Abstracts

Rationale: The aim of this study is to evaluate the psychiatric status of pediatric epilepsy patients prior to consideration for epilepsy surgery. Patients with intractable seizures are believed to have a high degree of psychiatric comorbidity; however, few studies have been done with high subject numbers or sophisticated psychiatric assessment. The study aimed to characterize psychiatric illness in this population, and to ascertain whether specific seizure localization was associated with higher psychiatric comorbidity.Methods: A retrospective chart review was done in a tertiary care pediatric hospital where surgical procedures for the treatment of epilepsy are commonly performed. Each patient received a full evaluation by a child psychiatrist specializing in neuropsychiatric issues, and parents completed a Child Behavior Checklist (CBCL) prior to their surgical procedure. The CBCL is a well-validated 113 item questionnaire that generates t-scores for broad symptom categories as well as for eight specific categories of behavior problems. Examples of some CBCL subcategories include attention problems, social problems, anxious/depressed, withdrawn/depressed, thought, and somatic problems. Group comparisons were made based upon seizure localization and associated psychiatric diagnoses or CBCL subcategory t-scores of 65 or higher.Results: Full records were available for 43 pediatric patients(average age 10.8; 27 male, 16 female) who had undergone presurgical evaluation. 22 patients had seizure foci restricted to the temporal lobe (T), and 21 had seizure foci outside of the temporal lobe (EX-T). Both groups had a high amount of comorbid psychiatric illness. The most common comorbidities were ADHD (8 T vs. 8 EX-T), Anxiety (7 T vs. 6 EX-T), and depression (7 T vs. 1 EX-T). Depression was more common in patients with temporal lobe seizure foci(p=0.046). Elevated CBCL subcategory scores were high in both groups, although consistently higher in patients with temporal lobe seizure foci. Two or more CBCL categories were elevated at a t-score of 70+ in 10 T vs. 2 EX-T (p=0.016). Two or more CBCL categories were elevated at a t-score of 65+ in 16 T vs. 5 EX-T (p=0.002). The most commonly elevated CBCL subcategories were attention problems (9 T vs. 5 EX-T), and social problems (8 T vs. 5 EX-T). Depression-specific CBCL categories (anxious, withdrawn) were higher in patients with temporal lobe seizure foci (p=0.045).Conclusions: Pediatric epilepsy patients are known to have a high degree of psychiatric comorbidity, and based on this study, comorbidity is very common in patients with intractable seizures. The CBCL scores indicated significantly higher and more severe behavior problems in patients with temporal lobe seizure foci. Psychiatric diagnoses of Anxiety and ADHD were present in both groups equally; however, depression was significantly more common in the temporal lobe group. Overall, psychiatric illness, especially depression, may be more common in pediatric patients with temporal lobe seizure foci. Future studies that include prospective observation and long-term follow-up will help to confirm these findings.