Consensus-based recommendations for the diagnosis and treatment of anxiety and depression in children and adolescents with epilepsy: A report from the Psychiatric Pediatric Issues Task Force of the International League Against Epilepsy.

Autor: Valente KD; Laboratory of Clinical Neurophysiology, Hospital das Clínicas, Faculty of Medicine of the University of São Paulo (HCFMUSP), Sao Paulo, Brazil.; Laboratory of Medical Investigation-LIM 21-Faculty of Medicine, University of Sao Paulo (FMUSP), Sao Paulo, Brazil.; Division of Child and Adolescent Psychiatry, Department of Psychiatry, Faculdade de Medicina, FMUSP, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil., Reilly C; Research Department, Young Epilepsy, Lingfield, Surrey, UK.; Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.; Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden., Carvalho RM; Laboratory of Clinical Neurophysiology, Hospital das Clínicas, Faculty of Medicine of the University of São Paulo (HCFMUSP), Sao Paulo, Brazil.; Division of Child and Adolescent Psychiatry, Department of Psychiatry, Faculdade de Medicina, FMUSP, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil., Smith ML; Department of Psychology, University of Toronto Mississauga, Mississauga, Ontario, Canada.; Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, Ontario, Canada., Mula M; IMBE, St George's University of London and Atkinson Morley Regional Neuroscience Centre, St George's University Hospital, London, UK., Wirrell EC; Divisions of Child and Adolescent Neurology and Epilepsy, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA., Wilmshurst JM; Department of Paediatric Neurology, Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, Cape Town, South Africa., Jetté N; Department of Clinical Neurosciences and Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada., Brigo F; Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy., Kariuki SM; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.; Department of Psychiatry, University of Oxford, Oxford, UK.; Department of Public Health, Pwani University, Kilifi, Kenya., Fong CY; Division of Paediatric Neurology, Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia., Wang YP; Division of Child and Adolescent Psychiatry, Department of Psychiatry, Faculdade de Medicina, FMUSP, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil., Polanczyk GV; Division of Child and Adolescent Psychiatry, Department of Psychiatry, Faculdade de Medicina, FMUSP, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil., Castanho V; Federal University of Rio Grande Do Sul, Porto Alegre, Brazil., Demarchi IG; Federal University of Santa Catarina, Florianópolis, Brazil., Auvin S; Université Paris-Cité, INSERM NeuroDiderot, Paris, France.; APHP, Robert Debré University Hospital, Pediatric Neurology Department, ERN EpiCARE Member, Paris, France.; Institut Universitaire de France (IUF), Paris, France., Kerr M; Institute of Psychological Medicine and Clinical Neurosciences Cardiff University, Cardiff, UK.
Jazyk: angličtina
Zdroj: Epilepsia [Epilepsia] 2024 Sep 25. Date of Electronic Publication: 2024 Sep 25.
DOI: 10.1111/epi.18116
Abstrakt: The Psychiatric Pediatric Issues Task Force of the International League Against Epilepsy (ILAE) aimed to develop recommendations for the diagnosis and treatment of anxiety and depression in children and adolescents with epilepsy. The Task Force conducted a systematic review and identified two studies that assessed the accuracy of four screening measures for depression and anxiety symptoms compared with a psychiatric interview. Nine studies met the eligibility criteria for treatment of anxiety and depressive disorders or symptoms. The risk of bias and certainty of evidence were assessed. The evidence generated by this review followed by consensus where evidence was missing generated 47 recommendations. Those with a high level of agreement (≥80%) are summarized. Diagnosis: (1) Universal screening for anxiety and depression is recommended. Closer surveillance is recommended for children after 12 years, at higher risk (e.g., suicide-related behavior), with subthreshold symptoms, and experiencing seizure worsening or therapeutic modifications. (2) Multiple sources of ascertainment and a formal screening are recommended. Clinical interviews are recommended whenever possible. The healthcare provider must always explain that symptom recognition is essential to optimize treatment outcomes and reduce morbidity. (3) Questioning about the relationship between symptoms of anxiety or depression with seizure worsening/control and behavioral adverse effects of antiseizure medications is recommended. Treatment: (1) An individualized treatment plan is recommended. (2) For mild depression, active monitoring must be considered. (3) Referral to a mental health care provider must be considered for moderate to severe depression and anxiety. (4) Clinical care pathways must be developed. (5) Psychosocial interventions must be tailored and age-appropriate. (6) Healthcare providers must monitor children with epilepsy who are prescribed antidepressants, considering symptoms and functioning that may not improve simultaneously. (7) Caregiver education is essential to ensure treatment adherence. (8) A shared-care model involving all healthcare providers is recommended for children and adolescents with epilepsy and mental health disorders. We identified clinical decisions in the management of depression and anxiety that lack solid evidence and provide consensus-based guidance to address the care of children and adolescents with epilepsy.
(© 2024 International League Against Epilepsy.)
Databáze: MEDLINE
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