Neurobehavioral Comorbidities in Children with Epilepsy

Abstract

Objective: To study the prevalence, type and impact of neurobehavioral disorders in children with and without epilepsy. Methods: After IRB clearance 222 consecutive children with epilepsy, aged 5-12 years were enrolled as cases and 226 age, gender and socio-economic status matched children without epilepsy as controls. Detailed clinical, neurological and academic history was recorded and diagnosis done (case definitions, ILAE 2010). Both groups were administered Strength and Difficulties Questionnaire (SDQ), available in Hindi to screen for abnormal behaviors in 5 domains such as emotional symptoms, conduct problems, hyperactivity, peer relationship problems and prosocial behaviors. The total difficulties scores, individual domain symptom scores and impact scores were obtained. The data was analysed using chi square test or Fisher's exact test and the means between two groups were compared using the t-test. Results: The mean (SD) ages of the cases and controls were 8.56 and 8.6 years respectively (p=0.459). The behavioral comorbidities(epileptics vs non-epileptics) were emotional symptoms (38.2% vs 10.6%), conduct problems (32.4% vs 3.5%), hyperactivity (19.8% vs 3.1%) and peer relationships (38.2% vs 6.6%) p<0.001. School irregularity was seen in 25.6% and 6.1%, school dropouts in 17.5% and 3.9% of cases and controls respectively. Discussion: The prevalence of behavioral comorbidities in epileptics was 39.1% as compared to 7.9% nonepileptics (p<0.001). Epileptics had more internalizing behaviors such as emotional problems, poor peer relationships and few externalising ones as hyperactivity and conduct issues. One of the reasons for poor learning was school irregularity due to uncontrolled epilepsy, emotional problems. Existence of emotional problems and poor peer connections in epileptics lead to school dropouts. Conclusions: Neurobehavioral disorders are significant comorbid conditions seen in children with epilepsy and are a major cause of potentially treatable disability. Awareness of these problems will help target interventions and aid in the holistic management of pediatric epilepsy.