Psychiatric Disorders in Childhood Epilepsy

The link between childhood epilepsy and psychiatric disorders cannot be denied. Initial evaluation and management of a child presenting with seizures is focused on differential diagnosis of seizures and seizure medication. However, the impact of epilepsy often manifests as deficits in psychiatric and behavioral functioning, which can have far-reaching consequences in the realm of emotional and social well-being. An attending neurologist or epileptologist involved in the care of an epileptic child will face these comorbidities head-on during regular follow-up evaluations. It is our hope that this special issue will provide all clinicians involved in the care of these children with an insight to shift the paradigm of “epilepsy care” toward an ultimate goal of improved quality of life.

We bring together an international expertise from neurologists, epileptologists, psychiatrists, developmental pediatricians, and neuropsychologists to openly review and discuss seven thoughtfully selected topics. First, neuropsychologists, Joost Meekes and Aag Jennekens-Schinke, open the Special Issue with an up-to-date discussion of the effects of interictal epileptiform discharges on cognition. Then Drs. Rachel Tangen, a neuropsychologist, and Elizabeth Diekroger, a developmental pediatrician, tackle the most prevalent psychiatric comorbidity in children with epilepsy–attention deficit and hyperactive disorder (ADHD). They masterfully discuss the practical aspect of diagnosis and treatment. Next, a pediatric neurologist and psychiatrist, David Dunn, addresses multiple issues related to childhood anxiety, deepening our understanding of another common comorbidity. Dravet's syndrome is one of the most intractable epileptic disorders in children. Children with this condition are often on anti-epileptic drug (AED) poly therapy and yet continue to have frequent seizures. Furthermore, Bouewijn Gunning, a child neurologist and psychiatrist, and his colleague, Lisette van Gemert, provide an updated overview of the most commonly associated psychiatric conditions in children with Dravet's syndrome. Psychogenic nonepileptic seizure (PNES), a paroxysmal spell that resembles an epileptic seizure, can cause a significant challenge in diagnosis, especially when a child has both conditions. PNES is intimately related to a psychological cause. It is addressed in this issue as a comorbidity in the context of a pre-existing diagnosis of epilepsy. Two pediatric neurologists and epileptologists, Rajkumar Agarwal and Asim Shahid, succinctly and expertly outline the important aspects of PNES, including risk factors, pathophysiology, clinical features, and management and prognosis. Next, Drs. Monique van Schooneveld and Aag Jennekens-Schinke, neuropsychologists, point out and bring to light a complex interplay of both known and unknown factors that contribute to cognitive outcome after epilepsy surgery by discussing two children who underwent hemispherectomy. Finally, Garrett Brooks, a neurologist working with Jun Park, composes an objective view of the effect of epilepsy surgery in children from the behavioral, social, and cognitive aspects.