Psychiatric and neurodevelopmental disorders in childhood-onset epilepsy

Department of Biology, Northern Illinois University, DeKalb, IL 60115, USA.
Epilepsy & Behavior (Impact Factor: 2.26). 02/2011; 20(3):550-5. DOI: 10.1016/j.yebeh.2010.12.038
Source: PubMed


Childhood-onset epilepsy is associated with psychiatric and cognitive difficulties and with poor social outcomes in adulthood. In a prospective cohort of young people with epilepsy, we studied psychiatric and neurodevelopmental disorders and epilepsy-related characteristics, all factors that may influence long-term social outcomes. Five hundred one subjects, 159 with complicated (IQ <80 or brain lesion) and 342 with uncomplicated epilepsy, were included. Psychiatric disorders and neurodevelopmental disorders were more common in complicated epilepsy (P<0.005). In uncomplicated epilepsy, externalizing but not internalizing disorders were strongly associated with neurodevelopmental disorders. Internalizing disorders and neurodevelopmental disorders were associated with lack of 5-year remission. Type of epilepsy was not associated with neurodevelopmental disorders or psychiatric disorders. Various comorbid conditions in epilepsy cluster together and are modestly associated with imperfect seizure control. These need to be considered together in evaluating and managing young people with epilepsy and may help explain long-term social outcomes above and beyond poor seizure control.

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Available from: Rochelle Caplan, Dec 13, 2013
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    • "Autism spectrum disorders in epilepsy are most often seen in the presence of intellectual disabilities; it remains unsettled whether rates of ASDs are elevated in children with epilepsy with average IQs [34]. Importantly, although some comorbidities have been reported to occur mostly in association with specific epileptic syndromes [35] [36], overall, comorbidities have been found to occur across epilepsy syndromes [25] [27] [29]. Children with epilepsy present with neuropsychological disorders of all kinds [16] [19] [37]. "
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    ABSTRACT: In pediatric epilepsy, comorbidities are reported to be frequent. The present study focusedon the cognitive patterns of children with isolated epilepsy, children with isolated neurodevelopmental disorders (reading disorders, math disorders, autism spectrum disorders), and children with epilepsy and these neurodevelopmental disorders as comorbidities. Based on two samples of referred children, one with epilepsy, reading disorders, math disorders, or ASDs occurring in "isolation" (n=117) and one with reading disorders, math disorders, and ASDs occurring comorbid with epilepsy (n=171), cognitive patterns were compared. The patterns displayed by verbal and nonverbal abilities from the WISC series were studied with repeated measures ANOVA. Thereafter, an exploratory 2∗3∗2 factorial analysis was done to study the independent contribution of the type of comorbidity and of the presence or absence of epilepsy to the VIQ-PIQ pattern. In isolated epilepsy, a VIQ>PIQ pattern was found, which was not seen in the other disorders. When epilepsy and another disorder co-occurred, patterns were altered. They resembled partly the pattern seen in isolated epilepsy and partly the pattern seen in the isolated neurodevelopmental disorder. In comorbid reading disorders, the VIQ>PIQ pattern was mitigated; in comorbid math disorders, it was exacerbated. In comorbid ASDs, no clear pattern emerged. In the presence of epilepsy, patterns characteristic of isolated disorders appeared systematically shifted toward relatively lowered performance abilities or relatively spared verbal abilities. The similar "impact" exerted by epilepsy on the patterns of the various conditions suggested shared mechanisms. Copyright © 2015 Elsevier Inc. All rights reserved.
    Epilepsy & Behavior 02/2015; 44C:159-168. DOI:10.1016/j.yebeh.2015.02.007 · 2.26 Impact Factor
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    • "need to treat epileptic seizures even though these associated difficulties can have a greater impact on quality of life (Baca, Vickrey, Vassar, & Berg, 2011; Ferro et al., 2013). Pathological Demand Avoidance (PDA) is a term that has been used to describe children who display what appears to be an obsessive resistance to demands and requests and a need to be in control when interacting with others (O'Nions, Christie, Gould, Viding, & Happé , 2013). "
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    ABSTRACT: Childhood epilepsy is associated with a range of neurobehavioural comorbidities including Attention-Deficit/Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), motor impairments and emotional problems. These difficulties frequently have a greater impact on quality of life than seizures. Pathological Demand Avoidance (PDA) is a term increasingly in use in the UK and Europe to describe behaviours associated with an extreme resistance to demands and requests and the need to be in control in social interactions. In a population-based group of 85 children with epilepsy, four (5%) were identified as displaying significant symptoms of PDA, were assessed using the Extreme Demand Avoidance Questionnaire (EDA-Q) and are described in detail. As well as significant symptoms of PDA, the four children met criteria for a range of neurobehavioural disorders; all four had cognitive impairment (IQ < 85) and met DSM-IV-TR criteria for ADHD. Three, in addition, met criteria for ASD and Developmental Coordination Disorder (DCD) and two for Oppositional Defiant Disorder (ODD). All four experienced their first seizure before 5 years of age. School and parent reports indicated very significant functional impairment and management concerns, particularly with respect to complying with everyday demands. Symptoms of PDA should be considered when evaluating neurobehavioural comorbidity in childhood epilepsy.
    Research in Developmental Disabilities 12/2014; 35(12):3236–3244. DOI:10.1016/j.ridd.2014.08.005 · 3.40 Impact Factor
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    • "Studies have highlighted the relationship between seizure variables (e.g., age at onset, time since diagnosis, and medications), psychological well-being, and independent functioning [8, 12–16]. A number of studies have concluded that epilepsy-related factors are not strong predictors of psychopathology in childhood [17, 18]. In contrast, there are indications that demonstration of adaptive behavior may be associated with seizure severity and control [2, 5, 19, 20]. "
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    ABSTRACT: Objective. Children with epilepsy are at risk for less than optimum long-term outcomes. The type and severity of their epilepsy may contribute to educational, psychological, and social outcomes. The objective of this study was to determine the relation between somatization and adaptive skills based on seizure type that could impact on those outcomes. Methods. This study examined adaptive functioning and somatization in 87 children with epilepsy using archival data from a tertiary care facility. Results. No significant differences in adaptive skills emerged between groups of children diagnosed with complex partial (CP) as compared to CP-secondary generalized (SG) seizures; however, deficits in adaptive behavior were found for both groups. The number of medications, possibly reflecting the severity of the epilepsy, was highly correlated to adaptive function. Conclusions. Identification of deficits in adaptive behavior may represent an opportunity for tailored prevention and intervention programming for children with epilepsy. Addressing functional deficits may lead to improved outcomes for these children.
    01/2014; 2014:856735. DOI:10.1155/2014/856735
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