Abstracts

Rationale: The underpinnings of emotional and behavioral disturbances in children with epilepsy appear to be multi-dimensional, involving both neurological and social factors. There is some evidence that maternal anxiety about epilepsy contributes to lower levels of adaptive functioning in these children, even when seizures are well controlled. In this study we evaluated the relative contributions of maternal anxiety and seizure-related variables to the emotional, social and behavioral characteristics of a group of children and adolescents with intractable focal seizures. Methods: Fifty children with intractable seizures and their mothers participated in this study. To be included in this study the patient had to be at least 6 years old, English speaking and have a Full Scale IQ greater than 69. Age of the patients ranged from 6 to 19 years. Seizure foci included temporal lobe (55%), frontal lobe (21%) and other (24%). Range of estimated seizure frequency in the previous three months was 0 to 540. Emotional and behavioral functioning was assessed with parent, teacher and self-report measures. These included the Achenbach Child Behavior Checklist (CBCL), Student Behavior Survey (SBS), Children's Depression Inventory (CDI) and Reynold's Child Manifest Anxiety Scale(RCMAS). Predictor variables included seizure frequency, duration of seizure disorder, number of anticonvulsants, Full Scale IQ, maternal education and the Parental Anxiety about Epilepsy Questionnaire (PAEQ). Relationships were evaluated with multiple regression analyses. Results: Maternal anxiety (PAEQ score) had a significant association with emotional distress as reported by the child, the teacher and the parent. PAEQ explained 9%, 10% and 34% of the variance, respectively. IQ, maternal education and the seizure variables did not contribute to reports of emotional distress. No variable had a significant association with teacher reports of disruptive behavior but PAEQ scores, seizure frequency and number of medications were significantly correlated with scores on the CBCL Externalizing Scale, explaining 33% of the variance. Lower IQ scores were significantly associated with both teacher and parent report of social problems, explaining 15% of the variance for both. PAEQ scores explained an additional 15% of the variance of parent report of social problems. Conclusions: Maternal anxiety about epilepsy was the strongest and most consistent predictor of reported emotional, behavioral and social problems in children with epilepsy. Lower IQ's contributed, additionally, to social problems. Seizure frequency and number of anticonvulsants increased the likelihood of disruptive behaviors. These findings suggest that parental anxiety about epilepsy should be a target for intervention.