Authors :
Presenting Author: Itay Tokatly Latzer, MD – Boston Children's Hospital
Tracey Richmond, MD – Director, Adolescent and Young Adult Medicine, Eating Disorders Program, Boston Children's Hospital; Bo Zhang, PhD – Senior Biostatistician, Neurology, Boston Children's Hospital; Phillip Pearl, MD – Director, Epilepsy, Boston Children's Hospital
Rationale: Eating disorders (EDs) comprise a group of psychiatric conditions, including anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED), characterized by failure to meet nutritional needs and severe psychosocial functioning impairment. The lifetime prevalence of EDs in adolescence is ~3.5% in females and ~0.5% in males. EDs have been associated with many chronic medical conditions, however, their relationship with epilepsy has not been described. The aims of this study were to assess the rate of EDs in adolescents seen in epilepsy clinics, and to characterize their specific seizure and ED-related traits.
Methods:
This was a 10-year observational study of intellectually intact adolescents seen in epilepsy clinics who had comorbid EDs, who were compared to two age matched control groups of intellectually intact adolescents seen in epilepsy clinics who did not have an ED and those seen in ED-related clinics only for an ED. Data retrieved included demographic and anthropometric details and clinical variables relating to seizure types, EDs, and psychiatric disorders and behaviors.
Results:
A total of 438 subjects were included in the study; 146 from the study group and each of the two control groups. The rate of EDs in adolescents seen in the epilepsy clinics was 8.4% (95%CI 7.1-9.8%) overall; 13.1% (95%CI 11.0-15.5%) in females, and 3.5% (95%CI 2.4-5.0%) in males. There was a significant increase in the annual number of adolescents seen in epilepsy clinics who had comorbid EDs between the years 2013 and 2022 (R = 0.904, p < 0.001). Notable risk factors for EDs were PNES [OR 8.489 (95%CI 3.757-19.183), p< 0.001] and lower zBMI percentiles [OR 2.293 (95%CI 1.785-2.946), p< 0.001]. The EDs of adolescents assessed for seizures began at a younger age (p< 0.001) and occurred at relatively higher rates in males (p=0.005) compared to adolescents with only an ED. Three distinct ED patterns were associated with different seizure types: non-provoked seizures (epilepsy) preceded anorexia nervosa-restrictive type (p=0.01), provoked seizures followed atypical anorexia (p=0.01), and PNES were preceded by bulimia nervosa (p=0.001). Adolescents seen in epilepsy clinics who had an ED, especially those with PNES, were more likely to have psychiatric comorbidities such as depression, anxiety, suicidality, and a history of sexual abuse than adolescents from either control group.