Abstracts

Rationale: Neurobehavioral comorbidities have higher than normal prevalence in children with epilepsy, and are often present at time of diagnosis. Data regarding the course of comorbidities during early phase of epilepsy are limited. In follow-up to our previous 2014 study, the current study describes cumulative data from the first 2 years of our multidisciplinary protocol for new onset pediatric epilepsy (NOPE), including one-year follow-up data. Clinic logistics, evaluation findings, and epilepsy variables are provided. Information from the NOPE clinic has facilitated prompt assessment and treatment for children.Methods: The NOPE clinic includes neuropsychological screening, pediatric psychology screening, and clinic visit with nurse practitioner. Patients are referred by pediatric epileptologists. Inclusion criteria for referral: age 3 – 18, first diagnosis of epilepsy, first exposure to antiepileptic drugs, ability to participate in neuropsychological testing. Most patients are scheduled within 8 weeks of diagnosis. Patients return to clinic for 1-year follow-up. The clinic started in October 2013. Records from 69 consecutive patients are reviewed, and thus far, 18 of these patients have 1-year follow-up data. Summaries of initial visit (T1) and follow-up (T2) are provided.Results: 69 children were seen at T1, 67% within 8 weeks of initial epilepsy diagnosis. 36 were seen initially on the EMU; of those, 30 direct admissions from the ED. 33 were seen initially in the outpatient clinic; of those, 19 were referrals from the ED. 33 females, age 3-16 years (median 7.7). No history of head trauma or neurological disorder. 63/69 had abnormal EEG. 12/62 had abnormal MRI. Focal seizures in 47, primary generalized in 22. 20 had 1 observed seizure; 33 had 2-5 seizures; 16 had >6 seizures, 10 had an episode of status epilepticus prior to first visit. 66 started on AED prior to clinic visit. T1 mean FSIQ: 102 (SD 13). At T1, 61/69 demonstrated one or more indications of neurobehavioral comorbidity. Of these 61, 21 had symptoms that rose to the level of clinical diagnoses, and 40 showed risk factors subthreshold for diagnosis. Academic accommodations recommended for 19 patients, outpatient psychotherapy recommended for 27 patients. 18 patients were seen at T2. 10 continued to have seizures in the interim; 3 had been admitted to EMU. T2 mean FSIQ: 99 (SD 16). 8 had neurobehavioral symptoms that met criteria for new diagnosis at T2. 7 patients for whom intervention (IEP, 504, psychotherapy) was recommended at T1, had received that intervention in the interim.Conclusions: This study describes data for pediatric patients seen during the first 2 years of Minnesota Epilepsy Group’s multidisciplinary NOPE clinic. Shortly after initial epilepsy diagnosis, patients show higher than normal incidence of and/or risk factors for neurobehavioral comorbidities. At 1 year follow up, previously indicated symptoms rose to level of diagnosis in approximately half the group. Future research will clarify associations among epilepsy variables and clinical presentations.