title: Children with epilepsy and anxiety: Subcortical and cortical differences.
abstract: OBJECTIVE
  Using a hypothesis-driven approach, subcortical and cortical regions implicated in anxiety disorders in the general population were examined in children with recent-onset epilepsy with versus without anxiety compared to controls. This study reports frequency of anxiety disorders while examining familial, clinical, and demographic variables associated with anxiety in children with epilepsy.
  
  
  METHODS
  Participants included 88 children with epilepsy aged 8-18 years: 25 with a current anxiety disorder and 63 children with epilepsy and no current anxiety disorder. Forty-nine controls without anxiety disorders were included. T1 volumetric magnetic resonance imaging (MRI) scans were collected; subcortical volumes and cortical thickness were computed using the FreeSurfer image analysis suite. Analyses focused on adjusted measures of subcortical volumes and cortical thickness.
  
  
  RESULTS
  Relative to controls, larger left amygdala volumes were found in the Epilepsy with Anxiety group compared to the Epilepsy without Anxiety group (p = 0.027). In the hippocampus, there were no significant differences between groups. Examination of cortical thickness demonstrated that the Epilepsy with Anxiety group showed thinning in left medial orbitofrontal (p = 0.001), right lateral orbitofrontal (p = 0.017), and right frontal pole (p = 0.009). There were no differences between groups in age, sex, IQ, age of onset, medications, or duration of epilepsy. There were more family members with a history of anxiety disorders in the Epilepsy with Anxiety group compared to the Epilepsy without Anxiety group (p = 0.005).
  
  
  CONCLUSIONS
  Anxiety is a common psychiatric comorbidity in children with recent-onset epilepsy with volumetric enlargement of the amygdala and thinner cortex in orbital and other regions of prefrontal cortex, suggesting structural abnormalities in brain regions that are part of the dysfunctional networks reported in individuals with anxiety disorders in the general population. These findings are evident early in the course of epilepsy, are not related to chronicity of seizures, and may be linked to a family history of anxiety and depressive disorders.
authors.affiliation: Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A.
authors.forename: Jana E
authors.initials: JE
authors.lastname: Jones
authors.forename: Daren C
authors.initials: DC
authors.lastname: Jackson
authors.forename: Karlee L
authors.initials: KL
authors.lastname: Chambers
authors.forename: Kevin
authors.initials: K
authors.lastname: Dabbs
authors.forename: David A
authors.initials: DA
authors.lastname: Hsu
authors.forename: Carl E
authors.initials: CE
authors.lastname: Stafstrom
authors.forename: Michael
authors.initials: M
authors.lastname: Seidenberg
authors.forename: Bruce P
authors.initials: BP
authors.lastname: Hermann
mesh_terms: D000293:Adolescent; D000679:Amygdala / Q000473:pathology; D001007:Anxiety / Q000175:diagnosis / Q000473:pathology*; D001008:Anxiety Disorders / Q000473:pathology*; D001931:Brain Mapping / Q000379:methods; D002540:Cerebral Cortex / Q000473:pathology*; D002648:Child; D004827:Epilepsy / Q000175:diagnosis / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male
keywords: Amygdala; Anxiety disorders; Pediatric Epilepsy