Abstracts

Rationale: Children with chronic epilepsy have high rates of emotional and behavioral problems compared to healthy peers or children with other medical conditions, but the natural history of these disorders is unknown. In order to characterize psychiatric comorbidity over 2 years, a standardized psychiatric interview was administered at baseline and follow-up. We hypothesized that children with recent-onset epilepsy would have higher rates of any Axis 1 disorders than controls, with high rates of depression, anxiety and ADHD. Methods: Participants were 171 youth aged 8-18 years (mean age=11.8), 98 children with epilepsy (CWE) and 73 controls. Inclusion criteria for CWE were: diagnosis of epilepsy in past 12 months, no developmental disabilities or neurological disorders, normal neurological examinations and clinical imaging. A pediatric neurologist confirmed that participants had focal or generalized epilepsy. Controls were first-degree cousins of children with epilepsy with no history of seizures, early initial precipitating injuries, developmental or neurological diseases, or loss of consciousness >5 minutes. At baseline and 2 years, participants and parents underwent separate standardized psychiatric interviews to characterize DSM-IV diagnoses using the Schedule for Affective Disorders and Schizophrenia (KSADS) to identify current and lifetime psychiatric disorders. Data were analyzed using Pearson Chi-Square. Results: At baseline, more CWE had an Axis I disorder (n= 60, 61.2%) compared to controls (n=17, 23.3%), (p<0.001). At 2-year follow-up, CWE continued to meet criteria for an Axis I disorder (n=50, 51.0%) at a higher rate than controls (n=15, 20.5%), (p<0.001). At baseline, children with epilepsy were more likely than controls to meet criteria for depression (n=16, 16.3% vs. n=2, 2.7%), anxiety (n=34, 34.7% vs. n=11, 15.1%) and ADHD (n=24, 24.5% vs. n=5, 6.8%). For all three disorders at baseline, differences between the two groups were significant at p =0.01. At 2-year follow-up in CWE compared to controls, depression (n = 8, 8.2% vs. n=2, 2.7%) Anxiety (n=32, 32.7% vs. n=7, 9.6%), and ADHD (n=18, 18.4% vs. n=3, 4.1%) remained elevated. At 2-year follow-up only Anxiety and ADHD were significantly different between the groups (p<0.001; p = 0.005). Children with focal seizures have significantly higher rates of Axis I disorders (66.7% vs. 36.4%), anxiety disorders (44.0% vs. 18.2%) and ADHD (25.9% vs. 9.1%) compared to children with generalized seizures. Conclusions: This is the first prospective evaluation of psychiatric comorbidity using independent structured psychiatric interviews of the parent and child over a 2-year interval in children with recent-onset epilepsy. Compared to controls, children with epilepsy have higher rates of Axis I disorders at baseline and 2-year follow-up which remained stable over time. At baseline, depression, anxiety and ADHD are more prevalent in children with epilepsy compared to controls. Children with focal seizures were significantly more likely to have a psychiatric disorder compared to those with generalized seizures.