Depressive symptoms in youth with refractory epilepsy: Exploration of seizure, sociodemographic and cognitive factors

Abstract

Introduction: Rates of depressive symptoms in children and youth with epilepsy (CYE) vary among studies, ranging from 12 to 41%. The current study examined depressive symptoms in a large, multi-site sample of CYE who completed measures of emotional and behavioral functioning as part of a pre-surgical neuropsychological evaluation.

Methods: CYE ranged in age from 5 to 18 years old, had refractory epilepsy (n = 416), and underwent neuropsychological assessment, including standardized assessment of intellectual (IQ), emotional, and behavioral functioning using caregiver-proxy. Sociodemographic (e.g., age, biological sex, race/ethnicity, insurance status, distance from hospital) and epilepsy-specific characteristics e.g., seizure type, epilepsy duration, frequency, foci, number of anti-seizure medications [ASM], and MRI findings) were also examined.

Results: Elevated levels (i.e., at-risk or clinically significant threshold) of depressive symptoms were reported in 28.9 % of CYE. Youth with temporal lobe epilepsy (TLE; 18.9 %) had significantly higher rates of depressive symptoms compared to youth with extratemporal epilepsy (11.7 %; OR = 1.73, 95 % CI [1.10, 2.73]; χ² (2) = 7.08, p = 0.029). All other sociodemographic and epilepsy-specific variables were unrelated to levels of depressive symptoms. There was no difference in level of depressive symptoms for CYE with IQ below 70 despite being more likely to be in a minority racial/ethnic group, having public insurance, and experiencing more frequent seizures.

Conclusions: CYE are at risk of comorbid depressive symptoms, especially if they have TLE. However, other seizure and sociodemographic variables did not increase risk or resilience. Depression screening during routine epilepsy care is indicated, including for those CYE with low IQ.

Keywords: Depression; Epilepsy; IQ; Pediatric; Pre-Surgical.