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Anti-seizure medication is a minor causative factor in behavioral problems of children with tuberous sclerosis
H M Hulshof1, J K Heijstek2, W M Otte1
1Department of Pediatric Neurology, UMC Utrecht Brain Center, Utrecht, the Netherlands.
Insights
This study found no evidence that specific anti-seizure medications (ASMs) worsen behavioral problems in children with Tuberous Sclerosis Complex (TSC) and epilepsy. The benefits of ASMs likely outweigh potential behavioral risks in managing TSC symptoms.
Area of Science:
- Neuroscience
- Pediatrics
- Pharmacology
Background:
- Behavioral problems significantly burden patients and caregivers with Tuberous Sclerosis Complex (TSC), often lacking a clear etiology.
- Anti-seizure medications (ASMs) are commonly used in TSC, but their impact on behavioral issues requires further investigation.
Purpose of the Study:
- To investigate the relationship between specific anti-seizure medications (ASMs) and behavioral manifestations in children diagnosed with Tuberous Sclerosis Complex (TSC) and epilepsy.
- To determine if certain ASMs are associated with an increase or decrease in behavioral problems, including aggression, attention deficits, eating and sleeping disturbances, and temper tantrums.
Main Methods:
- A retrospective cohort study included 118 children (aged 2-18) with TSC and epilepsy.
- Behavioral problems were categorized, and their association with specific ASMs versus any other ASM was analyzed using Odds Ratios within 90 days of ASM initiation.
- Multivariable multinomial log-linear modeling was employed to relate behavioral problems to disease characteristics.
Main Results:
- Behavioral problems were reported in 66% of patients, with temper tantrums being the most prevalent (53%).
- No significant evidence indicated that specific ASMs aggravated behavioral problems.
- Intellectual disability and autism spectrum disorder were linked to attention and sleeping problems.
Conclusions:
- The study did not find a causal link between specific anti-seizure medications and the exacerbation of behavioral problems in children with TSC.
- The potential therapeutic benefits of ASMs in managing epilepsy associated with TSC are likely to outweigh the observed risks of behavioral issues.
Introduction:
Behavioral problems in Tuberous Sclerosis Complex (TSC) are considered among the highest disease burden for both patients and caregivers, while the cause is often not clear. The current study aimed to explore the relationship between anti-seizure medication (ASM) and behavioral manifestations in children with TSC and epilepsy.
Methods:
118 children referred to the University Medical Center Utrecht with definite TSC and epilepsy, aged 2-18 years, were included in a retrospective cohort study. Behavioral problems were categorized into: 'any behavioral problem', 'aggressive behavior', 'attentional', 'eating' and 'sleeping' problems, and 'temper tantrums'. In a descriptive analysis, we studied the relationship between behavioral problems and exposure to specific ASMs compared to any other ASM. We looked in detail at manifestations occurring within ninety days after ASM initiation. For both time points we calculated Odds Ratios, comparing use of a specific ASM with use of any other ASMs. In addition, behavioral problems were related to disease characteristics with multivariable multinomial log-linear modeling after variable selection.
Results:
During a mean follow-up of nine years, 616 ASM prescriptions were made. Behavioral problems were reported in 66% of patients, with temper tantrums showing the highest prevalence (53%). However, behavioral problems were low in association with a specific ASM. From the disease-inherent factors intellectual disability and autism spectrum disorder were significantly associated with attention and sleeping problems.
Conclusion:
We did not find evidence for aggravation of behavioral problems with specific ASM use. In this complexity of symptoms of TSC the possible benefits of ASM, therefore, likely outweigh the risk of behavioral problems.
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