Abstracts

Rationale: Children with epilepsy have an increased risk for behavioural problems, usually attributed to clinical factors including high seizure frequency, anti-epileptic drugs (AEDs) and seizure type. 25% of children with epilepsy can have pre-existing behavioural problems when their epilepsy is diagnosed suggesting that there may be other factors that independently increase risk for epilepsy and behavioural problems. This study aims to test the hypothesis that socioeconomic deprivation in children with epilepsy increases risk for behavioural problems. Methods: All parents of children attending epilepsy clinic at a tertiary children s hospital, the Royal Hospital for Sick Children, Edinburgh (RHSC) over two periods (30/10/11 15/12/11 and 6/11/12 11/12/12) were asked to complete a Child Behaviour Checklist (CBCL) questionnaire about their child. The CBCL is a validated tool for identification of behavioural and psychiatric disorders. Scores >63 are indicative of significant behavioural problems. Medical and sociodemographic data on patients were obtained through their paediatric neurologists. Postal code of residence was used to obtain quintiles of Scottish Index of Multiple Deprivation 2012 (SIMD2012) scores for individuals. Lower SIMD quintiles correspond to higher socioeconomic deprivation. Regression analysis was used to investigate whether lower SIMD2012 score was an independent risk factor of CBCL scores > 63. Results: Parents of 87 children (42 male, mean age 10.5 years, range 2-17 years) were enrolled. Mean total CBCL score was 60.4, which was significantly higher than the average American population (p<0.001). 41% had total scores >63. Compared to Children with SIMD quintiles 4-5, those with SIMD quintiles 1-3 had a higher proportion of externalising (49% vs 25%, p=0.021) and total (54% vs 30%, p=0.023) scores >63. SIMD quintiles 1-3 compared to 4-5 was independently associated (OR 2.9,95% CI=1.1,7.8) with behavioural scores >63 (p=0.02) after adjusting for seizure frequency, number of antiepileptic drugs and seizure type. The strongest associations were in the SIMD domains of income deprivation (OR 2.9,95% CI=1.2,7.0) and health (OR 3.1,95% CI=1.3,7.4). On subgroup analysis, fewer children with behavioural problems and SIMD quintiles 1-3 (6/23, 26%) were known to child and adolescent mental health service (CAMHS) than those in quintiles 4-5 (8/13, 62%) (p=0.01)Conclusions: Children with epilepsy have more behavioural problems than the general population. A high proportion of children with epilepsy have significant behavioural problems. Socioeconomic deprivation is an independent risk factor. Children who live in more socioeconomically deprived areas and have behavioural problems are less frequently referred to CAMHS compared to those from better areas.