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Jin Young S, Lee SA, Eom S, Kim HD. Emotional and behavioral profiles of adolescents with epilepsy: Associations with parental perception of epilepsy-related stigma. Epilepsy Behav 2023; 138:109014. [PMID: 36495800 DOI: 10.1016/j.yebeh.2022.109014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/10/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Abstract
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.
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Affiliation(s)
- Seo Jin Young
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Ahm Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Soyong Eom
- Epilepsy Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Heung-Dong Kim
- Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Gatta M, Raffagnato A, Mannarini S, Balottin L, Toldo I, Vecchi M, Boniver C. Pediatric epilepsy and psychiatric comorbidity: preliminary observational data from a prospective study. Minerva Pediatr 2018; 70:501-512. [DOI: 10.23736/s0026-4946.17.04753-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kim HW, Kim E, Kim JH, Park J, Bahn GH, Lee YJ, Jhung K, Shin D. The Revised Korean Practice Parameter for the Treatment of Attention-Deficit Hyperactivity Disorder (III) - Pharmacological Treatment -. Soa Chongsonyon Chongsin Uihak 2017. [DOI: 10.5765/jkacap.2017.28.2.70] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Hyo-Won Kim
- Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Eunjoo Kim
- Department of Psychiatry, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - Ji-Hoon Kim
- Department of Psychiatry, Pusan National University School of Medicine, Busan, Korea
| | - Jangho Park
- Department of Psychiatry, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Geon Ho Bahn
- Department of Psychiatry, Kyung Hee University School of Medicine, Seoul, Korea
| | - Yeon Jung Lee
- Department of Psychiatry, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Kyungun Jhung
- Department of Psychiatry, International St. Mary’s Hospital, Catholic Kwandong University, Incheon, Korea
| | - Dongwon Shin
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
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Abstract
First-line treatment for epilepsy is antiepileptic drug and requires an interdisciplinary approach and enduring commitment and adherence from the patient and family for successful outcome. Despite adherence to antiepileptic drugs, refractory epilepsy occurs in approximately 30% of children with epilepsy, and surgical treatment is an important intervention to consider. Surgical management of pediatric epilepsy is highly effective in selected patients with refractory epilepsy; however, an evidence-based protocol, including best methods of presurgical imaging assessments, and neurodevelopmental and/or behavioral health assessments, is not currently available for clinicians. Surgical treatment of epilepsy can be critical to avoid negative outcomes in functional, cognitive, and behavioral health status. Furthermore, it is often the only method to achieve seizure freedom in refractory epilepsy. Although a large literature base can be found for adults with refractory epilepsy undergoing surgical treatment, less is known about how surgical management affects outcomes in children with epilepsy. The purpose of the review was fourfold: (1) to evaluate the available literature regarding presurgical assessment and postsurgical outcomes in children with medically refractory epilepsy, (2) to identify gaps in our knowledge of surgical treatment and its outcomes in children with epilepsy, (3) to pose questions for further research, and (4) to advocate for a more unified presurgical evaluation protocol including earlier referral for surgical candidacy of pediatric patients with refractory epilepsy. Despite its effectiveness, epilepsy surgery remains an underutilized but evidence-based approach that could lead to positive short- and long-term outcomes for children with refractory epilepsy.
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Jones JE, Siddarth P, Almane D, Gurbani S, Hermann BP, Caplan R. Identification of risk for severe psychiatric comorbidity in pediatric epilepsy. Epilepsia 2016; 57:1817-1825. [PMID: 27739581 DOI: 10.1111/epi.13575] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2016] [Indexed: 01/20/2023]
Abstract
OBJECTIVE This study identified items on the Child Behavior Checklist (CBCL) that predict those children and adolescents with epilepsy at highest risk for multiple psychiatric diagnoses. METHODS Three hundred twenty-eight children, ages 5-18 years, and their parents participated in separate structured psychiatric interviews about the children, which yielded Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision (DSM-IV-TR) diagnoses. Parents completed the CBCL. The sample was divided into a younger (≤12 years, n = 214) group and an older (>12-18 years, n = 114) group. This study identified a reduced set of parent-reported CBCL items associated with Multiple Diagnoses versus Single Diagnosis versus No Diagnosis using chi-square tests and stepwise logistic regression. We then performed a generalized logistic regression with Multiple Diagnoses versus Single Diagnosis versus No Diagnosis as the dependent variable and the reduced CBCL set of items as predictors. We calculated the area under the ROC (receiver operating characteristic) curve (AUC) as a measure of diagnostic accuracy for pairwise comparisons. RESULTS For the younger group, seven items (clingy, cruelty/bullying, perfectionist, nervous, poor school work, inattentive, and sulks) had high diagnostic accuracy (AUC = 0.88), and for the older group, three items (disobedient at school, loner, and lies/cheats) had high accuracy (AUC = 0.91) when comparing children with multiple psychiatric diagnoses to children with no diagnosis. For both age groups, there was less diagnostic accuracy in identifying children with a single versus no diagnosis (AUC = 0.75 [young]; 0.70 [older]). SIGNIFICANCE These findings suggest that responses to these two subsets of parent-reported CBCL items should alert clinicians to children and adolescents with epilepsy at risk for multiple psychiatric diagnoses and in need of a psychiatric referral.
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Affiliation(s)
- Jana E Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Prabha Siddarth
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Dace Almane
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Suresh Gurbani
- Department of Pediatrics, University of California Irvine, Irvine, California, U.S.A
| | - Bruce P Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Rochelle Caplan
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California, U.S.A
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Tanriverdi M, Mutluay FK, Tarakçi D, Güler S, Iscan A. The impact of epilepsy on preschool children and their families. Epilepsy Behav 2016; 62:6-11. [PMID: 27428870 DOI: 10.1016/j.yebeh.2016.04.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 04/10/2016] [Accepted: 04/29/2016] [Indexed: 11/28/2022]
Abstract
This study investigated the possible presence of sensory-motor developmental impairments in preschool children with epilepsy and explored epilepsy impact on their activities and quality of life and on the stress load of their family. Study participants were children aged 2-6years diagnosed with epilepsy without any other comorbidities (epi-only children). The instruments used for assessment included the Neurological, Sensory, Motor, Developmental Assessment (NSMDA) scale for sensory-motor development, the Impact of Childhood Neurologic Disability Scale (ICNDS), and the Impact of Pediatric Epilepsy Scale (IPES) for disease impact on disability and Quality of Life (QoL), as well as the Pediatric Outcomes Data Collection Instrument (PODCI) for functional health status, and the Parental Stress Scale (PSS) for the family stress load. Required data were obtained from direct testing or observation of children's activities and mother-supplied answers to questions. Eighty-two children were investigated. The NSMDA scores were in the normal development range 6-8. Significant moderate impact of the disease on disability and QoL was estimated with the ICNDS and IPES instruments. The PODCI scores were similar to healthy population levels except for the happiness dimension which was better for children with epilepsy. PSS were significantly above normal. The functional health and QoL of the children as well as their family stress were found to be positively correlated with increasing age. It is found that epilepsy does not degrade neuromotor development and functional health status of preschool epi-only children, though it has a significant impact on their neurological disability and QoL and the stress level of their families; this impact seems to decrease with age.
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Affiliation(s)
- Müberra Tanriverdi
- Bezmialem Vakif University, Faculty of Health Science, Department of Physiotherapy and Rehabilitation, Adnan Menderes Bulvari, P.K. Fatih 34093 Istanbul, Turkey
| | - Fatma Karantay Mutluay
- Istanbul Medipol University, Faculty of Health Science, Department of Physiotherapy and Rehabilitation, Kavacik Mah. Ekinciler Cad. No.19 Beykoz, 34810 Istanbul, Turkey.
| | - Devrim Tarakçi
- Bezmialem Vakif University, Faculty of Health Science, Department of Physiotherapy and Rehabilitation, Adnan Menderes Bulvari, P.K. Fatih 34093 Istanbul, Turkey
| | - Serhat Güler
- Bezmialem Vakıf University, Faculty of Medicine, Department of Paediatrics, Adnan Menderes Bulvari, P.K. Fatih 34093 Istanbul, Turkey
| | - Akin Iscan
- Bezmialem Vakıf University, Faculty of Medicine, Department of Paediatrics, Adnan Menderes Bulvari, P.K. Fatih 34093 Istanbul, Turkey
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Forcelli PA. Short- and long-term neurological and psychiatric sequelae of developmental exposure to antiepileptic and anesthetic drugs. Front Neurol 2015; 6:41. [PMID: 25798126 PMCID: PMC4350400 DOI: 10.3389/fneur.2015.00041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 02/18/2015] [Indexed: 11/13/2022] Open
Affiliation(s)
- Patrick A Forcelli
- Department of Pharmacology and Physiology, Georgetown University , Washington, DC , USA
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8
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Jones JE, Jackson DC, Chambers KL, Dabbs K, Hsu DA, Stafstrom CE, Seidenberg M, Hermann BP. Children with epilepsy and anxiety: Subcortical and cortical differences. Epilepsia 2015; 56:283-90. [PMID: 25580566 PMCID: PMC4340751 DOI: 10.1111/epi.12832] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Using a hypothesis-driven approach, subcortical and cortical regions implicated in anxiety disorders in the general population were examined in children with recent-onset epilepsy with versus without anxiety compared to controls. This study reports frequency of anxiety disorders while examining familial, clinical, and demographic variables associated with anxiety in children with epilepsy. METHOD Participants included 88 children with epilepsy aged 8-18 years: 25 with a current anxiety disorder and 63 children with epilepsy and no current anxiety disorder. Forty-nine controls without anxiety disorders were included. T1 volumetric magnetic resonance imaging (MRI) scans were collected; subcortical volumes and cortical thickness were computed using the FreeSurfer image analysis suite. Analyses focused on adjusted measures of subcortical volumes and cortical thickness. RESULTS Relative to controls, larger left amygdala volumes were found in the Epilepsy with Anxiety group compared to the Epilepsy without Anxiety group (p = 0.027). In the hippocampus, there were no significant differences between groups. Examination of cortical thickness demonstrated that the Epilepsy with Anxiety group showed thinning in left medial orbitofrontal (p = 0.001), right lateral orbitofrontal (p = 0.017), and right frontal pole (p = 0.009). There were no differences between groups in age, sex, IQ, age of onset, medications, or duration of epilepsy. There were more family members with a history of anxiety disorders in the Epilepsy with Anxiety group compared to the Epilepsy without Anxiety group (p = 0.005). SIGNIFICANCE Anxiety is a common psychiatric comorbidity in children with recent-onset epilepsy with volumetric enlargement of the amygdala and thinner cortex in orbital and other regions of prefrontal cortex, suggesting structural abnormalities in brain regions that are part of the dysfunctional networks reported in individuals with anxiety disorders in the general population. These findings are evident early in the course of epilepsy, are not related to chronicity of seizures, and may be linked to a family history of anxiety and depressive disorders.
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Affiliation(s)
- Jana E. Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - Daren C. Jackson
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - Karlee L. Chambers
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - Kevin Dabbs
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - David A. Hsu
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - Carl E. Stafstrom
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Michael Seidenberg
- Department of Psychology, Rosalind Franklin School of Medicine and Science, North Chicago IL
| | - Bruce P. Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
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Influencia de la comorbilidad médica y neuropsiquiátrica en la evolución de la epilepsia infantil. An Pediatr (Barc) 2015; 82:e52-5. [DOI: 10.1016/j.anpedi.2014.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 01/31/2014] [Accepted: 02/13/2014] [Indexed: 11/19/2022] Open
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10
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Salpekar JA, Mishra G. Key issues in addressing the comorbidity of attention deficit hyperactivity disorder and pediatric epilepsy. Epilepsy Behav 2014; 37:310-5. [PMID: 24835083 DOI: 10.1016/j.yebeh.2014.04.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 04/22/2014] [Accepted: 04/23/2014] [Indexed: 11/16/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) is a common comorbidity of epilepsy encountered by clinicians. However, relatively little information is available to guide optimal diagnostic and treatment strategies. Differentiating ADHD from effects of epilepsy requires careful history taking and emphasis upon characteristic symptoms and course of illness. Rating scales for ADHD are well validated and may aid clinical management. Use of antiepileptic drugs may cause cognitive or behavioral side effects yet may improve behavior in some cases. Historically, clinicians have been hesitant to treat ADHD comorbidity for fear of lowering the seizure threshold. However, an aggregate of recent evidence now suggests that stimulants may be well tolerated and effective for ADHD comorbid with epilepsy. Studies that further clarify pathophysiology and treatment outcomes are needed in order to enhance clinical efficacy and quality of life for this population.
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Affiliation(s)
- Jay A Salpekar
- Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, George Washington University School of Medicine, Washington, DC, USA.
| | - Gaurav Mishra
- Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, George Washington University School of Medicine, Washington, DC, USA
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11
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Cole CM, Falcone T, Caplan R, Timmons-Mitchell J, Jares K, Ford PJ. Ethical dilemmas in pediatric and adolescent psychogenic nonepileptic seizures. Epilepsy Behav 2014; 37:145-50. [PMID: 25022823 PMCID: PMC4170022 DOI: 10.1016/j.yebeh.2014.06.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 06/10/2014] [Accepted: 06/12/2014] [Indexed: 11/17/2022]
Abstract
To date, only a very narrow window of ethical dilemmas in psychogenic nonepileptic seizures (PNES) has been explored. Numerous distinct ethical dilemmas arise in diagnosing and treating pediatric and adolescent patients with PNESs. Important ethical values at stake include trust, transparency, confidentiality, professionalism, autonomy of all stakeholders, and justice. In order to further elucidate the ethical challenges in caring for this population, an ethical analysis of the special challenges faced in four specific domains is undertaken: (1) conducting and communicating a diagnosis of PNESs, (2) advising patients about full transparency and disclosure to community including patients' peers, (3) responding to requests to continue antiepileptic drugs, and (4) managing challenges arising from school policy and procedure. An analysis of these ethical issues is essential for the advancement of best care practices that promote the overall well-being of patients and their families.
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Affiliation(s)
- Cristie M Cole
- Department of Bioethics, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Tatiana Falcone
- Neurological Institute, Department of Psychology and Psychiatry, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Epilepsy Center, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Rochelle Caplan
- Department of Psychiatry and Behavioral Services, David Geffen School of Medicine at UCLA, 150 UCLA Medical Plaza, Los Angeles, CA 90095, USA; Department of Child and Adolescent Psychiatry, Brain Research Institute, UCLA, Box 951761, Los Angeles, CA, USA.
| | - Jane Timmons-Mitchell
- Begun Center for Violence Prevention Research and Education, Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, 11402 Bellflower Road, Cleveland, OH 44106, USA.
| | - Kristine Jares
- Department of Social Work, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Paul J Ford
- Department of Bioethics, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Epilepsy Center, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; NeuroEthics Program, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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12
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Moreira FDS, Lima ABD, Fonseca PC, Maia Filho HDS. Mental health of children and adolescents with epilepsy: analysis of clinical and neuropsichological aspects. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 72:613-8. [DOI: 10.1590/0004-282x20140098] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 06/06/2014] [Indexed: 11/21/2022]
Abstract
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.
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13
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Verrotti A, Carrozzino D, Milioni M, Minna M, Fulcheri M. Epilepsy and its main psychiatric comorbidities in adults and children. J Neurol Sci 2014; 343:23-9. [PMID: 24929650 DOI: 10.1016/j.jns.2014.05.043] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 05/08/2014] [Accepted: 05/19/2014] [Indexed: 12/11/2022]
Abstract
Psychiatric disorders seem to be more frequent in patients with epilepsy (PWE) than the general population. Although researchers have documented a strong association between epilepsy and psychiatric comorbidities, the nature of this relationship is poorly understood. According to this, psychiatric diseases are often underdiagnosed and undertreated in PWE with further decrease of the quality of life of patients. The aim of the review was to examine the most frequent psychiatric comorbidities in adults with epilepsy (AWE) and the main psychiatric comorbidities in children with epilepsy (CWE) in order to better understand the relationship between epilepsy and the development of psychiatric disorders.
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Affiliation(s)
- Alberto Verrotti
- Department of Pediatrics, University of Perugia, Piazza Università 1, Perugia 06123, Italy.
| | - Danilo Carrozzino
- Department of Clinical and Experimental Sciences, School of Advanced Studies, "G. D'Annunzio" University of Chieti-Pescara, Via dei Vestini 31, Chieti 66013, Italy
| | - Maddalena Milioni
- Department of Pediatrics, University of Perugia, Piazza Università 1, Perugia 06123, Italy
| | - Maria Minna
- Department of Clinical and Experimental Sciences, School of Advanced Studies, "G. D'Annunzio" University of Chieti-Pescara, Via dei Vestini 31, Chieti 66013, Italy
| | - Mario Fulcheri
- Department of Psychological, Humanistic and Territorial Sciences, University "G. D'Annunzio" of Chieti-Pescara, Via dei Vestini 31, Chieti 66013, Italy
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14
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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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15
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Korgan AC, Green AD, Perrot TS, Esser MJ. Limbic system activation is affected by prenatal predator exposure and postnatal environmental enrichment and further moderated by dam and sex. Behav Brain Res 2013; 259:106-18. [PMID: 24185030 DOI: 10.1016/j.bbr.2013.10.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 10/18/2013] [Accepted: 10/24/2013] [Indexed: 02/07/2023]
Abstract
Epilepsy is a relatively common and chronic neurological condition, affecting 1-2% of the population. However, understanding of the underlying pathophysiology remains incomplete. To identify potential factors in the early environment that may increase the risk for experiencing seizures, maternal stress and environmental enrichment (EE) were utilized. Pregnant Long-Evans rats were exposed to an ethologically relevant predator stress (PS) and maternal glucocorticoid (GC) response was assessed across the exposure period. At birth, litters were divided into standard care (SC) and EE groups until postnatal day 14 (PD14) when a model of febrile convulsions was used to determine seizure susceptibility of the various groups. Pup brains were then processed for immunohistochemical detection of FosB from several structures in the limbic system as a measure of neuronal activation. Maternal PS-induced GC levels were elevated early in the exposure period, and pup birth weights, in both sexes, were lower in litters from dams exposed to PS. Seizure scores at PD14 were highly individualized and litter dependent, suggesting a dam-dependent and variable effect of controlled pre- and postnatal environmental factors. Further, analysis of FosB-immunoreactive (-ir) patterns revealed an activity dependent distribution, reflecting individual seizure susceptibility. EE had a varying effect on FosB-ir that was dependent on region. In the hippocampus FosB-ir levels were greater in the EE groups while extra-hippocampal regions showed lower levels of FosB-ir. Our results support the concept that pre- and postnatal environmental influences affect fetal programming and neurodevelopment of processes that could underlie seizure susceptibility, but that the magnitude of these effects appears to be dam- or litter-dependent.
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Affiliation(s)
- Austin C Korgan
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Amanda D Green
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Tara S Perrot
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada.
| | - Michael J Esser
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada; Departments of Pediatrics and Pharmacology, IWK Health Care Centre, Halifax, NS, Canada
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