Abstracts

Rationale: Children with recent-onset epilepsy (<1 year) have significantly higher rates of depression, anxiety, and oppositional behaviors relative to healthy controls (Dunn et al. 1997; Jones et al. 2007). A subset of patients show increased prevalence of psychiatric comorbidity pre-dating seizure onset (Austin et al. 2001; Jones et al. 2007). Little is known about the relationships between psychiatric symptoms and specific aspects of seizure presentation, such as seizure type (generalized vs. focal), frequency (single vs. multiple seizures), and medication regimen (monotherapy vs. multiple medications). These relationships are explored in the context of a New-Onset Pediatric Epilepsy (NOPE) clinic.Methods: 51 NOPE clinic participants aged 3-18 years had a confirmed epilepsy diagnosis based on EEG; 76% of participants were seen within 8 weeks of initial diagnosis. As part of this multidisciplinary clinic that includes a standard clinic visit and neuropsychological testing, all participants underwent psychological interviews with a psychologist. Chi-square analyses (Fisher's exact tests for measures with cell frequencies <5) and odds ratios examined relationships between seizure variables at the initial NOPE visit (seizure type, frequency, and medication regimen) and the presence of anxiety, depression, or oppositional behaviors both at the initial NOPE visit and prior to seizure onset.Results: Many participants reported elevated psychiatric symptoms at the initial NOPE visit (depression symptoms: 20% of sample; anxiety symptoms: 47%; oppositional behaviors: 60%). 30% met diagnostic criteria for a DSM-V psychiatric disorder at the initial visit; another 16% received a rule-out psychiatric diagnosis. 18% met criteria for a psychiatric disorder prior to seizure onset. Psychological follow-up was recommended to 43%. Chi-square tests and odds ratios revealed that at the initial visit, participants with generalized epilepsy were 4.5 times more likely to endorse depression symptoms (p=0.03), 4 times more likely to endorse anxiety symptoms (p=0.03), and 5.3 times more likely to get referred for psychological follow-up (p=0.01) compared to participants with focal epilepsy. Depression symptoms prior to seizure onset were predictive of a generalized epilepsy diagnosis at the initial visit (p=0.00). Participants who endorsed oppositional behavior prior to seizure onset were 6 times more likely to require multiple medications (p=0.03) and 4.4 times more likely to have experienced more than one seizure (p=0.02) by the time of the initial visit. An anxiety diagnosis prior to seizure onset was predictive of requiring multiple medications for seizure management by the initial visit (p=0.01).Conclusions: These findings highlight the prevalence of psychiatric symptoms in a new-onset epilepsy population, and reveal significant relationships between seizure variables and psychiatric symptoms both prior to and after seizure onset. This study is ongoing; an additional 35-45 participants will be added to the current sample, with an N of nearly 100 by AES.