Elsevier

Epilepsy & Behavior

Volume 18, Issue 3, July 2010, Pages 286-290
Epilepsy & Behavior

Suicidality and brain volumes in pediatric epilepsy

https://doi.org/10.1016/j.yebeh.2010.04.018Get rights and content

Abstract

This study examined the relationship between suicidal ideation and frontotemporal volumes, particularly orbital frontal gyrus volume, in 51 subjects with epilepsy with a mean age of 9.8 (2.1) years. Structured psychiatric interviews of the children and parents provided information on suicidal behavior and DSM-IV diagnoses. Tissue of 1.5-T MRI scans was segmented, and total brain, frontal lobe, frontal parcellations, and temporal lobe volumes were computed. The 11 subjects with epilepsy with suicidal ideation had significantly smaller right orbital frontal gyrus white matter volumes and larger left temporal lobe gray matter volumes than the 40 children without suicidal thoughts. Given the role of the orbital frontal gyrus in both emotional regulation and epilepsy, these findings highlight the biological underpinnings of suicidal ideation in pediatric epilepsy.

Introduction

Twenty percent of a non-psychiatrically referred group of 171 children with epilepsy with a mean age of 10.3 (2.74) years had suicidal ideation [1] compared with 8% of 12- to 15-year-old youths in the general population [2] and 11% in an epidemiological study of subjects aged 10 and older with an unprovoked seizure [3]. Having both disruptive and emotional psychiatric disorders, such as attention-deficit/hyperactivity (ADHD), depression, and anxiety, increased the likelihood of suicidal ideation in these children and adolescents with epilepsy [1]. In youth without epilepsy, predictors of suicidal ideation include depression/anxiety, female gender, age, ability to communicate feelings, negative attachment to parents/guardians, taunting/bullying or abuse, and presence of deviant peers [2].

Adolescents at risk for completed suicide, however, are more likely to be males and have disruptive disorder diagnoses (i.e., ADHD, oppositional defiant disorder, and conduct disorder), impulsivity, and aggression [4], as well as prepubertal depression and a family history of suicide and/or parental mood disorder (see reviews in [5], [6]). Avoidant and impulsiveness/carelessness styles of problem solving [7] and use of fewer cognitive meditational strategies to cope with stressful life events [8] are observed in children and adolescents, respectively, who have suicidal ideation and behavior.

Children with epilepsy have decreased orbital frontal volumes compared with healthy control subjects [9], [10]. In addition to its role in epilepsy [11], [12], [13], [14], structural and functional abnormalities in this brain region are associated with emotional dysregulation involving such behaviors as suicide [15], impulsivity [16], and aggression [17]. As suicidal ideation might reflect emotional dysregulation and impulsivity, the study described in this article examined if children with epilepsy with suicidal ideation had abnormal orbital frontal gyrus volumes compared with those without suicidal ideation. In the absence of prior volumetric studies on suicidal ideation in youth with and without epilepsy, we also explored if volumetric abnormalities in frontal regions other than the orbital frontal gyrus (inferior frontal gyrus and dorsolateral prefrontal gyrus) and in the temporal lobe were associated with suicidal thoughts in children with epilepsy.

Section snippets

Subjects

The study's subjects are part of a larger cohort of children with idiopathic epilepsy with complex partial seizures (CPS) and childhood absence epilepsy (CAE) with previously described volumetric findings [9], [10]. Data on both frontotemporal volumes and suicidal behavior were available for 51 subjects, 23 males and 28 females, who had a mean age of 9.8 (2.15) years and mean IQ of 94.2 (19.04). Thirty children were Caucasian and 38 from middle class families, based on the Hollingshead 2 factor

Subjects with epilepsy with and without suicidal ideation: Demographic, seizure, and psychiatric variables

Table 1 lists demographic features, IQ, family history of epilepsy, and psychopathology, and Table 2, the seizure variables of the 11 subjects with and 40 without suicidal ideation. Other than significantly older age in the children with suicidal ideation, there were no between-group significant differences in the demographic, family history, and seizure variables of the children with and without suicidal ideation.

There was a significant effect of type of psychiatric diagnosis, but not of the

Discussion

This first study on brain volumes and suicidal ideation in children demonstrated volumetric abnormalities in children with epilepsy who have suicidal ideation. Localization of these findings in the orbital frontal gyrus and temporal lobe, brain regions involved in emotional regulation [16], [23], [24], [25], [26], [27] and epilepsy [11], [12], [13], [14], highlights the biological underpinnings of this comorbidity of pediatric epilepsy.

By integrating factual and emotional information, the

Conflict of interest statement

None of the authors has any conflict of interest to disclose.

Acknowledgments

This study was supported by Grant NS32070 (R.C.). We appreciate the technical assistance of Erin Lanphier, Ph.D., Pamela Vona, M.A., Keng Nei Wu, B.A., Lesley Stahl, Ph.D., and Caroline Baker, Ph.D.

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