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Childhood epilepsy tied to psychiatric problems.

Boston -- An increased incidence of psychiatric and developmental comorbidities in children with a common form of childhood epilepsy might support the hypothesis that the benign epilepsies of childhood and epilepsy syndromes exist on a continuum, according to a retrospective study of EEGs.

In the study, children with benign focal epilepsy with centro-temporal spikes (BECTS)--the most common childhood epilepsy syndrome--had a higher incidence of psychiatric illnesses, attention-deficit/hyperactivity disorder (ADHD), and developmental delay than estimates from the general population, Dr. Shalaka Indulkar reported in a poster presentation at the annual meeting of the American Epilepsy Society.

The results of the study demonstrate the importance of screening children with benign focal epilepsy for psychological and other cognitive problems, Dr. Indulkar stressed. "Unfortunately, pediatric patients are not sufficiently screened for these problems; the nocturnal seizures are often missed, unless the child generalizes; and most institutions lack a good neuropsychiatry division to assess for learning difficulties. Subtle learning difficulties often go undetected."

The investigators reviewed consecutive routine EEGs from 1995 through 2004 for pediatric patients with benign focal epileptiform discharges and identified 117 whose seizures were consistent with BECTS. These features included typical brief hemifacial seizures associated with speech arrest, drooling, and preservation of consciousness or gurgling or grunting noises with loss of consciousness and terminating in vomiting; or with nocturnal secondarily generalized seizures. They collected data on general demographics and neurologic, behavioral, and psychiatric disorders and used descriptive data and the Fisher's exact test for analysis.

Of the 117 patients included in the final analysis, 51 were girls and 66 were boys, and the mean age at initial diagnosis of EEG abnormality was 6.8 years (6.2 years in girls and 7.0 years in boys), said Dr. Indulkar, a neurology resident at the Cleveland Clinic.

The prevalence of co-existing psychiatric problems, including anxiety, schizophrenia, obsessive compulsive disorder, and depression in the study population was 9.4%, she reported, noting that this rate is substantially higher than the estimated 1%-4% seen in the general pediatric population, she said.

ADHD was observed in 11% of the seizure population, compared with an estimated prevalence rate of 3%-7% among school-aged children in the United States.

Additionally, developmental delay, including pervasive developmental disorder, language disorder, and autism, was found in 10.2% of the seizure population, and tics were noted in 5.1% of the population.

"Interestingly, we also found a high incidence of children with migraine and headaches in the study population," Dr. Indulkar said.

Both psychiatric illness and developmental disorders were more common among boys in the study population than girls, she said.

The presence of epileptiform disturbances among children who have epilepsies of varying severity and learning, and other central nervous system-related comorbidities has led investigators to postulate that there is a link between the benign and more serious epilepsy syndromes.

However, "children with typical [BECTS] do not necessarily have abnormal EEGs in sleep, but they still may have learning difficulties, so the mechanism [for the CNS-related comorbidities] remains elusive," Dr. Indulkar said in an interview.

She and her associates did not consider the influence of antiseizure medications on children in this study, according to Dr. Indulkar. "Not all children with BECTS are treated, as most seizures are rare, occur nocturnally, and are self-limited, so it's unlikely that medications alone could explain the cognitive problems."


Major Finding: The prevalence of co-existing psychiatric problems was 9.4% among patients with epilepsy compared with the estimated 1%-4% prevalence of psychiatric problems seen in the general pediatric population.

Data Source: The investigators reviewed consecutive routine EEGs from 1995 through 2004 for pediatric patients with benign focal epileptiform discharges and identified 117 whose seizures were consistent with B ECTS. They then compared comorbidity rates among those children with the general age-matched population.

Disclosures: The investigator reported no conflicts of interest with respect to her presentation and said that no specific funding was used to conduct the study.
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Author:Mahoney, Diana
Publication:Family Practice News
Geographic Code:1USA
Date:Feb 1, 2010
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