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Epilepsy is a chronic neurological disease marked by recurrent, unpredictable seizures. These seizures are caused by abnormal electrical discharges in the brain, leading to behavior, sensation, or consciousness alterations. They can also cause transient impairment of awareness, interfering with daily activities.
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Internalizing symptoms in intractable pediatric epilepsy: Structural and functional brain correlates.

Michele Morningstar1, Andy Hung2, Whitney I Mattson2

  • 1Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States of America; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States of America.

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Internalizing disorders like depression and anxiety are common in youth with epilepsy. Brain imaging revealed reduced cortical thickness and function in these children, suggesting potential biomarkers.

Keywords:
AnxietyBrain structureDepressionEpilepsyFunctional activationInternalizing symptoms

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Area of Science:

  • Neuroscience
  • Pediatric Neurology
  • Child Psychiatry

Background:

  • Internalizing disorders (depression, anxiety) frequently co-occur with epilepsy in adults, impacting seizure control and quality of life.
  • Brain correlates of internalizing symptoms are less understood in pediatric epilepsy populations.

Purpose of the Study:

  • To investigate the neural correlates of internalizing symptoms in youth with intractable epilepsy.
  • To identify potential brain biomarkers associated with depression and anxiety in this demographic.

Main Methods:

  • Retrospective analysis of 45 youth (6-18 years) with intractable epilepsy.
  • Evaluation of internalizing symptoms using the Child Behavior Checklist (CBCL).
  • Magnetic resonance (MR) and fluorodeoxyglucose (FDG)-positron emission tomography (PET) imaging.

Main Results:

  • 42% of patients exhibited clinically significant internalizing symptoms.
  • Youth with internalizing problems showed reduced cortex volume, cortical thickness, and functional activation in specific brain regions (occipital/parietal, left temporal, left inferior frontal).
  • No differences were found in amygdala/hippocampus volumes or epilepsy-related variables.

Conclusions:

  • Refractory epilepsy in youth is associated with high rates of internalizing disorders.
  • Multifocal reductions in cortical thickness and function may indicate risk for internalizing symptoms.
  • Radiological findings of cortical thinning and reduced glucose uptake may prompt psychological evaluations.