Abstracts

Rationale: To identify and compare the prevalence and neurobiological and familial risk factors of self- and parent-reported anxiety and depression in children with epilepsy. Methods: Mayo Clinic patients ages 6-17 years with active epilepsy defined as taking an antiepileptic drug or having recurrent seizures in the past three months were recruited. Children with known neurodegenerative disorder, significant co-morbid medical disease, or significant cognitive delay (IQ<70) were excluded. Parents completed a demographic questionnaire, Family Assessment Measure III (FAM-III), Child Symptom Inventory (CSI) for ages 6-12, and Adolescent Symptom Inventory (ASI) for ages 13-18. Children completed the Child Depression Inventory (CDI) and the Revised Children’s Manifest Anxiety Scale (RCMAS). Seizure variables were obtained via chart review. Results: Forty six patients (mean age 11.3±3.1 yrs, 52% male, seizure onset 8±4 years) were included. Family history of anxiety or depression was present in 30% to 35% of first degree relatives respectively, and 39% to 59% of second degree relatives respectively. Sixty one percent of children required extra help at school but only 3 (6.5%) had borderline cognition. Epilepsy syndromes included 59% symptomatic partial, 28% idiopathic generalized, 11% idiopathic partial, and 2% symptomatic generalized. Patients were on a total of 1.4±0.8 (0-4) current AEDs. Depression prevalence was 9% based on self-report and 39% (11% moderate, 28% severe) based on parent report, with high correlation between each other (p<0.01). Parent-reported severe depression was more common in teens than younger children (55.5% vs 10.2%). Older age at seizure onset correlated with parent-reported depression (p<0.003), while low family function tended to correlate with child-reported depression (p=0.06). No correlation was noted between other neurobiological or familial factors and the incidence of depression. Anxiety prevalence was 11% based on self-report and 35% (22% moderate, 13% severe) based on parent report. Parent and child reported anxiety had high correlation (p<0.01). The only factor predictive of anxiety on parent-report was a second degree relative with anxiety (p<0.02). No correlation was noted between other neurobiological or familial factors and prevalence of anxiety on either child or parent report. History of a diagnosis of depression or anxiety and their treatment was much lower in our population (6.5% depression, 8.7% anxiety, and 6.5% in current treatment). Conclusions: Children with epilepsy have an increased incidence of depression and anxiety. However, self-reported prevalence of both depression and anxiety are much lower than the parent reported prevalence, with the biggest discrepancy observed in teens. This could explain the low prevalence of the diagnosis and treatment interventions. Most neurobiological, social or familial factors did not correlate with higher depression or anxiety risk.