Abstracts

Rationale: Previous research demonstrated high rates of psychopathology in NES youth, but related epilepsy, medical illness, and trauma risk factors have not been systematically studied. This study examined the specificity of psychiatric, epilepsy, medical, and trauma variables and the age of their occurrence in NES youth by comparing to their siblings. Methods: This multisite study included 48 NES youth and 33 siblings, aged 8-18 years. A video EEG confirmed an NES diagnosis. A demographic questionnaire on the child's medical/epilepsy, psychiatric, family, and educational history was completed by parents. Each child and parent underwent a structured psychiatric interview about the child that yielded DSM-IV diagnoses and information on traumatic experiences. Each child had standardized cognitive, language, and achievement testing. Probands and siblings were compared using a mixed model with family as a random effect for continuous variables. T-tests and chi-square analyses (Fisher's exact tests for measures with cell frequencies <5) examined between group differences in the distribution of continuous and categorical variables (deficit groups, psychiatric diagnosis, epilepsy), respectively. Results: NES youth were older than siblings (14.9 years (SD 2.6) vs. 13.6 years (SD 2.3). DSM-IV diagnoses were more prevalent in probands (100%) than siblings (81.8%) (p=.002) with significantly higher rates of Conversion (p <.0001), Anxiety (p<.0001), Depression (p=.007), PTSD (p=.02), Bipolar (p=.03), and Tic (p=.03) disorders. Compared to siblings, significantly more probands had multiple psychiatric diagnoses (p<.0001), experienced crime/violence (p=.04) and sexual abuse (p=.05). Within the NES group, those with epilepsy as compared to those without epilepsy had a greater number of psychiatric diagnoses (p =.05), learning disorder (p=.04), and past traumatic experiences (p=.04). No differences were found between these two groups on child's age, age of NES onset, cognitive or achievement scores, age of first psychiatric diagnosis, or presence of other types of psychiatric diagnosis. Significantly more NES probands than siblings had epilepsy (72.9% vs. 0%, p<.0001); additional central nervous system illnesses (p< .0001), general medical problems (p=.02); and were taking medications (p=.0009). Probands also had significantly more life time emergency room (ER) visits (p<.0001) and hospitalizations (p<.0001) compared to siblings; the number of NES ER visits was negatively correlated with the age of NES onset (p=.0005). Although probands missed significantly more days of school (p=.0005), there was no significant difference in the rates of special education. Conclusions: This is the first study to identify risk factors for pediatric NES in a large sample of NES youth compared and control subjects. Our findings reflect a biopsychosocial model of psychopathology and show that multiple psychiatric diagnoses, increased past and present use of intensive medical services, epilepsy and other CNS disorders, violent trauma, and missed school days are risk factors for pediatric NES.