Drug Treatment of Epilepsy Neuropsychiatric Comorbidities in Children
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REVIEW ARTICLE
Drug Treatment of Epilepsy Neuropsychiatric Comorbidities in Children Gregory L. Holmes1 Accepted: 30 October 2020 © Springer Nature Switzerland AG 2020
Abstract There is increasing recognition that epilepsy can be associated with a broad spectrum of comorbidities. While epileptic seizures are an essential element of epilepsy in children, there is a spectrum of neurological, mental health and cognitive disorders that add to the disease burden of childhood epilepsy resulting in a decreased quality of life. The most common comorbid conditions in childhood epilepsy include depression, anxiety, autism spectrum disorders, sleep disorders, attention deficits, cognitive impairment, and migraine. While epilepsy can result in comorbidities, many of the comorbidities of childhood have a bi-directional association, with the comorbid condition increasing risk for epilepsy and epilepsy increasing the risk for the comorbid condition. The bidirectional feature of epilepsy and the comorbidities suggest a common underlying pathological basis for both the seizures and comorbid condition. While recognition of the comorbid conditions of pediatric epilepsies is increasing, there has been a lag in the development of effective therapies partly out of concern that drugs used to treat the comorbid conditions could increase seizure susceptibility. There is now some evidence that most drugs used for comorbid conditions are safe and do not lower seizure threshold. Unfortunately, the evidence showing drugs are effective in treating many of the childhood comorbidities of epilepsy is quite limited. There is a great need for randomized, placebocontrolled drug trials for efficacy and safety in the treatment of comorbidities of childhood epilepsy. Key Points Children with epilepsy have a high prevalence of comorbid conditions. For most comorbid conditions, epilepsy is not causative but has a bidirectional association with the comorbidity. Most psychotropic medications are not contraindicated in children with epilepsy. Drug treatment of comorbid conditions in children with epilepsy is similar to treatment of children without epilepsy. Efficacy information on treatment of comorbid conditions in childhood epilepsy is based on limited data.
* Gregory L. Holmes [email protected] 1
Department of Neurological Sciences, Larner College of Medicine, University of Vermont, Stafford Hall, 118C, Burlington, VT 05405, USA
1 Introduction While epileptic seizures are the quintessential defining element of epilepsy, there has been increasing recognition that there is a spectrum of cognitive, behavioral, and psychiatric disorders that accompany epilepsy [1, 2]. Reflecting the idea that epilepsy can be associated with a broad spectrum of comorbidities, epilepsy is now defined as “a disease characterized by an enduring predisposition to generate epileptic seizures and by the neurobiological, cognitive, psychological, and social consequences of this condition” [3]. Indeed, comorbid conditions, defined as a greater than coincidental ass
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