Neurobehavioral Comorbidities in Children With Active Epilepsy: A Population-Based Study

Abstract

BACKGROUND: In addition to recurrent epileptic seizures, children with epilepsy can have coexisting cognitive and behavioral difficulties but the spectrum and prevalence of such difficulties are uncertain. METHODS: The Children with Epilepsy in Sussex Schools study is a prospective, community-based study involving school-aged children (5–15 years) with active epilepsy in a defined geographical area in the United Kingdom. Participants underwent comprehensive psychological assessment, including measures of cognition, behavior, and motor functioning. Consensus neurobehavioral diagnoses were made with respect to Diagnostic and Statistical Manual, Fourth Edition-Text Revision (DSM-IV-TR) criteria. RESULTS: A total of 85 children (74% of eligible population) were enrolled; 80% of children with active epilepsy had a DSM-IV-TR behavioral disorder and/or cognitive impairment (IQ <85). Intellectual disability (ID) (IQ <70) (40%), attention-deficit/hyperactivity disorder (ADHD) (33%), and autism spectrum disorder (ASD) (21%) were the most common neurobehavioral diagnoses. Of those who met criteria for a DSM-IV-TR behavioral disorder, only one-third had previously been diagnosed. Logistic regression revealed that seizures in the first 24 months compared with first seizures at 24 to 60 or 61+ months (odds ratio [OR] 13, 95% confidence interval 2.2–76.9; OR 21.3, 3.2–148.9) and polytherapy (OR 7.7, 1.6–36.3) were independently associated with ID and the presence of ID was associated with a diagnosis of ASD (OR 14.1, 2.3–87.1) after Bonferroni adjustment. Epilepsy-related factors did not independently predict the presence of behavioral disorders. CONCLUSIONS: Screening for neurobehavioral comorbidities should be an integral part of management in children with “active” epilepsy. There is a need for research to identify neurobiological mechanisms underpinning neurobehavioral impairments and studies to evaluate possible treatments.

Autism and epilepsy

“…Our data on the risk of ASD in individuals with epilepsy are consistent with earlier studies, [3][4][5] although previous risk estimates have varied substantially. One American study based on hospital health care data reported an OR of more than 22 for the association between ASD and epilepsy.…”

“…A US study of health care data, a British psychiatric morbidity survey, and a prospective screening study all found that ASD as a comorbidity in patients with epilepsy had a prevalence between 1.3% and 21% and an odds ratio (OR) between 6 and 22. [3][4][5] Prevalence of epilepsy in ASD has been studied in different large cohorts with results varying from 3.9% to 19.4%.…”

“…3 Two British studies combined included 26 patients with both epilepsy and ASD. 4,5 Our risk estimates were based on more than 1,300 patients with both epilepsy and ASD. This large sample size yielded high statistical power and narrower CIs (for instance, the 95% CI for future ASD was between 9.55 and 11.53).…”

Comorbidities of Refractory Epilepsy and the Update Mechanism

“…The epilepsy associated comorbidities are often underestimated, consequently, undertreated. Furthermore, cognitive deficits always remain despite seizure greatly control [9]. Increased attention and early management of associated comorbidities is of great significance to improve the quality of life and maximize the opportunity for patients to re-integrate the society.…”

The Formation of Cognitive and Mental Disorders in Epilepsy: The Role of Various Factors Associated With Disease and Treatment (A Review of Literature and Case Reports)

“…По данным проведенного в Вели-кобритании популяционного исследования CESS (Children with Epilepsy in Sussex Schools) с примене-нием современных диагностических инструментов (Diagnostic and statistical manual of mental disorders IV, DSM-IV), у 80 % детей были выявлены поведенческие и / или когнитивные нарушения, у 40 % -интеллекту-альные нарушения, у 33 % -СДВГ, у 21 % -аутисти-ческое расстройство [67].…”