Authors :
Presenting Author: Hayley Loblein, PhD – Children's National Hospital
Jessica Kania, BS – University of Wisconsin-Madison
Riley Dreier, BS – University of Wisconsin School of Medicine & Public Health
Alanna Kessler-Jones, PsyD – University of Wisconsin School of Medicine & Public Health
Madison Berl, PhD – Children's National Hospital
Jana Jones, PhD – University of Wisconsin–Madison
Rationale:
There is a lack of literature investigating anxiety levels in youth with focal epilepsy that are undergoing presurgical evaluation for epilepsy surgery. Past studies have suggested that anxiety problems are often linked to other emotional or behavioral problems such as depression, aggressive behaviors, attention, and somatic problems. This study aims to evaluate clinical and socio-demographic factors that are associated with elevated anxiety within pediatric focal epilepsy. It also investigates the relative risk between anxiety and other common emotional and behavioral outcomes in a pediatric presurgical epilepsy cohort.
Methods:
The multi-site Pediatric Epilepsy Research Consortium (PERC) surgery database identified 603 pediatric focal epilepsy patients. Patients were ages 6-18 (M=12.32 years), being evaluated for surgery, and did not have a history of prior epilepsy surgery. Anxiety was measured by parent reports from either the Behavior Assessment System for Children (BASC-3) or the Child Behavior Checklist (CBCL). The anxiety subscale score was categorized into clinically elevated and normal based on the designated T score cutoffs from each assessment. Pearson’s Chi-square was used to assess clinically-elevated anxiety to other socio-demographic and clinical factors. Pearson’s correlation, chi-squares, relative risk (RR), and confidence intervals (CI) were used to evaluate anxiety level’s relationship to other behavior and emotional measures.
Results:
One hundred thirty-nine (23.1%) of 603 participants showed clinically-elevated anxiety scores based on parent ratings. Females (28%) were more likely to have elevated anxiety than males (18.2%) (p=.005). Caucasian patients (25.9%) were more likely to have clinically-elevated anxiety levels than non-Caucasian (15.1%) (p=.039). Adolescents (ages 12-18) (25.9%) had more elevated anxiety than children (ages 6-11) (18.6%) (p=.047). Patients who had seizures at least weekly (26.2%) were more likely to have elevated anxiety scores than those who had less frequent seizures (18.3%) (p=.036). Age of epilepsy onset, ethnicity, and insurance type were not significant predictors of elevated anxiety. Patients with clinically-elevated anxiety were at higher risk of having clinically-elevated depression (RR=3.62, 95% CI [2.76, 4.73]), somatic problems (RR=3.61, 95% CI [2.78, 4.71]), aggression (RR=2.39, 95% CI [1.74, 3.31]), and attention problems (RR=1.67, 95% CI [1.38, 2.01]) than those without elevated scores for anxiety (Table 1). Conclusions:
This study characterizes the rates of clinically elevated anxiety scores in a presurgical pediatric focal epilepsy population. The cohort had higher rates of clinically-elevated anxiety (23.1%) compared to the current rates of the general youth population (5-10%) (Rapee et. al, 2023). Age, race, sex, and seizure frequency were all significant predictors of elevated anxiety. Patients with elevated anxiety were more likely to be at risk for elevated symptoms of depression, somatic complaints, attention problems, and aggression.
Funding: None