Behavioral problems in children with epilepsy
Abstract
Background Epilepsy is a neurological disorder that most often
affects children. Most cases of epilepsy are found in developing
countries. Children with epilepsy are at risk of behavioral disorders
that can affect their quality of life. Studies on behavioral problems
in children with epilepsy have been limited in Indonesia.
Objective To compare behavioral disorders in children with
epilepsy to those in normal children, and to assess for possible
factors associated with the occurrence of behavioral disorders.
Methods We conducted a cross-sectional study involving 47
children with epilepsy and 46 children without epilepsy, aged 3-16
years. Behavioral problems were screened with the Strength and
Difficulty Questionnaire (SDQ), Indonesian version. Information
about EEG description, medication, onset, and duration of epilepsy
were obtained from medical records.
Results Behavioral problems were found in 19.1% of children
with epilepsy and only in 2.2 % of children without epilepsy (PR
8.8; 95%CI 1.16 to 66.77; P= 0.015). Significant differences were
also found in the percentage of conduct problems and emotional
disorders. Multivariate analysis with logistic regression revealed
that the factors associated with behavioral disorders in children
with epilepsy were uncontrolled epilepsy (PR 13.9; 95%CI 1.45 to
132.4; P=0.023) and focal EEG appearance (PR 19; 95%CI 1.71
to 214.43; P=0.017). We also found that uncontrolled epilepsy
was a factor related to emotional (PR 6.7; 95%CI 1.66 to 26.76;
P=0.007) and conduct problems (PR 6.1; 95%CI 1.35 to 27.29;
P=0.019).
Conclusion Uncontrolled epilepsy and focal EEG results are
factors associated with increased risk of behavioral problems in
children with epilepsy. Children with epilepsy should undergo
behavioral disorder screening, followed by diagnosis confirmation
and treatment.
References
Attarian H, Vahle V, Carter J, Hykes E, Gilliam F. Relationship between depression and intractability of seizures. Epilepsy Behav. 2003;4:298–301.
Besag FM. Behavioral aspects of pediatric epilepsy syndromes. Epilepsy Behav. 2004;5:3–13.
Johnson EK, Jones JE, Seidenberg M, Hermann BP. The relative impact of anxiety, depression, and clinical seizure features on health-related quality of life in epilepsy. Epilepsia. 2004;45:544–50.
McDermott S, Mani S, Krishnaswami S. A populationbased analysis of specific behavior problems associated with childhood seizure disorders. J Epilepsy. 1995;8:110-18.
Piyasil V, Sriudomkajorn S, Suwanpairat J. Behavioral problems of epileptic children at Queen Sirikit National Institute of Child Health. J Med Assoc Thai. 2008;91:9–14.
Datta SS, Premkumar TS, Chandy S, Kumar S, Kirubakaran C, Gnanamuthu C, Cherian A. Behaviour problems in children and adolescents with seizure disorder: associations and risk factors. Seizure. 2005;14:190–97.
Pellock JM. Defining the problem: psychiatric and behavioral comorbidity in children and adolescents with epilepsy. Epilepsy Behav. 2004;5:3-9.
Rahmawati L, Soedjatmiko, Gunardi H, Sekartini R, Batubara JR, Pulungan AB. Gangguan perilaku pasien diabetes melitus tipe 1 di Poliklinik Endokrinologi Anak Rumah Sakit Cipto Mangunkusumo. Sari Pediatri. 2007;9:264-72.
Ott D, Siddarth P, Gurbani S, Koh S, Tournay A, Shields WD, et al. Behavioral disorders in pediatric epilepsy: unmet psychiatric need. Epilepsia. 2003;44:591-7.
Goodman R. Psychometric properties of the strengths and difficulties questionnaire. J Am Acad Child Adolesc Psychiatry. 2001;40:1337-45.
Cornaggia CM, Beghi M, Provenzi M, Beghi E. Correlation between cognition and behavior in epilepsy. Epilepsia. 2006;47:34–9.
Aldenkamp AP, Bodde N. Behavior, cognition, and epilepsy. Acta Neurol Scand. 2005;182:19-25.
Thome-Souza S, Kuczynski E, Assumpcao JF, Rzezak P, Fuentes D, Fiore L, et al. Which factors may play a pivotal role on determining the type of psychiatric disorder in children and adolescents with epilepsy? Epilepsy Behav. 2004;5:988–94.
Austin JK, Harezlak J, Dunn DW, Huster GA, Rose DF, Ambrosius WT. Behavior problems in children before first recognized seizures. Pediatrics. 2001;107:115–22.
Dunn DW, Austin JK, Huster GA. Behaviour problems in children with new-onset epilepsy. Seizure. 1997;6:283–7.
Kanner AM. Psychiatric comorbidity in patients with developmental disorders and epilepsy: a practical approach to its diagnosis and treatment. Epilepsy Behav. 2002;3:7–13.
Austin J, Perkins SM, Johnson CS, Fastenau PS, Byars AW, deGrauw TJ, et al. Behavior problems in children at time of first recognized seizure and changes over the following 3 years. Epilepsy Behav. 2011;21:373-81.
Hanssen-Bauer K, Heyerdahl S, Eriksson AS. Mental health problems in children and adolescents referred to a national epilepsy center. Epilepsy Behav. 2007;10:255-62.
Tanabe T, Kashiwagi M, Shimakawa S, Fukui M, Kadobayashi K, Azumakawa K, et al. Behavioral assessment of Japanese children with epilepsy using SDQ (strengths and difficulties questionnaire). Brain Dev. 2013;35:81-6.
Kariuki SM, Abubakar A, Holding PA, Mung’ala-Odera V, Chengo E, Kihara M, et al. Behavioral problems in children with epilepsy in rural Kenya. Epilepsy Behav. 2012;23:41-6.
Langunju IA, Bella-Awusah TT, Takon I, Omigbodun O. Mental health problems in Nigerian children with epilepsy: associations and risk factors. Epilepsy Behav. 2012;25:214-8.
Dunn DW, Austin JK, Harezlak J, Ambrosius WT. ADHD and epilepsy in childhood. Dev Med Child Neurol. 2003;45:50–4.
Ekinci O, Titus JB, Rodopman AA, Berkem M, Trevathan E. Depression and anxiety in children and adolescents with epilepsy: prevalence, risk factors, and treatment. Epilepsy Behav. 2009;14:8-18.
Bauer K, Heyerdahl, Eriksson. Mental health problems in children and adolescents referred to an national epilepsy center. Epilepsy Behav. 2002;10:255-62.
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
Accepted 2017-02-01
Published 2014-12-30