Abstracts

Rationale: Comorbid conditions such as cognitive impairment, developmental delay, and neuropsychiatric problems are common in children and adolescents with epilepsy and can be more disabling than the seizures themselves. Although screening for such co-morbidities is recommended in the primary care setting, it is often not routinely performed. We examined the yield of screening overall and for previously unidentified problems in a tertiary epilepsy population, a group anticipated to be at high risk. Methods: Parents completed screeners of development : Ages/Stages Questionnaire (ASQ, birth to 66 months), autism :Modified Checklist for Autism in Toddlers (M-CHAT, 16 to 30 months), Social Communication Questionnaire (SCQ, 4 years and up), behavioral and psychiatric concerns : Strength and Difficulties Questionnaire (SDQ, 4 17 years). Children received specific screeners as appropriate for age.Results: A total of 236 children and adolescents (average age = 6.6 y; 134(58%) boys) participated. 178 (75%) were established epilepsy patients, and 58 (25%) were new patients. Only 29/58 (50%) of new-onset patients were identified as having epilepsy. Other factors were found in the remaining 29. For development, 82/100 (82%) children screened positive on ASQ, 34/69 (49%) scored positive for autism on M-CHAT and 26/139 (19%) on SCQ. For behavioral and psychiatric concerns, 56/96 (58%) patients screened positive on the SDQ. Of new-onset patients, 16/25 (64%) screened positive for development delay on ASQ; 2/16 (13%) on M-CHAT, and 0/31 on SCQ for autism screening. 9/23 (39%) on SDQ were identified as positive. Of new-onset patients with epilepsy 5/9 (56%) screened positive on the ASQ; 1/7 (14%) on the M-CHAT, and 6/16 (38%) on the SDQ for behavior and psychiatric screening. Positive findings were new and required further assessment ( actionable ) in 46/236 (20%), including 34/178 (19%) in established and 14/58 (24%) in new-onset patients, 10/29 (35%) with epilepsy and 4/29 without. Referrals as a result of screening were made to psychiatry/social work (N=19), educational specialist/school services (N=16), neuropsychological testing (N=6), pediatrician/neurologist (N=5). Multiple referrals were made for some children. So far 28/46 have followed through on referral recommendationsConclusions: Despite screening recommendations for all children, many children with epilepsy, a high risk group for developmental, behavioral, and psychiatric problems, have not been adequately evaluated. We found a substantial proportion with co-morbidities who have not been previously identified or evaluated and children needed further evaluation. Even in established patients, we found almost one in five required further evaluation. Increased awareness and early diagnosis of comorbid condition through proactive screening in children and adolescents with epilepsy may affect therapeutic intervention and long-term outcome.