Children with both epilepsy and anxiety have volumetric brain changes similar to those found in nonepileptic patients with anxiety, according to new research presented at the 30th International Epilepsy Congress (IEC).
“Frequently, anxiety in epilepsy is viewed as a result of the unpredictability of seizures and is not treated,” said Jana Jones, PhD, assistant professor in neuropsychology at the University of Wisconsin School of Medicine and Public Health in Madison.
“But the results of this study suggest that there is a presence of an abnormal underlying neural biology that may be affecting some subcortical and cortical regions implicated in anxiety.”
“The clinical implication of this finding is that evidenced-based treatments for anxiety disorders should be utilized in children with epilepsy and anxiety, particularly if the neurobiology is similar in individuals with anxiety regardless of seizure status.”
The research involved 88 children with epilepsy (24 with anxiety and 64 without) and 50 control participants without epilepsy or anxiety who were first-degree cousins of the epilepsy patients.
The median age of participants was between 12 and 13 years old.
Age at seizure onset for those with anxiety was about 12 years old, and for participants without anxiety, about 11 years old.
“Children with epilepsy were assessed within 12 months of their diagnosis, had normal neurological exams and normal clinical MRI,” said Jones.
For the study, all participants and their parents took part in a semi-structured psychiatric interview (Kiddie Schedule for Affective Disorders and Schizophrenia).
In terms of types of anxiety disorders that were identified, “the most frequent diagnosis was specific phobia, and then second was separation anxiety, followed by social phobia and generalized anxiety disorder,” she said. “Many of the children had more than one anxiety disorder, or a depressive disorder was also present.”
Participants were also given T1 MRI brain scans.
“We focused on amygdala volumes and the prefrontal cortex thicknesses related to hypotheses from the general literature that we know about anxiety disorders and their involvement in these brain regions,” said Jones.
“These brain regions have not really been examined in kids with new or recent-onset epilepsy who also have a current anxiety disorder.”
The findings revealed that children who have an anxiety disorder plus epilepsy have much larger left amygdala volumes compared with children who have only epilepsy and also control individuals.
“In children with epilepsy plus anxiety, both the left and right amygdala volumes were greater — but only significantly so in the left amygdala,” she noted.
Furthermore, those with both epilepsy and anxiety showed a pattern of cortical thinning in frontal lobe regions known to be associated with emotion and anxiety, she said.
She said that these findings point to the importance of diagnosing and treating anxiety in children with epilepsy.
“We know that untreated anxiety in childhood increases the likelihood of depression and other [co-occurring] psychiatric conditions in adulthood, so it is important to treat these conditions early,” she said, adding that her group recently conducted a pilot study using cognitive-behavioral therapy to which children responded “quite well.”