Abstracts

Rationale: Behavioral and emotional problems are often unrecognized in children with epilepsy. Previous studies found that poor seizure control and cognition are the predictors for behavioral and emotional problems. In this study, we examined the role of cognition and seizure variables on behavioral and emotional status of children with drug resistant focal epilepsy (FE) by using parents’ and teacher’s report. Methods: Chart review was performed on 56 children (age:5-19 years) with drug resistant FE (2001-2007). A standard battery of neuropsychological tests was performed for each child. Child Behavioral Check List (CBCL) and Student Behavioral Survey (teacher’s report) were used to assess behavioral and emotional problems. Test scores of CBCL and intelligence quotient were compared in children grouped based on the localization of seizure focus or etiology. ANOVA test was used for group comparison; multiple regression analysis for the effect of seizure frequency, age of onset and IQ scores on child’s behavior and emotional status. Results: Mean age for seizure onset and age at the time of evaluation was 78±52 weeks, and 11.8±3.4 years. Seizure focus was identified in temporal lobe (n:32), frontal lobe (n:11) and other regions (n:10). Etiology was identified as cortical dysplasia (41% ), MST(12.5% ) and brain tumors (21% ). When groups were compared based on the location of seizure focus, parents scored highest for aggressive behavior (p: 0.07) whereas teacher for attention deficit and hyperactive behavior (ADHD) (p:0.07) in children with frontal lobe epilepsy (FLE). Subsequent analysis aimed to compare groups based on the underlying etiology. Teacher’s report failed to identify any difference between the groups, however parents reported higher scores for inattentiveness (p:0.02), anxiety (p:0.042) and aggression (p:0.07) in children with underlying causes other than tumor. Full scale IQ score (FSIQ) and seizure frequency but age of onset were found as significant predictors for aggressive behavior (p:0.032 and p:0.031) and externalizing behavior (p:0.005 and p:0.003); whereas FSIQ score alone for depression (p:0.005) and social problems (p:0.009) based on the parents’ report. FSIQ was the only predictor for social problems based on the teacher’s report. Conclusions: Seizure variables and cognition play a significant role on the pathophysiology of behavioral and emotional problems in children with drug resistant focal epilepsy. There is trend for aggressive behavior and ADHD in children with FLE. Early identification and addressing these problems will have significant impact on child’s and subsequently parent’s quality of life with epilepsy. Parents’ report might be more sensitive for the early detection of behavioral and emotional problems.