Psychopathology in childhood epilepsy: A prospective study of 150 newly diagnosed epileptic children

Three hundred and eleven consecutive epileptic children, younger than 12 years, were newly diagnosed and treated at the Epilepsy Centre, departmen of Pediatric, University of Milano, between jan., 1987 adn dec., 1987. Of these, only 150 patients, who encountered the following inclusion criteria, entered the study: 1. previously untreated, newly diagnosed epilepsy before 12 years; 2. absence of neurological and/or psychological impairment at the time of diagnosis; 3. at least two years of follow-up. These patients were studied in order to detect the appearance of psychological disorders following the first seizures. Eighty five (56.7%) did not develop psychopathological disturbances during the course of epilepsy. Some disorder followed the start of the illness in the remainders (43.4%), but only 40 (26.7% of the entire group) showed some types of psychological problem at the end of follow-up. Regarding the type of the disorder, mental retardation was the most frequent (19.0%); behavioural disorders were diagnosed in 16.7% of the patients immediately after the start of treatment, but most of them were transient and probably drug-dependent. Only 8 patients (5.3%) showed behavioural and/or neurotic disturbances at the end of the observation. Psychotic disorders were diagnosed in 4 children (2.7%). The cumulative probability of developing psychopathological disorders is linked to the early onset of the seizures (p = 0.0000), the appearance of neurological or neuroradiological impairment (p = 0.0000), the high frequency of seizures at the end of follow-up (p = 0.0002), the treatment with PB, PHT or benzodiazepines (p = 0.0239) and the type of epilepsy (West syndrome, Lennox-Gastaut syndrome, Myoclonic-Astitic Epilepsy). The present study suggests that a normal child who begins the treatment after at least two seizures has a 26.7% cumulative probability of developing an established psychopathological disorder. This risk is probably linked to the massive and subcontinuous (clinical or infraclinical) cerebral discharges characteristics of some type of first year generalized epilepsies, that can disconnect the continuity of the consciousness in a developing brain. Cognitive and psychotic disorders have been more frequently observed than behavioural or neurotic ones. This fact can support the hypothesis that the early onset of some generalized epilepsies can affect basically the cerebral functions.