Abstracts

Rationale: Mood disorders are the most frequent psychiatric co-morbidities in epilepsy. There is robust evidence that mood disorders and epilepsy have a complex bidirectional relationship. Patients with epilepsy are at greater risk of developing depression, and patients with depression have a higher risk of developing epilepsy. Such relationship can only be explained by the existence of common pathogenic mechanisms that are operant in both conditions. Depression is described as an important co-morbidity in temporal lobe epilepsy (TLE). The rationale for the present study is: i. to evaluate the presence and characteristics of depressive symptoms in children with TLE; ii. to determine severity by using a quantitative measure - Children Depression Rating Scale and iii. to establish global function impairments in these children. Methods: Thirty-one children and adolescents (mean age 11.6± 2.7) with TLE diagnosed by neurophysiologic and neuroimaging studies. Exclusion criteria were: presence of other chronic medical illnesses; previous epilepsy surgery; history of substance and/or alcohol abuse or dependence; pervasive developmental disorder; schizophrenia; severe psychotic disorder; and moderate to severe mental retardation. All children were assessed by “Schedule for Affective Disorders and Schizophrenia for School Aged-Children and Adolescents"- K-SADS-PL for axis I DSM-IV diagnosis. Severity of depressive symptomatology was measured by Children Depression Rating Scale - Revised - CDRS-R. Global functional impairment was assessed with the Child Global Assessment Scale - CGAS. Results: Thirty-one patients were interviewed. Twenty-five patients (80.6%) (11.6 ± 2.27) had current depressive symptoms (DS). Twenty-two (88%) presented DS during interictal periods and three (12%) had only perictal DS. From those with interictal DS, 16 (63.6%) reported worsening of DS in the perictal period. DS were considered mild in 16%, moderate in 44% and severe in 40%, according to CDRS-R T Score. There was no difference in severity of DS comparing age (p=0,377) and gender groups (p=0,132). CAWTLE had important functional impairments measured by CGAS (MD 48.7± SD 8.8) and adolescents were more impaired when compared to children, independent of the severity of DS (p=0,035). There was no correlation between severity of DS and seizure control (p=0.936), age of onset (p=0.731) and duration of epilepsy (p=0.602). There was no difference between severity of DS when comparing those with and without hippocampal sclerosis (p=0.614). Impairment of global functioning was not associated to epilepsy variables (p>0.05). Conclusions: Our findings suggest that most children and adolescents with TLE have moderate to severe depressive symptoms with a relevant impact on their global functional activities. Epilepsy severity seems not to be correlated to the severity of depressive symptoms, contradicting the idea of a cause-consequence relationship. However, more systematic research is needed to better understand the association between depressive disorders and TLE in children and adolescents.