Abstracts

Rationale: Youth with epilepsy (YWE) are at high risk for psychological comorbidities, which can result from seizures, antiepileptic drug (AED) side effects, or common neurobehavioral pathways. Despite expert guidelines, few pediatric epilepsy programs have implemented routine psychosocial screening to proactively identify psychological symptoms. We have established an innovative interdisciplinary model of care that integrates behavioral medicine services (i.e., Epilepsy Psychosocial Service; EPS) into routine pediatric epilepsy care for youth with new-onset epilepsy. The EPS is provided by pediatric psychologists specializing in epilepsy who integrate standardized assessments into behavioral medicine consultations, which involve real-time feedback and recommendations. The current study examined the frequency of EPS visits, interventions provided, the impact of the EPS on relevant symptoms, and frequency of referrals to other specialists. Methods: From July 2011 to June 2013, YWE 2 to 24 years of age received the EPS during routine care. All patients were screened using standard age-appropriate psychological and epilepsy-specific outcome measures (e.g., Behavioral Assessment Schedule for Children-2, Pediatric Epilepsy Side Effects Questionnaire) and received targeted behavioral interventions. An IRB-approved chart review was then conducted to obtain demographic and medical variables, along with EPS assessment and intervention data. Results: We screened 232 YWE who had the following demographics: M_age=8.8±4.2 years, 48.7% female, 85.2% Caucasian; 35.4% localization-related epilepsy; 53.7% had seizure control. Approximately 25% of children had clinically-elevated externalizing (e.g., hyperactivity) and/or internalizing symptoms (e.g., depression), while 27% exhibited behavioral symptoms (e.g., withdrawal, inattention). During EPS consultations, pediatric psychologists provided brief interventions targeting AED non-adherence, disruptive/oppositional behavior, anxiety, and learning/developmental concerns (see Table 1). Provision of specific interventions led to a significant decrease in symptoms. Specifically, when families received interventions for behavior, the Behavior Scale of the Pediatric Epilepsy Side Effects Questionnaire decreased significantly (F(2,73)=7.47, p=.008, 11 point improvement), after controlling for AED changes. Referrals for additional services included behavioral medicine/neuropsychology (8.4%), developmental testing (1.7%), and psychiatry (1%). Thirty-five percent followed through with these referrals and scheduled an appointment. Conclusions: Psychological screening can proactively identify at risk children with new-onset epilepsy. Commonly targeted concerns in YWE include disruptive/oppositional behaviors, anxiety, medication non-adherence, and learning/development. The EPS aids in decreasing AED behavioral side effects, which can lead to better outcomes (e.g., no seizures, best quality of life). In the course of interdisciplinary epilepsy care, pediatric psychologists can address these concerns and increase patient access to additional needed services.