Abstracts

Rationale: Epidemiological studies indicate that psychiatric disturbance is present in up to 50% of children with epilepsy. There is a need for a review of the evidence for effective assessment and management of these psychiatric disorders. Methods: The Child Neuropsychiatry Taskforce of the Neuropsychobiology Commission of the International League against Epilepsy undertook a review of the epidemiology and management of the major psychiatric disturbances in children with epilepsy. Results: International epidemiological studies indicate that psychiatric disturbance is present in up to 50% of children with epilepsy. ADHD occurs in around 30% of children with epilepsy. Standard ADHD medication is effective in around 70% of children with both epilepsy and ADHD; it does not appear to be associated with any increase in seizures. A high proportion of children with epilepsy also have autism spectrum disorder, around 20%. A recent survey found anxiety in about 17% and depression in about 8% of children with current epilepsy. Psychosis in children with epilepsy is very rare but it is much more common in teenagers. It can be postictal, interictal or drug induced. Epilepsy syndromes associated with behavioural/psychiatric disturbance include West syndrome, Dravet syndrome, Lennox-Gastaut syndrome and juvenile myoclonic epilepsy. Subtle behavioural manifestations of epilepsy can result from frequent absence seizures, frequent localised epileptiform discharges, transitory cognitive impairment, transient epileptic amnesia and electrical status epilepticus of slow wave sleep. Recognition and prompt treatment is of major importance. Behavioural adverse effects can be associated with phenobarbital, valproate, gabapentin, topiramate, levetiracetam and zonisamide. Epilepsy surgery can result in psychiatric improvement or deterioration in individual children but there is little overall group effect. Treatment with psychotropic medication, including methylphenidate, dexamfetamine, atomoxetine, clonidine, selective serotonin reuptake inhibitors or low-dose risperidone can be beneficial and is unlikely to precipitate seizures. Conclusions: Meticulous assessment of the cause of psychiatric disturbance in each individual child with epilepsy, allows rational intervention to be implemented. This is successful in a large proportion of cases but there are many variables that affect outcome, including the nature of psychiatric disturbance, intellectual disability, the epilepsy syndrome, treatment with medication or surgery and other factors.