Abstracts

Rationale: Behavioral problems in children with epilepsy are common. As part of an ongoing study of sleep problems in children we evaluated behavioral problems in children with epilepsy, neurologic disease,children referred for polysomnography with sleep disordered breathing, and a control group from general pediatric clinics. Behavioral measures were obtained in children prior to treatment and those children on 1,2, or 3 anticonvulsants.Methods: A 111 item questionnaire was administered to 462 pediatric neurology patients (55% M,45% F). Of these patients, 151 had the diagnosis of epilepsy. The control group consisted of 185 children recruited from general pediatric clinics with a similar distribution. The sleep disordered breathing group consisted of children referred to sleep lab with snoring and apnea defined as an apnea hypopnea index greater than 5. Patients ranged in age from 5 to 17 years old, with an average age of 10. Children under age 5 were excluded. Behavioral measures consisted of 11 questions assessing daytime attention at school and home, acting out at school and at home, sleep related anxiety, and or learning disability. These were related to five measures, of symptoms of sleep problems, excessive daytime sleepiness, restlessness, insomnia, and parasomnias.Results: We found that behavioral scores ranged from 2.9 in control group to 14 in the ADHD subgroup, children with apnea 9.5, children with PSG and no apnea 4.5, headache 7.5 and epilepsy 8.6. These groups were significantly different (Kruskal –Walish) p<0.05. However the behavioral scores for children with epilepsy untreated 8.1 on monotherapy 9.4, two anticonvulsants 10.0 and three anticonvulsants 7.9 demonstrated no significant differences. In addition behavioral scores correlated (Pearson R) with EDS 0.647, parasomnia 0.305, restlessness 0.408, and insomnia 0.456 (p< 0.001 for all measures). Conclusions: Our behavioral measure demonstrated no significant differences between children with epilepsy prior to anticonvulsant treatment and those receiving one, two or three drugs. Clear significant differences were noted in the controls epilepsy and ADHD groups. These findings suggest that a child's underlying epilepsy syndrome and not anticonvulsant therapy plays the major role in behavioral issues in children with epilepsy. Further study and neuropsychological assessment are necessary to confirm these results.