Deborah M. Weisbrot

Symptoms of Depression and Anxiety in Pediatric Epilepsy Patients

Summary: Purpose: We assessed rates of symptoms of anxiety and depression among pediatric patients with epilepsy.

Cognitive functioning in children and adolescents with multiple sclerosis

Objective: To examine cognitive functioning in children with multiple sclerosis (MS). Methods: The authors examined the neuropsychological profile of 37 children with a diagnosis of clinically definite MS and assessed the associations between cognitive function and clinical features. Results: Of 37 children and adolescents evaluated, 35% demonstrated significant cognitive impairment. Cognitive functioning was strongly related to several clinical variables, including current Expanded Disability Status Scale, total number of relapses, and total disease length. The consequences of MS adversely affected academic functioning in over a third of the children. Conclusions: Cognitive deficits occur in children with multiple sclerosis. Comprehensive treatment planning should involve recognition that they may require academic accommodations for their education.

A comprehensive profile of clinical, psychiatric, and psychosocial characteristics of patients with psychogenic nonepileptic seizures

Summary: Purpose: To attain a comprehensive profile of clinical, psychiatric and psychosocial characteristics of patients with psychogenic nonepileptic seizures (NESs), and to assess the relation of these factors to NES outcome.

Positive and Negative Psychotropic Effects of Lamotrigine in Patients with Epilepsy and Mental Retardation

Summary: Purpose: To describe significant positive or negative psychotropic effects of lamotrigine (LTG) observed in epilepsy patients with mental retardation (MR).

Headaches and other pain symptoms among patients with psychogenic non-epileptic seizures

Studies of patients with psychogenic non-epileptic seizures (NES) typically focus upon the phenomenology and outcome of NES episodes. Little is known, however, about the frequency and nature of other somatic symptoms such as pain, in this population. To assess the frequency, location and severity of symptoms of pain among NES patients, we administered structured interviews to 56 patients, 6 or more months following the diagnosis of psychogenic non-epileptic seizures (NES). Patients were recruited from a tertiary hospital-based epilepsy monitoring unit. Seventy-seven percent of patients suffered from moderate to severe pain, most commonly headache (61%), while neck pain and backache were also common. Twenty-six of 27 patients with persistent NES vs. 17 of 29 patients whose NES resolved experienced moderate to severe pain (P < 0.001). Pain is an under-recognized problem that occurs frequently and with significant severity among NES patients. Pain symptoms are more common among patients with persistent NES than those whose NES resolve.

A multisite controlled study of risk factors in pediatric psychogenic nonepileptic seizures

Psychogenic nonepileptic seizures (PNES) in youth are symptoms of a difficult to diagnose and treat conversion disorder. PNES is associated with high medical and psychiatric morbidity, but specific PNES risk factors in the pediatric population are not known. We examined if youth with PNES have a distinct biopsychosocial risk factor profile compared to their siblings and if the interrelationships between these risk factors differentiate the PNES probands from the sibling group.

Fatigue and Depression in Epilepsy

Fatigue is commonly reported as an adverse effect of antiepileptic drugs. In other disorders, fatigue has been closely correlated with depression. We examined the frequency of fatigue in epilepsy patients, the contribution of depression to fatigue, and the impact of fatigue upon quality of life. We measured fatigue and depression with the Fatigue Severity Scale (FSS) and Center for Epidemiological Studies-Depression scale (CES-D), respectively in 89 patients with epilepsy at an epilepsy center, 26 depressed controls (DC), and 30 normal health adults (NHA). Patients with epilepsy also completed the Quality of Life in Epilepsy (QOLIE-10) scale. Forty-four percent of epilepsy patients met criteria for severe fatigue, while 52% were depressed. The correlation between fatigue and depression was high among epilepsy patients (r = .60, p = .0001). Both fatigue and depression had an inverse relationship with quality of life in epilepsy (p < .0001). Fatigue in epilepsy is common and is closely associated with depression. Fatigue is associated with significant impairment in quality of life in epilepsy.

Psychiatric diagnoses and cognitive impairment in pediatric multiple sclerosis

Background: Pediatric multiple sclerosis (MS) represents approximately 5% of the MS population; information regarding clinical features is slowly accumulating. Cognitive and psychiatric impairments frequently occur, but remain poorly understood. Objectives: To describe psychiatric diagnoses among children with MS referred for psychiatric assessment and their relation to cognitive impairment. Methods: Forty-five pediatric MS patients (aged 8 to 17 years) were referred for outpatient psychiatric evaluation including a psychiatric interview (K-SADS), a clinician-based global assessment of functioning (Children’s Global Assessment Scale, CGAS), a neurologic examination including the Expanded Disability Status Scale (EDSS), and a neuropsychological test battery. Results: The most common categories of psychiatric diagnoses were anxiety disorders (n=15), attention deficit hyperactivity disorder (ADHD, n=12), and mood disorders (n=11). Cognitive impairment was classified in 20/25 (80%) of patients meeting criteria for a psychiatric disorder versus 11/20 (55%) of those without psychiatric disorder (p=0.08). Those diagnosed with anxiety or mood disorder had the highest frequency of cognitive impairment, with a significantly higher rate when compared with those with psychiatric diagnoses in other categories (p=0.05). Conclusions: A variety of psychiatric diagnoses can occur in children with pediatric MS. Many of these children also had cognitive impairment, particularly those in the mood and anxiety groups.

Prelude to a school shooting? Assessing threatening behaviors in childhood and adolescence

On March 21, 2005, Jeffrey Weise, a 16-year-old student at Red Lake High School, Minnesota, killed his grandfather and his grandfather_s girlfriend. Next, he drove his grandfather_s squad car to the high school and fatally shot a security guard. Before mortally wounding five students and a teacher and injuring seven others, Jeffrey smiled and waved. He then committed suicide by shooting himself in the head.

Pediatric psychogenic nonepileptic seizures: A study of assessment tools

The goal of this study was to identify assessment tools and associated behavioral domains that differentiate children with psychogenic nonepileptic seizures (PNES) from those with epilepsy. A sample of 24 children with PNES (mean age 14.0 years, 14 female), 24 children with epilepsy (mean age 13.6 years, 13 female), and their parents were recruited from five epilepsy centers in the United States. Participants completed a battery of behavioral questionnaires including somatization, anxiety, and functional disability symptoms. Children with PNES had significantly higher scores on the Childhood Somatization and Functional Disability Inventories, and their parents reported more somatic problems on the Child Behavior Checklist (CBCL). Depression, anxiety, and alexithymia instruments did not differentiate the groups. Measures of somatization and functional disability may be promising tools for differentiating the behavioral profile of PNES from that of epilepsy. Increased somatic awareness and perceived disability emphasize the similarity of PNES to other pediatric somatoform disorders.