Impact of epilepsy in adolescence: A UK controlled study

doi:10.1016/j.yebeh.2005.03.011

Epilepsy & Behavior

Volume 6, Issue 4, June 2005, Pages 556-562

https://doi.org/10.1016/j.yebeh.2005.03.011 Get rights and content

Abstract

Purpose

The goals of the work described here were to investigate the psychological and social impact of epilepsy on adolescents and to identify to what degree clinical and demographic variables and knowledge of epilepsy could influence psychosocial functioning.

Methods

Seventy adolescents with epilepsy were compared with healthy controls (matched for age, sex, and reading ability) on measures of self-esteem, social adjustment, depression, and obsession. Within the epilepsy group, the impact of seizure frequency, seizure severity, and knowledge of epilepsy on the above measures was also determined.

Results

Adolescents with epilepsy showed significantly higher levels of depression, anhedonia, and social anxiety and significantly higher numbers of obsessive symptoms than the adolescents without epilepsy. Among the adolescents with epilepsy, high seizure frequency was significantly associated with low self-esteem, and tonic–clonic seizures were specifically associated with higher levels of depression. Finally, low levels of epilepsy knowledge were significantly associated with higher levels of depression, lower levels of self-esteem, and higher levels of social anxiety.

Conclusions

Epilepsy has a significant psychosocial impact on adolescents at this difficult time of life. Social support and access to appropriate information about epilepsy could be of help.

Introduction

Adolescence is a turbulent period of development marked by identity formation and self-definition [1], a period when individuals pay particular attention to peer norms and beliefs [2]. Adolescents engage in social activities and begin to prepare for employment, relationships, and driving [3], [4]. These are all important aspects in the move toward achieving independence [5]. It is thus recognized as a crucial time for the acquisition of knowledge and social skills that allow for natural integration into society [6].

The majority of individuals emerge from this transitional period with a positive self-image, a strong sense of self-identity, and an ability to interact positively with their friends, family, and society as a whole [6]. Epilepsy is the most common neurological disorder in adolescents, with a prevalence of 1.5–2% [2], [7], [8]. Its presence can impact on the formation of such independence through its social, educational, emotional, and behavioral consequences [5]. Recent studies have demonstrated that for the adolescent with epilepsy, this particular period may be difficult to negotiate [9], [10], [11]. This can be explained by the prohibitive impact that epilepsy can have on many aspects of the adolescent’s life, including schoolwork, sports, employment, and driving [12].

A study investigating the relationship between stigma and self-esteem in adolescents [13] using a multivariate approach found that low self-esteem could be predicted by high seizure frequency and the belief that epilepsy was stigmatizing. Studies have shown that children with epilepsy have poorer perception of control, as well as lower self-esteem, than those without epilepsy [14]. Austin and Dunn [15] found that children with epilepsy were concerned about seizures, their effects, their timing, and what restrictions they would impose on their day-to-day activities. They also reported fear of seizures, concern about why they had them and whether they would be the subject of bullying or teasing, and guilt about the anxiety their parents experienced. These findings suggest that children with epilepsy may be at greater risk from anxiety and depression as a consequence of the fear of the reactions of others. A number of studies have identified individual predictors of adjustment to epilepsy in children and adolescents with the condition. These include being a boy [16], seizure control, polytherapy/monotherapy, and parental marital status [17], and seizure frequency [18].

Few studies, however, have examined whether the psychosocial problems associated with adolescents with epilepsy can be observed in adolescents without the condition to a similar or lesser degree. One study of adolescents with epilepsy (AWE) who were matched for age and sex with controls reported that the AWE group was more likely to report problems with transport and behavior in class, and had lower reading abilities, than the control group [19].

This study set out to examine whether the psychological difficulties observed in adolescents with epilepsy are unique or can be observed in populations without significant health problems and whether possessing knowledge of epilepsy is likely to ameliorate the effects of the condition on psychological functioning. The aims of this study were twofold: (1) to investigate psychological adjustment of adolescents with epilepsy in comparison to healthy control subjects (matched for age, sex, and reading ability); (2) to identify whether clinical and demographic variables and knowledge of epilepsy could influence psychological functioning in adolescents with epilepsy.

Section snippets

Methods

This study was a matched, controlled study. Adolescents aged between 12 and 18 with epilepsy were matched by age, sex, and reading ability (a surrogate for intellectual functioning) with adolescents who do not suffer from any physical or psychological health problems. Adolescents with epilepsy were recruited from two major epilepsy centers in the United Kingdom (London and Liverpool, where specialist adolescent epilepsy clinics have been established). The control group was recruited from

Results

Of the 305 adolescents with epilepsy who attended epilepsy clinics at the two centers, 126 were not considered suitable (learning difficulties, non-English-speaking, other severe medical and/or mental disabilities). Of the remaining 179, only 42% (75) agreed to participate. Participants were matched by age, sex, and reading age. Of the 75 adolescents, 5 could not be matched with any of the controls for reading age and, thus, were not included in the between-group analysis.

Discussion

The aims of this study were twofold: (1) to investigate psychological adjustment of adolescents with epilepsy in comparison to healthy control subjects (matched for age, sex, and reading ability); (2) to identify whether clinical and demographic variables and knowledge of epilepsy could influence psychological functioning in adolescents with epilepsy.

Adolescents with epilepsy had significantly higher levels of depression relating to interpersonal problems and anhedonia, as measured by two of

Acknowledgments

This study was supported by an educational grant provided by the Charles Sykes Memorial Fund. The authors dedicate this work to the memory of Charles Sykes, a young man with epilepsy who dedicated his brief career as a psychologist to understanding the impact of the condition.

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A change detection task with image stimuli assesses visual episodic memory. During the memory encoding and decoding phases, the ERP signals were analyzed from twenty-nine TLE patients (twelve with left TLE patients, seventeen with TLE), and thirty healthy controls. Given that EM is a complex process involving many fundamental cognitive processes, the amplitudes and latencies of EM-related ERP (FN400, late positive potential (LPC), and late posterior negativity (LPN)), and the ERP reflecting the fundamental processes (P100, N100, P200, and P300) were calculated. Then we used a three-by-two factorial design on the ERP metrics for interaction and main effects. The correlation analysis among Wechsler Memory Scales-Chinese Revision (WMS-RC) results, behavioral data, and the ERPs was carried out.
The TLE patients performed worse in WMS-RC and the memory task. The increased P200 and decreased P300 amplitudes were observed in the TLE patients, and LPN was abnormal in only LTLE patients. For EM-related components, differences were observed in both the LTLE and RTLE patients: the lack of the FN400 effect, the lack of the reversed LPC effect, and the reduced FN400. No significant inter-group difference was detected for the latencies of all the ERPs. Additionally, there were significant correlations among WMS-RC scores, behaviors, and some ERP amplitudes.
The impaired EM is linked to the increased P200 and decreased P300 amplitudes. LPN seems to be sensitive to left temporal lobe dysfunction. More importantly, the abnormal old or new effects of the FN400 and LPC, and the reduced FN400 amplitude might be associated with the visual EM deficit in the TLE patients. These findings may assist in the deep understanding of the EM disorder and the evaluation of the side effects of antiepileptic drugs.
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Anhedonia, the impaired ability to experience pleasure, is a core feature of major depressive disorder, one of the most common comorbidities in epilepsy. It is also reported as a clinical feature independent of depression in a number of other neurological conditions. This study aimed to establish the prevalence of anhedonia in a sample of people with epilepsy, with and without a diagnosis of depression, and to examine the clinical and demographic characteristics of those who present with this symptom.
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While anhedonia is well recognized as a feature of depression, our data suggests that it can be present in up to a third of people with epilepsy who do not have a diagnosis of depression. Cognitive difficulties, particularly impaired memory function may mediate some features of anhedonia. The implications of these findings for the clinical management of anhedonia in people with epilepsy are discussed.
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We investigated sex differences in the effect of seizures on social anxiety in persons with epilepsy.
In this cross-sectional multicenter study, social anxiety was measured using the short forms of the Social Phobia Scale (SPS-6) and Social Interaction Anxiety Scale (SIAS-6). SPS-6 scores ≥ 9 and SIAS-6 scores ≥ 12 were considered to indicate social phobia and social interaction anxiety, respectively. The Patient Health Questionnaire-9, Stigma Scale-Revised, and Family Adaptation-Partnership-Growth-Affection-Resolve scale were also completed. A logistic regression analysis with an interaction term was used to analyze the data.
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‘To reveal or to conceal’- Disclosure strategies in parents of children with epilepsy in India
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Epilepsy is a common, chronic neurological disorder affecting children at a prevalence of 3-9 per 1000 children [1,2].
: Disclosure of epilepsy is a relevant but under-researched topic in epilepsy research. This study was done to assess the disclosure strategies in parents of CWE in a developing country with conservative culture. The study also assessed the influence of demographic factors and seizure characteristics on the choice of disclosure. Enablers and barriers behind disclosure and the consequences after disclosure were evaluated.
: A cross-sectional analytical, self-report survey was done in 284 parents of CWE with the help of a semi-structured questionnaire over a 7-month period in the paediatric epilepsy clinic. Disclosure was considered present if epilepsy was revealed to two or more of the five target groups (extended family, school, friends, neighbours, and peers of children). Separate set of questions was given for reasons behind their choice and consequences after disclosure. For continuous variables, unpaired T test or Mann – Whitney U test between group and for categorized variables, Pearson's Chi square test or Fisher's exact test was used.
: 92.96 % of 284 subjects disclosed their child's epilepsy while 7.04% concealed. Demographic factors and seizure characteristics did not influence the disclosure choice. Most parents revealed to the extended family followed by teachers. Type of seizure was the commonest information revealed. The main reason behind disclosure was better acceptance of the child followed by safety while main barrier was considering epilepsy as private grief. 92.8% felt their children were better accepted after disclosure.
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Warped rhythms: Epileptic activity during critical periods disrupts the development of neural networks for human communication
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It is well established that temporal lobe epilepsy—the most common and well-studied form of epilepsy—can impair communication by disrupting social-emotional and language functions. In pediatric epilepsy, where seizures co-occur with the development of critical brain networks, age of onset matters: The earlier in life seizures begin, the worse the disruption in network establishment, resulting in academic hardship and social isolation. Yet, little is known about the processes by which epileptic activity disrupts developing human brain networks. Here we take a synthetic perspective—reviewing a range of research spanning studies on molecular and oscillatory processes to those on the development of large-scale functional networks—in support of a novel model of how such networks can be disrupted by epilepsy. We seek to bridge the gap between research on molecular processes, on the development of human brain circuitry, and on clinical outcomes to propose a model of how epileptic activity disrupts brain development.
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Little is known about children's perspectives and attitudes towards their long-term and rescue anticonvulsant medication.
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Impact of epilepsy in adolescence: A UK controlled study

Abstract

Purpose

Methods

Results

Conclusions

Introduction

Section snippets

Methods

Results

Discussion

Acknowledgments

Epilepsy Behav

Seizure

Seizure

Epilepsy Behav

J Am Acad Child Psychiatry

Epilepsy Res

Seizure

J Am Acad Child Adolesc Psychiatry

Epilepsy Behav

J Epilepsy

Seizure

Seizure

Epilepsy Behav

Risk factors for poor health-related quality of life in adolescents with epilepsy

Epilepsia

Adolescent seizures and epilepsy syndromes

Epilepsia

Parent and patient-validated content for pediatric epilepsy quality-of-life assessment

Epilepsia

Teenagers with epilepsy

Arch Dis Child

Adolescent pregnancy and childbearing: new data, new challenges

Paediatrics

Epilepsy in adolescents: diagnosis and treatment

Adolesc Med

A teenager epilepsy clinic: observational study

Eur J Neurol

Adolescent’s lived experience of epilepsy

J Neurosci Nurs