Behavioral phenotypes of pediatric temporal lobe epilepsy

Abstract

Objective A broad spectrum of emotional‐behavioral problems have been reported in pediatric temporal lobe epilepsy (TLE), but with considerable variability in their presence and nature of expression, which hampers precise identification and treatment. The present study aimed to empirically identify latent patterns or behavioral phenotypes and their correlates. Methods Data included parental ratings of emotional‐behavioral status on the Behavior Assessment System for Children, 2nd Edition (BASC‐2) of 81 children (mean age = 11.79, standard deviation [SD] = 3.93) with TLE. The nine clinical subscales were subjected to unsupervised machine learning to identify behavioral subgroups. To explore concurrent validity and the underlying composition of the identified clusters, we examined demographic factors, seizure characteristics, psychosocial factors, neuropsychological performance, psychiatric status, and health‐related quality of life (HRQoL). Results Three behavioral phenotypes were identified, which included no behavioral concerns (Cluster 1, 43% of sample), externalizing problems (Cluster 2, 41% of sample), and internalizing problems (Cluster 3, 16% of sample). Behavioral phenotypes were characterized by important differences across clinical seizure variables, psychosocial/familial factors, everyday executive functioning, and HRQoL. Cluster 2 was associated with younger child age, lower maternal education, and higher rate of single‐parent households. Cluster 3 was associated with older age at epilepsy onset and higher rates of hippocampal sclerosis and parental psychiatric history. Both Cluster 2 and 3 demonstrated elevated family stress. Concurrent validity was demonstrated through the association of psychiatric (i.e., rate of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐5) disorders and psychotropic medication) and parent‐rated HRQoL variables. Significance Youth with TLE present with three distinct behavioral phenotypes that correspond with important clinical and sociodemographic markers. The current findings demonstrate the variability of behavioral presentations in youth with TLE and provide a preliminary framework for screening and targeting intervention to enhance support for youth with TLE and their families.

The presence, nature and network characteristics of behavioural phenotypes in temporal lobe epilepsy

“…Only two other investigations have taken this approach. 15 , 16 In an investigation of adults with TLE ( n = 96) and controls ( n = 82) using a different measure of psychopathology (Symptom Checklist 90-Revised), 15 the behavioural results were similar to this investigation in that (i) TLE patients as a group demonstrated significantly greater psychopathology across the behavioural measures compared with controls in both investigations; (ii) three underlying behavioural clusters were identified reflecting stepwise increases in psychopathology with a cluster characterized by comparable or better performance compared with controls, a severely affected group and an intermediate group, with proportions equivalent to those reported here; (iii) cluster membership was associated with (different) indicators of validity [Structured Clinical Interview for DSM Disorders (SCID) diagnoses in the prior investigation and NIH Toolbox behavioural measures here and QOL metrics in both investigations]; and (iv) both studies identified demographic, clinical and imaging metrics associated with the clusters. A recent investigation of 81 children with TLE ( n = 81) using the Behavioural Assessment System for Children-2 also demonstrated three behavioural phenotypes including no behavioural concerns (43%), internalizing (16%) and externalizing problems (41%), again associated with clinical variables, psychosocial and familial factors, everyday executive function and QOL.…”

“…A recent investigation of 81 children with TLE ( n = 81) using the Behavioural Assessment System for Children-2 also demonstrated three behavioural phenotypes including no behavioural concerns (43%), internalizing (16%) and externalizing problems (41%), again associated with clinical variables, psychosocial and familial factors, everyday executive function and QOL. 16 Thus, the phenotype approach appears reliable and reproducible across studies and robust in its ability to identify meaningful behavioural subgroups with applicability to both children and adults with epilepsy.…”

“…Much more slowly developing are comparable approaches to the behavioural complications of the epilepsies. One investigation examined adults with TLE, 15 one focused on children with TLE, 16 and the third examined children with new onset focal and generalized epilepsies. 17 Three clusters have been identified across these studies including one group behaviourally comparable with controls, one highly distressed group with pathology across all behavioural measures and an intermediate group with elevated but less striking patterns of distress.…”

Disadvantage and neurocognitive comorbidities in childhood idiopathic epilepsies

“…An extensive literature has documented elevated rates of neurobehavioral comorbidity in pediatric epilepsy spanning cognitive, [1][2][3] behavioral, 4,5 social-adaptive, 6 and academic 7 domains that exceed rates in other common pediatric medical populations. 8 Collectively, neurobehavioral comorbidities of pediatric epilepsy represent significant barriers to child quality of life impacting both immediate and long-term outcome.…”