Psychosocial problems and seizure-related factors in children with epilepsy

In this study we describe psychosocial functions and seizure-related factors in a population-based sample of children with epilepsy. Psychosocial problems (Achenbach scales), cognitive function, and socioeconomic status were studied in 117 children with epilepsy aged between 6 and 13 years (mean age 11y [SD 2y 1mo] and 10y 8mo [SD 2y]; 71 males, 46 females) and in randomly selected controls matched with 117 children for sex and age (mean age 11y 2mo [SD 2y 1mo] and 10y 5mo [SD 2y 4mo]; 69 males, 48 females). The children had partial (n=67), generalized (n=43), or undetermined (n=7) epilepsy syndromes, and partial (n=68), generalized (n=47), or other (n=2) main seizure types. Psychosocial problems were more common among children with epilepsy than controls (odds ratio 5-9) and significantly related to epilepsy syndrome, main seizure type, age at onset, and seizure frequency. Mothers and teachers reported males with epilepsy as having more problems than females. Females self-reported psychosocial problems, males did not. Psychosocial problems were common in childhood epilepsy. Females appreciated the problems more realistically than males. Psychosocial problems should be considered an integral part of epilepsy management.     

Self-concept in adolescents with epilepsy: biological and social correlates

The purposes of this study were to (1) compare self-esteem in teens with epilepsy to the normative mean, and (2) identify which neurologic/epilepsy and social/familial variables are associated with self-esteem. Thirty-seven adolescents (aged 12-18 years) attending a pediatric neurology clinic completed the Piers-Harris 2 Self-Concept Scale, Family Assessment Measure III, Child Attitude to Illness Scale, and a brief questionnaire about current seizure status (frequency, severity, and number of antiepileptic drugs). Neurology clinic charts were reviewed for seizure types, etiology, age at diagnosis, and number of failed therapies. While Total Piers-Harris t score and most subscales did not differ significantly from the normative mean, teens with epilepsy had higher scores on Behavioral Adjustment (P < 0.04) and Physical Appearance and Attributes (P < 0.03). On univariate analysis, number of current antiepileptic drugs (P < 0.05) and Attitude to Illness and Family Function scores (P < 0.02 for both) were significantly associated with self-esteem. On linear regression analysis, only the Family Function score (P < 0.02) and number of antiepileptic drugs (P < 0.05) were associated with total self-concept. We conclude that self-concept in teens with epilepsy is most strongly associated with Family Function. With the exception of current number of antiepileptic drugs used, epilepsy-specific factors are of minimal importance.     

Acute seizure-related hospitalizations in children with newly diagnosed epilepsy

Hospitalizations due to breakthrough seizures were studied in children with newly diagnosed epilepsy to evaluate (1) risk factors associated with such admissions, in particular the withholding of medication and subtherapeutic dose of anticonvulsants, and (2) the impact of the unscheduled hospitalization on subsequent seizure outcome. We recruited patients aged less than 18 years with newly diagnosed epilepsy who presented to the pediatric department in Tuen Mun Hospital between January 2002 and December 2003. Patients with acute seizure-related hospitalization within 1 year after diagnosis were included as cases (n = 36); patients with no such hospitalization were included as controls (n = 86). Treatment effect was analyzed at the last follow-up visit before January 2005. Significant univariate association was observed between seizure-related hospitalization and age at seizure onset (OR = 0.91, 95% CI 0.84, 1), idiopathic epilepsy (OR = 0.35, 95% CI 0.15, 0.81), no antiepileptic drug (OR = 3.67, 95% CI 1.51, 8.18), and subtherapeutic doses of antiepileptic drug (OR = 9.9, 95% CI 2.2, 43.8). Independent risk factors of such hospitalizations were etiology of epilepsy, no antiepileptic drug, subtherapeutic dose of antiepileptic drug, and history of febrile convulsion. Sixty-four percent of the cohort was seizure-free. Acute seizure-related hospitalization was associated with less favorable outcome (OR = 3.79, 95% CI 1.48, 9.26).     

Depression and anxiety in epilepsy: the association with demographic and seizure-related variables

Background  

Depression and anxiety are common psychiatric symptoms in patients with epilepsy, exerting a profound negative effect on health-related quality of life. Several issues, however, pertaining to their association with psychosocial, seizure-related and medication factors, remain controversial. Accordingly, the present study was designed to investigate the association of interictal mood disorders with various demographic and seizure-related variables in patients with newly-diagnosed and chronic epilepsy.     

Executive functions and seizure-related factors in children with epilepsy in Western Norway

Executive functions (EFs), seizure-related factors, and school performance were studied in a population-based sample of children with epilepsy (n=117; 71 males, 46 females; mean age 10y 5mo [SD 2y]; range 6y-12y 11mo) and a comparison group (n=124; 71 males, 53 females; mean age 10y 1mo [SD 2y 1mo]; range 6y-12y 11mo). EF, cognitive function, depression, socioeconomic status, and school performance were examined. Patients with epilepsy performed significantly lower than the comparison group on all EF measures except incidental memory. Intellectual dysfunction and depression accounted for 43% of EF problems. All epilepsy syndrome groups (except Rolandic epilepsy) were associated with decreased EF in addition to early epilepsy onset, high seizure frequency, and polytherapy. Patients had more school performance problems than comparison children which were attributed partly to EF difficulties. All aspects of EF were affected in children with epilepsy and all epilepsy syndrome groups, except Rolandic epilepsy, influenced EF negatively. EF problems contributed to patients' school difficulties beyond intellectual dysfunction.     

Risk factors for seizure-related motor vehicle crashes in patients with epilepsy

OBJECTIVE: We identified clinical risk factors for seizure-related motor vehicle crashes in patients with epilepsy. BACKGROUND: Current US laws permit epilepsy patients with controlled seizures to drive. These laws attempt to balance the important economic and social value of driving with the risk to public safety from seizure-related crashes. Various clinical factors are considered in these laws, particularly the seizure-free interval. Driving restrictions range from 3 to 18 months, however, and studies have not established how these various seizure-free intervals and other clinical factors influence the risk for seizure-related motor vehicle crashes. METHODS: We performed a retrospective case-control study to determine the influence of clinical risk factors associated with seizure-related motor vehicle crashes. Both "case" and "control" patients had epilepsy, drove, and were from the same clinic, but the cases differed in having had seizure-related crashes. RESULTS: Fifty patients with epilepsy who crashed during seizures and 50 matched control patients were compared. Factors that significantly decreased the odds of patients with epilepsy having motor vehicle crashes due to seizures were: long seizure-free intervals, reliable auras, few prior nonseizure-related accidents, and having had their antiepileptic drugs (AEDs) reduced or switched. For example, patients who had seizure-free intervals > or = 12 months had a 93% reduced odds for crashing compared to patients with shorter intervals. Other findings were: 25% of patients had more than one seizure-related crash and 20% had missed an AED dose just prior to their crash. The majority (54%) of patients who crashed were driving illegally, with seizure-free intervals shorter than legally permitted. CONCLUSION: Seizure-free intervals, the presence of reliable auras, AED therapy modifications, and a history of nonseizure-induced crashes should be considered when counseling patients with epilepsy on driving and when formulating driving regulatory policy. Case control studies of crashes due to seizures can help in assessing and monitoring such risks.     

Adaptive functioning in pediatric epilepsy: Contributions of seizure-related variables and parental anxiety

Young people with epilepsy are less likely to achieve the level of independence attained by their peers. We examined the seizure-related variables that placed a group of 97 pediatric patients with intractable seizures at risk for poor adaptive functioning. Analyses evaluated both the direct effects of the medical variables and indirect effects that were mediated through increased parental anxiety about their child's epilepsy. Higher numbers of anticonvulsants, presence of seizures that secondarily generalize, longer duration of seizure disorder, and younger age at onset were all identified as risk factors for poor adaptive functioning. Depending on the specific behavioral domain of adaptive functioning, the effects were sometimes direct and sometimes indirect. Lower levels of parental education and positive family history of seizures were associated with higher levels of parental anxiety. Interventions that target parental anxiety about seizures may mitigate the deleterious effects of epilepsy on social development.     

Neuropsychological performance and seizure-related risk factors in patients with temporal lobe epilepsy: a retrospective cross-sectional study

The aim of this study was to identify the neuropsychological features in patients with temporal lobe epilepsy (TLE) and their correlation with seizure-related variables. For this purpose, we carried out a retrospective analysis of data from 65 patients with TLE who had undergone a comprehensive neuropsychological assessment. The results suggest that the majority of patients with TLE were impaired in more than one cognitive domain, and among these patients, the mean proportions with defective semantic memory, language, motor/psychomotor speed, verbal episodic memory, and executive function were > 50% each. Moreover, age at seizure onset was the strongest predictor of general intellectual impairment, and number of antiepileptic drugs and seizure frequency could significantly predict deficits in verbal memory, language, and psychomotor speed. However, epilepsy duration was a less potent predictor of cognitive deficit than has been reported in cross-sectional studies.     

Psychosocial and neuropsychological function in children with epilepsy

This paper reviews the psychosocial and neuropsychological effects of epilepsy on children and families across environments in which children function, specifically home and school. Epilepsy is a chronic disorder, affecting one percent of the population, that alters neurocognitive functioning effecting learning, memory and family adaptation. A review of epilepsy and its impact on quality of life, family and school function and psychiatric comorbidity are discussed.     

Neuropsychological performance and seizure-related risk factors in patients with temporal lobe epilepsy: A retrospective cross-sectional study

The aim of this study was to identify the neuropsychological features in patients with temporal lobe epilepsy (TLE) and their correlation with seizure-related variables. For this purpose, we carried out a retrospective analysis of data from 65 patients with TLE who had undergone a comprehensive neuropsychological assessment. The results suggest that the majority of patients with TLE were impaired in more than one cognitive domain, and among these patients, the mean proportions with defective semantic memory, language, motor/psychomotor speed, verbal episodic memory, and executive function were > 50% each. Moreover, age at seizure onset was the strongest predictor of general intellectual impairment, and number of antiepileptic drugs and seizure frequency could significantly predict deficits in verbal memory, language, and psychomotor speed. However, epilepsy duration was a less potent predictor of cognitive deficit than has been reported in cross-sectional studies.     

Self-esteem and behavioural adjustment in children with epilepsy and children with diabetes

This paper describes a study to investigate the relationship between self-esteem and behavioural adjustment in two groups of children with chronic illness, one with epilepsy and the other diabetes. A total of 62 children with epilepsy and 91 children with diabetes were recruited from the total population of children aged 8–15 attending the epilepsy and diabetic clinics at a children's hospital over a 12 month period. Self-esteem and behavioural adjustment were assessed with the Harter and Achenbach Questionnaires respectively. The results showed the children with epilepsy were consistently more behaviourally disturbed and had lower self-esteem than children with diabetes. The independent completion of the questionnaires, (the Harter by the child and the Achenbach by the parents) increases the validity of the findings. Long duration of illness was the most consistent illness variable associated with poor behavioural adjustment in the two groups. The cross-sectional design of the study did not make it possible to draw any definite conclusions about the causal or temporal relationship between low self-esteem and behavioural disturbance. Once again, the potential value of prospective studies into the psychosocial adjustment of children with chronic illness is highlighted.     

Psychosocial problems among adults with epilepsy

The psychosocial functioning of adults with epilepsy was evaluated by the administration of the Washington Psychosocial Seizure Inventory, which was given to five groups of patients across the United States. In four of the five samples, the results were indistinguishable from one another, with similar psychosocial problems suggested despite substantially different patient characteristics and referral sources. Emotional, interpersonal, vocational, and financial concerns were most commonly found, as well as difficulties in dealing with seizures. Persons in the fifth sample were selected somewhat differently; they had fewer vocational and financial problems, but were otherwise similar. The results have implications for the study of psychosocial problems in epilepsy and for the establishment of treatment programs.     

Psychosocial issues for children with epilepsy

Epilepsy is a pervasive disorder that consists not only of seizures, but of behavioral, academic, and social difficulties. Epilepsy has an impact on the entire family and may have a significant effect on the interrelationships between child and parent. Epilepsy also has a potentially deleterious effect on academic functioning that may be the result of central nervous system dysfunction, seizures, antiepileptic drugs, or child and family response to illness. Early assessment for psychosocial problems and appropriate interventions can be beneficial for the child and family. Particular attention should be paid to periods of transition such as the move from adolescence to adulthood.     

Psychosocial treatment of adolescents with ADHD

Attention-deficit/hyperactivity disorder (ADHD) is a disruptive behavior disorder that is associated with social, family, and academic impairment. These areas of impairment are predictive of negative outcomes for adolescents, such as peer rejection, low or failing grades, and family conflict. This article reviews impairment associated with adolescents with ADHD and treatment approaches for these youth, with an emphasis on recent findings. There is a need for more research targeted at developing effective interventions for adolescents with ADHD, establishing reliable and valid assessment instruments, and identifying effective dissemination procedures.     

青少年抑郁障碍患者心理社会学特征

目的探讨青少年抑郁障碍患者的心理社会学特点。方法收集符合《国际疾病分类(第10版)》(ICD-10)抑郁障碍诊断标准的96例青少年抑郁症患者。所有患者均未经治疗,且均为首次就诊。正常对照组按性别、年龄等一般特征与病例组进行1∶1匹配。采用自编一般资料调查表、艾森克人格问卷(EPQ)、家庭环境量表中文版(FES-CV)、父母教养方式评价量表(EMBU)、青少年生活事件量表(ASLEC)和抑郁自评量表(SDS)进行测评。结果病例组EPQ的神经质(N)维度评分高于对照组,内外向(E)维度评分低于对照组(P0.01);病例组中独立性、亲密度、知识性、娱乐性、情感表达、成功性评分均较对照组低,差异均有统计学意义(P均0.01);父母情感温暖与理解因子评分低于对照组,差异有统计学意义(P0.01)。结论青少年抑郁障碍可能与其成长环境、父母因素、人格、应激生活事件、社会支持、同伴关系等有关。     

Depression in children and adolescents with epilepsy

Depression in children and adolescents with epilepsy is a common but often unrecognized disorder. Both epilepsy and depression are characterized by a chronic course and poor long-term psychosocial outcome. The risk of suicide is even greater in depressed youth with epilepsy than in the general youth population. Educating parents about mood disorders may allow them to be more receptive to psychiatric treatment for their child or themselves. Epidemiological and clinical data on depression in children/adolescents with epilepsy are presented. Seizure-related and general risk factors for the development of depression in youth with epilepsy are reviewed. General guidelines for diagnosis and treatment of depression in children and adolescents are discussed. The early identification and treatment of childhood-onset depression is an important clinical task for all pediatric specialists. Safe and effective multimodal treatment approaches are available.