Depression screening in pediatric epilepsy: evidence for the benefit of a behavioral medicine service in early detection.

Despite the increased risk and prevalence of depression in youth with epilepsy, only one-third receive mental health services. Untreated depression can contribute to negative outcomes and increased health-care utilization and medical cost. Proactive behavioral medicine screening may facilitate identification of depressive symptoms and necessary interventions in efforts to optimize behavioral health and health-related quality of life (HRQOL). Primary study aims included the examination of 1) rates of self-reported depression in youth with epilepsy, 2) differences in depression by demographic and medical variables, 3) the impact of depression on HRQOL, and 4) changes in depression and suicidal ideation following a behavioral medicine consultation. As part of routine clinic care over a 24-month period, youth with epilepsy of 7-17years of age completed the Children's Depression Inventory-Second Edition. Parents completed the PedsQL. A chart review was conducted to ascertain demographics, medical variables, and behavioral medicine visits and recommendations. A subsample with Time 1 and Time 2 depression data was examined. Time 1 participants included 311 youth with epilepsy (Mage=11.9years, 50% female, 84% Caucasian, 46.0% with localization-related epilepsy, 71.0% with seizure control in the past 3months). Elevated depression was identified in 23% of youth, with 14% endorsing suicidal ideation. Depression significantly varied by age, antiepileptic drug, and insurance. After controlling for seizure status, HRQOL worsened with elevated depression. Depression significantly decreased from Time 1 to Time 2 (n=159), particularly for those referred for behavioral medicine services at Time 1. Systematic assessment and early detection of depression and/or suicidal ideation in youth with epilepsy can improve HRQOL and decrease depression. Depression screening can be implemented through clinic-based behavioral medicine services.

Development and validation of the Pediatric Epilepsy Medication Self-Management Questionnaire.

Study aims were to describe the development and validation of a Pediatric Epilepsy Medication Self-Management Questionnaire (PEMSQ) for caregivers of children 2-14 years. It was expected that PEMSQ scales would have 1) factors with high internal consistency (e.g., Cronbach's alpha>0.70) and 2) moderate associations with adherence and seizures. Participants included caregivers of 119 children with epilepsy (M(age)=7.2 yrs, 36% female, 72% Caucasian) who completed the PEMSQ, demographics questionnaire, and AED adherence was assessed (e.g., electronic monitors, self-report). Factor analysis was conducted and internal consistency and construct validity were assessed. The final PEMSQ is 27 items with four scales (Epilepsy and Treatment Knowledge and Expectations, Adherence to Medications and Clinic Appointments, Barriers to Medication Adherence, and Beliefs about Medication Efficacy) accounting for 88% variance. Cronbach's alphas ranged from 0.68-0.85. Significant associations were found between PEMSQ scales, adherence, and seizures. The PEMSQ represents the first self-management measure validated for caregivers of children with epilepsy, with clinical and research utility.

Even a single seizure negatively impacts pediatric health-related quality of life.

PURPOSE: Both a single seizure and chronic recurrent seizures (epilepsy) occur commonly in childhood. Although several studies have documented the impact of pediatric epilepsy on psychosocial functioning, such as health-related quality of life (HRQOL), no studies have examined the impact of a single seizure on HRQOL. The primary objectives of this study were: (1) to compare parent-proxy HRQOL in children with a single seizure and newly diagnosed untreated epilepsy to normative data and (2) to examine differences in parent-proxy HRQOL between children with single seizure and newly diagnosed untreated epilepsy. METHODS: A retrospective medical chart review was conducted on a consecutive cohort of children being evaluated for seizures at a New-Onset Seizure Disorder Clinic. Information from the medical chart review included demographic data, seizure information, and the parent-proxy Pediatric Quality of Life Inventory (PedsQL), a well-validated measure of HRQOL in pediatric chronic illnesses. RESULTS: Participants included 109 children (n = 53 single seizure; n = 56 newly diagnosed untreated epilepsy). Results indicated that both children with a single seizure and children with newly diagnosed untreated epilepsy had significant impairments in HRQOL compared to normative data. However, no significant HRQOL differences were found between the single seizure and the untreated epilepsy groups. DISCUSSION: Children diagnosed with a single seizure or epilepsy have similar clinically significant impairments in HRQOL. Evaluation of HRQOL, even after a first seizure, is important and will identify children at risk at the earliest opportunity, allowing for timely psychosocial intervention.