Abstracts

Recent studies have demonstrated a high prevalence of psychiatric disorders (PD) in children and adolescents with epilepsy. Due to particularities of epilepsy in this age group, especially as to disease duration, it is of interest that this group be studied separately. Most studies with children approach heterogeneous groups with focal and generalized epilepsy, both symptomatic and idiopathic. We aimed to evaluate the frequency and type of PD that occurs in children and adolescents with temporal lobe epilepsy (TLE) and to analyze possible predictive factors, concerning the epilepsy, for the occurrence of PD in these patients., A multidisciplinary team evaluated patients taking part in this study. Psychiatric interviews were carried out with KIDDIE-SADS and patients were classified according to DSM IV and CID 10. Twenty-six children and adolescents with mean age of 12 years were studied. Mean age of epilepsy onset was 3.6 years (SD 3.2) and mean duration of 8.6 years (SD 4.5). As to etiology, nineteen patients had mesial temporal sclerosis (MTS) and seven, lateral temporal epilepsy (LTE). Fourteen patients were on polytherapy and fourteen were considered refractory to clinical treatment., From 26 patients with TLE, 22 (84.6%) presented PD, of which 10, more than one. The diagnosed PD were: affective disorders in 13 patients (59%), behavioral disorders in 6 (27.3%); hyperkinetic disorder, mental deficiency and dissociative disorder in 4 (18.2%); and oppositional defiant disorder and bipolar disorder in 1 patient (4.5%). Of the 13 patients with affective disorders, depressive disorder was diagnosed in 9 patients (mild in 4 and moderate to severe in 5) and anxiety disorder in 4 patients. Nine families (40.9%) reported history of PD preceding the onset of epileptic seizures. Mean age of epilepsy onset in patients with PD was 3.5 years, and in those without PD of 4.3 years. As to duration of epilepsy, patients with PD had a longer duration (8.5 years) when compared to patients without PD (7.5 years). As to etiology, out of 19 patients with mesial structure lesions, 19 (100%) presented PD, and out of seven patients with lateral lesions, three (42.9%) presented PD, a statistically significant difference. Family history for PD was reported in 13 out of 22 patients (59%)., The study of children with epilepsy enables us to study in an unusual manner the relationship between epilepsy and PD, without interference of important variables observed in adult series such as prolonged disease duration. In this series the prevalence of PD in children with TLE was as high as that observed in adults, mainly affective disorders. Patients with PD present an earlier age-onset of epilepsy and longer duration, although these differences were not significant. In this study presence of MTS was the most relevant predictive factor for PD., (Supported by FAPESP.)