Screening for the Neuropsychiatric Comorbidities of Pediatric Epilepsy in a Clinically Recruited, Canadian Tertiary Care Sample
Abstract number :
1.382
Submission category :
6. Cormorbidity (Somatic and Psychiatric)
Year :
2024
Submission ID :
1273
Source :
www.aesnet.org
Presentation date :
12/7/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Kirsten Sjonnesen, MD – University of Calgary
Rumi Dasgupta, MS – University of Calgary
Yuvraj Agnihotri, BS (Pursuing) – University of Calgary
Minette Krisel Manalo, MD – Alberta Children's Hospital
Margarita Maltseva, MD – University of Calgary
Paola Meza Santoscoy, PhD – University of Calgary
Riddhi Chabrotra, BS – Alberta Children's Hospital, University of Calgary
Sonia Rosenquist, BS (Pursuing) – University of Calgary
Karin Ho, MBChB – University of Calgary
Juan Pablo Appendino, MD – University of Calgary
Kara Murias, MD, PhD – University of Calgary
Julia Jacobs, MD, PhD – University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada
Rationale: Neuropsychiatric and behavioural comorbidities in epilepsy are common and consequential. Identifying these conditions is increasingly emphasized, as unaddressed comorbidities of epilepsy negatively impact health-related quality of life and health outcomes in children and youth with epilepsy (CYE) (Epilepsy Behav 2019;101:106214). Barriers to addressing these comorbidities in CYE include lack of recognition and time limitations. Screening for neuropsychiatric symptoms was introduced at our pediatric epilepsy centre, to characterize our patients’ needs and facilitate improvements in patient care.
Methods: Participant inclusion criteria were: aged 6-18 years, having a diagnosis of epilepsy, and attending the neurology clinics at the Alberta Children’s Hospital in Calgary, Canada. Exclusion criteria included parent inability to complete survey instruments. Between October 2023-May 2024, a sample of 49 participants were recruited with local institutional ethics approval (REB23-0372). The free-license, 47-item Revised Children’s Anxiety and Depression Scale parent version (RCADS-P) was administered to the parents of CYE immediately prior to clinical appointments, facilitating systematic screening for anxiety and depression symptoms (Behav Res Ther 2000;38:835-855). Items were rated on a 4-point Likert scale, from 0 (“never”) to 3 (“always”) and age- and sex-standardized scores (T-scores) were produced through automated scoring. The RCADS-P includes sub-scales screening for major depression, social phobia, panic disorder, separation anxiety, generalized anxiety, and obsessive-compulsive disorder. Its standardized mean T-score is 50, ≥ 65 is considered borderline, and ≥ 70 surpasses the threshold for clinical significance. Between-groups differences in positive screening rates and mean scores were tested for significance using Fisher’s exact tests and Kruskal-Wallis tests, respectively.
Results: The mean age of participants was 11.3 (standard deviation (SD) 3.4) years and the sex distribution was relatively balanced (47% male, 53% female). 94% of participants were taking anti-seizure medications at study entry. Notably, the major depression symptom mean score in children aged 6-8 years was borderline (65.0) and 29% of all participants had borderline or clinically significant major depression symptoms. Among the anxiety sub-scales, symptoms of generalized anxiety disorder and panic disorder were most frequently elevated, each screening positive in 18% (Fig. 1). No statistically significant differences by sex or age category were found in the proportion screening positive, nor in mean scores.
Conclusions: A free-license, brief screening instrument completed by the caregivers of CYE provided valuable clinical insights into the burden of depression and anxiety symptoms in our clinical population. Major depression symptoms were unexpectedly elevated across our sample, especially in the 6- to 8-year-old age group. Timely and targeted involvement of mental health and behavioural support resources is paramount in CYE, and formal screening for neuropsychiatric comorbidity should be broadly considered.
Funding: This project was supported by the Alberta Children’s Hospital Foundation.
Cormorbidity (Somatic and Psychiatric)