May 24, 2013
Washington, DC – A new study led by Jay Salpekar, MD
, Director, Neurobehavior Program
at Children’s National Medical Center, determined that children and adolescents with seizures involving the temporal lobe are likely to have clinically significant behavioral problems and psychiatric illness, especially depression. Findings published in Epilepsia
, a journal of the International League Against Epilepsy (ILAE
), highlight the importance of routine psychiatric evaluation for pediatric epilepsy patients—particularly for those who do not respond to anti-seizure medications and who may be candidates for epilepsy surgery.
Current medical evidence indicates that mental illness occurs in up to 40% of pediatric epilepsy patients, with depression, anxiety, attention issues, and learning difficulties being the most common conditions in children. This pediatric study fills a gap in epilepsy research, as most research considering the link between epilepsy and co-morbid psychiatric illness has focused on adult patients.
“Our research examined whether psychiatric illness was more prominent in children who were unresponsive to anti-seizure medications and had seizures in the temporal lobe versus elsewhere in the brain,” explains Dr. Salpekar. “In children who do not respond to drug therapy, epilepsy surgery may be the only option to improve their quality of life. Understanding the post-surgery pediatric patients’ mental health status is important, as the severity of psychiatric illness may impact the overall risk-benefit of epilepsy surgery, and may also inform post-surgery behavioral care management.”
Researchers reviewed case records of 40 children between the ages of 6 and 17, who did not respond to anti-seizure medications. Patients were given pre-surgical psychiatric evaluations, and their parents completed the Child Behavioral Checklist (CBCL). The seizure location and suitability for surgical procedures were confirmed by epilepsy specialists.
The investigators found that this specific pediatric patient group (patients with seizures in the temporal lobe vs. extratemporal areas) – had psychiatric and behavioral problems well beyond what is typically reported in children with chronic epilepsy. Nearly 80% of participants had significant psychiatric symptoms—far greater than the 20-40 percent prevalence of mental illness found in chronic pediatric epilepsy. Furthermore, children with seizures suspected to be localized in the temporal lobe were more likely to have depression symptoms and more significant behavioral issues reported by parents compared to children with seizures in other brain regions.
“Given that psychiatric illness, particularly depression, is so prominent in those with temporal lobe seizures, routine psychiatric evaluation appears to be important for children and adolescents prior to epilepsy surgery. We know this is true in adults, but we now know this is also true for pediatric patients. In fact, it may be beneficial for most patients with medically refractory epilepsy to have a psychiatric assessment, regardless of seizure localization to improve quality of life. Future studies are needed to investigate the variables associated with mental illness outcomes in patients following epilepsy surgery.
“With intractable epilepsy, parents and patients have complex decisions to make, not only in considering surgery but also in considering mental health complications of epilepsy. This study adds to our understanding and will help us support families in providing comprehensive care for their child.
Emily Hartman or Paula Darte, 202-476-4500
For Wiley, publishers of Epilepsia: Dawn Peters (US) +1 781-388-8408
Ben Norman (UK) +44 (0) 1243 770375
Children's National Medical Center
Children’s National Medical Center in Washington, DC, has been serving the nation’s children since 1870. Home to Children’s Research Institute and the Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National is consistently ranked among the top pediatric hospitals by U.S.News & World Report and the Leapfrog Group. Children’s National is a Magnet® designated hospital. With 303 beds and eight regional outpatient centers, Children’s National is the only exclusive provider of acute pediatric services in the Washington metropolitan area. For more information, visit ChildrensNational.org, or follow us on Facebook and Twitter.
About the Journal
Epilepsia is the leading, most authoritative source for current clinical and research results on all aspects of epilepsy. As the journal of the International League Against Epilepsy, subscribers every month will review scientific evidence and clinical methodology in: clinical neurology, neurophysiology, molecular biology, neuroimaging, neurochemistry, neurosurgery, pharmacology, neuroepidemiology, and therapeutic trials. For more information, please visit http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1528-1167.
About the Society
The International League Against Epilepsy (ILAE) is the world’s preeminent association of physicians and health professionals working toward a world where no person’s life is limited by epilepsy. Since 1909 the ILAE has provided educational and research resources that are essential in understanding, diagnosing and treating persons with epilepsy. The ILAE supports health professionals, patients, and their care providers, governments, and the general public worldwide by advancing knowledge of epilepsy. To learn more, visit http://www.ilae.org/.