The Other Side of the Equation: the Emotional and Psychological Impact of Pediatric Epilepsy

pediatric_epilepsyAt Advanced Neurosurgery Associates (ANA), we are acutely aware that epilepsy represents a complicated combination of physical as well as psychological and emotional consequences. In fact, that’s why we emphasize our team approach to complete family care for our many pediatric epilepsy patients.

In order to address all facets of this condition, some general background information is useful. According to the Society for Pediatric Psychology, “About six out of 1,000 children currently have epilepsy in the U.S. Epilepsy is slightly more prevalent in males compared to females and tends to increase with age. Children under two years of age and children from lower-income families are at highest risk for epilepsy. A national community-based survey reported that 66 percent of children with a current or previous diagnosis of epilepsy were white non-Hispanic, 13 percent white Hispanic, 11 percent black and 9 percent multi/biracial/other.”

The Society also confirms “that children with epilepsy represent a vulnerable population who, even when compared to other pediatric conditions, are at highest risk for psychological comorbidities (34 percent), with highest prevalence for disruptive behavioral disorders (e.g., ADHD), followed by learning disorders (executive dysfunction and memory) and internalizing disorders (e.g., anxiety, depression). Continued seizures are associated with significant deficits in academic performance, IQ, quality of life, psychopathology and family functioning. Children with epilepsy are also more likely to have physical health comorbidities (e.g., hearing/vision, asthma, headaches).”

One thing is for certain, among seizure variables, age of onset, seizure type and seizure focus have been inconsistent predictors. Seizure frequency and severity have been better predictors of emotional trouble. That’s why it is important that if all methods of controlling seizures prove unsuccessful, an evaluation for a surgical solution is warranted.

Despite the cause or status of the epilepsy, emotional, behavioral and relationship difficulties are common in children with this condition and constitute a significant burden to the children and their families, indicating the need for effective mental health services for these patients.

Approximately 50 percent of children with epilepsy have some form of learning difficulty. This compares to approximately 15 percent of the general population who have learning difficulties. The functions most often influenced by epilepsy are speech and language, attention, memory and executive functioning.

There are multiple risk factors for behavioral problems in children with epilepsy and a variety of behavioral problems seen in them. Childhood epilepsy is a particular concern to psychiatrists because of the frequency of associated behavioral problems. The prevalence of behavioral problems in children with epilepsy is twice that’s seen in children with chronic illnesses not involving the central nervous system and four times that’s seen in healthy children.
“There is a big psychological component to both pediatric and adult epilepsy. In general, there is a significant amount of stress from the start of the diagnosis with an impact on both a child or adult and their families,” confirms Theresa Gabay, Advanced Practice Nurse at ANA.

The results of a 2013 study published in Pediatrics, a journal published by The American Academy of Pediatrics (AAP), reinforce the importance of neuropsychological assessment in clinical care in pediatric epilepsy and suggest important areas of focus for psychological intervention.

According to Gabay, there is a neuropsychological exam for any patient undergoing an epilepsy surgery workup, and significant counseling resources are available at the various hospitals where ANA performs surgery.

“We, as a practice, look for those support resources that are available. We direct our patients to social workers, child life therapists or other therapists,” she adds.
Resources: Society for Pediatric Psychology; Psychiatric Times (Behavioral Issues in Pediatric Epilepsy)