Beyond Seizures: Psychiatric comorbidities in children with epilepsy

Children with epilepsy are at an increased risk of developing psychiatric comorbidities, which exacerbate the overall disease burden. However, these disorders are often underreported in developing countries. This study, conducted in a developing country, aims to evaluate the frequency of psychiatric disorders and associated factors in a large cohort of children with epilepsy.

This study is part of a large, ongoing prospective study on a cohort of children with epilepsy in Lebanon. Children were recruited at the onset of their seizures between March 2010 and May 2016 and were followed for periods ranging from 2 to 12 years. The medical records of 598 children with new-onset seizures were analyzed throughout their follow-up period to identify the presence of any psychiatric disorders. Psychiatric disorders were classified as internalizing or externalizing disorders based on DSM-5 criteria and were considered present if the child had been referred and diagnosed by a pediatric psychiatrist, therapist, or neurologist, or if the medical record provided clear evidence of the child taking medication for a psychiatric disorder. Multivariable logistic regression was used to identify factors associated with psychiatric disorders.

Of the 598 children with new onset seizures, 75 (12.5 %) were diagnosed with a psychiatric disorder, with 30 (5.0 %) having an internalizing disorder and 47 (7.9 %) having an externalizing disorder. Externalizing psychiatric disorders were most commonly reported children with developmental epileptic encephalopathies (18.2 %) compared to other epilepsy groups. Intellectual and developmental delay was the most important factor associated with externalizing disorders (OR 3.36, 95 %CI 1.48-7.62, p = 0.004). In contrast, the frequency of internalizing disorders didn't differ across epilepsy groups. The most significant factors associated with the occurrence of internalizing psychiatric comorbidity were the failure of at least two antiseizure medications (OR 3.25, 95 % CI 1.37-7.71, p = 0.007) and an older age at seizure onset (> 10 years vs. < 2 years, OR 6.86, 95 % CI 1.49-31.57, p = 0.013).

The prevalence of diagnosed psychiatric comorbidities in children with epilepsy in this study was lower than previously reported in developed countries. This may indicate potential underreporting of psychiatric disorders in Lebanon, where local practices may prioritize epilepsy management over mental health. This study highlights the need for systematic psychiatric screening during routine clinic visits, particularly for children with intellectual or developmental delays and those with poor seizure control.