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| |  Psychiatric Comorbidities May Remain in Children With Epilepsy Even After Brain Surgery: Presented at AES By John Otrompke BOSTON -- December 8, 2009 -- The incidence of psychiatric comorbidities in children and adolescents with epilepsy remains in many patients even after treatment and surgery has rendered the patient seizure-free, impacting the child’s quality of life and performance, according to a study presented here at the American Epilepsy Society (AES) 63rd Annual Meeting. Unfortunately, more than half of paediatric patients who report comorbidities are not referred for psychiatric treatment. “The frequency of comorbidities in these patients runs between 16% and 77%,” said Tatiana Falcone, MD, Cleveland Clinic-Lerner College of Medicine, Cleveland, Ohio, during a poster presentation on December 6. “At a tertiary care centre like [ours], the frequency of comorbidities is as high as 60%, because our patients have more severe epilepsy.” For the study, Dr. Falcone and colleagues reviewed inpatient and outpatient psychiatric consults for 116 children with epilepsy between 2007 and 2009. Of those, 23 were postsurgical consults, 60 were presurgery patients, and 33 were inpatient consults, some of whom had surgery and some who did not. Two of the patients had suicidal ideation. During surgery, neurologists identify and remove the portion of the brain lobe afflicted by epilepsy, according to Dr. Falcone. In the 23 postsurgical psychiatric consultations, the most frequent cause was depression associated with temporal lobectomy. Overall, mood disorders occurred in 40% of patients (including major depression in 37.9%), attention-deficit hyperactivity disorder (ADHD) in 31%, anxiety disorder in 25%, and autism spectrum disorders in 14.7%. “Around 50% of our patients had already seen a neurologist in the last month,” said Dr. Falcone. “The parent would come in and say that the child complained of irritability, ADHD, or mood disorder, but the patient was ignored when there was an available and effective treatment.” When referred for treatment, however, the comorbidities improved. “At least half our kids end up on both medication and therapy,” he said, noting that those patients who were referred for treatment improved more than 20 points on the Child Depression Inventory. No increase in seizures was noted in those patients prescribed a selective serotonin reuptake inhibitor. [Presentation title: Psychiatric Comorbidities in Children and Adolescents Undergoing Epilepsy Surgery. Abstract 2.169]
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