Abstracts

Rationale: When a patient is newly prescribed an anti-epileptic drug (AED) and subsequently reports AED behavioral side effects, epilepsy providers often struggle differentiating AED behavioral side effects from pre-morbid behavioral problems existing prior to AED initiation. Particularly when the AED provides seizures control, a clear distinction is warranted so that AED changes can be minimized. Although understudied, some studies suggest that AED behavioral side effects may differ in presentation by the child's age (i.e., aggression in younger children along with depressed mood in adolescents). The aim of this study was to assess, by age, the impact of pre-morbid behavioral health symptoms prior to AED initiation on parent-reported AED behavioral side effects one month following AED treatment for new-onset epilepsy. We hypothesized that hyperactivity and aggression would significantly predict AED behavioral side effects in preschool and school-aged children; whereas, depression and anxiety, along with hyperactivity and aggression, would significantly predict AED behavioral side effects for adolescents one month following AED initiation. Methods: A total of 284 children and adolescents newly diagnosed with epilepsy (Mage=9.24.3 years; 83.4% Caucasian; 34.8% localization-related epilepsy, 41.1% generalized epilepsy, 23.7% unclassified epilepsy) were included. Chart reviews extracted sociodemographic and medical data, along with scores from the Behavioral Assessment Scale for Children-2nd Edition: Parent Rating Scale completed at epilepsy diagnosis clinic visit and the Pediatric Side Effects Questionnaire completed by parents at the one-month follow-up clinic visit. Pre-school and school-aged children (i.e., 2-11 years) were examined separately from adolescents (i.e., 12-18 years) by conducting two parallel hierarchical linear regression analyses, controlling for sex and AED. Results: For both cohorts, increased elevations in hyperactivity prior to AED initiation significantly predicted higher AED behavioral side effects one month after AED initiation. Table 1 outlines regression results for pre-school and school-aged children (n = 189) and highlights the model accounted for 7% of the variance in AED behavioral side effects. Hyperactivity was a significant predictor beyond sex, AED and aggression. Table 2 outlines results for adolescents (n = 95) and highlights that 13% of variance was accounted for in the model. Hyperactivity was a significant predictor beyond sex, AED, aggression, depression and anxiety. Conclusions: Proactive assessment of premorbid behavioral health functioning prior to AED initiation, in particular hyperactivity, may assist epilepsy providers in differentiating pre-existing behavioral difficulties from reported AED behavioral side effects following AED initiation. If the AED is providing seizure control, pediatric psychologists can assist in addressing pre-existing behavioral health difficulties, even if these symptoms have been exacerbated by an AED behavioral side effect if the side effect is considered tolerable by the patient and family. Funding: N/A