Authors :
Presenting Author: Ana Arenivas, PhD, MPH – Cleveland Clinic
Lisa Ferguson, MA – Cleveland Clinic; Brittany Lapin, PhD, MPH – Cleveland Clinic; Holly Strecker, MA – Cleveland Clinic; Trent George, BS – Cleveland Clinic; Ingmar Blumcke, MD – Cleveland Clinic; Imad Najm, MD – Cleveland Clinic; Robyn Busch, PhD – Cleveland Clinic
Rationale: Nearly half of childhood pharmacoresistant epilepsies are caused by focal cortical dysplasias (FCDs) or other malformations of cortical development (MCDs; e.g., tuberous sclerosis, polymicrogyria, mild MCD with oligodendroglial hyperplasia in epilepsy). Neuropsychological impairment is a substantial disease burden, yet little is known about emotional and behavioral morbidities in children with epilepsy due to FCDs/MCDs. This study characterized base rates of emotional-behavioral function in children with pharmacoresistant epilepsy due to FCDs/MCDs via results of standardized inventories completed by the child and/or their caregiver (parent/guardian). Behavioral morbidity ratings for MCDs were expected to be higher than for FCDs.
Methods: One hundred fourteen pediatric patients with pharmacoresistant focal epilepsy (5-21years; mean age=14years [SD=4.6], 46% female) completed presurgical neuropsychological evaluations that included measures of anxiety, depression, and behavioral problems (See Table 1). Patients were grouped by pathological diagnosis (FCD/MCD/other structural brain abnormalities/nonlesional epileptogenic cortex). Descriptive statistics characterized base rates of emotional-behavioral problems reported (self/caregiver). ANOVA and chi-square analyses examined group differences.
Results: Self-reports showed that 11% from the FCD group and 17% from the MCD group endorsed clinically elevated anxiety symptoms. In both groups, 24% of self-reports indicated clinically elevated depression symptoms. Base rates for clinically elevated psychological symptoms were higher from caregiver ratings (anxiety-33% FCD, 29% MCD; depression-29% FCD, 36% MCD). Caregiver ratings of problem behaviors included somatic (38% FCD, 27% MCD), attention-deficit (37% FCD, 47% MCD), oppositional (0% FCD, 21% MCD), and conduct problems (0% FCD, 33% MCD). Caregivers of children with MCDs reported significantly more conduct problems than FCD, x
2 (1,N=24)=4.8;
p=0.028). No other significant differences existed between the 2 pathology groups. Additional comparisons of emotional-behavioral morbidities for epilepsy in the context of nonlesional epileptogenic cortex or other structural brain abnormalities showed similar findings. See Table1.
Conclusions: Ratings of anxiety, depression, and behavior problems in children with pharmacoresistant epilepsy due to FCDs/MCDs were found to be higher than US population rates of 4% (depression), 9% (anxiety), 10-24% (externalizing disorders), respectively. Given the impact of emotional and behavioral function on cognition and daily function, routine screening should be implemented in youth with pharmacoresistant epilepsy due to FCDs/MCDs, particularly when it comes to externalizing behaviors, such as conduct. Future studies with larger sample sizes should seek to examine relationships among psychological factors and clinical variables (i.e., lesion side/location/extent, etc.), including potential moderators/mediators, and seek to identify/optimize best treatments.
Funding: This study was made possible by funding supported by the American Epilepsy Society (AES2207AA, Junior Investigator Research Award)