Abstracts

Rationale: Peri-ictal depression is frequently neglected in children with epilepsy. Postictal depressive episodes (PDE) are described as a transient but disabling depression and, although PDE shares the same symptoms observed in Major Depressive Disorder (MDD), the duration of symptomatology in PDE differs from MDD because in general it lasts less than two weeks, the period for the diagnosis according to DSM-IV-TR criteria. This descriptive cross-sectional study aimed to evaluate the presence and characteristics of peri-ictal depressive symptoms (DS) in children and adolescents with TLE. Methods: After consent and assent were obtained, parents were interviewed about their children. Children and adolescents were directly interviewed for a clinical diagnosis and classified according to DSM-IV TR criteria by a child and adolescent psychiatrist. Patients were scheduled for a second interview with KSADS-PL no more than 6 weeks later. During the peri-ictal period, depression was assessed by clinical interview and severity by CDRS-R with parents and patients. Preictal and postictal intervals were respectively defined as the seventy-two hours before and after the seizure. Results: In the preictal period, 11 (44%) patients had behavioral complaints highly suggestive of DS, such as irritability, psychomotor agitation and listlessness. In these patients, it was impossible to obtain a categorical classification of these symptoms. Three (12%) patients had DS only in the postictal period. In the postictal period, these episodes lasted from 48 hours (two patients) to 10 days (one patient). Considering patients who presented DS only in the post-ictal period, there was no difference in DS severity between the postictal and interictal DS groups (p=0.737). Twenty-two (92%) patients had interictal DS, out of which 14 (63.6%) patients had an aggravation in DS severity during the postictal period. Postictal DS required clinical treatment of depressive symptoms and seizure control. Conclusions: In this series, children with TLE presented DS in the postictal period, that was severe enough to determine important function impairment as seen in interictal DS. As to pre-ictal DS, most parents reported vague behavioral complaints, highly suggestive of DS but that could not be characterized as a pre-ictal depressive episode. In our opinion, parents are more alert to their children’s behavioral changes after the occurrence of seizures, when they are prone to observe with more care. Further research is needed, especially when considering the close relationship between interictal and peri-ictal DS and suicidal risk associated to postictal DS.