Comorbidites in Epilepsy

An eight-year-old boy with epilepsy shows signs of learning problems and is having trouble at school. A 13-year-old girl with complex partial seizures complains of frequent abdominal pain. A 19-year-old whose seizures are well controlled by medication is diagnosed with depression.

As if dealing with the uncertainty and difficulty of epilepsy weren’t enough, many children and teens with epilepsy also experience comorbidities—concurrent medical or psychological conditions of various kinds. Several different types of comorbidities exist in epilepsy. Cognitive comorbidities are learning problems that cause difficulty in school and can have lasting effects on educational and professional success. Psychiatric comorbidities are behavior and mood problems including Attention Deficit Disorder (ADD), depression, anxiety disorders and combinations of these conditions. There are also physical comorbidities, ranging from headaches to ulcers to chronic fatigue. And  there are the psycho-social issues of having to deal with the stigma that surrounds epilepsy, the experience of having seizures in public, the difficulty of peer relationships and the discrimination that people with epilepsy often encounter in schools, jobs, sports and social settings.

Comorbidities create some of the most challenging issues for people with epilepsy and their families. “The packet of having cognitive, linguistic and psychiatric comorbidities makes this a very difficult illness to deal with, even if your seizures are controlled,” says Rochelle Caplan, M.D., professor and director of the Pediatric Neuropsychiatry Program at UCLA. Researchers agree that rates of comorbidities in people with epilepsy are high; some studies show twice the rate of ADD as in the general population, and estimates are that as many as 50 percent of people with poorly controlled or other complicated epilepsies have psychiatric or behavioral comorbidities.

A number of intersecting variables affect who experiences which comorbidities, and how severe their impact is—and it can be extraordinarily difficult to tease these variables apart. Some are basic epilepsy factors: age of onset of seizures, frequency of seizures, duration of treatment, effects of medication and so on. “The earlier the onset of seizures, usually the more severe the seizure disorder, the more difficult to control the seizures are, and the more medications the kids are on,” says Dr. Caplan. "So these are all very confounding variables, all of which can contribute to behavior and cognition.”

Joan Austin, D.N.S., a researcher and professor at the Indiana University School of Nursing who has studied epilepsy comorbidities extensively, believes that seizure frequency is often key. “We do find that the more seizures they have, the more likely they are to have mental health problems,” she says. “And even in the type of seizures that are relatively benign, the kind they outgrow, we find that these children also have behavior problems.”

Yet Dr. Austin also feels that social variables can be enormously important. “We’ve found that families who are fairly organized in the way they approach life—you could almost say the environment’s pretty organized— that those children actually do better at school and behaviorally,” she says. “The family environment is very important. In families who work together, have routines, and the child has rules to follow — not a rigid family, but an organized one — these children are better able to compensate for some of the cognitive deficits and do better than anticipated in school. And children who are in these families also do better behavior-wise; they don’t have as many mental health problems.”