Abstracts

Rationale: Pediatric epilepsy is often associated with high rates of neuropsychiatric comorbidities like attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and anxiety disorders with a reported prevalence of 40%, 18% and 18.9%, respectively (Reilly et al., 2019; Dagar et al., 2020). These conditions have a significant impact on quality of life and can complicate treatment; specifically, presurgical evaluation and intracranial monitoring in children with drug resistant epilepsy (DRE). Our review attempted to quantify the prevalence among our pediatric epilepsy surgery patients to better identify and address these comorbidities and incorporate appropriate management strategies into the surgical evaluation and admission processes.

Methods: Retrospective chart review of patients undergoing epilepsy surgery at our center between 2018 and 2024. Those who had a documented neuropsychological evaluation in their medical records were included. Pre- and post-surgical clinical data were analyzed including demographics, epilepsy type, etiology, pre-surgical conference review and planned surgical procedures. Neuropsychiatric diagnoses based on the DSM-5 criteria and time of diagnosis (prior to or during the pre-surgical neuropsychological evaluation) were reviewed.

Results: Among the 44 patients reviewed (median age 13 years, 23M, 21F), 65.9% (n=29) had one or more neuropsychiatric diagnoses. The most common comorbidity was ADHD (31.8%, n=14) followed by intellectual disabilities (18%, n=8), trauma- and stressor-related e.g., posttraumatic stress and adjustment disorders (18%, n=8), anxiety disorders (13%, n=6), ASD (9%, n=4), and externalizing disorders e.g., oppositional defiant and unspecified disruptive (9%, n=4). A sizable number (9/29, 31%) were diagnosed at the time of presurgical evaluation. Among the patients with ADHD and lesional epilepsy, a significant association with frontal lobe lesions (4/11, 36%) was seen.

Conclusions: These findings underscore the substantial burden of neuropsychiatric comorbidities in pediatric epilepsy. In patients with DRE undergoing surgical evaluations, reconciliation of prior diagnoses and a high index of suspicion for new diagnoses based on structural abnormality/lobar involvement is warranted. Since these conditions require appropriate management strategies, we recommend adoption of a collaborative multidisciplinary approach including a team of neuropsychologists, social workers, child life specialists, and psychiatrists to tailor inpatient strategies and treatment plans and enhance the surgical and post operative experience of these patients and their families.

Funding: None