Abstracts

This abstract is a recipient of the Young Investigator Award
This abstract has been invited to present during the Pediatric Epilepsy Highlights platform session

Rationale: Individuals with epilepsy have increased risk of suicidal ideation and behaviors when compared to the general population. Despite increasing evidence of a bidirectional relationship between epilepsy and suicidality in adults, the degree of this relationship among adolescents has been largely unexplored. In this study we investigated the prevalence of suicidal ideation and behaviors in adolescents with newly diagnosed focal epilepsy within four months of treatment initiation and examined its progression in the subsequent months._x000D_
Methods: This was a retrospective analysis of the enrollment and follow-up data from the Human Epilepsy Project, an international multi-institutional study that collected data from 34 sites in the U.S., Canada, Europe, and Australia between 2012 and 2017. Participants enrolled were 11 to 17 years of age within 4 months of treatment initiation for focal epilepsy. We used data from the Columbia Suicide Severity Rating Scale (C-SSRS) administered at enrollment and at 12-month follow-ups for 36 months as well as medical records to evaluate prevalence of suicidality._x000D_
Results: A total of 67 subjects were enrolled and completed the C-SSRS. At enrollment, over one in five (20.9%, 14 of 67) adolescents with newly diagnosed epilepsy endorsed any lifetime suicidal ideation (SI). Lifetime passive SI was present in 6% (4 of 67) of adolescents and lifetime active SI, ranging from non-specific active suicidal thoughts to active SI with plan and intent, was present in 15% (10 of 67) of adolescents. The prevalence of lifetime SI observed in the adolescent group was similar to that observed in the adult cohort of the Human Epilepsy Project (21.6% in adults; Kanner et al, 2020). Suicidal behaviors, ranging from preparatory acts to suicidal attempts, were noted in 7.5% (5 of 67) of adolescents. Two adolescents reported prior non-fatal suicide attempts. At follow-up, 5 of the 14 adolescents with any lifetime SI at enrollment continued to report SI in the 3 years following enrollment, and an additional 7 adolescents with no lifetime SI at enrollment reported new onset SI. Similarly, suicidal behaviors also increased at follow up with 5 adolescents endorsing new onset preparatory or suicidal behavior. From these, two had a non-fatal suicide attempt. Thus, the lifetime prevalence of SI within this population at follow up increased to 31% (21 of 67) and the lifetime prevalence of preparatory or suicidal behaviors increased to 15% (10 of 67).

Conclusions: The rates of suicidal ideation and behaviors in adolescents with focal epilepsy reported in our study are consistent with previous findings of significant suicidality observed in epilepsy. Our study adds to this field of knowledge and identifies adolescents as an at-risk population for suicidality both at time of epilepsy diagnosis and in the following months. The high percentage of youth with lifetime suicidal ideation or behavior supports the need for improved psychological risk assessment, which should not be limited to the screening of these two comorbidities, and effective suicide prevention programs for adolescents with focal epilepsy.

Funding: Not applicable