Abstracts

RATIONALE: Psychiatric and behavioral problems are known to be overrepresented among epilepsy patients. These problems are especially significant in children and adults with intractable seizures that necessitate surgical treatment. Despite the debilitating nature of psychiatric illness, these issues are less well studied in the pediatric population. Little is known about behavioral issues in pediatric epilepsy patients that ultimately receive surgical treatment.
METHODS: We assessed behavioral problems in seven pediatric patients undergoing routine psychiatric evaluation prior to epilepsy surgery. Each patient received clinical DSM-IV diagnoses if appropriate, and parents completed a Child Behavioral Checklist (CBCL). The CBCL is a well-validated 113 question measure that asks parents to rate the frequency of various behavioral problems. Clinically significant t scores on eight CBCL subcategories (withdrawn, somatic complaints, anxious/depressed, social problems, thought problems, attention problems, delinquent behavior, aggressive behavior) were tabulated.
RESULTS: CBCL results of this sample revealed many subcategory t scores at levels of clinical significance. Five of the seven patients had at least one clinically significant behavioral finding on the CBCL. Four had significant social problems, and two had significant attention problems. Single significant scores were also found in areas of thought problems, anxiety/depression, aggression, and somatic problems. Four had borderline levels of clinical significance in the CBCL subcategory of somatic problems. DSM-IV diagnoses of this group were clinically identifiable for six of the seven patients. Three had at least a subtype of Attention Deficit Hyperactivity Disorder, four had Major Depression or Depressive Disorder Not Otherwise Specified, and three had Generalized Anxiety Disorder or Anxiety Disorder Not Otherwise Specified. Three patients had more than one diagnosis. Two patients had comorbid depression and anxiety disorder.
CONCLUSIONS: Behavioral problems are prominent in pediatric patients presenting for epilepsy surgery. Especially notable is the presence of psychiatric problems and clinically significant CBCL scores in pediatric epilepsy patients who had not previously received psychiatric treatment. Attention and anxiety/depressive disorders were prominent in this sample. Routine psychiatric evaluation is an important component of a comprehensive workup prior to epilepsy surgery.