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Psychiatric and Behavioural Disorders in Children with Epilepsy:an ILAE Task Force Report Volume 18, supplement 1, May 2016

 

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1. Epidemiology of psychiatric/behavioural disorder in children with epilepsy

 

Question 1.1. What is the approximate rate of psychiatric disorder in children with epilepsy reported in epidemiological studies?

Question 1.2. What is the prevalence of psychiatric disorder in children with epilepsy and intellectual disability?

Question 1.3. What is the most common psychiatric disorder in children with epilepsy?

 

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2. Epilepsy and ADHD

 

Question 2.1. What is the prevalence of ADHD in children with epilepsy?

Question 2.2. Is there any sound evidence to indicate that methylphenidate exacerbates seizures in children with ADHD and epilepsy?

Question 2.3. What factors can be responsible for the characteristics of ADHD in children with epilepsy who do not actually have ADHD?

 

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3. Epilepsy and autism

 

Question 3.1. What is the approximate prevalence of autism in young people with epilepsy by the end of the teenage years?

Question 3.2. What disease complex is associated with a high rate of infantile spasms and autism?

Question 3.3. What is the most common relationship between epilepsy and autism: epilepsy causing the autism, autism causing the epilepsy or some underlying factor predisposing to both disorders?

 

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4. Anxiety, depression and childhood epilepsy

 

Question 4.1. What is the reported prevalence of anxiety in children with epilepsy?

Question 4.2. What is the rate of depression that has been reported in children with epilepsy?

Question 4.3. Is there a firm evidence base for the efficacy of CBT for the treatment of anxiety or depression in children with epilepsy?

 

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5. Epilepsy and psychosis in children and teenagers

 

Question 5.1. Has AED-associated psychosis been reported in both children and teenagers with epilepsy?

Question 5.2. Does post-ictal psychosis occur in teenagers with epilepsy?

Question 5.3. What factors are likely to increase the risk of AED-associated psychosis in teenagers with epilepsy?

 

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6. Behavioural and psychiatric disorders associated with childhood epilepsy syndromes

 

Question 6.1. Why is the classification of epilepsy into the appropriate syndrome of relevance with regard to behavioural/psychiatric disturbance in children with epilepsy?

Question 6.2. For children with a history of West syndrome and tuberous sclerosis complex, what additional anatomical abnormality is associated with the risk of developing autism?

Question 6.3. In which epilepsy syndrome is there considerable evidence for frontal lobe dysfunction, on the basis of both clinical findings and neuroimaging?

 

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7. Subtle behavioural and cognitive manifestations of epilepsy in children

 

Question 7.1. What psychiatric disorder appears to be associated with the frequent epileptiform discharges in so-called benign epilepsy with centrotemporal spikes?

Question 7.2. Is there any evidence for epileptiform discharges causing cognitive or behavioural problems in children with epilepsy, in the absence of obvious epileptic seizures?

Question 7.3. What syndrome, in which memory loss may vary, has been reported in children and adults with epilepsy?

 

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8. Adverse cognitive and behavioural effects of antiepileptic drugs in children

 

Question 8.1. What prominent type of behavioural disturbance has been reported in some children with epilepsy treated with phenobarbital?

Question 8.2. What AED has been associated with overall improvement in behaviour in children with epilepsy?

Question 8.3. Is levetiracetam associated with only negative behavioural effects, only positive behavioural effects or both negative and positive behavioural effects, in different children with epilepsy?

 

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9. Behavioural effects of epilepsy surgery

 

Question 9.1. In children with epilepsy and psychiatric disorder undergoing epilepsy surgery, are only positive effects on behaviour, only negative effects on behaviour or both positive and negative effects on behaviour reported in different children?

Question 9.2. Do reliable reports of group data show an overall beneficial effect, an overall deleterious effect or no overall effect of epilepsy surgery on psychiatric disturbance in children with epilepsy?

 

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10. When should pharmacotherapy for behavioural/psychiatric disorders in children with epilepsy be prescribed?

 

Question 10.1. What is mandatory before the prescription of psychotropic medication in a child with epilepsy?

Question 10.2. Which psychiatric disorder occurs most commonly in children with epilepsy and responds to appropriate psychotropic medication in a high proportion of cases?

Question 10.3. Which of the following medications are associated with a high risk of seizure exacerbation when administered to children with epilepsy: selective serotonin reuptake inhibitors, low-dose risperidone, methylphenidate, dexamfetamine?

 

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Answer 1.1. Around 35 - 50%.

Answer 1.2. Over 50%.

Answer 1.3. ADHD, with a prevalence of about 30%.

 

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Answer 2.1. About 30%.

Answer 2.2. No.

Answer 2.3. Some antiepileptic drugs, notably phenobarbital and the benzodiazepines, can precipitate features resembling the characteristics of ADHD, particularly hyperactivity. Very frequent epileptiform activity can also present with some features of ADHD.

 

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Answer 3.1. Approximately 20%.

Answer 3.2. Tuberous sclerosis complex.

Answer 3.3. The most common relationship is that there is an underlying factor predisposing to both disorders.

 

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Answer 4.1. The prevalence of anxiety in children with epilepsy in reported studies is typically from 15 to 36%.

Answer 4.2. The reported rate of depression in children with epilepsy varies widely from 8 to 35%.

Answer 4.3. Not at present.

 

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Answer 5.1. Yes, AED-associated psychosis has been reported in both children and teenagers with epilepsy.

Answer 5.2. Yes, post-ictal psychosis can occur in teenagers with epilepsy.

Answer 5.3. The factors appear to be similar to those that increase the risk of AED-associated psychosis in adults with epilepsy, namely rapid escalation of the AED dose and/or a personal or family history of psychosis.

 

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Answer 6.1. Because some syndromes are associated with particular types of psychiatric disorder.

Answer 6.2. Temporal lobe tubers.

Answer 6.3. Juvenile myoclonic epilepsy (Janz syndrome).

 

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Answer 7.1. ADHD.

Answer 7.2. There is evidence that transitory cognitive impairment can occur with epileptiform discharges both in children and adults. There is also evidence that electrical status epilepticus of slow-wave sleep (ESES) can be associated with both cognitive and behavioural problems.

Answer 7.3. Transient epileptic amnesia.

 

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Answer 8.1. Hyperactivity.

Answer 8.2. Lamotrigine.

Answer 8.3. Levetiracetam has been associated with both negative behavioural effects and positive behavioural effects. The negative behavioural effects have been reported in a larger percentage of children with epilepsy than the positive behavioural effects.

 

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Answer 9.1. Both positive effects on behaviour and negative effects on behaviour (or no appreciable effect on behaviour) have been reported in children with epilepsy undergoing epilepsy surgery.

Answer 9.2. Group data appear to show no overall effect of epilepsy neurosurgery on psychiatric disturbance in children with epilepsy; the psychiatric state of individual children may either improve or deteriorate following epilepsy surgery.

 

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Answer 10.1. A meticulous assessment to determine the cause of the behavioural or psychiatric disturbance is mandatory before the prescription of psychotropic medication; the assessment may reveal that another approach is more likely to be beneficial and that psychotropic medication is not appropriate.

Answer 10.2. ADHD. Reports suggest that, in children with epilepsy and ADHD, treatment of the ADHD is of benefit in around 70%.

Answer 10.3. None of these medications is associated with a high risk of seizure exacerbation.

 

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