title: Neurobehavioral comorbidities in children with active epilepsy: a population-based study.
abstract: BACKGROUND
  In addition to recurrent epileptic seizures, children with epilepsy can have coexisting cognitive and behavioral difficulties but the spectrum and prevalence of such difficulties are uncertain.
  
  
  METHODS
  The Children with Epilepsy in Sussex Schools study is a prospective, community-based study involving school-aged children (5–15 years) with active epilepsy in a defined geographical area in the United Kingdom. Participants underwent comprehensive psychological assessment, including measures of cognition, behavior, and motor functioning. Consensus neurobehavioral diagnoses were made with respect to Diagnostic and Statistical Manual, Fourth Edition-Text Revision (DSM-IV-TR) criteria.
  
  
  RESULTS
  A total of 85 children (74% of eligible population) were enrolled; 80% of children with active epilepsy had a DSM-IV-TR behavioral disorder and/or cognitive impairment (IQ ,85). Intellectual disability (ID) (IQ ,70) (40%), attention-deficit/hyperactivity disorder (ADHD) (33%), and autism spectrum disorder (ASD) (21%) were the most common neurobehavioral diagnoses. Of those who met criteria for a DSM-IV-TR behavioral disorder, only one-third had previously been diagnosed. Logistic regression revealed that seizures in the first 24 months compared with first seizures at 24 to 60 or 61+ months (odds ratio [OR] 13, 95% confidence interval 2.2–76.9; OR 21.3, 3.2–148.9) and polytherapy (OR 7.7, 1.6–36.3) were independently associated with ID and the presence of ID was associated with a diagnosis of ASD (OR 14.1, 2.3–87.1) after Bonferroni adjustment. Epilepsy-related factors did not independently predict the presence of behavioral disorders.
  
  
  CONCLUSIONS
  Screening for neurobehavioral comorbidities should be an integral part of management in children with “active” epilepsy. There is a need for research to identify neurobiological mechanisms underpinning neurobehavioral impairments and studies to evaluate possible treatments.
authors.forename: Colin
authors.initials: C
authors.lastname: Reilly
authors.forename: Patricia
authors.initials: P
authors.lastname: Atkinson
authors.forename: Krishna B
authors.initials: KB
authors.lastname: Das
authors.forename: Richard F M C
authors.initials: RF
authors.lastname: Chin
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Aylett
authors.forename: Victoria
authors.initials: V
authors.lastname: Burch
authors.forename: Christopher
authors.initials: C
authors.lastname: Gillberg
authors.forename: Rod C
authors.initials: RC
authors.lastname: Scott
authors.forename: Brian G R
authors.initials: BG
authors.lastname: Neville
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis / Q000453:epidemiology*; D002675:Child, Preschool; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004739:England; D004827:Epilepsy / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006306:Health Surveys; D006801:Humans; D008607:Intellectual Disability / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D009422:Nervous System Diseases / Q000175:diagnosis / Q000453:epidemiology*; D012307:Risk Factors
chemical_list: D000927:Anticonvulsants