Childhood Epilepsy Does Not Translate to Increased Psychiatric Burden in Adults

A new population study finds evidence that there is no association between childhood epilepsy and psychiatric problems in young adults.

Epilepsy has been long been tied to mental health issues on the idea that neurological and psychiatric problems share neural mechanisms in the brain, coupled with the fact that children with epilepsy often feel stigmatized for having seizures.

Also, some research has suggested that children with epilepsy show higher rates of psychiatric disorders compared with control children.

But these previous studies may have had some biases that affected their results, said Anne Berg, Ph.D, a research professor in the Epilepsy Center at the Ann and Robert H. Lurie Children’s Hospital of Chicago.

“One of the most cited reports is a study from Iceland, but in that case the researchers also included children with strokes, and strokes are a known risk factor for later depression,” she told Psychiatric News. “Other studies enrolled children only from specialized care centers, so the participant pool might have been skewed, or they assessed the children shortly after their epilepsy diagnosis.”

In a study published September 20 in Epilepsia, Berg and colleagues took a broader view, enrolling over 600 children newly diagnosed with epilepsy from across the state of Connecticut between 1993 and 1997. About 15 years later, when most of the participants were adults (average age of 22), all the patients who had neurotypical epilepsy (that is, not caused by an underlying issue like a traumatic brain injury or Down’s syndrome) were assessed on their psychiatric state.

The 257 neurotypical patients who participated were compared with two sets of controls: 134 sibling controls or 771 unrelated matched controls taken from a national survey of mental health (the NCS-R).

Whether compared with their siblings or strangers, the adults with epilepsy showed no higher rates of lifetime or current mood disorders, lifetime or current anxiety disorders, suicidal ideation, or suicide attempts. For example, lifetime prevalence of mood disorders was 20.6 percent for epilepsy cases, 23.1 percent for sibling controls, and 23.9 percent for unrelated controls.

“Epilepsy is a tough disorder to live with as a child, but these findings show a positive outlook that once these young people are grown up, their epilepsy does not cause persistent problems,” Berg said.

Berg added that parents and practitioners should not let their guard down, however. “A child with epilepsy may still develop a mood or anxiety disorder due to other reasons,” she said. “And depending on the severity of seizures, they may have an increased risk of neurocognitive problems down the line.”

Another consideration is that epilepsy represents a broad spectrum of disorders, and there may be some subtypes that affect the limbic system (the brain’s emotional center), which may indeed alter the risk of mood disorder. Berg believes these specific cases warrant further investigation.

She also noted her study’s limitations with regard to the results. “At the time the children were being monitored, Connecticut had a really high penetration of special education services, which these children received,” she said. “And that may have helped their psychological well-being to some degree.”

Berg’s study was funded by a grant from the National Institute of Neurological Disorders and Stroke. ■