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Salpekar J, Ertenu DD. Anxiety and school avoidance in an 8-year-old child with epilepsy. Epilepsy Behav Rep 2024; 26:100659. [PMID: 38532902 PMCID: PMC10963191 DOI: 10.1016/j.ebr.2024.100659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/04/2024] [Accepted: 03/11/2024] [Indexed: 03/28/2024] Open
Abstract
Anxiety is ubiquitous in school age children. Co-occurring medical illness adds to the complexity of identifying pathologic anxiety as opposed to that of typical development such as with social interactions or academic pressures. Anxiety may also occur in the context of cognitive difficulties or inattention, both of which may be exacerbated by epilepsy or by anti-seizure medicines themselves. Treatment strategies may require patience and long-term observations to account for the typical range of stressors that may be expected with disease progression or with development through childhood. This section illustrates the challenge of diagnosis and management of anxiety in the context of epilepsy in a school aged child and addresses nuances that neurology clinicians need to consider. Practical strategies for management including stepwise options for pharmacologic treatment will be emphasized.
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Affiliation(s)
- Jay Salpekar
- Neuropsychiatry Center, Kennedy Krieger Institute, Psychiatry and Neurology, Johns Hopkins University School of Medicine, 1741 Ashland Ave., Baltimore, MD 21205, United States
| | - D. Dilara Ertenu
- Neuropsychiatry Center, Kennedy Krieger Institute, Psychiatry and Neurology, Johns Hopkins University School of Medicine, 1741 Ashland Ave., Baltimore, MD 21205, United States
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2
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Slingerland AL, Chua MMJ, Bolton J, Staffa SJ, Tsuboyama M, Prabhu SP, Pearl PL, Madsen JR, Stone SSD. Stereoelectroencephalography followed by combined electrode removal and MRI-guided laser interstitial thermal therapy or open resection: a single-center series in pediatric patients with medically refractory epilepsy. J Neurosurg Pediatr 2023; 31:206-211. [PMID: 36681974 DOI: 10.3171/2022.11.peds22262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/11/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Stereoelectroencephalography (SEEG) and MRI-guided laser interstitial thermal therapy (MRgLITT) have emerged as safe, effective, and less invasive alternatives to subdural grid placement and open resection, respectively, for the localization and treatment of medically refractory epilepsy (MRE) in children. Reported pediatric experience combining these complementary techniques is limited, with traditional workflows separating electrode removal and ablation/resection. The authors describe the largest reported series of pediatric epilepsy patients who underwent MRgLITT following SEEG contrasted with a cohort that underwent craniotomy following SEEG, combining ablation/resection with electrode explantation as standard practice. METHODS The medical records of all patients with MRE who had undergone SEEG followed by MRgLITT or open resection/disconnection at Boston Children's Hospital between November 2015 and December 2020 were retrospectively reviewed. Primary outcome variables included surgical complication rates, length of hospital stay following treatment, and Engel classification at the last follow-up. RESULTS Of 74 SEEG patients, 27 (median age 12.1 years, 63% female) underwent MRgLITT and 47 (median age 12.1 years, 49% female) underwent craniotomy. Seventy patients (95%) underwent SEEG followed by combined electrode removal and treatment. Eight MRgLITT cases (30%) and no open cases targeted the insula (p < 0.001). Complication rates did not differ, although trends toward more subdural/epidural hematomas, infarcts, and permanent unanticipated neurological deficits were evident following craniotomy, whereas a trend toward more temporary unanticipated neurological deficits was seen following MRgLITT. The median duration of hospitalization after treatment was 3 and 5 days for MRgLITT and open cases, respectively (p = 0.078). Seizure outcomes were similar between the cohorts, with 74% of MRgLITT and craniotomy patients attaining Engel class I or II outcomes (p = 0.386) at the last follow-up (median 1.1 and 1.9 years, respectively). CONCLUSIONS MRgLITT and open resection following SEEG can both effectively treat MRE in pediatric patients and generally can be performed in a two-surgery workflow during a single hospitalization. In appropriately selected patients, MRgLITT tended to be associated with shorter hospitalizations and fewer complications following treatment and may be best suited for focal deep-seated targets associated with relatively challenging open surgical approaches.
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Affiliation(s)
| | | | | | - Steven J Staffa
- 3Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital
| | | | - Sanjay P Prabhu
- 4Department of Radiology, Division of Neuroradiology, Boston Children's Hospital, Boston, Massachusetts
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Schraegle WA, Tillman R, Ailion A, Babajani-Feremi A, Titus JB, DeLeon RC, Clarke D, Hermann BP. Behavioral phenotypes of pediatric temporal lobe epilepsy. Epilepsia 2022; 63:1177-1188. [PMID: 35174484 DOI: 10.1111/epi.17193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/01/2022] [Accepted: 02/01/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE A broad spectrum of emotional-behavioral problems have been reported in pediatric temporal lobe epilepsy (TLE), but with considerable variability in their presence and nature of expression, which hampers precise identification and treatment. The present study aimed to empirically identify latent patterns or behavioral phenotypes and their correlates. METHODS Data included parental ratings of emotional-behavioral status on the Behavior Assessment System for Children, 2nd Edition (BASC-2) of 81 children (mean age = 11.79, standard deviation [SD] = 3.93) with TLE. The nine clinical subscales were subjected to unsupervised machine learning to identify behavioral subgroups. To explore concurrent validity and the underlying composition of the identified clusters, we examined demographic factors, seizure characteristics, psychosocial factors, neuropsychological performance, psychiatric status, and health-related quality of life (HRQoL). RESULTS Three behavioral phenotypes were identified, which included no behavioral concerns (Cluster 1, 43% of sample), externalizing problems (Cluster 2, 41% of sample), and internalizing problems (Cluster 3, 16% of sample). Behavioral phenotypes were characterized by important differences across clinical seizure variables, psychosocial/familial factors, everyday executive functioning, and HRQoL. Cluster 2 was associated with younger child age, lower maternal education, and higher rate of single-parent households. Cluster 3 was associated with older age at epilepsy onset and higher rates of hippocampal sclerosis and parental psychiatric history. Both Cluster 2 and 3 demonstrated elevated family stress. Concurrent validity was demonstrated through the association of psychiatric (i.e., rate of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) disorders and psychotropic medication) and parent-rated HRQoL variables. SIGNIFICANCE Youth with TLE present with three distinct behavioral phenotypes that correspond with important clinical and sociodemographic markers. The current findings demonstrate the variability of behavioral presentations in youth with TLE and provide a preliminary framework for screening and targeting intervention to enhance support for youth with TLE and their families.
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Affiliation(s)
- William A Schraegle
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA.,Comprehensive Pediatric Epilepsy Center, Dell Children's Medical Center, Austin, Texas, USA.,Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Rachael Tillman
- Division of Neuropsychology, Center for Neuroscience and Behavioral Medicine, Children's National Hospital, Washington, District of Columbia, USA
| | - Alyssa Ailion
- Department of Neurology and Psychiatry, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Abbas Babajani-Feremi
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA.,Comprehensive Pediatric Epilepsy Center, Dell Children's Medical Center, Austin, Texas, USA.,Department of Neurosurgery, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Jeffrey B Titus
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA.,Comprehensive Pediatric Epilepsy Center, Dell Children's Medical Center, Austin, Texas, USA
| | - Rosario C DeLeon
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA.,Comprehensive Pediatric Epilepsy Center, Dell Children's Medical Center, Austin, Texas, USA.,Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Dave Clarke
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA.,Comprehensive Pediatric Epilepsy Center, Dell Children's Medical Center, Austin, Texas, USA.,Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, Texas, USA.,Department of Neurosurgery, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Bruce P Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Vinti V, Dell'Isola GB, Tascini G, Mencaroni E, Cara GD, Striano P, Verrotti A. Temporal Lobe Epilepsy and Psychiatric Comorbidity. Front Neurol 2021; 12:775781. [PMID: 34917019 PMCID: PMC8669948 DOI: 10.3389/fneur.2021.775781] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/28/2021] [Indexed: 12/14/2022] Open
Abstract
Most focal seizures originate in the temporal lobe and are commonly divided into mesial and lateral temporal epilepsy, depending upon the neuronal circuitry involved. The hallmark features of the mesial temporal epilepsy are aura, unconsciousness, and automatisms. Symptoms often overlap with the lateral temporal epilepsy. However, the latter present a less evident psychomotor arrest, frequent clones and dystonic postures, and common focal to bilateral tonic–clonic seizures. Sclerosis of the hippocampus is the most frequent cause of temporal lobe epilepsy (TLE). TLE is among all epilepsies the most frequently associated with psychiatric comorbidity. Anxiety, depression, and interictal dysphoria are recurrent psychiatric disorders in pediatric patients with TLE. In addition, these alterations are often combined with cognitive, learning, and behavioral impairment. These comorbidities occur more frequently in TLE with hippocampal sclerosis and with pharmacoresistance. According to the bidirectional hypothesis, the close relationship between TLE and psychiatric features should lead to considering common pathophysiology underlying these disorders. Psychiatric comorbidities considerably reduce the quality of life of these children and their families. Thus, early detection and appropriate management and therapeutic strategies could improve the prognosis of these patients. The aim of this review is to analyze TLE correlation with psychiatric disorders and its underlying conditions.
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Affiliation(s)
- Valerio Vinti
- Department of Pediatrics, University of Perugia, Perugia, Italy
| | | | - Giorgia Tascini
- Department of Pediatrics, University of Perugia, Perugia, Italy
| | | | | | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, Istituto di Ricovero e Cura a Carattere Scientifico Giannina Gaslini (IRCCS "G. Gaslini") Institute, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
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Jules-Dole N, Uribe-Cardenas R, McReynolds LJ, Borden L, Chambers S, Bell WR, Ahn ES, Raabe E, Salpekar JA. Psychosis Remitted After Ependymoma Resection in a School-Aged Child. J Neuropsychiatry Clin Neurosci 2021; 32:305-308. [PMID: 31795806 DOI: 10.1176/appi.neuropsych.19070147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Nadimire Jules-Dole
- The Departments of Psychiatry (Jules-Dole, Borden, Chambers, Salpekar), Neurosurgery (Uribe-Cardenas), Pathology (Bell, Raabe), and Neurology (Salpekar) and the Division of Oncology, Division of Pediatric Oncology, Sidney Kimmel Comprehensive Cancer Center (McReynolds, Raabe), Johns Hopkins University School of Medicine, Baltimore; the Department of Neurological Surgery, Cornell University, New York (Uribe-Cardenas); the Department of Neurologic Surgery, Mayo Clinic, Rochester Minn. (Ahn); and the Kennedy Krieger Institute, Baltimore (Salpekar)
| | - Rafael Uribe-Cardenas
- The Departments of Psychiatry (Jules-Dole, Borden, Chambers, Salpekar), Neurosurgery (Uribe-Cardenas), Pathology (Bell, Raabe), and Neurology (Salpekar) and the Division of Oncology, Division of Pediatric Oncology, Sidney Kimmel Comprehensive Cancer Center (McReynolds, Raabe), Johns Hopkins University School of Medicine, Baltimore; the Department of Neurological Surgery, Cornell University, New York (Uribe-Cardenas); the Department of Neurologic Surgery, Mayo Clinic, Rochester Minn. (Ahn); and the Kennedy Krieger Institute, Baltimore (Salpekar)
| | - Lisa J McReynolds
- The Departments of Psychiatry (Jules-Dole, Borden, Chambers, Salpekar), Neurosurgery (Uribe-Cardenas), Pathology (Bell, Raabe), and Neurology (Salpekar) and the Division of Oncology, Division of Pediatric Oncology, Sidney Kimmel Comprehensive Cancer Center (McReynolds, Raabe), Johns Hopkins University School of Medicine, Baltimore; the Department of Neurological Surgery, Cornell University, New York (Uribe-Cardenas); the Department of Neurologic Surgery, Mayo Clinic, Rochester Minn. (Ahn); and the Kennedy Krieger Institute, Baltimore (Salpekar)
| | - Lindsay Borden
- The Departments of Psychiatry (Jules-Dole, Borden, Chambers, Salpekar), Neurosurgery (Uribe-Cardenas), Pathology (Bell, Raabe), and Neurology (Salpekar) and the Division of Oncology, Division of Pediatric Oncology, Sidney Kimmel Comprehensive Cancer Center (McReynolds, Raabe), Johns Hopkins University School of Medicine, Baltimore; the Department of Neurological Surgery, Cornell University, New York (Uribe-Cardenas); the Department of Neurologic Surgery, Mayo Clinic, Rochester Minn. (Ahn); and the Kennedy Krieger Institute, Baltimore (Salpekar)
| | - Shawn Chambers
- The Departments of Psychiatry (Jules-Dole, Borden, Chambers, Salpekar), Neurosurgery (Uribe-Cardenas), Pathology (Bell, Raabe), and Neurology (Salpekar) and the Division of Oncology, Division of Pediatric Oncology, Sidney Kimmel Comprehensive Cancer Center (McReynolds, Raabe), Johns Hopkins University School of Medicine, Baltimore; the Department of Neurological Surgery, Cornell University, New York (Uribe-Cardenas); the Department of Neurologic Surgery, Mayo Clinic, Rochester Minn. (Ahn); and the Kennedy Krieger Institute, Baltimore (Salpekar)
| | - W Robert Bell
- The Departments of Psychiatry (Jules-Dole, Borden, Chambers, Salpekar), Neurosurgery (Uribe-Cardenas), Pathology (Bell, Raabe), and Neurology (Salpekar) and the Division of Oncology, Division of Pediatric Oncology, Sidney Kimmel Comprehensive Cancer Center (McReynolds, Raabe), Johns Hopkins University School of Medicine, Baltimore; the Department of Neurological Surgery, Cornell University, New York (Uribe-Cardenas); the Department of Neurologic Surgery, Mayo Clinic, Rochester Minn. (Ahn); and the Kennedy Krieger Institute, Baltimore (Salpekar)
| | - Edward S Ahn
- The Departments of Psychiatry (Jules-Dole, Borden, Chambers, Salpekar), Neurosurgery (Uribe-Cardenas), Pathology (Bell, Raabe), and Neurology (Salpekar) and the Division of Oncology, Division of Pediatric Oncology, Sidney Kimmel Comprehensive Cancer Center (McReynolds, Raabe), Johns Hopkins University School of Medicine, Baltimore; the Department of Neurological Surgery, Cornell University, New York (Uribe-Cardenas); the Department of Neurologic Surgery, Mayo Clinic, Rochester Minn. (Ahn); and the Kennedy Krieger Institute, Baltimore (Salpekar)
| | - Eric Raabe
- The Departments of Psychiatry (Jules-Dole, Borden, Chambers, Salpekar), Neurosurgery (Uribe-Cardenas), Pathology (Bell, Raabe), and Neurology (Salpekar) and the Division of Oncology, Division of Pediatric Oncology, Sidney Kimmel Comprehensive Cancer Center (McReynolds, Raabe), Johns Hopkins University School of Medicine, Baltimore; the Department of Neurological Surgery, Cornell University, New York (Uribe-Cardenas); the Department of Neurologic Surgery, Mayo Clinic, Rochester Minn. (Ahn); and the Kennedy Krieger Institute, Baltimore (Salpekar)
| | - Jay A Salpekar
- The Departments of Psychiatry (Jules-Dole, Borden, Chambers, Salpekar), Neurosurgery (Uribe-Cardenas), Pathology (Bell, Raabe), and Neurology (Salpekar) and the Division of Oncology, Division of Pediatric Oncology, Sidney Kimmel Comprehensive Cancer Center (McReynolds, Raabe), Johns Hopkins University School of Medicine, Baltimore; the Department of Neurological Surgery, Cornell University, New York (Uribe-Cardenas); the Department of Neurologic Surgery, Mayo Clinic, Rochester Minn. (Ahn); and the Kennedy Krieger Institute, Baltimore (Salpekar)
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Executive function and depressed mood are independently disruptive to health-related quality of life in pediatric temporal lobe epilepsy. Epilepsy Behav 2021; 115:107681. [PMID: 33360405 DOI: 10.1016/j.yebeh.2020.107681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/21/2020] [Accepted: 11/28/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Youth with temporal lobe epilepsy (TLE) are at increased risk of depressive features and diminished health-related quality of life (HRQOL). To assist in the development of future behavioral interventions for youth with TLE, the current study explored potential pathways by which executive functioning (EF) and depressive features impinge upon HRQOL in the context of psychosocial and seizure-specific factors. METHODS Data included parental ratings on the Behavior Assessment System for Children (BASC-2), Behavior Rating Inventory of Executive Function (BRIEF), and the Quality of Life in Childhood Epilepsy (QOLCE) questionnaires for 82 children (Age = 11.99, SD = 3.80) with TLE. Observed path analysis was used to simultaneously investigate the determinants of HRQOL in pediatric TLE. Indirect effects were evaluated with bootstrap analyses. RESULTS Both executive dysfunction and depressive features were negatively linked to child HRQOL, and, furthermore, EF and HRQOL were indirectly connected by depressive features. In addition, depressive features were linked to lower EF, current antiepileptic drug (AED) regimen, and the presence of hippocampal sclerosis. Diminished EF was linked to parental psychiatric history and family stress; EF mediated the relationship of parental psychiatric history and family stress on both depressive features and diminished HRQOL. Finally, a more complicated AED regimen and higher HRQOL were indirectly connected by depressive features. CONCLUSION This study underscores the importance of child depressive features and EF along with environmental and epilepsy-specific factors on HRQOL in pediatric TLE.
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Gökçen O, Turgut M. An Overview of Anxiety Disorders and Depression in Children with Epilepsy: A Literature Review. JOURNAL OF PEDIATRIC EPILEPSY 2020. [DOI: 10.1055/s-0040-1715566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractComorbid 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.
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Affiliation(s)
- Onur Gökçen
- Psychiatry Clinic, Kütahya Health Sciences University School of Medicine, Kütahya, Turkey
| | - Mehmet Turgut
- Department of Neurosurgery, Aydın Adnan Menderes University School of Medicine, Aydın, Turkey
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Hermann BP, Struck AF, Stafstrom CE, Hsu DA, Dabbs K, Gundlach C, Almane D, Seidenberg M, Jones JE. Behavioral phenotypes of childhood idiopathic epilepsies. Epilepsia 2020; 61:1427-1437. [PMID: 32557544 DOI: 10.1111/epi.16569] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/11/2020] [Accepted: 05/11/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To characterize the presence and nature of discrete behavioral phenotypes and their correlates in a cohort of youth with new and recent onset focal and generalized epilepsies. METHODS The parents of 290 youth (age = 8-18 years) with epilepsy (n = 183) and typically developing participants (n = 107) completed the Child Behavior Checklist for children aged 6-18 from the Achenbach System of Empirically Based Assessment. The eight behavior problem scales were subjected to hierarchical clustering analytics to identify behavioral subgroups. To characterize the external validity and co-occurring comorbidities of the identified subgroups, we examined demographic features (age, gender, handedness), cognition (language, perception, attention, executive function, speed), academic problems (present/absent), clinical epilepsy characteristics (epilepsy syndrome, medications), familial factors (parental intelligence quotient, education, employment), neuroimaging features (cortical thickness), parent-observed day-to-day executive function, and number of lifetime-to-date Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) diagnoses. RESULTS Hierarchical clustering identified three behavioral phenotypes, which included no behavioral complications (Cluster 1, 67% of epilepsy cohort [n = 122]), nonexternalizing problems (Cluster 2, 11% of cohort [n = 21]), and combined internalizing and externalizing problems (Cluster 3, 22% of cohort [n = 40]). These behavioral phenotypes were characterized by orderly differences in personal characteristics, neuropsychological status, history of academic problems, parental status, cortical thickness, daily executive function, and number of lifetime-to-date DSM-IV diagnoses. Cluster 1 was most similar to controls across most metrics, whereas Cluster 3 was the most abnormal compared to controls. Epilepsy syndrome was not a predictor of cluster membership. SIGNIFICANCE Youth with new and recent onset epilepsy fall into three distinct behavioral phenotypes associated with a variety of co-occurring features and comorbidities. This approach identifies important phenotypes of behavior problem presentations and their accompanying factors that serve to advance clinical and theoretical understanding of the behavioral complications of children with epilepsy and the complex conditions with which they co-occur.
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Affiliation(s)
- Bruce P Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Aaron F Struck
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Carl E Stafstrom
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - David A Hsu
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Kevin Dabbs
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Carson Gundlach
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Dace Almane
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Michael Seidenberg
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Jana E Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Gonzalez LM, Wrennall JA. A neuropsychological model for the pre-surgical evaluation of children with focal-onset epilepsy: An integrated approach. Seizure 2020; 77:29-39. [DOI: 10.1016/j.seizure.2018.12.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/28/2018] [Accepted: 12/17/2018] [Indexed: 12/20/2022] Open
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Salpekar JA, Mula M. Common psychiatric comorbidities in epilepsy: How big of a problem is it? Epilepsy Behav 2019; 98:293-297. [PMID: 30149996 DOI: 10.1016/j.yebeh.2018.07.023] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 07/24/2018] [Indexed: 11/28/2022]
Abstract
Psychiatric illness and epilepsy commonly co-occur in adults and in children and adolescents. Theories of comorbidity are complex, but recurring associations between the conditions suggest overlap that is more than simple co-occurrence. Common underlying pathophysiology may imply that epilepsy itself may constituently include psychiatric symptoms. Conditions such as depression or cognitive difficulties commonly occur and in some cases, are considered to be associated with specific epilepsy characteristics such as localization or seizure type. Regardless of etiologic attributions to psychiatric comorbidity, it is clear today that treatment for epilepsy needs to target psychiatric illness. In many cases, quality-of-life improvements depend more upon addressing psychiatric symptoms than seizures themselves. This article is part of the Special Issue "Obstacles of Treatment of Psychiatric Comorbidities in Epilepsy".
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Affiliation(s)
- Jay A Salpekar
- Kennedy Krieger Institute, Johns Hopkins University, USA.
| | - Marco Mula
- Institute of Medical and Biomedical Education, St George's University of London, United Kingdom; Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
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Stewart E, Abel TJ, Davidson B, Smith ML. Behaviour outcomes in children with epilepsy 1 year after surgical resection of the ventromedial prefrontal cortex. Neuropsychologia 2019; 133:107155. [PMID: 31398427 DOI: 10.1016/j.neuropsychologia.2019.107155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 07/01/2019] [Accepted: 08/01/2019] [Indexed: 10/26/2022]
Abstract
Early damage to the ventromedial prefrontal cortex (VM) has been associated with impaired behavioural functioning in children without epilepsy, yet behaviour in children with epilepsy and VM lesions has not been investigated. The primary aim of this study was to examine behavioural outcomes in children with epilepsy emanating from the VM preoperatively and one year after epilepsy surgery compared to the general population and matched epilepsy controls. Behavioural outcomes were defined as comprising both problems and competencies (i.e. social, school and co-curricular performance). A secondary aim was to examine whether seizure outcome, number of antiepileptic drugs (AEDs), or age at surgery related to behavioural outcomes. Ratings on the Child Behavior Checklist were examined preoperatively and 1 year after surgery for 20 children with epilepsy who had undergone surgical resection of the VM (N = 10) or temporal lobe (TL, N = 10). VM and TL groups were comparable on Full Scale IQ (40-101), age of seizure onset (0.5-9.0 years), age at surgery (3.1-16.9 years), seizure laterality (5 left in each group), age at assessments, sex (3 female in VM group, 2 female in TL group) and seizure outcome (7 seizure free in VM group, 6 seizure free in TL group). The VM group had significantly elevated behaviour problems (i.e. withdrawn, thought, social and attention problems) and reduced competencies (i.e. social and school) compared to the general population before and after surgery. VM and TL cases did not differ on any behaviour problem scales pre or postoperatively and neither group showed significant change in functioning over time; however, VM patients had significantly lower total competence than TL patients postoperatively. A significant seizure outcome × time interaction was observed: children who were seizure free following surgery (collapsed across surgical site) showed an improvement in total behaviour problems and aggression at 1 year follow-up, whereas children with ongoing seizures showed a deterioration in these domains. In conclusion, VM lesions in children with epilepsy are associated with behavioural problems but their profile does not differ from that of children with temporal lobe epilepsy. These results are consistent with the concept that seizures arise from epileptogenic networks that may affect multiple cortical areas, even when onset is in a focal site.
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Affiliation(s)
- Elizabeth Stewart
- School of Psychology, The University of Sydney, Camperdown, NSW, 2007, Australia
| | - Taylor J Abel
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, 15238, USA
| | - Benjamin Davidson
- Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Canada
| | - Mary Lou Smith
- Department of Psychology, University of Toronto Mississauga, Mississauga ON, L5L 1C6, Canada; Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada.
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Salpekar J. Psychiatric Residue of Epilepsy Surgery: De Novo or Not. Epilepsy Curr 2019; 19:227-228. [PMID: 31189385 PMCID: PMC6891840 DOI: 10.1177/1535759719854753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Predicting De Novo Psychopathology After Epilepsy Surgery: A 3-Year Cohort Study Novais F, Pestana LC, Loureiro S, Andrea M, Figueira ML, Pimentel J. Epilepsy Behav. 2019;90:204-208. doi:10.1016/j.yebeh.2018.11.037. PMID: 30573340. OBJECTIVE The aim of this study was to determine the potential risk factors for de novo psychiatric syndromes after epilepsy surgery. METHODS Refractory epilepsy surgery candidates were recruited from our Refractory Epilepsy Reference Centre. Psychiatric evaluations were made before surgery and every year, during a 3-year follow-up period. Demographic, psychiatric, and neurological data were recorded. The types of surgeries considered were resective surgery (resection of the epileptogenic zone) and palliative surgery (deep brain stimulation of the anterior nuclei of the thalamus [ANT-DBS]). A survival analysis model was used to determine pre- and postsurgical predictors of de novo psychiatric events after surgery. RESULTS One hundred and six people with refractory epilepsy submitted to epilepsy surgery were included. Sixteen (15%) people developed psychiatric disorders that were never identified before surgery. Multilobar epileptogenic zone (P = .001) and DBS of the ANT-DBS (P = .003) were found to be significant predictors of these events. CONCLUSION People with more generalized epileptogenic activity and those who undergo ANT-DBS seem to present an increased susceptibility for the development of mental disorders, after neurosurgical interventions, for the treatment of refractory epilepsy. People considered to be at higher risk should be submitted to more frequent routine psychiatric assessments."
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Executive Dysfunction and Depression in Pediatric Temporal Lobe Epilepsy: The Contribution of Hippocampal Sclerosis and Psychosocial Factors. J Int Neuropsychol Soc 2018; 24:606-616. [PMID: 29573759 DOI: 10.1017/s1355617718000140] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Temporal lobe epilepsy (TLE) has been identified as a risk factor for increased depression features in children and adolescents; however, less is known regarding specific neurocognitive predictors of depression in this population above and beyond seizure-specific and sociodemographic factors. METHODS The study included 62 patients with TLE (64% male) aged 8 to 16 years (M=12.62; SD=2.26) who underwent comprehensive neuropsychological evaluation. RESULTS Correlation analyses revealed significant association between patient depression and WCST Total Perseverations, BRIEF Behavioral Regulation Index (BRI) and family stress. Perseverative errors on the WCST and the BRI were found to significantly predict depression features in youth with TLE. Patient performance on WCST was also found to fully mediate the significant relationship between hippocampal sclerosis (HS) and depression in pediatric TLE. Finally, logistic regression indicated HS in the presence of TLE was associated with a four-fold risk of clinically significant depression ratings. CONCLUSIONS The current findings offer strong support for the relationship between executive function (EF) and depression in pediatric TLE. Also, as HS is not modifiable, these findings suggest EF intervention may be a potential modality for improving health-related quality of life (HRQOL) in youth with TLE. (JINS, 2018, 24, 606-616).
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Abstract
PURPOSE OF REVIEW The overlap of neuropsychiatric illness and developmental disability continues to be prominently recognized in clinical practice and in the academic literature. Theoretical and practical considerations may represent a frontier for understanding brain and behavior relationships. The purpose of this review is to explore this common relationship and report on recent literature that helps advance the larger fields of psychiatry and neurology. RECENT FINDINGS Overlap between developmental disability, epilepsy, and neuropsychiatric illness may be more common than originally thought. Excessive excitatory neurotransmitter activity may be present in epilepsy and in autism spectrum disorder. Specific seizure types may be associated with features of developmental disabilities and neuropsychiatric conditions. SUMMARY Neuropsychiatric illness is common in epilepsy and more frequent in developmental disabilities than generally recognized. Seizure foci in the temporal lobe may play a significant role. Brain connectivity and specific neurotransmitter systems are active areas of investigation. Antiepileptic drugs may improve neuropsychiatric symptoms in persons with developmental disability and epilepsy.
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Dal Canto G, Pellacani S, Valvo G, Masi G, Ferrari AR, Sicca F. Internalizing and externalizing symptoms in preschool and school-aged children with epilepsy: Focus on clinical and EEG features. Epilepsy Behav 2018; 79:68-74. [PMID: 29253677 DOI: 10.1016/j.yebeh.2017.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 09/29/2017] [Accepted: 10/01/2017] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Psychiatric and behavioral problems are frequent comorbidities of epilepsy, although their clinical and electroencephalographic (EEG) correlates remain uncertain. In this study, we have assessed the frequency of psychopathological problems in a cohort of children with epilepsy, and established their main clinical and EEG-associated features. METHODS One hundred fifty-nine young patients with epilepsy were recruited and assessed through the Child Behavior Checklist for preschool-aged children (CBCL 1 1/2-5) or for school-aged children (CBCL 6-18). Child Behavior Checklist (CBCL) results were then correlated to the main clinical and EEG data. RESULTS We found emotional and behavioral problems in about half of the children in our sample. Internalizing, social, and attention problems were more common than externalizing features. Moderate intellectual disability, a nonidiopathic etiology of epilepsy, a poor control of seizures, and antiepileptic polytherapies, as well as an early age at seizure-onset and a longer duration of the disorder, were all associated with specific behavioral and emotional problems. A temporal site of interictal EEG abnormalities also enhanced the risk for psychiatric comorbidities, especially in the externalizing domain. CONCLUSIONS Several clinical and EEG features are associated with an increased risk for emotional and behavioral comorbidities in children with epilepsy. Their identification may foster an early diagnosis and appropriate care, limiting the worsening of psychiatric symptoms and their impact on quality of life and health status. A better understanding of the underlying clinical and molecular mechanisms is needed to further improve prevention and treatment interventions.
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Affiliation(s)
- Giulia Dal Canto
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Via dei Giacinti 2, Calambrone, 56128 Pisa, Italy
| | - Simona Pellacani
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Via dei Giacinti 2, Calambrone, 56128 Pisa, Italy
| | - Giulia Valvo
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Via dei Giacinti 2, Calambrone, 56128 Pisa, Italy
| | - Gabriele Masi
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Via dei Giacinti 2, Calambrone, 56128 Pisa, Italy
| | - Anna Rita Ferrari
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Via dei Giacinti 2, Calambrone, 56128 Pisa, Italy
| | - Federico Sicca
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Via dei Giacinti 2, Calambrone, 56128 Pisa, Italy.
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Cognitive predictors of adaptive functioning in children with symptomatic epilepsy. Epilepsy Res 2017; 136:67-76. [DOI: 10.1016/j.eplepsyres.2017.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 07/24/2017] [Accepted: 07/25/2017] [Indexed: 12/18/2022]
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Berg AT, Altalib HH, Devinsky O. Psychiatric and behavioral comorbidities in epilepsy: A critical reappraisal. Epilepsia 2017; 58:1123-1130. [PMID: 28464309 PMCID: PMC5498258 DOI: 10.1111/epi.13766] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2017] [Indexed: 01/26/2023]
Abstract
Psychiatric and behavioral disorders are important aspects of epilepsy and have received increasing attention in the last several years. The literature upon which most of the field relies contains some biases that must be carefully examined and resolved in future studies. First, in the pediatric epilepsy literature, many reports find that children with epilepsy have high levels of behavioral and psychiatric disorders when compared to appropriate controls. Most of these studies rely on parent-proxy completed instruments to assess these behavioral endpoints. Parents' reports are not objective but reflect parents' reactions and emotions. Increasing evidence suggests inherent biases in proxy reports and highlights the need to assess children directly. Second, periictal phenomena may be mischaracterized as underlying mood disorders. Third, many studies report elevated levels of psychiatric morbidity before and after the diagnosis of epilepsy, suggesting an inherent relation between the two types of disorders. Psychogenic nonepileptic seizures, while widely recognized as posing a diagnostic dilemma in the clinic, may account for some of these research findings. Diagnostic errors between epilepsy and psychogenic nonepileptic seizures need careful consideration when evaluating studies demonstrating associations between psychiatric disorders and epilepsy or poorer seizure control in association with psychiatric disorders in people who have epilepsy. Mental health concerns are important for everyone. An accurate, undistorted understanding of the relation between mental health disorders and epilepsy is essential to ensure appropriate therapy and to avoid unnecessary and potentially harmful treatments and common misconceptions.
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Affiliation(s)
- Anne T. Berg
- Ann & Robert H Lurie Children’s Hospital of Chicago, Northwestern-Feinberg School of Medicine, Chicago, IL
| | - Hamada H. Altalib
- Hamada H. Altalib, DO, MPH, Yale University School of Medicine, New Haven, CT
| | - Orrin Devinsky
- Orrin Devinsky, MD, New York University School of Medicine, New York, NY
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Schraegle WA, Titus JB. The relationship of seizure focus with depression, anxiety, and health-related quality of life in children and adolescents with epilepsy. Epilepsy Behav 2017; 68:115-122. [PMID: 28142130 DOI: 10.1016/j.yebeh.2016.12.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 11/30/2016] [Accepted: 12/12/2016] [Indexed: 10/20/2022]
Abstract
For youth with epilepsy, comorbid psychiatric conditions, such as depression and anxiety, require further examination as they carry increased risk for reduced health-related quality of life (HRQOL). The current study assessed whether rates of depression, anxiety, and withdrawal behaviors differed based on seizure location. Data included parental ratings on the Behavior Assessment System for Children (BASC-2) and the Quality of Life in Childhood Epilepsy (QOLCE) questionnaire for 132 children and adolescents (mean age=11.34, SD=3.95) with generalized or partial (i.e., frontal [FLE] or temporal lobe epilepsy [TLE]) epilepsy. Our results identified clinically significant internalizing psychopathology in nearly half of our sample (41%). Although rates of internalizing behavior were similar between generalized and partial groups, children and adolescents with TLE demonstrated higher rates of depression compared to youth with FLE. No effects of laterality on internalizing behaviors were identified between TLE and FLE groups. Finally, for youth with TLE, parental depression ratings along with current number of antiepileptic medications (AEDs) were found to be significant barriers to HRQOL above and beyond anxiety, withdrawal, and epilepsy-specific variables. Temporal lobe epilepsy was associated with a two-fold risk of clinically significant depression ratings. These findings highlight the high prevalence of internalizing psychopathology features in pediatric epilepsy and offer further support for the relationship between depression and TLE in children and adolescents with epilepsy.
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Affiliation(s)
- William A Schraegle
- Comprehensive Epilepsy Program, Dell Children's Medical Center of Central Texas, Austin, TX, USA; Department of Educational Psychology, The University of Texas at Austin, Austin, TX, USA
| | - Jeffrey B Titus
- Comprehensive Epilepsy Program, Dell Children's Medical Center of Central Texas, Austin, TX, USA; Department of Psychology, The University of Texas at Austin, Austin, TX, USA.
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Huemer J, Plattner B, Planer N, Steiner H, Feucht M. Psychopathology in adolescents with TLE and FLE. Eur J Paediatr Neurol 2016; 20:880-887. [PMID: 27474513 DOI: 10.1016/j.ejpn.2016.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 07/08/2016] [Accepted: 07/11/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND To describe the rates and types of psychiatric disorders among adolescents with chronic symptomatic epilepsies and to evaluate syndrome-specific differences between temporal lobe (TLE) and frontal lobe (FLE) epilepsies. METHODS A cross-sectional single-center study design applying the Youth Self Report (YSR) to investigate psychopathological symptoms and the Weinberger Adjustment Inventory (WAI) to investigate personality dimensions was used. Consecutive adolescents between 14 and 18 years of age with drug-resistant symptomatic TLE and FLE were investigated during pre-surgical evaluation prior to epilepsy surgery. Data from twenty-eight patients (19 with TLE and 9 with FLE) were analyzed for this report. RESULTS Compared with the test norm, higher prevalence rates and a wider range of psychopathological symptoms were seen in patients with TLE. This result was not seen in patients with FLE. Concerning personality dimensions, significantly higher values of repressive defensiveness and significantly lower values of positive emotion and confidence were found in patients with TLE. In contrast, significantly lower levels of distress and significantly higher levels of repressive defensiveness and denial of distress were seen in patients with FLE. Comparing TLE with FLE, a significantly higher mean score for distress, and a significantly lower mean score for positive emotion and denial of distress were found in patients with TLE. CONCLUSION In summary, psychiatric comorbidity was frequently found in this sample of youths with chronic drug-resistant localization-related epilepsies. Although results have to be interpreted with caution because of the small sample size, psychiatric symptomatology was significantly different between TLE and FLE. Our results show that continuous and syndrome-specific psychiatric monitoring is essential in young patients with epilepsy.
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Affiliation(s)
- Julia Huemer
- Department of Child and Adolescent Psychiatry, Medical University of Vienna (MUW), Vienna, Austria
| | - Belinda Plattner
- Department of Child and Adolescent Psychiatry, Paracelsus Private Medical University, Salzburg, Austria
| | - Nadja Planer
- Department of Pediatrics, Division of General Pediatrics, MUW, Vienna, Austria
| | - Hans Steiner
- Stanford University School of Medicine, Division of Child Psychiatry and Child Development, Department of Psychiatry and Behavioral Sciences, Stanford, United States
| | - Martha Feucht
- Department of Pediatrics, Division of General Pediatrics, MUW, Vienna, Austria.
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Abstract
Mood disorders associated with epilepsy are very common and overrepresented compared with other chronic medical conditions. Depression is a particularly common and worrisome comorbidity, especially because suicidality seems to be increased significantly in the context of epilepsy. Although psychosocial stressors commonly are associated, intrinsic characteristics of seizure disorders may contribute to the expression of depressive symptoms. Depression and epilepsy may exacerbate each other. Epilepsy with seizure foci in the temporal lobe may represent a higher risk of developing depression, especially if the seizures do not generalize. Treatment of depression is multifaceted and includes psychotherapy and sophisticated regimens of anticonvulsants. Most antidepressants may be used safely and effectively in the context of depression, although high-quality evidence is lacking. Ultimately, treatment of comorbid mood disorder has important implications for outcome and quality of life, perhaps even more than treatment of epilepsy itself.
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Affiliation(s)
- Jay Salpekar
- Dr. Salpekar is director of the Neuropsychiatry and Epilepsy Program, Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Baltimore (e-mail: )
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Nickels KC, Zaccariello MJ, Hamiwka LD, Wirrell EC. Cognitive and neurodevelopmental comorbidities in paediatric epilepsy. Nat Rev Neurol 2016; 12:465-76. [PMID: 27448186 DOI: 10.1038/nrneurol.2016.98] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cognitive and behavioural comorbidities are often seen in children with epilepsy, and are more common and severe in refractory epilepsy. These comorbidities are associated with worse quality of life, increased behavioural and language problems and worse social skills, all of which adversely affect long-term psychosocial functioning. To enable early intervention and therapy, children and teens with epilepsy should be periodically screened for cognitive comorbidities. The location of the epileptic focus can, to a certain degree, predict the type(s) of comorbidity; however, the spectrum of disability is often broad, presumably because focal perturbations can cause network dysfunction. Comorbidities often result from underlying structural or functional pathology that has led to seizures. In selected cases, therapy targeting the underlying cause, such as the ketogenic diet for GLUT1 deficiency syndromes, may be remarkably effective in ameliorating both seizures and cognitive concerns. In many cases, however, cognitive impairment persists despite seizure control. In epileptic encephalopathies, frequent seizures and/or interictal epileptiform abnormalities exacerbate neurocognitive dysfunction, owing to synaptic reorganization or impaired neurogenesis, or to other effects on developing neural circuits, and prompt initiation of effective antiepileptic therapy is essential to limit cognitive comorbidities.
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Affiliation(s)
- Katherine C Nickels
- Child and Adolescent Neurology and Epilepsy, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - Michael J Zaccariello
- Child and Adolescent Neurology and Epilepsy, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - Lorie D Hamiwka
- Seattle Children's Hospital, MB.7.420 - Neurology, 4800 Sand Point Way NE, Seattle, Washington 98105, USA
| | - Elaine C Wirrell
- Child and Adolescent Neurology and Epilepsy, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
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23
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Law N, Kerr E, Smith ML. Evaluation of behavioral outcomes in children 1 year after epilepsy surgery. Epilepsia 2015; 56:1605-14. [DOI: 10.1111/epi.13126] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Nicole Law
- Department of Psychology; University of Toronto; Toronto Ontario Canada
- Department of Psychology; Hospital for Sick Children; Toronto Ontario Canada
- Program in Neurosciences and Mental Health; Hospital for Sick Children; Toronto Ontario Canada
| | - Elizabeth Kerr
- Department of Psychology; Hospital for Sick Children; Toronto Ontario Canada
- Department of Pediatrics; University of Toronto; Toronto Ontario Canada
| | - Mary Lou Smith
- Department of Psychology; University of Toronto; Toronto Ontario Canada
- Department of Psychology; Hospital for Sick Children; Toronto Ontario Canada
- Program in Neurosciences and Mental Health; Hospital for Sick Children; Toronto Ontario Canada
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Key issues in addressing the comorbidity of depression and pediatric epilepsy. Epilepsy Behav 2015; 46:12-8. [PMID: 25863941 DOI: 10.1016/j.yebeh.2015.02.036] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 02/24/2015] [Accepted: 02/25/2015] [Indexed: 12/14/2022]
Abstract
Depression is a common comorbidity associated with epilepsy. However, the etiology of depression is difficult to establish given the heterogeneity in both epilepsy and depression. Nevertheless, the co-occurrence is so common that a bidirectional relationship between depression and epilepsy has been theorized. Persons with temporal lobe seizure foci and partial-onset epilepsy may be more vulnerable to the development of depression. In pediatrics, depression differs but may be readily identified by understanding nuances of mood states and variability of neurovegetative symptom presentation. Although no clear treatment guidance exists in the context of epilepsy, antidepressants have been relatively well studied in pediatrics and are effective and well tolerated. Anticonvulsant drugs may also improve depressive symptoms though clinical research is lacking in pediatrics. Treatment of depression may independently improve outcome for epilepsy and for quality of life. Future studies will clarify etiologies of depression in the context of epilepsy and improve the evidence base for treatment outcomes.
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25
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Comments on "Key issues in addressing the comorbidity of depression in pediatric epilepsy". Epilepsy Behav 2015; 46:7. [PMID: 25936277 DOI: 10.1016/j.yebeh.2015.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 04/02/2015] [Indexed: 11/22/2022]
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Kavanaugh BC, Scarborough VR, Salorio CF. Parent-rated emotional-behavioral and executive functioning in childhood epilepsy. Epilepsy Behav 2015; 42:22-8. [PMID: 25499157 DOI: 10.1016/j.yebeh.2014.11.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 11/03/2014] [Accepted: 11/08/2014] [Indexed: 01/20/2023]
Abstract
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.
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Affiliation(s)
- Brian C Kavanaugh
- Department of Neuropsychology, Kennedy Krieger Institute, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA
| | | | - Cynthia F Salorio
- Department of Neuropsychology, Kennedy Krieger Institute, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, USA.
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Are children affected by epileptic neuropsychiatric comorbidities? Epilepsy Behav 2014; 38:8-12. [PMID: 24239433 DOI: 10.1016/j.yebeh.2013.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 10/01/2013] [Accepted: 10/02/2013] [Indexed: 11/22/2022]
Abstract
Childhood-onset epilepsy is associated with psychiatric and cognitive difficulties and with poor social outcomes in adulthood. Some antiepileptic drugs adversely affect behavior in susceptible children with easy-to-control or refractory epilepsies, contributing to a high risk of psychological and psychiatric disturbance. Studies had demonstrated that patients with benign rolandic epilepsy and absence epilepsy had more aggressive behavior, depression, and anxiety disorders than control children. Psychiatric comorbidities are strongly associated with a poor long-term health-related quality of life in childhood-onset epilepsy, which suggests that comprehensive epilepsy care must include screening and long-term treatment for these conditions, even if seizures remit.
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Kenney D, Wirrell E. Patient considerations in the management of focal seizures in children and adolescents. Adolesc Health Med Ther 2014; 5:49-65. [PMID: 24808722 PMCID: PMC3986281 DOI: 10.2147/ahmt.s44316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Focal epilepsy accounts for approximately one-half to two-thirds of new-onset epilepsy in children. Etiologies are diverse, and range from benign epilepsy syndromes with normal neuroimaging and almost certain remission to focal malformations of cortical development or hippocampal sclerosis with intractable seizures persisting lifelong. Other important etiologies in children include pre-, peri-, or postnatal brain injury, low-grade neoplasms, vascular lesions, and neuroimmunological disorders. Cognitive, behavioral, and psychiatric comorbidities are commonly seen and must be addressed in addition to seizure control. Given the diverse nature of focal epilepsies in children and adolescents, investigations and treatments must be individualized. First-line therapy consists of prophylactic antiepileptic drugs; however, prognosis is poor after failure of two to three drugs for lack of efficacy. Refractory cases should be referred for an epilepsy surgery workup. Dietary treatments and neurostimulation may be considered in refractory cases who are not good candidates for surgery.
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Affiliation(s)
- Daniel Kenney
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Elaine Wirrell
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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Andresen EN, Ramirez MJ, Kim KH, Dorfman AB, Haut JS, Klaas PA, Jehi LE, Shea K, Bingaman WE, Busch RM. Effects of surgical side and site on mood and behavior outcome in children with pharmacoresistant epilepsy. Front Neurol 2014; 5:18. [PMID: 24600433 PMCID: PMC3928572 DOI: 10.3389/fneur.2014.00018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 01/31/2014] [Indexed: 11/24/2022] Open
Abstract
Children with epilepsy have a high rate of mood and behavior problems; yet few studies consider the emotional and behavioral impact of surgery. No study to date has been sufficiently powered to investigate effects of both side (left/right) and site (temporal/frontal) of surgery. One hundred patients (aged 6–16) and their families completed measures of depression, anxiety, and behavioral function as part of neuropsychological evaluations before and after surgery for pharmacoresistant epilepsy. Among children who had left-sided surgeries (frontal = 16; temporal = 38), there were significant interactions between time (pre to post-operative neuropsychological assessment) and resection site (frontal/temporal) on anhedonia, social anxiety, and withdrawn/depressed scales. Patients with frontal lobe epilepsy (FLE) endorsed greater pre-surgical anhedonia and social anxiety than patients with temporal lobe epilepsy (TLE) with scores normalizing following surgery. While scores on the withdrawn/depressed scale were similar between groups before surgery, the FLE group showed greater symptom improvement after surgery. In children who underwent right-sided surgeries (FLE = 20; TLE = 26), main effects of time (patients in both groups improved) and resection site (caregivers of FLE patients endorsed greater symptoms than those with TLE) were observed primarily on behavior scales. Individual data revealed that a greater proportion of children with left FLE demonstrated clinically significant improvements in anhedonia, social anxiety, and aggressive behavior than children with TLE. This is the first study to demonstrate differential effects of both side and site of surgery in children with epilepsy at group and individual levels. Results suggest that children with FLE have greater emotional and behavioral dysfunction before surgery, but show marked improvement after surgery. Overall, most children had good emotional and behavioral outcomes, with most scores remaining stable or improving.
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Affiliation(s)
- Elizabeth N Andresen
- Department of Psychiatry and Psychology, Neurological Institute, Cleveland Clinic , Cleveland, OH , USA
| | - Maya J Ramirez
- Department of Psychiatry and Psychology, Neurological Institute, Cleveland Clinic , Cleveland, OH , USA
| | - Kevin H Kim
- Department of Psychology in Education, University of Pittsburgh , Pittsburgh, PA , USA
| | - Ava B Dorfman
- Department of Psychiatry and Psychology, Neurological Institute, Cleveland Clinic , Cleveland, OH , USA
| | - Jennifer S Haut
- Department of Psychiatry and Psychology, Neurological Institute, Cleveland Clinic , Cleveland, OH , USA ; Cleveland Clinic Epilepsy Center, Neurological Institute, Cleveland Clinic , Cleveland, OH , USA
| | - Patricia A Klaas
- Department of Psychiatry and Psychology, Neurological Institute, Cleveland Clinic , Cleveland, OH , USA ; Cleveland Clinic Epilepsy Center, Neurological Institute, Cleveland Clinic , Cleveland, OH , USA
| | - Lara E Jehi
- Cleveland Clinic Epilepsy Center, Neurological Institute, Cleveland Clinic , Cleveland, OH , USA
| | - Katherine Shea
- Cleveland Clinic Epilepsy Center, Neurological Institute, Cleveland Clinic , Cleveland, OH , USA
| | - William E Bingaman
- Cleveland Clinic Epilepsy Center, Neurological Institute, Cleveland Clinic , Cleveland, OH , USA
| | - Robyn M Busch
- Department of Psychiatry and Psychology, Neurological Institute, Cleveland Clinic , Cleveland, OH , USA ; Cleveland Clinic Epilepsy Center, Neurological Institute, Cleveland Clinic , Cleveland, OH , USA
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Pinn S. Optical coherence tomography gives insights into bioresorbable vascular scaffold position. Br J Hosp Med (Lond) 2013. [DOI: 10.12968/hmed.2013.74.6.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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31
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Depression common in children with temporal lobe epilepsy. Br J Hosp Med (Lond) 2013. [DOI: 10.12968/hmed.2013.74.6.308b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Pinn S. Renal sympathetic denervation improves nocturnal dipping in hypertensive patients. Br J Hosp Med (Lond) 2013. [DOI: 10.12968/hmed.2013.74.6.310a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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