Epilepsi Tanılı Çocuk ve Ergenlerde Ruhsal Bozukluklar

Epilepsi yüksek morbiditeye sahip kronik bir hastalıktır. Son yıllarda yapılmış çok sayıda araştırma epilepsi tanılı çocuk ve ergenlerde ruhsal bozuklukların sık olarak görüldüğünü göstermiştir. En sık görülen ruhsal bozukluklar arasında depresyon, anksiyete bozuklukları ve dikkat eksikliği hiperaktivite bozukluğu yer almaktadır. Aralarında demografik değişkenler, epilepsi ile ilişkili nedenler ve psikososyal faktörler olmak üzere çok sayıda faktörün epilepside ruhsal bozuklukların gelişiminde rol oynadığı düşünülmektedir. Ruhsal bozukluk eş tanılarına yaklaşımda disiplinler arası işbirliği, hasta ve ailenin eğitimi ve psikososyal destek büyük önem taşımaktadır. Araştırmalar bazı psikotrop ilaçların epilepsi tanılı çocuk ve ergenlerde genel olarak yüksek bir güvenilirlik ve etkinlikle kullanılabileceğini göstermiştir.

Psychiatric Disorders in Children and Adolescents with Epilepsy

Epilepsy is a chronic disease with a high morbidity. Many recent studies have shown that psychiatric disorders are commonly encountered in children and adolescents with epilepsy. Depression, anxiety disorders and attention deficit hyperactivity disorder are among the most common psychiatric disorders. Many factors, including demographic variables, epilepsy related factors and psychosocial factors, have been suggested to have a role on the development of psychiatric disorders in epilepsy. In the management of psychiatric comorbidities, cooperation between disciplines, education of the patient and family and psychosocial support are of vital importance. Recent studies have shown that some psychotropic agents can be used with a generally high safety and efficacy in children and adolescents with epilepsy.

___

  • Waaler PE, Blom BH, Skeidsvoll H, Mykletun A. Prevalence, classification, and severity of epilepsy in children in western Norway. Epilepsia 2000; 41:802-810.
  • Camfield CS, Camfield PR, Gordon K, Wirrell E, Dooley JM. Incidence of epilepsy in childhood and adolescence. a population-based study in Nova Scotia from 1977 to 19 Epilepsia 1996; 37:19-23.
  • Ott D, Caplan R, Guthrie D, Siddarth P, Komo S, Shields WD et al. Measures of psychopathology in children with complex partial seizures and primary generalized epilepsy with absence. J Am Acad Child Adolesc Psychiatry 2001; 40:907-914.
  • Ott D, Siddarth P, Gurbani S, Koh S, Tournay A, Shields WD et al. Behavioral disorders in pediatric epilepsy: unmet psychiatric need. Epilepsia 2003; 44:591-597.
  • Plioplys S. Depression in children and adolescents with epilepsy. Epilepsy Behav 2003; 4(Suppl 3):S39-S45.
  • Kanner AM. Psychiatric comorbidity in patients with developmental disorders and epilepsy: a practical approach to its diagnosis and treatment. Epilepsy Behav 2002; 3(6S1):7-13.
  • Pellock JM. Defining the problem: psychiatric and behavioral comorbidity in children and adolescents with epilepsy. Epilepsy Behav 2004; 5(suppl 3):S3-S9.
  • Jones JE, Austin JK, Caplan R, Dunn D, Plioplys S, Salpekar JA. Psychiatric disorders in children and adolescents who have epilepsy. Pediatr Rev 2008; 29:9-14.
  • Trevathan E. Seizures and epilepsy among children with language regression and autistic spectrum disorders. J Child Neurol 2004; 19(suppl 1):S49-S57.
  • Kanner AM. Psychosis of epilepsy: a neurologists perspective. Epilepsy Behav 2000; 1:219-227.
  • Hesdorffer DC, Ishihara L, Mynepalli L, Webb DJ, Weil J, Hauser WA. Epilepsy, suicidality, and psychiatric disorders: a bidirectional association. Ann Neurol 2012; 72:184-191.
  • Austin JK, Harezlak J, Dunn DW, Huster GA, Rose DF, Ambrosius WT. Behavior problems in children before first recognized seizures. Pediatrics 2001; 107:115-122
  • Elger CE, Hoppe C. What is depression in epilepsy? Front Neurol 2011; 2:79.
  • 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; 14:8-18.
  • Devinsky O. Psychiatric comorbidity in patients with epilepsy: implications for diagnosis and treatment. Epilepsy Behav 2003; 4(suppl 4):2-10.
  • Tosun A, Gokcen S, Ozbaran B, Serdaroglu G, Polat M, Tekgul H et al. The effect of depression on academic achievement in children with epilepsy. Epilepsy Behav 2008; 13:494-498.
  • Caplan R, Siddarth P, Gurbani S, Hanson R, Sankar R, Shields WD. Depression and anxiety disorders in pediatric epilepsy. Epilepsia 2005; 46:720-730.
  • Barry JJ, Ettinger AB, Friel P, Gilliam FG, Harden CL, Hermann B et al. Consensus statement: the evaluation and treatment of people with epilepsy and affective disorders. Epilepsy Behav 2008; 13(suppl 1):1-29.
  • Oguz A, Kurul S, Dirik E. Relationship of epilepsy-related factors to anxiety and depression scores in epileptic children. J Child Neurol 2002; 17:37-40.
  • Thome-Souza S, Kuczynski E, Assumpção Jr F, Rzezak P, Fuentes D, Fiore L 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; 5:988-994.
  • 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; 40:1715-1720.
  • Stores G. School-children with epilepsy at risk for learning and behaviour problems. Dev Med Child Neurol 1978; 20:502-508.
  • Datta SS, Premkumar TS, Chandy S, Kumar S, Kirubakaran C, Gnanamuthu C et al. Behaviour problems in children and adolescents with seizure disorder: associations and risk factors. Seizure 2005; 14:190-197.
  • Paradiso S, Hermann BP, Blumer D, Davies K, Robinson RG. Impact of depressed mood on neuropsychological status in temporal lobe epilepsy. J Neurol Neurosurg Psychiatry 2001; 70:180-185.
  • Sanchez-Gistau V, Sugranyes G, Baillés E, Carreño M, Donaire A, Bargalló N et al. Is major depressive disorder specifically associated with mesial temporal sclerosis? Epilepsia 2012; 53:386-392.
  • Titus JB, Kanive R, Sanders SJ, Blackburn LB. Behavioral profiles of children with epilepsy: parent and teacher reports of emotional, behavioral, and educational concerns on the BASC-2. Psychol Schools 2008; 45:892-903.
  • De Araşjo Filho GM, Pascalicchio TF, Sousa Pda S, Lin K, Ferreira Guilhoto LM, Yacubian EM. Psychiatric disorders in juvenile myoclonic epilepsy: a controlled study of 100 patients. Epilepsy Behav 2007; 10:437-441.
  • Perini GI, Tosin C, Carraro C, Bernasconi G, Canevini MP, Canger R et al. Interictal mood and personality disorders in temporal lobe epilepsy and juvenile myoclonic epilepsy. J Neurol Neurosurg Psychiatry 1996; 61:601-605.
  • Austin JK, Dunn DW, Caffrey HM, Perkins SM, Harezlak J, Rose DF. Recurrent seizures and behavior problems in children with first recognized seizures: a prospective study. Epilepsia 2002; 43:1564-1573.
  • Turky A, Beavis JM, Thapar AK, Kerr MP. Psychopathology in children and adolescents with epilepsy: an investigation of predictive variables. Epilepsy Behav 2008; 12:136-144.
  • Rodenburg R, Meijer AM, Dekovic´ M, Aldenkamp AP. Family factors and psychopathology in children with epilepsy: a literature review. Epilepsy Behav 2005; 6:488-503.
  • Rodenburg R, Marie Meijer A, Dekovic´ M, Aldenkamp AP. Family predictors of psychopathology in children with epilepsy. Epilepsia 2006; 47:601-614.
  • Carlton-Ford S, Miller R, Nealeigh N, Sanchez N. The effects of perceived stigma and psychological over-control on the behavioural problems of children with epilepsy. Seizure 1997; 6:383-391.
  • Fazlıoğlu K, Hocaoğlu Ç, Sönmez FM, Cansu A. Epilepsi tanısı konan çocukların aile işlevleri, anne- babalarındaki kaygı ve başa çıkma tutumları. Yeni Symposium 2010; 48:198-206.
  • Hodes M, Garralda ME, Rose G, Schwartz R. Maternal expressed emotion and adjustment in children with epilepsy. J Child Psychol Psychiatry 1999; 40:108310
  • Baker GA. Assessment of quality of life in people with epilepsy: some practical implications. Epilepsia 2001; 42(suppl 3):66-69.
  • Baker GA, Brooks J, Buck D, Jacoby A. The stigma of epilepsy: a European perspective. Epilepsia 2000; 41:98-104
  • MacLeod JS, Austin JK. Stigma in the lives of adolescents with epilepsy: a review of the literature. Epilepsy Behav 2003; 4:112-117.
  • Mazarati A, Shin D, Auvin S, Caplan R, Sankar R. Kindling epileptogenesis in immature rats leads to persistent depressive behavior. Epilepsy Behav 2007; 10:3773
  • Drevets WC, Frank E, Price JC, Kupfer DJ, Holt D, Greer PJ et al. PET imaging of serotonin 1A receptor binding in depression. Biol Psychiatry 1999; 46:1375-1387.
  • Gilliam FG, Maton BM, Martin RC, Sawrie SM, Faught RE, Hugg JW et al. Hippocampal 1H-MRSI correlates with severity of depression symptoms in temporal lobe epilepsy. Neurology 2007; 68:364-368.
  • Brent DA, Crumrine PK, Varma R, Brown RV, Allan MJ. Phenobarbital treatment and major depressive disorder in children with epilepsy: a naturalistic follow-up. Pediatrics 1990; 85:1086-1091.
  • Schmitz B. Effects of antiepileptic drugs on mood and behavior. Epilepsia 2006; 47(suppl 2):28-33.
  • Kanner AM, Palac S. Depression in epilepsy: a common but often unrecognized comorbid malady. Epilepsy Behav 2000; 1:37-51.
  • Ben-Menachem E. Topiramate: current status and therapeutic potential. Expert Opin Investig Drugs 1997; 6:1085-1094.
  • Leppik IE, Gram L, Deaton R, Sommerville KW. Safety of tiagabine: summary of 53 trials. Epilepsy Res 1999; 33:235-246.
  • Choi-Kwon S, Chung C, Kim H, Lee S, Yoon S, Kho H et al. Factors affecting the quality of life in patients with epilepsy in Seoul, South Korea. Acta Neurol Scand 2003; 108:428-434.
  • 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; 7:161-171.
  • Berg AT, Caplan R, Hesdorffer DC. Psychiatric and neurodevelopmental disorders in childhood-onset epilepsy. Epilepsy Behav 2011; 20:550-555.
  • Ettinger AB, Weisbrot DM, Nolan EE, Gadow KD, Vitale SA, Andriola MR et al. Symptoms of depression and anxiety in pediatric epilepsy patients. Epilepsia 1998; 39:595-599.
  • Williams J, Steel C, Sharp GB, DelosReyes E, Philips T, Bates S et al. Anxiety in children with epilepsy. Epilepsy Behav 2003; 4:729-732.
  • Dunn DW, Austin JK, Perkins SM. Prevalence of psychopathology in childhood epilepsy: categorical and dimensional measures. Dev Med Child Neurol 2009; 51:364-372.
  • Dunn DW, Austin JK. Differential diagnosis and treatment of psychiatric disorders in children and adolescents with epilepsy. Epilepsy Behav 2004; 5(suppl 3):10-17.
  • Pianta RC, Lothman DJ. Predicting behavior problems in children with epilepsy: child factors, disease factors, family stress, and child–mother interaction. Child Dev 1994; 65:1415-1428.
  • Alwash RH, Hussein MJ, Matloub FF. Symptoms of anxiety and depression among adolescents with seizures in Irbid, northern Jordan. Seizure 2000; 9:412-416.
  • Adewuya AO, Ola BA. Prevalence of and risk factors for anxiety and depressive disorders in Nigerian adolescents with epilepsy. Epilepsy Behav 2005; 6:342-347.
  • Dunn DW, Austin JK, Harezlak J, Ambrosius WT. ADHD and epilepsy in childhood. Dev Med Child Neurol 2003; 45:50-54.
  • McDermott SM, Akrishnaswami S. A population based analysis of specific behavior problem associated with childhood seizure. J Epilepsy 1995; 8:110-118.
  • Torres AR, Whitney J, Gonzalez-Heydrich J. Attention-deficit/hyperactivity disorder in pediatric patients with epilepsy: review of pharmacological treatment. Epilepsy Behav 2008; 12:217-233.
  • Tan M, Appleton R. Attention deficit and hyperactivity disorder, methylphenidate, and epilepsy. Arch Dis Child 2005; 90:57-59.
  • Parisi P, Moavero R, Verrotti A, Curatolo P. Attention deficit hyperactivity disorder in children with epilepsy. Brain Dev 2010; 32:10-16.
  • Sherman EM, Slick DJ, Connolly MB, Eyrl KL. ADHD, neurological correlates and health-related quality of life in severe pediatric epilepsy. Epilepsia 2007; 48:108310
  • Semrud-Clikeman M, Wical B. Components of attention in children with complex partial seizures with and without ADHD. Epilepsia 1999; 40:211-215.
  • Delgado-Escueta AV, Swartz BE, Walsh GO, Chauvel P, Bancaud J, Broglin D. Frontal lobe seizures and epilepsies in neurobehavioral disorders. Adv Neurol 1991; Powell AL, Yudd A, Zee P, Mandelbaum DE. Attention deficit hyperactivity disorder associated with orbitofrontal epilepsy in a father and a son. Neuropsychiatry Neuropsychol Behav Neurol 1997; 10:151-154.
  • Piccirilli M, D'Alessandro P, Sciarma T, Cantoni C, Dioguardi MS, Giuglietti M et al. Attention problems in epilepsy: possible significance of the epileptogenic focus. Epilepsia 1994; 35:1091-1096.
  • Deltour L, Barathon M, Quaglino V, Vernier MP, Despretz P, Boucart M, et al. Children with benign epilepsy with centrotemporal spikes (BECTS) show impaired attentional control: evidence from an attentional capture paradigm. Epileptic Disord 2007; 9:32-38.
  • Delgado-Escueta AV, Swartz BE, Walsh GO, Chauvel P, Bancaud J, Broglin D. Frontal lobe seizures and epilepsies in neurobehavioral disorders. Adv Neurol 1991; 55:317-340.
  • Powell AL, Yudd A, Zee P, Mandelbaum DE. Attention deficit hyperactivity disorder associated with orbitofrontal epilepsy in a father and a son. Neuropsychiatry Neuropsychol Behav Neurol 1997; 10:151–154.
  • Ben-Ari YHolmes GL. Effects of seizures on developmental processes in the immature brain. Lancet Neurol 2006; 5:1055-1063.
  • Holtmann M, Becker K, Kentner-Figura B, Schmidt MH. Increased frequency of rolandic spikes in ADHD children. Epilepsia 2003; 44:1241-1244.
  • Piedad J, Rickards H, Besag FM, Cavanna AE. Beneficial and adverse psychotropic effects of antiepileptic drugs in patients with epilepsy: a summary of prevalence, underlying mechanisms and data limitations. CNS Drugs 2012; 26:319-335.
  • Kanner AM, Soto A, Gross-Kanner H. Prevalence and clinical characteristics of postictal psychiatric symptoms in partial epilepsy. Neurology 2004; 62:708-713.
  • Kanner AM. Depression in epilepsy: a complex relation with unexpected consequences. Curr Opin Neurol 2008; 21:190-194
  • Fazlıoğlu K, Hocaoğlu Ç, Sönmez FN. Çocukluk çağı epilepsisinin aileye etkisi. Psikiyatride Güncel Yaklaşımlar 2010; 2:190-205.
  • Martinovic´ Z, Simoncovic´ P, Djokic´ R. Preventing depression in adolescents with epilepsy. Epilepsy Behav 2006; 9:619-624.
  • 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; 5:547-556.
  • Schmitz B. Antidepressant drugs: indications and guidelines for use in epilepsy. Epilepsia 2002; 43(suppl 2):14-18.
  • Hovorka J, Herman E, Nemcová I. Treatment of interictal depression with citalopram in patients with epilepsy. Epilepsy Behav 2000; 1:444-447.
  • Specchio LM, Iudice A, Specchio N, La Neve A, Spinelli A, Galli R et al. Citalopram as treatment of depression in patients with epilepsy. Clin Neuropharmacol 2004; Kanner AM, Kozak AM, Frey M. The use of sertraline in patients with epilepsy: is it safe? Epilepsy Behav 2000; 1:100-105.
  • Harden CL, Goldstein MA. Mood disorders in patients with epilepsy: epidemiology and management. CNS Drugs. 2002; 16:291-302.
  • Scicutella A, Ettinger AB. Treatment of anxiety in epilepsy. Epilepsy Behav 2002; 3(suppl 5):10-12.
  • Marsh L, Rao V. Psychiatric complications in patients with epilepsy: a review. Epilepsy Res 2002; 49:11-33.
  • Thomé-Souza MS, Kuczynski E, Valente KD. Sertraline and fluoxetine: safe treatments for children and adolescents with epilepsy and depression. Epilepsy Behav 2007; 10:417-425.
  • Feldman H, Crumrine P, Handen BL, Alvin R, Teodori J. Methylphenidate in children with seizures and attention-deficit disorder. Am J Dis Child 1989; 143:1081-1086.
  • Gross-Tsur V, Manor O, van der Meere J, Joseph A, Shalev RS. Epilepsy and attention deficit hyperactivity disorder: is methylphenidate safe and effective? J Pediatr 1997; 130:670-674.
  • Gucuyener K, Erdemoglu AK, Senol S, Serdaroglu A, Soysal S, Kockar AI. Use of methylphenidate for attention-deficit hyperactivity disorder in patients with epilepsy or electroencephalographic abnormalities. J Child Neurol 2003; 18:109-112.
  • Öç ÖY, Karakaya I, Şişmanlar ŞG. Epilepsi ve DEHB tanılı çocuklarda güncel tedavi yaklaşımları. Yeni Symposium 2009; 47:129-134.
  • Torres A, Whitney J, Rao S, Tilley C, Lobel R, Gonzalez-Heydrich J. Tolerability of atomoxetine for treatment of pediatric attention-deficit/hyperactivity disorder in the context of epilepsy. Epilepsy Behav 2011; 20:95-102.
  • Pisani F, Oteri G, Costa C, Di Raimondo G, Di Perri R. Effects of psychotropic drugs on seizure threshold. Drug Saf 2002; 25:91-110.
  • Owens MJ, Risch SC. Atypical antipsychotic. In Textbook of Psychopharmacology (Eds AF Schatzberg, CB Nemeroff):263-280. Washington DC, American Psychiatric Press, 1995.
  • Holzhausen SP, Guerreiro MM, Baccin CE, Montenegro MA. Use of risperidone in children with epilepsy. Epilepsy Behav 2007; 10:412-416.
  • Gonzalez-Heydrich J, Pandina GJ, Fleisher CA, Hsin O, Raches D, Bourgeois BF et al. No seizure exacerbation from risperidone in youth with comorbid epilepsy and psychiatric disorders: a case series. J Child Adolesc Psychopharmacol 2004; 14:2953
  • Roeder R, Roeder K, Asano E, Chugani HT. Depression and mental health helpseeking behaviors in a predominantly African American population of children and adolescents with epilepsy. Epilepsia 2009; 50:1943-1952.
  • Reilly C, Agnew R, Neville BG. Depression and anxiety in childhood epilepsy: a review. Seizure. 2011; 20:589-597.
  • Gürkan K, Tüzün Ü. Epileptik çocuk ve ergenlerde psikiyatrik başvuru ve tedavi. Klinik Psikofarmakoloji Bülteni 2006; 16:22-30.
  • Bilgiç A, Yılmaz S, Tıraş S, Deda G, Kılıç EZ. Bir grup epilepsili çocukta depresyon ve anksiyete belirti düzeyi ve ilişkili faktörler. Turk Psikiyatri Derg 2006; 17:165-172. Özalp Ekinci, Yrd.Doç.Dr., Mersin Üniversitesi Tıp Fakültesi, Mersin; Fevziye Toros, Prof. Dr., Mersin Üniversitesi Tıp Fakültesi, Mersin . Yazışma Adresi/Correspondence: Özalp Ekinci, Mersin Üniversitesi Tıp Fakültesi, Mersin, Turkey. E-mail: ozalpekinci@yahoo.com Yazarlar bu makale ile ilgili herhangi bir çıkar çatışması bildirmemişlerdir. The authors reported no conflict of interest related to this article. Çevrimiçi adresi / Available online at: www.cappsy.org/archives/vol5/no1/ Çevrimiçi yayım / Published online 5 Kasım/November 5, 2012; doi:10.5455/cap.20130505