Abstracts

Among children with recent onset idiopathic epilepsies (age 8-18), a subset have been found to exhibit learning and education problems prior to the first recognized seizure. These children exhibit greater abnormalities in neuropsychological status as well as left hemisphere MRI volumetrics compared to children with recent onset epilepsy without problematic educational histories and healthy controls. These findings are consistent with the hypothesis that a subset of children with new onset epilepsy sustained an antecedent neurobiolgical insult affecting brain function and structure. The degree to which comorbid mental health problems may also be overrepresented in this at risk cohort remains to be determined and represents the focus of this investigation., Subjects were children age 8-18 with recent onset (diagnosed within the past 12 months) epilepsy of idiopathic etiology (n=51). Participants and their parents underwent a standardized psychiatric interview to characterize DSM-IV diagnoses (K-SADS). Structured interview identified 35 children with no history of academic problems (AP-) and 16 children with prior (pre-epilepsy onset) academic problems (AP+) that included either special education, special assistance in reading and math, mandatory summer school, tutors, or grade retention., AP+ children exhibited significantly elevated rates of lifetime-to-date Axis I disorders of any type compared to AP- children (93.8% vs. 60.0%, p[lt].01). There were higher rates of externalizing disorders (62.5% vs. 11.4%, p[lt].001), including ADHD (26.4% vs. 10%) and conduct disorders (12.5% vs. 0.0%, p[lt].05). A majority of the AP+ children (62.5%) exhibited psychiatric comorbidity prior to the first recognized seizure. Internalizing disorders (depression, anxiety) were not overrepresented in AD+ children., Children with academic problems (AP+) antedating epilepsy onset also exhibit an increased rate of psychiatric comorbidity, especially externalizing disorders which includes ADHD and conduct disorders. This emerging pattern of pre-epilepsy onset learning and psychiatric disorders as well as MR volumetric abnormalities is consistent with a presumed antecedent neurobiological insult independent of seizures, epilepsy syndrome, and medication treatment. Evidence of early learning problems and psychiatric comorbidity needs to be integrated in models of the development and course of epilepsy in children and adolescents., (Supported by NIH NS R0144351, M01RR03186 (GCRC), and F32 MH649882.)