Managing the psychiatric comorbidities in children and adolescents with epilepsy can improve the quality of life and school performance. However, physicians are reluctant to prescribe psychotropic medications.
BOSTON—About half of children and adolescents with epilepsy who have been evaluated by a mental health care provider have not received appropriate psychiatric care, despite the presence of severe psychiatric symptomatology, according to research presented at the 63rd Annual Meeting of the American Epilepsy Society.
Tatiana Falcone, MD, PhD, Assistant Professor of Medicine at the Cleveland Clinic Neurological Institute, Pediatric Epilepsy Center, and colleagues reviewed all inpatient and outpatient child and adolescent psychiatric presurgical and postsurgical consults that took place between 2007 and 2009. A total of 116 children and adolescents (ages 4 to 18) with chronic epilepsy were evaluated. The self-report Child Depression Inventory and the Screen for Child Anxiety Related Disorders were used in the analysis. Sixty presurgical consultations, 23 postsurgical consultations, and 33 inpatient psychiatric consultations were conducted in the epilepsy monitoring unit.
Forty percent of the patients had a mood disorder—37.9% had major depressive disorder, 2.6% had bipolar disorder, and 2.6% had medication-related mood disorders. Anxiety disorders were present in 25% of patients; generalized anxiety disorder was the most frequent, followed by social anxiety disorder. Thirty-one percent of the population had ADHD. Conversion disorder was less common, diagnosed in 10.3% of patients. Pervasive developmental disorder was present in 10.5% of the patients, and autism was diagnosed in 5.2%.
“Managing the psychiatric comorbidities in epileptic patients can improve the quality of life, school performance, and the family interactions,” Dr. Falcone stated. “Doctors remain reluctant to use psychotropic medication, even when needed.
“In the case of the 23 postsurgical consultations, the most frequent cause was depression associated with temporal lobectomy; patients improved after the addition of an SSRI to help with depression,” Dr. Falcone noted. No changes in the number of seizures were reported, and patients were monitored closely after adding psychotropic medications. Some patients benefited from the combination of cognitive behavioral therapy, school intervention, and medication.
“Just three of the 44 patients diagnosed with mood disorders were related to AED [use], which speaks more [about the] increase of comorbidity of depression secondary to chronic neurologic illness than about AEDs,” Dr. Falcone stated.
Dr. Falcone noted that the Knowledge Project is systematically assessing depression and suicidality in all outpatient visits to the Cleveland Clinic Epilepsy Center. “Integrated clinical services teams in epilepsy care are essential to achieve the goal of evidence-based practice in this population,” she concluded.
—Laura Sassano