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Psychiatric comorbidities common in newly diagnosed pediatric epilepsy cases

By: Doug Brunk

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01/23/17

HOUSTON – About one in three children diagnosed with new-onset epilepsy presents with psychiatric diagnoses at the onset, results from a single-center study showed.

 

The finding “tells us that when kids are coming in, even if they’re only having psychiatric symptoms at their onset of epilepsy, they should be referred for some treatment to help them possibly mitigate the development of these psychiatric diagnoses in the first year,” lead study author Julia Doss, PsyD, said in an interview at annual meeting of the American Epilepsy Society.

 

About 3 years ago, Minnesota Epilepsy Group, P.A., a private practice group that consults with United Hospital and Children’s Hospitals and Clinics of Minnesota, launched a New Onset Pediatric Epilepsy (NOPE) clinic. There, referred patients undergo a psychological evaluation, neuropsychological testing, and medical evaluation in the same day. Psychological assessment measures include the Clinical Interview (parent and patient), the Strengths and Difficulties Questionnaire (SDQ), and the Revised Children’s Anxiety and Depression Scale (RCADS). Dr. Doss presented results from 96 patients who presented for their first NOPE clinic visit within 8 weeks of their epilepsy diagnosis. More than half (50) were male and they ranged in age from 3 to 18 years.

Dr. Doss, a clinical psychologist with Minnesota Epilepsy Group, and her associates divided the children into three groups: age 3-6 (group 1), age 7-11 (group 2), and age 12-18 (group 3). Based on the Clinical Interview, none of the patients in group 1 screened positive for depression or anxiety, but 16% met criteria for some other behavioral disorder. However, among patients in group 2, the percentage who met criteria for depression, anxiety, and other behavioral disorders was 13%, 25%, and 13%, respectively. The corresponding percentages for patients in group 3 were 29%, 38%, and 10%.

Of the 96 patients evaluated in the clinic, 64 parents completed all of the questions on the SDQ. The researchers observed significant correlations between parent response and diagnoses assigned on the Clinical Interview for behavior diagnoses (P = .002) and anxiety diagnoses (P = .009) but not for depression diagnoses. “Despite the correlations on both behavior and anxiety responses and clinical diagnoses assigned, parents still only reported significant concerns in about half of the children that were given diagnoses,” Dr. Doss and her associates wrote in their abstract.

The comparison of RCADS scores between parent and child demonstrated moderate to strong correlation with each other on the following scales: separation anxiety, generalized anxiety, obsessive/compulsive, and depression.

Dr. Doss cited the study’s small sample size as a key limitation. “Early evaluation or at least screening is necessary in all of our kids who present with an epilepsy diagnosis, because more than 30% develop psychiatric disorders within the first year of their diagnosis,” she concluded. “That’s one in three, so if we can start to better evaluate that early and get them funneled into treatment early, we might be able to prevent some of these problems from becoming lifelong issues.”

She reported having no financial disclosures.

dbrunk@frontlinemedcom.com


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