correlated to the lower well-being of the family. A search of these emotional problems is recommended for better care of the patients and their families.

Health-related quality of life in adolescents with epilepsy in Montenegro

OBJECTIVE

The objective of this study was to establish potential risk factors for poor health-related quality of life among adolescents with epilepsy in Montenegro.

MATERIAL AND METHODS

A sample of 104 adolescents with epilepsy (age: 11-19years) at a tertiary referral center in Podgorica, Montenegro, completed the validated Serbian version of the QOLIE-AD-48 questionnaire. They were divided into two groups: a group with active epilepsy (60 adolescents) and a group with inactive epilepsy (44 adolescents). Demographic and clinical data were collected.

RESULTS

Adolescents with active epilepsy had low quality of life and felt the negative impact of the disease. They also had more cognitive impairments, felt more stigmatized, and had considerably more distorted perception of their health than adolescents with inactive epilepsy (p<0.05). Females reported better social support than males (p<0.05). Older males had lower grades at school (p<0.05) than the younger ones. As expected, adolescents with the highest number of seizures in the past two years had the lowest quality of life (p<0.05).

CONCLUSION

In our study, the quality of life in adolescents with epilepsy was determined by severity of the disease, age, and gender.

Frequency and predictors of psychological distress after a diagnosis of epilepsy: A community-based study

OBJECTIVE

The objective of the study was to determine the frequency and predictors of psychological distress after a diagnosis of epilepsy.

METHODS

The Sydney Epilepsy Incidence Study to Measure Illness Consequences (SEISMIC) was a prospective, multicenter, community-based study of people of all ages with newly diagnosed epilepsy in Sydney, Australia. Analyses involved multivariate logistic regression and multinomial logit regression to identify predictors of psychological distress, assessed using the Hospital Anxiety and Depression Scale (HADS) and the Strengths and Difficulties Questionnaire (SDQ), as part of structured interviews.

RESULTS

Psychological distress occurred in 33% (95% confidence interval [CI] 26 to 40%) and 24% (95% CI 18 to 31%) of 180 adults at baseline and 12months, respectively, and 23% (95% CI 14 to 33%) of 77 children at both time points. Thirty adults and 7 children had distress at baseline who recovered at 12months, while 15 adults and 7 children had new onset of distress during this period. History of psychiatric or behavioral disorder (for adults, odds ratio [OR] 6.82, 95% CI 3.08 to 15.10; for children, OR 28.85, 95% CI 2.88 to 288.60) and higher psychosocial disability (adults, OR 1.17, 95% CI 1.07 to 1.27) or lower family functioning (children, OR 1.80, 95% CI 1.08 to 3.02) were associated with psychological distress (C statistics 0.80 and 0.78).

CONCLUSIONS

Psychological distress is common and fluctuates in frequency after a diagnosis of epilepsy. Those with premorbid psychological, psychosocial, and family problems are at high risk of this adverse outcome.

Considerations for ADHD in the child with epilepsy and the child with migraine

INTRODUCTION

Attention Deficit Hyperactivity Disorder (ADHD) is a common comorbid condition in children with epilepsy and migraine. Treatment of ADHD in children with epilepsy or migraine is essential but clinicians may overlook symptoms of ADHD and avoid appropriate use of medications that may reduce symptoms of ADHD without compromising treatment of epilepsy or migraine. Areas covered: PubMed was searched for articles on ADHD and epilepsy or migraine. Key papers were reviewed for additional articles. Areas of interest were: epidemiology, etiological factors, and treatment with emphasis on therapy. Expert commentary: Stimulant medication, especially methylphenidate, appears to be safe and effective in the treatment of ADHD in children with epilepsy or migraine. Unfortunately, data is limited with very few controlled trials of methylphenidate and very limited information on the use of amphetamines or non-stimulant drugs.

The influence of levetiracetam on psychosocial and behavioral functioning in children: A case-control and follow-up study

BACKGROUND

Levetiracetam, a widely used antiepileptic drug in children, has been associated with psychosocial and behavioral problems, which are also influenced by epilepsy variables, including duration or seizure frequency.

PURPOSE

The objective of this study is to investigate the frequency and timing of treatment-emergent psychosocial and behavioral problems in children receiving levetiracetam, irrespective of seizure variables which are possible confounders.

METHODS

A prospective, case-control study with a 3-month follow-up was conducted. Consecutive children aged 6 to 16years with new-onset partial seizures were included in case of starting treatment with either levetiracetam or valproic acid. Psychosocial and behavioral functioning were assessed using a set of standardized questionnaires including Strengths and Difficulties Questionnaire (SDQ) and Children's Depression Inventory (CDI) at baseline, 1 and 3-month follow-up. Patients' baseline scores were compared to healthy subjects. The difference in the follow-up SDQ and CDI scores was evaluated in patients receiving levetiracetam and valproic acid.

RESULTS

A total of 101 participants were analyzed; 32 patients in levetiracetam group, 19 patients in valproic acid group and 50 healthy controls. Baseline SDQ and CDI scores were not statistically different between patients and healthy subjects (p>0.05). No statistically significant difference was observed in CDI, total and subscale SDQ scores between patients receiving levetiracetam or valproic acid during the study period (p>0.05). A girl aged 15years receiving levetiracetam had a CDI score of 18 without suicidal ideation at baseline. She developed suicidal ideation and depression, which resolved after switching of levetiracetam to valproic acid, at the 1-month follow-up. No other psychiatric or behavioral side-effects were observed in other patients.

CONCLUSION

Psychosocial and behavioral side-effects of levetiracetam treatment are not frequent and they don't emerge in most of children at lower doses. At this dose, and after 3months, using these specific instruments, we did not observe any difference between the valproic acid and levetiracetam treatment groups.

Systemic Family Therapy of Comorbidity of Anxiety and Depression with Epilepsy in Adolescents

OBJECTIVE

The aim of this study was to find if systemic family therapy (SFT) does work in anxiety and depression with epilepsy in adolescents (ADAE).

METHODS

104 adolescents with epilepsy, aged 13-20 years old, were included from December 2009 to December 2010, the enrolled patients were with anxiety [Hamilton Anxiety Scale (HAMA) score ≥14 points] or depression [Hamilton Depression Scale (HAMD) score ≥20 points]. The patients were randomly divided into the control group (n=52) treated with antiepileptic drugs (AED) and the intervention group (n=52) undergone Systemic Family Therapy (SFT) as well as AED. The AED improvements, anxiety and depression scores, Social Support Rating Scale (SSRS), Family Assessment Device (FAD) and scale of systemic family dynamics (SSFD) were observed after 3-month treatment.

RESULTS

The frequencies of epileptic seizures in intervention group was decreased much more significantly than the control group (4.22±3.54 times/month vs. 6.20±5.86 times/month, p=0.04); and the scores of anxiety (9.52±6.28 points vs. 13.48±8.47 points, p=0.01) and depression (13.86±9.17 points vs. 18.89±8.73 points, p=0.02) were significantly decreased than the control group; meanwhile, the family dynamics and family functions were significantly improved, and the social support was also increased (p<0.05).

CONCLUSION

SFT combined with AEDs had better efficacies than AEDs alone, not only the frequency of epileptic seizures was decreased, but also the patients' anxiety and depression were improved, and the family dynamics, family functions and social support were improved.

Psychiatric comorbidity in children and youth with epilepsy: An association with executive dysfunction?

OBJECTIVES

Psychopathology in children and youth with epilepsy has previously been related to executive dysfunction, but the nature of the association is uncertain. We sought to explore risk factors for psychiatric disorders in children and youth with epilepsy, with emphasis on executive dysfunction, along with seizure-related and psychosocial factors.

METHODS

The cohort consisted of one hundred and one consecutive patients aged 10-19 years with focal (n=52) or genetic generalized (n=49) epilepsy. All were screened for psychiatric symptoms, using part of an extensive questionnaire, the Strengths and Difficulties Questionnaire (SDQ) for both patients and their parents. Participants scoring in the borderline or abnormal range on the SDQ received a psychiatric interview (Kiddie-SADS-PL). All participants underwent a neuropsychological examination, and those with general cognitive abilities (IQ)<70 were excluded.

RESULTS

Forty-seven of 101 participants (46.5%) had a SDQ score in the borderline or abnormal range and underwent a psychiatric evaluation. Of these, 44 (93.6%) met the criteria for a psychiatric diagnosis, the most common being ADHD and anxiety. An executive deficit was identified in 26.8% of the participants with a psychiatric diagnosis, but in only 5.4% of those without such a diagnosis (p=0.003). Multivariate logistic regression analysis showed that executive dysfunction was an independent risk factor for having a psychiatric disorder (OR 8.2, CI 1.8-37.2, p=0.006), along with male gender (OR 2.9, CI 1.2-7.3, p=0.02), and early seizure onset (0.86-that is one year older equals risk of psychiatric disorder reduced by 14%-CI 0.77-0.96, p=0.01). Other epilepsy-related or psychosocial factors were not significantly associated with psychiatric disorders.

CONCLUSIONS

Multiple factors are associated with psychiatric problems in children and youth with epilepsy. In this study, executive dysfunction, male gender, and early epilepsy onset were independent risk factors for having a psychiatric disorder. An evaluation of psychiatric and cognitive problems is important to enable a positive long-term outcome in childhood epilepsy.

Anxiety and Depression in Adolescents With Epilepsy

The present study examined anxiety and depression in adolescents with epilepsy and the association of these disorders with seizure-related and sociodemographic variables. The Hospital Anxiety and Depression Scale was administered to 140 children with epilepsy and 50 children with asthma aged 10 to 18 years attending mainstream schools. Adolescents with epilepsy had significantly higher scores on the depression subscale than those with asthma (5.2 ± 3.3 vs 4.2 ± 3.2, P = .032). Anxiety subscale scores and the frequency of anxiety and depression in both the epilepsy and asthma groups were not statistically significant. In the epilepsy group, 32.8% had anxiety and 22.1% had depression. Factors associated with anxiety were older age at the time of the study and polytherapy (2 or more antiepileptic drugs). Adolescents who had been seizure-free for 12 months or more at time of the study were less likely to experience anxiety. Factors associated with depression were medical comorbidities, female gender, frequent seizures, and younger age of seizure onset. A common risk factor for both anxiety and depression was the duration of epilepsy. Anxiety and depression were also highly associated with each other. Affective disorders are common in epilepsy and screening for psychiatric symptoms is required.

Symptoms of anxiety and depression in school-aged children with active epilepsy: A population-based study

METHODS

Children (5-15 years) with active epilepsy were screened using the parent-report (n=69) and self-report (n=48) versions of the Spence Children's Anxiety Scale (SCAS) and the self-report version of the Children's Depression Inventory (CDI) (n=48) in a population-based sample.

RESULTS

A total of 32.2% of children (self-report) and 15.2% of children (parent-report) scored ≥1 SD above the mean on the SCAS total score. The subscales where most difficulty were reported on parent-report were Physical Injury and Separation Anxiety. There was less variation on self-report. On the CDI, 20.9% of young people scored ≥1 SD above the mean. Children reported significantly more symptoms of anxiety on the SCAS total score and three of the subscales (p<.05). There was a significant effect on the SCAS total score of respondents by seizure type interaction, suggesting higher scores on SCAS for children with generalized seizures on self- but not parent-report. Higher CDI scores were significantly associated with generalized seizures (p>.05).

SUMMARY

Symptoms of anxiety were more common based on self-report compared with parent-report. Children with generalized seizures reported more symptoms of depression and anxiety.

Children's perspective of quality of life in epilepsy

OBJECTIVE

To study child mental health, parental support, and social support of children with epilepsy as these relate to quality of life (QOL) using child self-report, seizure-related variables, and estimated verbal intelligence based on receptive vocabulary.

METHODS

A cross-sectional structural equation model of baseline data from the QUALITÉ cohort study, which includes 6 Canadian child epilepsy ambulatory programs. A sample of 3,481 children were screened for the following eligibility: 8 to 14 years of age, with active or medication-managed epilepsy. Of 894 eligible children, 506 agreed to participate, of whom 26 were then excluded because of an inability to self-report based on a standard cutoff score of receptive vocabulary lower than 70. The primary outcome of child-reported QOL was measured using the Child Epilepsy QOL Questionnaire.

RESULTS

From the child's perspective, epilepsy-specific QOL is strongly related to their mental health and social support but not to their seizures. Specifically, child mental health and peer support exhibit direct associations with QOL; parental support has both direct and indirect associations with QOL (via child mental health); estimated verbal intelligence exerts its strongest association with QOL through mental health; and seizure status exhibits a weak relationship to QOL only through mental health.

CONCLUSIONS

Among children with epilepsy aged 8 to 14 years, mental health and social support should be areas of focus in the assessment of QOL. Controlling seizures is insufficient care for influencing the child's perception of their life.

Illness perceptions determine psychological distress and quality of life in youngsters with epilepsy

The aim of this cross-sectional study was to explore the extent to which gender, epilepsy severity, and self-regulation concepts (illness perceptions, autonomous treatment regulation, perceived autonomy support by parents) predict psychological distress and quality of life (QoL) in young patients with epilepsy. Structured interviews were conducted in 100 patients (Mage=13.9, SD=2.21, 41% girls), and data were analyzed by means of multiple hierarchical regression analyses. Seizures of most patients (91%) were well controlled by antiepileptics, 3% of the patients had infrequent seizures, and seizures in 6% were pharmacoresistant. At a multivariate level, it appeared that youngsters with epilepsy who expect that their disease will last for a long time, who believe that they have less personal control over their illness, and who expect the illness to have a high emotional impact reported higher levels of distress. In addition, a better QoL was reported by youngsters who believed that treatment did not control their illness and who thought that their epilepsy would not affect them emotionally. Findings indicate the importance of illness perceptions, and it is suggested that they should be targeted in future interventions in youngsters with epilepsy.

Parent-rated emotional-behavioral and executive functioning in childhood epilepsy

The present study examined clinical and demographic risk factors associated with parent-rated emotional-behavioral and executive functioning in children and adolescents with epilepsy. The medical records of 152 children and adolescents with epilepsy referred for neuropsychological evaluation were reviewed. Results indicated that the sample displayed significantly elevated symptoms across the emotional-behavioral and executive domains assessed. Executive functioning and behavioral symptoms had the highest rates of clinically elevated scores, with lowest rates of elevated scores in internalizing and externalizing emotional problems. Only 34% of those participants with clinically significant emotional-behavioral or executive functioning difficulties had a history of psychological or counseling services, highlighting the underserved mental health needs of this population. In regard to clinical factors, the majority of seizure-related variables were not associated with emotional-behavioral or executive functioning. However, the frequency of seizures (i.e., seizure status) was associated with behavioral regulation aspects of executive functioning, and the age at evaluation was associated with externalizing problems and behavioral symptoms. Family psychiatric history (with the exception of ADHD) was associated with all domains of executive and emotional-behavioral functioning. In summary, emotional-behavioral and executive functioning difficulties frequently co-occur with seizures in childhood epilepsy, with both seizure-related and demographic factors contributing to the presentation of such neurobehavioral comorbidities. The present findings provide treatment providers of childhood epilepsy with important information to assist in better identifying children and adolescents who may be at risk for neurobehavioral comorbidities and may benefit from intervention.

Social competence among well-functioning adolescents with epilepsy

PURPOSE

The aims of the study were to measure the social competence of well-functioning adolescents with epilepsy and compare it with that of their healthy peers as well as to analyze the effects of epilepsy-related variables on the social competence.

METHODS

Ninety well-functioning adolescents with epilepsy 12-19years of age were compared with healthy controls using the Achenbach Youth Self-Report Questionnaire measures of social competence. Within the group with epilepsy, the impact of duration of epilepsy, etiology, seizure frequency, seizure type, and antiepileptic drugs (AEDs) (monotherapy or polytherapy) on the above measures was also determined.

RESULTS

Twenty-five (27.8%) adolescents with epilepsy obtained Total Competence T scores in the clinical range, as opposed to only two (3.3%) of the healthy adolescents. There were statistically significant differences in the Activity and Social subscales and Total Competence T score between the group with epilepsy and the control group (p<0.05). Comparing T scores for epilepsy-related variables in the group with epilepsy, we found that there were statistically significant differences in all the social competence subscales regarding the seizure control and seizure types. No significant differences were obtained for other epilepsy-related variables: duration of epilepsy, onset of epilepsy, etiology, and AEDs.

CONCLUSION

Our results indicate that adolescents with epilepsy are less active in clubs, socialize less with their friends, and have a poorer school performance compared with their healthy peers. This study shows that adolescents with epilepsy are at an increased risk of having difficulties in social competence.

Depressive symptoms contribute to quality of life in children with epilepsy

BACKGROUND

Improvement of the quality of life (QOL) for children with epilepsy is one of the most important therapeutic goals. It is widely acknowledged that in adults with epilepsy one of the best QOL predictors is psychiatric comorbidity. In children with epilepsy, however, it is not clear whether psychiatric comorbidity impairs QOL.

AIMS

The aim of this study was to evaluate QOL in children with epilepsy and to identify the strongest predictors of the same.

METHODS

A total of 28 enrolled patients completed the Questionnaire for Measuring Health-Related Quality of Life in Children (KINDL-R) and 3 assessments of clinical status: the Depression Self-Rating Scale for Children (DSRS-C), the Children Manifest Anxiety Scale (CMAS), and the Side Effects and Life Satisfaction (SEALS). Various demographic and clinical factors were analyzed as possible predictors of KINDL-R scores.

RESULTS

The strongest predictor of QOL was the total DSRS-C score (r = -0.69, p < 0.01), which also predicted physical (r = -0.58, p < 0.01) and emotional wellbeing (r = -0.53, p < 0.05) subscale scores.

CONCLUSIONS

Symptoms of depression were more predictive of QOL than were seizure type, seizure duration, number and adverse effects of AEDs, or anxiety. Number of AEDs did have an effect, just not as prominent as symptoms of depression.

Screening for mental health disorders in active childhood epilepsy: population-based data

BACKGROUND

Children with epilepsy are at increased risk for behavioral and psychiatric disorders and it has been recommended that all children with epilepsy be screened for such conditions. There is thus a need to identify appropriate screening measures in this population.

METHODS

Children with active epilepsy (on AEDs and/or had a seizure in the last year) with an IQ>34 (n=69) were screened for behavioral/psychiatric disorders using the parent and teacher versions of the Strengths and Difficulties Questionnaire (SDQ) in a population-based sample. Consensus clinical diagnoses were made with respect to DSM-IV-TR data. Parent and teacher responses on the SDQ total and subscales were compared using paired samples t-tests and Pearson's correlation. The screening properties of the SDQ were explored. Regression using generalized estimating equations was used to identify predictors of responses on the SDQ.

RESULTS

62% of children received a DSM-IV-TR diagnosis. On the total SDQ score the number of children identified at risk by parents (61%) was higher than the number identified by teachers (43%). Mean parent scores were significantly higher than teacher scores on the SDQ Conduct and Hyperactive subscales and total score after Bonferroni correction (adjusted alpha p<.007). Sensitivity and specificity of the SDQ total score were maximized by combining parent and teacher responses. The positive predictive values (PPVs) were much higher for the total score than the specific subscales suggesting that while the SDQ total score has good predictive ability the specific scales are less useful. Respondent (i.e., parent and teacher) was a significant predictor of scores for some but not all subscales.

CONCLUSION

The SDQ can be considered a promising tool for screening children with active epilepsy provided the total score is used as a screener for the presence of any DSM-IV-TR disorder and multi-informant data are used.

Epilepsy, cognition and behavior

Epilepsy is defined as two or more unprovoked seizures. Epileptic patients have intellectual disability and behavioral co-morbidities to the tune of up to 25 and 75% respectively. Various factors like underlying etiology, socioeconomic environment at home, age at onset, seizure semiology, seizure descriptors like duration, severity and frequency, therapy related adverse effects secondary to antiepileptic drugs and epilepsy surgery have been implicated for the causation of cognitive and behavioral impairment in epilepsy. Cognitive epilepsy has emerged as a specific entity. This may manifest as a transient behavioral or cognitive change, insidous onset subacute to chronic encephalopathy or more catastrophic in the form of nonconvulsive status epilepticus. Cognitive impairment seen in epileptic children include difficulties in learning, memory, problem solving as well as concept formation. Anxiety, depression and attention deficit hyperkinetic disorders are the most common psychiatric co-morbidities seen. Investigating a child with epilepsy for cognitive and behavioral impairment is difficult as these tests would require cooperation from the patient's side to a significant extent. A rational approach towards treatment would be judicious selection of antiepileptic drugs, treatment of underlying cause, appropriate management of behavioral co-morbidities including psychopharmacotherapy and a trial of immunotherapy (particularly in cognitive epilepsies), wherever appropriate.

Mental health of children and adolescents with epilepsy: analysis of clinical and neuropsichological aspects

Epilepsy compromises the development of cognitive and social skills and represents a risk of psychiatric comorbidity. Objective: To compare psychopathological symptoms in children with epilepsy and in a healthy group, and to correlate the results with neuropsychological and clinical variables. Method: Forty five children with idiopathic epilepsy and sixty five healthy controls underwent neuropsychological evaluation and their caregivers replied to a psychopathology questionnaire (Child Behavior Checklist – CBCL). Results: There were significant differences in CBCL, with poorer results showed mainly by patients with epilepsy. There was no significant association between any psychopathological symptom and disease duration or amount of antiepileptic drugs used. There was positive correlation between intelligence quocient and CBCL on items such as sluggish cognitive tempo, aggressive behavior, attention problems and activities and a negative relation between academic achievement, conduct and rule-breaking behavior. Conclusion: Children with epilepsy had the worse results in the psychopathology evaluation. Certain psychopathological variables are related to the cognitive profile, with no relation to clinical variables.

Life quality and health in adolescents and emerging adults with epilepsy during the years of transition: a scoping review

AIMS

The aims of this study were to (1) search the literature in order to identify the challenges facing adolescents and emerging adults with epilepsy; and (2) categorize these issues within both the framework of the International Classification of Functioning, Disability and Health (ICF) and an empirical model of quality of life (QOL) in childhood epilepsy.

METHOD

We systematically searched PsycINFO, Ovid MEDLINE and Web of Science for studies reporting on QOL and health identified in people with epilepsy aged 12 to 29 years. Studies were limited to those that were published in the last 20 years in English, presenting the patient perspective. Data were extracted and charted using a descriptive analytical method. Identified issues were classified according to the ICF and QOL frameworks.

RESULTS

Fifty four studies were identified. Another 62 studies with potentially useful information were included as an addendum. The studies highlight a range of psychosocial issues emphasizing peer acceptance, social isolation, and feelings of anxiety, fear, and sadness.

INTERPRETATION

The ICF and QOL constructs represent useful starting points in the analytical classification of the potential challenges faced by adolescents with epilepsy. Progress is needed on fully classifying issues not included under these frameworks. We propose to expand these frameworks to include comorbidities, impending medical interventions, and concerns for future education, employment, marriage, dignity, and autonomy.

Outpatient screening of Japanese children with epilepsy for attention-deficit/hyperactivity disorder (AD/HD)

The significance of the Strengths and Difficulties Questionnaire (SDQ) score for AD/HD (attention-deficit/hyperactivity disorder) screening was assessed in Japanese epileptic children.

SUBJECTS AND METHODS

Sixty-eight epileptic children were enrolled in this study. Parents were asked to fill out both the SDQ and AD/HD-rating scale (AD/HD-RS) simultaneously.

RESULTS

The SDQ subscale of hyperactivity showed the highest score. The AD/HD-RS showed higher scores for both inattention and hyperactivity-impulsivity. Twenty-two (32.4%) of these subjects were diagnosed as having AD/HD. The SDQ subscale for hyperactivity showed 86.4% sensitivity and 95% specificity, respectively, for detection of AD/HD. All SDQ subscales correlated significantly with inattention and hyperactivity-impulsivity scores of the AD/HD-RS.

CONCLUSIONS

The SDQ is a good screening tool which can contribute to the detection of AD/HD, not only of the hyperactive/impulsive but also the inattentive subtype. Furthermore, the SDQ can elucidate more complicated behavioral problems than the core symptoms of AD/HD that are not noticed in the epilepsy clinic.

Psychometric properties of the modified Czech version of the children self-report Quality-of-life Measure for Children with Epilepsy (CHEQOL-25)

Quality of life (QoL) is a crucial factor in the treatment of individuals suffering from epilepsy. We aimed to adapt the children's version of the CHEQOL-25 questionnaire to allow the QoL measurement in children suffering from epilepsy in the Czech Republic. The adaptation was conducted on a group of 250 children and adolescents aged 8-15years. It was found that the questionnaire required modification to fit the Czech pediatric population. Indirect questions were changed to direct questions, and two items were omitted from the original version of the questionnaire. The reasons for these modifications are discussed. The modified questionnaire was subjected to exploratory factor analysis, and a 4-factor structure was favored over the 5-factor structure of the original version. The internal consistency measured using Cronbach's alpha was found to be in the range of 0.78-0.83 for the individual scales, and test-retest reliability was expressed using intraclass correlation coefficient which was found to be in the range of 0.65-0.75. The modified Czech version of the CHEQOL-25 questionnaire displayed very good results with regard to construct validity. Its strength is its simplicity and clarity which allows it to be used in children with impaired cognitive functions. The results showed that the modified version of the Czech CHEQOL-25 has very good psychometric properties and could be used in further research and clinical practice.

A survey of quality of life in adolescents with epilepsy in Iran

BACKGROUND

Psychosocial problems seem to be common in epilepsy, and they could negatively affect the social affairs and networking of adolescents with epilepsy. They could cause decreased self-esteem and social performance, leading to isolation and civil discrimination. This study was performed to assess the quality of life (QOL) of a group of adolescents with epilepsy in Iran.

METHODS

An analytic cross-sectional study was performed in 197 young Iranian adolescents with epilepsy. To measure the QOL of these cases, the Persian version of the QOL in Epilepsy Inventory for Adolescents 48 (QOLIE-AD-48) scale was used.

RESULTS

The mean total score of the scale was 61.5±10.4. The highest mean was in the school behavior domain (83.85±12.27), while the lowest mean was in the domain of attitudes toward epilepsy (22.45±15.78). There was a significant correlation between QOL and age, number of drugs taken, and frequency of seizures per year. Sixty-six percent of the adolescents with epilepsy had never talked to their friends or teachers about their disease.

CONCLUSION

This study revealed an unsatisfactory state of the QOL of adolescents with epilepsy in our population in comparison with other studies. This indicates the need for greater concern about the psychological status and risk factors for the QOL of adolescents with epilepsy in Iran.

Research on psychosocial aspects of epilepsy in Arab countries: a review of literature

This study reviewed research conducted on the psychological aspects of epilepsy in Arab countries. Several databases (Medline, PubMed, Science Direct, Springer Link, and PsycInfo) were searched using the following two sets of search words: (1) Arab, Jordan, Lebanon, United Arab Emirates (UAE), Bahrain, Qatar, Kuwait, Oman, Saudi Arabia, Syria, Iraq, Egypt, Yemen, Tunisia, Libya, Morocco, Algiers, Palestine, Mauritania, Djibouti, Sudan, Comoros, and Somalia; and (2) epilepsy, seizure disorders, and convulsive disorders. Fifty-one studies were conducted in 12 Arab states. Social/emotional, employment, and other problems; knowledge and attitudes; and quality of life (QOL) were the most commonly measured parameters of psychosocial aspects of epilepsy in Arab countries. Results revealed elevated levels of depression and anxiety, a decline in cognitive function, various behavioral problems, sexual dysfunction, and underemployment among persons with epilepsy (PWE). Misconceptions about epilepsy were found to be prevalent. While many studies reported limited knowledge of epilepsy, some studies found an average knowledge. Negative attitudes toward epilepsy were reported in most studies, and moderately positive attitudes were reported in some studies. Finally, PWE showed low overall QOL scores in the majority of studies.

Review: Psychopathology in childhood epilepsy

BACKGROUND

Population-based studies of psychopathology are important in childhood epilepsy given that there is a spectrum of severity with regard to the impact of epilepsy and associated behavioural/psychiatric difficulties.

METHOD

Population-based studies in childhood epilepsy which have focused on global measures of psychopathology and rates of specific behavioural and psychiatric disorders were reviewed with respect to prevalence of disorders and possible correlates of difficulties. Clinic-based studies and meta-analyses were reviewed where they added to an understanding of the correlates or treatment of psychopathology in childhood epilepsy. The systematic review methodology was based on a search of PubMed from January 1980 to June 2011.

RESULTS

Children with epilepsy are at significantly higher risk for a range of behavioural and psychiatric disorders including attention deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), depressive and anxiety disorders. Available evidence suggests that these difficulties are under-recognised and there have been few studies focussing on interventions to treat these behavioural and psychiatric issues in childhood epilepsy.

CONCLUSION

Population-based studies suggest high rates of psychopathology in childhood epilepsy. As a result children with epilepsy need close monitoring with regard to the presence of behavioural difficulties. There is a need for studies on how such difficulties can be best managed so that affected children and their families can maximise their quality of life.

Behavioral assessment of Japanese children with epilepsy using SDQ (strengths and difficulties questionnaire)

The aim of this study was to elucidate the availability of the strengths and difficulties questionnaire (SDQ) as a screening tool for identifying behavioral problems in Japanese children with epilepsy.

METHODS

Eighty-three 4-16 year-old epileptic patients, followed at Tanabe-Kadobayashi Children's Clinic, were studied. Children with severe mental or physical disability were excluded. The Japanese version of the SDQ was used, and scores were compared to the Japanese standard.

RESULTS

'Hyperactivity' was the SDQ category with the most striking differences from normal: a significant numbers of children had scores above the clinically normal range and only a small proportion were within the normal range (p<0.0001). The rates of epilepsy patients with scores above normal range were also significantly higher for 'peer problems' and 'conduct problems' (p<0.0001 and p<0.01). The rates of epilepsy patients with scores within the normal range was significantly lower for 'emotional symptoms' than in normal controls (p<0.001). On the other hand, the 'pro-social behavior' score did not differ significantly from the Japanese standard. As for clinical factors, patients with symptomatic localization-related epilepsy and focal electroencephalographic abnormalities had significantly higher scores for some SDQ items. Age at epilepsy onset correlated negatively with scores for 'total difficulties' and 'hyperactivity', suggesting early onset to be a risk factor for poor SDQ scores.

CONCLUSIONS

These findings confirm that higher rates of psychiatric comorbidity in Japanese children with epilepsy may be diagnosed using SDQ in Japanese children with epilepsy. These problems should be addressed in the early phase of epilepsy management in order to preserve health-related quality of life for affected patients.

Depression in epilepsy: a systematic review and meta-analysis

OBJECTIVE

To estimate the prevalence of depression in persons with epilepsy (PWE) and the strength of association between these 2 conditions.

METHODS

The MEDLINE (1948-2012), EMBASE (1980-2012), and PsycINFO (1806-2012) databases, reference lists of retrieved articles, and conference abstracts were searched. Content experts were also consulted. Two independent reviewers screened abstracts and extracted data. For inclusion, studies were population-based, original research, and reported on epilepsy and depression. Estimates of depression prevalence among PWE and of the association between epilepsy and depression (estimated with reported odds ratios [ORs]) are provided.

RESULTS

Of 7,106 abstracts screened, 23 articles reported on 14 unique data sources. Nine studies reported on 29,891 PWE who had an overall prevalence of active (current or past-year) depression of 23.1% (95% confidence interval [CI] 20.6%-28.31%). Five of the 14 studies reported on 1,217,024 participants with an overall OR of active depression of 2.77 (95% CI 2.09-3.67) in PWE. For lifetime depression, 4 studies reported on 5,454 PWE, with an overall prevalence of 13.0% (95% CI 5.1-33.1), and 3 studies reported on 4,195 participants with an overall OR of 2.20 (95% CI 1.07-4.51) for PWE.

CONCLUSIONS

Epilepsy was significantly associated with depression and depression was observed to be highly prevalent in PWE. These findings highlight the importance of proper identification and management of depression in PWE.

Quality of life in children with new-onset epilepsy: a 2-year prospective cohort study

OBJECTIVES

To assess health-related quality of life (HRQL) over 2 years in children 4-12 years old with new-onset epilepsy and risk factors.

METHODS

Data are from a multicenter prospective cohort study, the Health-Related Quality of Life Study in Children with Epilepsy Study (HERQULES). Parents reported on children's HRQL and family factors and neurologists on clinical characteristics 4 times. Mean subscale and summary scores were computed for HRQL. Individual growth curve models identified trajectories of change in HRQL scores. Multiple regression identified baseline risk factors for HRQL 2 years later.

RESULTS

A total of 374 (82) questionnaires were returned postdiagnosis and 283 (62%) of eligible parents completed all 4. Growth rates for HRQL summary scores were most rapid during the first 6 months and then stabilized. About one-half experienced clinically meaningful improvements in HRQL, one-third maintained their same level, and one-fifth declined. Compared with the general population, at 2 years our sample scored significantly lower on one-third of CHQ subscales and the psychosocial summary. After controlling for baseline HRQL, cognitive problems, poor family functioning, and high family demands were risk factors for poor HRQL 2 years later.

CONCLUSIONS

On average, HRQL was relatively good but with highly variable individual trajectories. At least one-half did not experience clinically meaningful improvements or declined over 2 years. Cognitive problems were the strongest risk factor for compromised HRQL 2 years after diagnosis and may be largely responsible for declines in the HRQL of children newly diagnosed with epilepsy.