Abstracts

Rationale: The threat of unpredictable seizures, and the experience being out of control during seizures, makes epilepsy unique among childhood chronic illnesses. One of the primary consequences is that people who have childhood-onset epilepsy, even without other neurologic problems, often have poor social adjustment and competence in adulthood. Interventions are urgently needed to avoid such adverse life-long outcomes, to benefit affected individuals and families, and to reduce financial pressures on social support programs. We created a group cognitive behavioral therapy program, designed to enhance the level of social and emotional functioning of adolescents with epilepsy as they become more independent in managing their disorder. Here, we report the baseline mental health characteristics of our study subjects.Methods: Adolescents with epilepsy (ages 13-to-17), whose cognitive abilities allowed independent completion of questionnaires, and their parent, were recruited. Patients and their parents independently completed the Strengths and Difficulties Questionnaire (SDQ) prior to the patients attending a group session that was designed to teach about epilepsy and employ psycho-education to help youth identify the feelings, thoughts and behaviors that lead to negative outcomes and experiential exercises to change the way they cope with adverse situations. The SDQ is a measure of emotional and behavioral difficulties, as well as the resultant distress and social impairment, validated for children aged 4 17-years. Medical records were reviewed for relevant clinical and demographic data. Results: Thirty-five adolescents participated in the group intervention (N=26 males; mean age 14.8 SD 1.4 years). Fifty-four percent (N=25) had generalized and 39% (N=18) had focal epilepsy syndromes. Forty-six percent were seizure-free and 54% had at least one seizure per month. Baseline SDQ scores suggested that many participants were possibly at risk (parent report=35.9%, adolescent=10.3%) or probably at risk (parent report=18.2%, adolescent=9.1%) for a psychiatric disorder. Parents tended to report higher Peer Problems scores than their adolescent child (37.2% vs 4.7% abnormal; p = 0.009). The same was true for Emotional Symptoms scores (42.2% vs 13.3% abnormal scores; p=0.009). Adolescents were more likely than their parents to report normal Impact Score classifications (59.1% vs 38.6%, p=0.031). Immediately after the group intervention, adolescents reported marginally improved scores on the Hyperactivity (p=0.08) and Prosocial Behavior (p=0.06) SDQ subscales. Long-term follow-up is ongoing. Conclusions: Parents appear pessimistic about their children s mental health and social functioning. However, even among high-functioning adolescents with well-controlled epilepsy, both patients and their parents report that epilepsy has a major impact at home, with friendships, and in learning and leisure activities. Preliminary data suggest that adolescents self-reported mental health improved after a group cognitive behavioral therapy intervention, coupled with epilepsy education.