Behavioral Disorders in Pediatric Epilepsy: Unmet Psychiatric Need

Division of Adult Psychiatry, University of California, Los Angeles, Los Ángeles, California, United States
Epilepsia (Impact Factor: 4.57). 04/2003; 44(4):591-7. DOI: 10.1046/j.1528-1157.2003.25002.x
Source: PubMed


This study examined the relation between psychiatric diagnosis and mental health services in children with epilepsy and the associated demographic, cognitive, linguistic, behavioral, and seizure-related variables.
The Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS), the Child Behavior Checklist, the Test of Language Development, and the Wechsler Intelligence Scale for Children-Revised (WISC-R) were administered to 114 children, aged 5 to 16 years, with either complex partial seizures (CPS) or primary generalized with absence (PGE, petit mal). A Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) diagnosis and information regarding mental health services were derived from the K-SADS.
Although approximately 60% of the subjects had a DSM-IV psychiatric diagnosis, >60% received no mental health treatment. Absence of mental health care was associated with younger age, less parental education, limited number of antiepileptic drugs (AEDs; i.e., one or none), and higher verbal IQ. In addition, children with PGE and a single psychiatric diagnosis were less likely to have a history of mental health treatment.
This is the first study to demonstrate unmet mental health need in a large sample of children with CPS and PGE. The study's findings suggest that parents and clinicians should be aware of the mental health needs of children with epilepsy, particularly if they have one or more of the identified risk factors.

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    • "Epilepsy is the most common neurological disorder in children, and its prevalence in childhood is estimated to be 0.05–1% [1] [2]. Children with epilepsy have been reported to have 3–6 times increased risk of comorbid conditions such as depression [3] [4], anxiety [4] [5], and low selfefficacy [6] when compared with the general population [7]. In addition, they are at increased risk of many comorbid health conditions [8], a finding compounded by lower rates of participation in sports activities [9] [10]. "
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    ABSTRACT: Objectives The purposes of the current study were to test the feasibility of exercise therapy for children with benign epilepsy with centrotemporal spikes (BECTS) and to collect pilot data about the impact of exercise therapy on neurocognitive, emotional, and behavioral outcomes. Methods Ten children with BECTS (9.7 ± 1.42 years) participated in a therapeutic exercise program consisting of ten supervised exercise sessions and home-based exercises for five weeks. Electroencephalography (EEG), seizure frequency, and neurocognitive and psychological factors, including attention, executive function, depression, anxiety, behavioral problems, and quality of life, were assessed before and after the exercise program. Results No clinical symptoms were observed to worsen during the study, demonstrating that the exercise therapy was safe and also feasible. After five weeks of exercise therapy, significant improvements in neurocognitive domains such as simple visual and auditory attention, sustained attention, divided attention, psychomotor speed, and inhibition–disinhibition were observed. Furthermore, parent ratings of internalizing behavioral problems and social problems and mood-related well-being from quality of life improved after exercise therapy. Although not statistically significant, trends were noted toward improvement in children's self-reports of negative mood/somatization, parent reports of somatic complaints, and general health on a quality-of-life measure. Conclusions A five-week structured exercise program was successfully implemented, with preliminary data suggesting beneficial impact on neurocognitive and psychobehavioral function. Exercise therapy should be further evaluated as a part of a comprehensive treatment program for children with benign epilepsy.
    Epilepsy & Behavior 08/2014; 37:151–156. DOI:10.1016/j.yebeh.2014.06.017 · 2.26 Impact Factor
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    • "the lifespan, and despite numerous federal studies, benchmarks, and recommendations, contemporary standards of practice fail to integrate screening and treatment of the comorbidities into routine clinical care. Again and again it is pointed out that the comorbidities continue to be underrecognized and undertreated and that patients with epilepsy have significant unmet mental health needs [17]. Nonetheless, there is no indication that this disappointing state of affairs will change anytime soon. "
    Epilepsy & Behavior 01/2014; 31C:127-128. DOI:10.1016/j.yebeh.2013.11.027 · 2.26 Impact Factor
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    • "In the study done in epileptic children by Otto and colleagues published in Epileptia in 2003 in spite that 66% of their cases had DSM-IV psychiatric diagnosis, only 33% were receiving any treatment [10]. Our study indicates that the situation is even more complicated. "
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    ABSTRACT: The suicidal rate among epileptic patients is up to 5 times more than general population and depression is the most common mood disturbance among them while usually under noticed. This study was performed to determine possible symptoms of psychiatric disorders for suicidal behavior in pediatric patients with epilepsy that had attempted suicide. Among medical records of 1169 patients under 17 years of age being admitted to the exclusive university hospital for poisoning in Tehran since April 2006 to Feb 2008 due to attempt to suicide, 31 cases (13 male and 18 female) with mean age 15.8±1.3 years had concomitant epilepsy. Mental status and epilepsy data sheet of these patients were analyzed. The psychological evaluation of these 31 cases revealed long lasting symptoms of psychological disorder in 21 (91.4%) cases before their attempt to suicide while only 5(16%) cases had been noticed for psychiatric care and merely 3 of them had been under treatment. Despite strong correlation between affective disorders and epilepsy it is unfortunately under-diagnosed or undertreated. Since overdose of antiepileptic drugs used for treatment of epilepsy may be lethal, dismissing suicidal behavior can be life threatening.
    Iranian Journal of Pediatrics 09/2012; 22(3):404-7. · 0.52 Impact Factor
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