Abstracts

Rationale: The increased prevalence of emotional and behavioral disturbance in children with epilepsy is well established through several studies, including a few large epidemiological studies. While studies have examined psychiatric comorbidities after epilepsy onset , few pediatric studies examined psychological functioning prior to epilepsy onset, at onset and at one-year post diagnosis. Furthermore, the relationships among seizure type, severity of seizures and onset/early course of psychiatric symptoms remains largely unknown. The current study describes symptoms at diagnosis of epilepsy and one-year post diagnosis, in the New Onset Pediatric Epilepsy Clinic (NOPE).Methods: Pediatric patients presented to NOPE clinic within 8 weeks of epilepsy diagnosis. 69 patients aged 3-16 (33 female, 36 male) have presented for initial NOPE evaluation (T1), and 18 have presented for 1 year follow-up (T2). As part of this multidisciplinary assessment, participants have a psychological evaluation, neuropsychological testing and medical evaluation. Descriptive statistics were employed to analyze frequency of psychiatric symptoms prior to seizure onset, at epilepsy diagnosis and one-year post diagnosis. An analysis of individual patient outcomes was completed to provide insight about psychological functioning at these data points and to develop a risk factor profile for those who were initially flagged as ""at risk"" for worsening psychological functioning.Results: Of the 69 patients, the following psychiatric diagnoses were noted at T1: depression (11%), anxiety (15%) and behavior disorders (13%). Those with psychiatric symptoms that did not reach level of clinical impairment for diagnosis (78%) were considered to be ""at risk"" for worsening psychological difficulties. At T2, the majority of patients met criteria for a psychiatric diagnosis (61%): depression (11%), anxiety (33%) and behavior disorders (44%). At T1, 39% of the patients were identified ""at risk"" (7/18), and 85% (6/7) of those patients went on to have diagnoses by T2. 1 identified as ""no risk"" at T1 went on to have a diagnosis at T2, and 3 patients carried a diagnosis from T1 to T2. Patients recommended psychotherapy at T1 all had attended some psychotherapy by T2, (5/5) and 1 patient not recommended therapy attended. Patients with psychiatric diagnoses were evenly distributed amongst focal and generalized epilepsies . Psychiatric Diagnoses were also evenly distributed amongst no seizures in the first year and multiple seizures.Conclusions: Consistent with literature from prior studies, pediatric patients with new onset epilepsy have a number of psychiatric symptoms and are at risk for worsening symptoms early in the course of their epilepsy. The majority of those patients identified as ""at risk"" at the onset of their epilepsy went on to experience impairment in functioning by their second evaluation, one-year after initial diagnosis, demonstrating both the need for evaluation at onset and the importance of exploring preventative psychological intervention with the at risk population, even within the first year.