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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    • "Therefore, identification of the extent and nature of symptoms of depression and anxiety would seem crucial with respect to promoting quality of life in childhood epilepsy. However, neurodevelopmental and psychiatric difficulties are often not identified or treated [1] [10]. "
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    ABSTRACT: Methods: Children (5-15years) 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.
    Epilepsy & Behavior 11/2015; 52(Pt A):174-179. DOI:10.1016/j.yebeh.2015.09.004 · 2.26 Impact Factor
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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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