Childhood Epilepsy Linked to Psychiatric and Learning Problems

BOSTON – Children with benign focal epilepsy with centro-temporal spikes had a higher incidence of psychiatric illnesses, attention-deficit/hyperactivity disorder, and developmental delay compared with the estimated incidence in the general population.

These children “are not sufficiently screened for psychological and other cognitive 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,” Dr. Shalaka Indulkar said in a poster presentation.

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

Of the 117 patients, 51 were girls and 66 were boys. Mean age at initial diagnosis of EEG abnormality was 6.8 years (6.2 in girls and 7.0 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%–substantially higher than the estimated 1%-4% in the general pediatric population.

ADHD was seen in 11% of the seizure population, compared with an estimated prevalence rate of 3%-7% in school-aged children. Developmental delay, including pervasive developmental disorder, language disorder, and autism, was seen in 10.2% of the seizure population, and tics were noted in 5.1%. There was also a high incidence of migraine and headaches in the study population.

Investigators have postulated that there is a link between the benign and more serious epilepsy syndromes, based on the presence of epileptiform disturbances in children who have epilepsies of varying severity and learning, and other CNS-related comorbidities. 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.

The investigators did not consider the influence of antiseizure medications on children in this study. “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,” she said.

Dr. Indulkar reported no conflicts of interest with respect to her presentation.

BOSTON – Children with benign focal epilepsy with centro-temporal spikes had a higher incidence of psychiatric illnesses, attention-deficit/hyperactivity disorder, and developmental delay compared with the estimated incidence in the general population.

These children “are not sufficiently screened for psychological and other cognitive 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,” Dr. Shalaka Indulkar said in a poster presentation.

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

Of the 117 patients, 51 were girls and 66 were boys. Mean age at initial diagnosis of EEG abnormality was 6.8 years (6.2 in girls and 7.0 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%–substantially higher than the estimated 1%-4% in the general pediatric population.

ADHD was seen in 11% of the seizure population, compared with an estimated prevalence rate of 3%-7% in school-aged children. Developmental delay, including pervasive developmental disorder, language disorder, and autism, was seen in 10.2% of the seizure population, and tics were noted in 5.1%. There was also a high incidence of migraine and headaches in the study population.

Investigators have postulated that there is a link between the benign and more serious epilepsy syndromes, based on the presence of epileptiform disturbances in children who have epilepsies of varying severity and learning, and other CNS-related comorbidities. 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.

The investigators did not consider the influence of antiseizure medications on children in this study. “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,” she said.

Dr. Indulkar reported no conflicts of interest with respect to her presentation.

BOSTON – Children with benign focal epilepsy with centro-temporal spikes had a higher incidence of psychiatric illnesses, attention-deficit/hyperactivity disorder, and developmental delay compared with the estimated incidence in the general population.

These children “are not sufficiently screened for psychological and other cognitive 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,” Dr. Shalaka Indulkar said in a poster presentation.

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

Of the 117 patients, 51 were girls and 66 were boys. Mean age at initial diagnosis of EEG abnormality was 6.8 years (6.2 in girls and 7.0 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%–substantially higher than the estimated 1%-4% in the general pediatric population.

ADHD was seen in 11% of the seizure population, compared with an estimated prevalence rate of 3%-7% in school-aged children. Developmental delay, including pervasive developmental disorder, language disorder, and autism, was seen in 10.2% of the seizure population, and tics were noted in 5.1%. There was also a high incidence of migraine and headaches in the study population.

Investigators have postulated that there is a link between the benign and more serious epilepsy syndromes, based on the presence of epileptiform disturbances in children who have epilepsies of varying severity and learning, and other CNS-related comorbidities. 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.

The investigators did not consider the influence of antiseizure medications on children in this study. “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,” she said.

Dr. Indulkar reported no conflicts of interest with respect to her presentation.