An Overview of Anxiety Disorders and Depression in Children with Epilepsy: A Literature Review

Abstract

Comorbid psychiatric disorders in children with epilepsy have long been a subject of medical literature. Many studies conducted by pediatric neurologists, neurosurgeons, psychiatrists, and psychologists have revealed that psychiatric disorders, including anxiety disorders and depression, are frequently seen in children and adolescents with epilepsy. Due to various etiologies behind epilepsy, causes, manifestation, and treatment of anxiety and depression all have unique aspects. We think there are multiple reasons behind anxiety disorders and depression in children with epilepsy, varying from the physiological nature of the epilepsy itself to the environmental factors such as family, parenting, and social status. In this article, we aim to review the causes, risk factors, and management of anxiety disorders and depression in children with epilepsy.

Keywords

childhood epilepsy - children with epilepsy - anxiety - depression - antiepileptic drugs

Publication History

Received: 11 September 2019

Accepted: 17 June 2020

Article published online:
14 August 2020

• References

• 1 Aaberg KM, Gunnes N, Bakken IJ. et al. Incidence and prevalence of childhood epilepsy: a nationwide cohort study. Pediatrics 2017; 139 (05) e20163908
• 2 Friedman MJ, Sharieff GQ. Seizures in children. Pediatr Clin North Am 2006; 53 (02) 257-277
• 3 Baldin E, Hesdorffer DC, Caplan R, Berg AT. Psychiatric disorders and suicidal behavior in neurotypical young adults with childhood-onset epilepsy. Epilepsia 2015; 56 (10) 1623-1628
• 4 Graham P, Rutter M. Organic brain dysfunction and child psychiatric disorder. BMJ 1968; 3 (5620): 695-700
• 5 Gaitatzis A, Trimble MR, Sander JW. The psychiatric comorbidity of epilepsy. Acta Neurol Scand 2004; 110 (04) 207-220
• 6 Verrotti A, Carrozzino D, Milioni M, Minna M, Fulcheri M. Epilepsy and its main psychiatric comorbidities in adults and children. J Neurol Sci 2014; 343 (1-2): 23-29
• 7 Sillanpää M, Besag F, Aldenkamp A, Caplan R, Dunn DW, Gobbi G. Psychiatric and behavioural disorders in children with epilepsy (ILAE Task Force Report): epidemiology of psychiatric/behavioural disorder in children with epilepsy. Epileptic Disord 2016; 18 (s1) S2-S7
• 8 Speechley KN, Ferro MA, Camfield CS. et al. Quality of life in children with new-onset epilepsy: a 2-year prospective cohort study. Neurology 2012; 79 (15) 1548-1555
• 9 Dreier JW, Pedersen CB, Cotsapas C, Christensen J. Childhood seizures and risk of psychiatric disorders in adolescence and early adulthood: a Danish nationwide cohort study. Lancet Child Adolesc Health 2019; 3 (02) 99-108
• 10 Stevanovic D, Jancic J, Lakic A. The impact of depression and anxiety disorder symptoms on the health-related quality of life of children and adolescents with epilepsy. Epilepsia 2011; 52 (08) e75-e78
• 11 Dunn DW, Besag F, Caplan R, Aldenkamp A, Gobbi G, Sillanpää M. Psychiatric and behavioural disorders in children with epilepsy (ILAE Task Force Report): anxiety, depression and childhood epilepsy. Epileptic Disord 2016; 18 (s1) S24-S30
• 12 Caplan R, Siddarth P, Gurbani S, Hanson R, Sankar R, Shields WD. Depression and anxiety disorders in pediatric epilepsy. Epilepsia 2005; 46 (05) 720-730
• 13 Jones JE, Watson R, Sheth R. et al. Psychiatric comorbidity in children with new onset epilepsy. Dev Med Child Neurol 2007; 49 (07) 493-497
• 14 Russ SA, Larson K, Halfon N. A national profile of childhood epilepsy and seizure disorder. Pediatrics 2012; 129 (02) 256-264
• 15 Reilly C, Agnew R, Neville BG. Depression and anxiety in childhood epilepsy: a review. Seizure 2011; 20 (08) 589-597
• 16 Davies S, Heyman I, Goodman R. A population survey of mental health problems in children with epilepsy. Dev Med Child Neurol 2003; 45 (05) 292-295
• 17 Berg AT, Caplan R, Hesdorffer DC. Psychiatric and neurodevelopmental disorders in childhood-onset epilepsy. Epilepsy Behav 2011; 20 (03) 550-555
• 18 Reilly C, Atkinson P, Das KB. et al. Neurobehavioral comorbidities in children with active epilepsy: a population-based study. Pediatrics 2014; 133 (06) e1586-e1593
• 19 Aaberg KM, Bakken IJ, Lossius MI. et al. Comorbidity and childhood epilepsy: a nationwide registry study. Pediatrics 2016; 138 (03) e20160921
• 20 Oguz A, Kurul S, Dirik E. Relationship of epilepsy-related factors to anxiety and depression scores in epileptic children. J Child Neurol 2002; 17 (01) 37-40
• 21 Agrawal N, Govender S. Epilepsy and neuropsychiatric comorbidities. Adv Psychiatr Treat 2011; 17 (01) 44-53
• 22 Kariuki SM, Newton CR, Prince MJ, Das-Munshi J. The association between childhood seizures and later childhood emotional and behavioral problems: findings from a nationally representative birth cohort. Psychosom Med 2016; 78 (05) 620-628
• 23 Hesdorffer DC, Ishihara L, Mynepalli L, Webb DJ, Weil J, Hauser WA. Epilepsy, suicidality, and psychiatric disorders: a bidirectional association. Ann Neurol 2012; 72 (02) 184-191
• 24 Berg AT, Altalib HH, Devinsky O. Psychiatric and behavioral comorbidities in epilepsy: a critical reappraisal. Epilepsia 2017; 58 (07) 1123-1130
• 25 Elger CE, Hoppe C. What is depression in epilepsy?. Front Neurol 2011; 2: 79
• 26 Monroe SM, Simons AD. Diathesis-stress theories in the context of life stress research: implications for the depressive disorders. Psychol Bull 1991; 110 (03) 406-425
• 27 Rodenburg R, Meijer AM, Deković M, Aldenkamp AP. Family factors and psychopathology in children with epilepsy: a literature review. Epilepsy Behav 2005; 6 (04) 488-503
• 28 Rodenburg R, Marie Meijer A, Deković M, Aldenkamp AP. Family predictors of psychopathology in children with epilepsy. Epilepsia 2006; 47 (03) 601-614
• 29 Austin JK, Dunn DW, Johnson CS, Perkins SM. Behavioral issues involving children and adolescents with epilepsy and the impact of their families: recent research data. Epilepsy Behav 2004; 5 (Suppl 3) S33-S41
• 30 Han S-H, Lee S-A, Eom S, Kim H-D. Korean QoL in Epilepsy Study Group. Family factors contributing to emotional and behavioral problems in Korean adolescents with epilepsy. Epilepsy Behav 2016; 56: 66-72
• 31 Puka K, Widjaja E, Smith ML. The influence of patient, caregiver, and family factors on symptoms of anxiety and depression in children and adolescents with intractable epilepsy. Epilepsy Behav 2017; 67: 45-50
• 32 Save-Pédebos J, Bellavoine V, Goujon E. et al. Difference in anxiety symptoms between children and their parents facing a first seizure or epilepsy. Epilepsy Behav 2014; 31: 97-101
• 33 Sönmez FM, Cansu A. EPİLEPSİ TANISI KONAN ÇOCUKLARIN İLE İŞLEVLERİ, ANNE-BABALARINDAKİ KAYGI VE BAŞA ÇIKMA TUTUMLARI. Paper presented at: Yeni Symposium 2010
• 34 Li Y, Ji CY, Qin J, Zhang Z-X. Parental anxiety and quality of life of epileptic children. Biomed Environ Sci 2008; 21 (03) 228-232
• 35 Pekcanlar Akay A, Hiz Kurul S, Ozek H, Cengizhan S, Emiroglu N, Ellidokuz H. Maternal reactions to a child with epilepsy: depression, anxiety, parental attitudes and family functions. Epilepsy Res 2011; 95 (03) 213-220
• 36 Çelen Yoldaş T, Günbey C, Değerliyurt A, Erol N, Özmert E, Yalnızoğlu D. Behavioral problems of preschool children with new-onset epilepsy and one-year follow-up - a prospective study. Epilepsy Behav 2019; 92: 171-175
• 37 Thome-Souza S, Kuczynski E, Assumpção Jr F. et al. Which factors may play a pivotal role on determining the type of psychiatric disorder in children and adolescents with epilepsy?. Epilepsy Behav 2004; 5 (06) 988-994
• 38 Ak PD, Atakli D, Yuksel B, Guveli BT, Sari H. Stigmatization and social impacts of epilepsy in Turkey. Epilepsy Behav 2015; 50: 50-54
• 39 Bielen I, Friedrich L, Sruk A. et al. Factors associated with perceived stigma of epilepsy in Croatia: a study using the revised Epilepsy Stigma Scale. Seizure 2014; 23 (02) 117-121
• 40 MacLeod JS, Austin JK. Stigma in the lives of adolescents with epilepsy: a review of the literature. Epilepsy Behav 2003; 4 (02) 112-117
• 41 Devinsky O, Westbrook L, Cramer J, Glassman M, Perrine K, Camfield C. Risk factors for poor health-related quality of life in adolescents with epilepsy. Epilepsia 1999; 40 (12) 1715-1720
• 42 Ekinci O, Titus JB, Rodopman AA, Berkem M, Trevathan E. Depression and anxiety in children and adolescents with epilepsy: prevalence, risk factors, and treatment. Epilepsy Behav 2009; 14 (01) 8-18
• 43 Salpekar JA, Berl MM, Havens K. et al. Psychiatric symptoms in children prior to epilepsy surgery differ according to suspected seizure focus. Epilepsia 2013; 54 (06) 1074-1082
• 44 Pereira A, Valente KD. Severity of depressive symptomatology and functional impairment in children and adolescents with temporal lobe epilepsy. Seizure 2013; 22 (09) 708-712
• 45 Caetano SC, Fonseca M, Hatch JP. et al. Medial temporal lobe abnormalities in pediatric unipolar depression. Neurosci Lett 2007; 427 (03) 142-147
• 46 Salpekar JA, Mula M. Common psychiatric comorbidities in epilepsy: how big of a problem is it?. Epilepsy Behav 2019; 98 (Pt B): 293-297
• 47 Austin JK, Perkins SM, Johnson CS. et al. Self-esteem and symptoms of depression in children with seizures: relationships with neuropsychological functioning and family variables over time. Epilepsia 2010; 51 (10) 2074-2083
• 48 Turky A, Beavis JM, Thapar AK, Kerr MP. Psychopathology in children and adolescents with epilepsy: an investigation of predictive variables. Epilepsy Behav 2008; 12 (01) 136-144
• 49 Hesdorffer DC, Hauser WA, Olafsson E, Ludvigsson P, Kjartansson O. Depression and suicide attempt as risk factors for incident unprovoked seizures. Ann Neurol 2006; 59 (01) 35-41
• 50 McAfee AT, Chilcott KE, Johannes CB, Hornbuckle K, Hauser WA, Walker AM. The incidence of first provoked and unprovoked seizure in pediatric patients with and without psychiatric diagnoses. Epilepsia 2007; 48 (06) 1075-1082
• 51 Adelöw C, Andersson T, Ahlbom A, Tomson T. Hospitalization for psychiatric disorders before and after onset of unprovoked seizures/epilepsy. Neurology 2012; 78 (06) 396-401
• 52 Mula M. Epilepsy: bidirectional link between epilepsy and psychiatric disorders. Nat Rev Neurol 2012; 8 (05) 252-253
• 53 Kanner AM. Mood disorder and epilepsy: a neurobiologic perspective of their relationship. Dialogues Clin Neurosci 2008; 10 (01) 39-45
• 54 Kanner AM, Schachter SC, Barry JJ. et al. Depression and epilepsy: epidemiologic and neurobiologic perspectives that may explain their high comorbid occurrence. Epilepsy Behav 2012; 24 (02) 156-168
• 55 Aldenkamp A, Besag F, Gobbi G, Caplan R, Dunn DW, Sillanpää M. Psychiatric and behavioural disorders in children with epilepsy (ILAE Task Force Report): adverse cognitive and behavioural effects of antiepileptic drugs in children. Epileptic Disord 2016; 18 (s1): S55-S67
• 56 Afzal KI, Anam S, Hunter SJ. The effects of antiepileptic drugs on pediatric cognition, mood, and behavior. J Pediatr Epilepsy 2017; 6 (01) 3-18
• 57 Brent DA, Crumrine PK, Varma RR, Allan M, Allman C. Phenobarbital treatment and major depressive disorder in children with epilepsy. Pediatrics 1987; 80 (06) 909-917
• 58 Salpekar JA, Mishra G, Hauptman AJ. Key issues in addressing the comorbidity of depression and pediatric epilepsy. Epilepsy Behav 2015; 46: 12-18
• 59 Schmitz B. Effects of antiepileptic drugs on mood and behavior. Epilepsia 2006; 47 (Suppl 2): 28-33
• 60 Cianchetti C, Bianchi E, Guerrini R. et al; TASCA Study Group. Symptoms of anxiety and depression and family's quality of life in children and adolescents with epilepsy. Epilepsy Behav 2018; 79: 146-153
• 61 Tosun A, Gokcen S, Ozbaran B. et al. The effect of depression on academic achievement in children with epilepsy. Epilepsy Behav 2008; 13 (03) 494-498
• 62 Pellock JM. Defining the problem: psychiatric and behavioral comorbidity in children and adolescents with epilepsy. Epilepsy Behav 2004; 5 (Suppl 3): S3-S9
• 63 Stevanovic D, Jancic J, Topalovic M, Tadic I. Agreement between children and parents when reporting anxiety and depressive symptoms in pediatric epilepsy. Epilepsy Behav 2012; 25 (02) 141-144
• 64 Beyenburg S, Mitchell AJ, Schmidt D, Elger CE, Reuber M. Anxiety in patients with epilepsy: systematic review and suggestions for clinical management. Epilepsy Behav 2005; 7 (02) 161-171
• 65 Coppola G, Operto FF, Matricardi S, Verrotti A. Monitoring and managing depression in adolescents with epilepsy: current perspectives. Neuropsychiatr Dis Treat 2019; 15: 2773-2780
• 66 Fiest KM, Patten SB, Jetté N. Screening for depression and anxiety in epilepsy. Neurol Clin 2016; 34 (02) 351-361 , vii–viii
• 67 Wagner JL, Kellermann T, Mueller M. et al. Development and validation of the NDDI-E-Y: a screening tool for depressive symptoms in pediatric epilepsy. Epilepsia 2016; 57 (08) 1265-1270
• 68 Dunn DW. Should pediatric neurologists play a role in the management of the most common psychiatric comorbidities in children with epilepsy? Practical considerations. Epilepsy Behav 2019; 98 (Pt B): 314-317
• 69 Kanner AM. Management of psychiatric and neurological comorbidities in epilepsy. Nat Rev Neurol 2016; 12 (02) 106-116
• 70 Ramos-Perdigués S, Baillés E, Mané A. et al. Psychiatric symptoms in refractory epilepsy during the first year after surgery. Neurotherapeutics 2018; 15 (04) 1082-1092
• 71 Mula M, Jauch R, Cavanna A. et al. Interictal dysphoric disorder and periictal dysphoric symptoms in patients with epilepsy. Epilepsia 2010; 51 (07) 1139-1145
• 72 Buelow JM, Johnson CS, Perkins SM, Austin JK, Dunn DW. Creating Avenues for Parent Partnership (CAPP): an intervention for parents of children with epilepsy and learning problems. Epilepsy Behav 2013; 27 (01) 64-69
• 73 Michaelis R, Tang V, Goldstein LH. et al. Psychological treatments for adults and children with epilepsy: evidence-based recommendations by the International League Against Epilepsy Psychology Task Force. Epilepsia 2018; 59 (07) 1282-1302
• 74 Snead K, Ackerson J, Bailey K, Schmitt MM, Madan-Swain A, Martin RC. Taking charge of epilepsy: the development of a structured psychoeducational group intervention for adolescents with epilepsy and their parents. Epilepsy Behav 2004; 5 (04) 547-556
• 75 Martinović Z, Simonović P, Djokić R. Preventing depression in adolescents with epilepsy. Epilepsy Behav 2006; 9 (04) 619-624
• 76 Blocher JB, Fujikawa M, Sung C, Jackson DC, Jones JE. Computer-assisted cognitive behavioral therapy for children with epilepsy and anxiety: a pilot study. Epilepsy Behav 2013; 27 (01) 70-76
• 77 Thomé-Souza MS, Kuczynski E, Valente KD. Sertraline and fluoxetine: safe treatments for children and adolescents with epilepsy and depression. Epilepsy Behav 2007; 10 (03) 417-425
• 78 Ettinger AB, Weisbrot DM, Nolan EE. et al. Symptoms of depression and anxiety in pediatric epilepsy patients. Epilepsia 1998; 39 (06) 595-599
• 79 Dunn DW, Austin JK, Huster GA. Symptoms of depression in adolescents with epilepsy. J Am Acad Child Adolesc Psychiatry 1999; 38 (09) 1132-1138
• 80 Alwash RH, Hussein MJ, Matloub FF. Symptoms of anxiety and depression among adolescents with seizures in Irbid, Northern Jordan. Seizure 2000; 9 (06) 412-416
• 81 Williams J, Steel C, Sharp GB. et al. Anxiety in children with epilepsy. Epilepsy Behav 2003; 4 (06) 729-732
• 82 Adewuya AO, Oseni SB. Impact of psychiatric morbidity on parent-rated quality of life in Nigerian adolescents with epilepsy. Epilepsy Behav 2005; 7 (03) 497-501
• 83 Caplan R, Siddarth P, Stahl L. et al. Childhood absence epilepsy: behavioral, cognitive, and linguistic comorbidities. Epilepsia 2008; 49 (11) 1838-1846
• 84 Dunn DW, Austin JK, Perkins SM. Prevalence of psychopathology in childhood epilepsy: categorical and dimensional measures. Dev Med Child Neurol 2009; 51 (05) 364-372
• 85 Roeder R, Roeder K, Asano E, Chugani HT. Depression and mental health help-seeking behaviors in a predominantly African American population of children and adolescents with epilepsy. Epilepsia 2009; 50 (08) 1943-1952