Abstracts

Rationale: In 2008, the US Food and Drug Administration issued a warning that antiepileptic drugs (AEDs) result in twice the rate of suicidal ideation as placebo and required a warning in the package insert. Experts in epilepsy, epidemiology, and mood disorders have questioned the strength of the association. We assessed suicidal ideation in children with new-onset epilepsy that subsequently were started on AEDs. Methods: We recruited 349 children ages 6-14 years with new-onset seizures and prospectively followed them at 18 and 36 months (Austin et al 2010). These children had an estimated IQ of >55 (93%>70) and no complicating pediatric health conditions. AED use was recorded at each follow up. Caregivers completed the Child Behavior Checklist (CBCL) and children > 7.5 years completed the Child Depression Inventory (CDI). For this study we looked at question 91 (Talks about killing self - never vs. sometimes/often) on the CBCL and question 9 ( I do not think about killing myself vs. I think about killing myself but I would not do it/I want to kill myself) on the CDI. The association of suicidal ideation with AED use was assessed by Chi-square or Fisher s exact test. Results: Data from CBCL was available on 337 children at baseline, 297 at 18 months, and 276 at 36 months. Parents reported suicidal ideation in 7.2%, 6.4%, and 3.3% of children at baseline, 18 months, and 36 months respectively. There was no association between suicidal ideation on the CBCL and AED use at any time. CDI was available on 226 children at baseline, 264 at 18 months, and 271 at 36 months. Suicidal ideation was reported by 25.8% of children at baseline, 21.2% at 18 months, and 14.4% at 36 months. When we restrict to those children not on AEDs at baseline, there were increased thoughts of suicide among children currently taking an AED at 18 months compared to children not taking an AED(39% vs. 15%, p=0.003). However, by 36 months, though more children on AEDs reported suicidal ideation (24% vs. 13%), the association was not significant. No suicide attempts or completed suicides occurred during the 36-month period. Conclusions: The prevalence of suicidal ideation reported by children is higher than that described by parents and is similar to the 20% prevalence reported by Caplan et al. (2005). Suicidal ideation was highest at baseline prior to substantial exposure to AEDS. However, we did find an initial association between AEDs and suicidal ideation at 18 months that weakened at 36 months. Given the frequency of suicidal ideation and the potential association with AEDs, clinicians should monitor for suicidal ideation and psychopathology to reduce risk for the child and to promote quality of life. Funded by NIH/NINDS R01 NS22416 (Austin). References Austin JK, Perkins SM, Johnson CS, et al. Self-esteem and symptoms of depression in children with seizures: relationships with neuropsychological functioning and family variables over time. Epilepsia, in press, published online 20 Apr 2010. Caplan R, Siddarth P, Gurbani S, et al. Depression and anxiety in pediatric epilepsy Epilepsia 2005; 46: 720-730.