Alfstad Kristin Å, Torgersen Halvor, Van Roy Betty, Hessen Erik, Hansen Berit Hjelde, Henning Oliver, Clench-Aas Jocelyne, Mowinckel Petter, Gjerstad Leif, Lossius Morten I
National Centre for Epilepsy, Division for Surgery and Clinical Neuroscience, Oslo University Hospital, Norway.
National Centre for Epilepsy, Division for Surgery and Clinical Neuroscience, Oslo University Hospital, Norway.
Epilepsy Behav. 2016 Mar;56:88-94. doi: 10.1016/j.yebeh.2016.01.007. Epub 2016 Feb 3.
Psychopathology in children and youth with epilepsy has previously been related to executive dysfunction, but the nature of the association is uncertain. We sought to explore risk factors for psychiatric disorders in children and youth with epilepsy, with emphasis on executive dysfunction, along with seizure-related and psychosocial factors.
The cohort consisted of one hundred and one consecutive patients aged 10-19 years with focal (n=52) or genetic generalized (n=49) epilepsy. All were screened for psychiatric symptoms, using part of an extensive questionnaire, the Strengths and Difficulties Questionnaire (SDQ) for both patients and their parents. Participants scoring in the borderline or abnormal range on the SDQ received a psychiatric interview (Kiddie-SADS-PL). All participants underwent a neuropsychological examination, and those with general cognitive abilities (IQ)<70 were excluded.
Forty-seven of 101 participants (46.5%) had a SDQ score in the borderline or abnormal range and underwent a psychiatric evaluation. Of these, 44 (93.6%) met the criteria for a psychiatric diagnosis, the most common being ADHD and anxiety. An executive deficit was identified in 26.8% of the participants with a psychiatric diagnosis, but in only 5.4% of those without such a diagnosis (p=0.003). Multivariate logistic regression analysis showed that executive dysfunction was an independent risk factor for having a psychiatric disorder (OR 8.2, CI 1.8-37.2, p=0.006), along with male gender (OR 2.9, CI 1.2-7.3, p=0.02), and early seizure onset (0.86-that is one year older equals risk of psychiatric disorder reduced by 14%-CI 0.77-0.96, p=0.01). Other epilepsy-related or psychosocial factors were not significantly associated with psychiatric disorders.
Multiple factors are associated with psychiatric problems in children and youth with epilepsy. In this study, executive dysfunction, male gender, and early epilepsy onset were independent risk factors for having a psychiatric disorder. An evaluation of psychiatric and cognitive problems is important to enable a positive long-term outcome in childhood epilepsy.
癫痫患儿和青少年的精神病理学此前已与执行功能障碍相关，但这种关联的性质尚不确定。我们试图探讨癫痫患儿和青少年精神障碍的危险因素，重点关注执行功能障碍以及与癫痫发作相关和社会心理因素。
该队列由101名年龄在10至19岁之间的连续患者组成，其中局灶性癫痫患者（n = 52）或遗传性全身性癫痫患者（n = 49）。使用一份广泛问卷的一部分，即优势与困难问卷（SDQ）对患者及其父母进行精神症状筛查。在SDQ上得分处于临界或异常范围的参与者接受了精神科访谈（儿童版情感障碍和精神分裂症问卷[Kiddie-SADS-PL]）。所有参与者都接受了神经心理学检查，一般认知能力（智商）<70的参与者被排除。
101名参与者中有47名（46.5%）的SDQ得分处于临界或异常范围，并接受了精神科评估。其中，44名（93.6%）符合精神科诊断标准，最常见的是注意力缺陷多动障碍（ADHD）和焦虑症。在有精神科诊断的参与者中，26.8%存在执行功能缺陷，但在无此类诊断的参与者中这一比例仅为5.4%（p = 0.003）。多因素逻辑回归分析表明，执行功能障碍是患精神障碍的独立危险因素（比值比[OR] 8.2，置信区间[CI] 1.8 - 37.2，p = 0.006），男性性别（OR 2.9，CI 1.2 - 7.3，p = 0.02）以及癫痫发作早发（0.86——即每大一岁患精神障碍的风险降低14%——CI 0.77 - 0.96，p = 0.01）也是独立危险因素。其他与癫痫相关或社会心理因素与精神障碍无显著关联。
多种因素与癫痫患儿和青少年的精神问题相关。在本研究中，执行功能障碍、男性性别和癫痫早发是患精神障碍的独立危险因素。对精神和认知问题进行评估对于实现儿童癫痫的良好长期预后很重要。
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