Children with epilepsy and anxiety: Subcortical and cortical differences

Abstract

Summary Objective Using a hypothesis driven approach, subcortical and cortical regions implicated in anxiety disorders in the general population were examined in children with recent-onset epilepsy with versus without anxiety compared to controls. This study reports frequency of anxiety disorders while examining familial, clinical and demographic variables associated with anxiety in children with epilepsy. Method Participants included 88 children with epilepsy aged 8–18 years; 25 with a current anxiety disorder and 63 children with epilepsy no current anxiety disorder. 49 controls without anxiety disorders were included. T1 volumetric MRI scans were collected; subcortical volumes and cortical thickness were computed using the FreeSurfer image analysis suite. Analyses focused on adjusted measures of subcortical volumes and cortical thickness. Results Relative to controls, larger left amygdala volumes were found in the Epilepsy Anxiety group compared to the Epilepsy No Anxiety group (p = 0.027). In the hippocampus there were no significant differences between groups. Examination of cortical thickness demonstrated that the Epilepsy Anxiety group showed thinning in left medial orbitofrontal (p=0.001), right lateral orbitofrontal (p=0.017), and right frontal pole (p=0.009). There were no differences between groups in age, sex, IQ, age of onset, medications, or duration of epilepsy. There were more family members with a history of anxiety disorders in the Epilepsy Anxiety group compared to the Epilepsy No Anxiety group (p=0.005). Significance Anxiety is a common psychiatric comorbidity in children with recent-onset epilepsy with volumetric enlargement of the amygdala and thinner cortex in orbital and other regions of prefrontal cortex, suggesting structural abnormalities in brain regions that are part of the dysfunctional networks reported in individuals with anxiety disorders in the general population. These findings are evident early in the course of epilepsy, are not related to chronicity of seizures, and may be linked to a family history of anxiety and depressive disorders.

Cortical thickness asymmetries and surgical outcome in neocortical epilepsy

“…In our study, however, the group differences of cortical thickness asymmetries remained highly significant when we excluded the valproate users. Another confounding factor could be epilepsy-associated anxiety: a recent study of 25 children with recent-onset epilepsy and anxiety disorder demonstrated thinning in bilateral orbital frontal and prefrontal cortex [31]. Although we did not have detailed neuropsychology data on anxiety, only one patient had clinically diagnosed depression in our cohort.…”

WONOEP appraisal: Biomarkers of epilepsy‐associated comorbidities

“…Akin to neuroimaging findings in patients with epilepsy and ID, patients with epilepsy and anxiety demonstrate alterations in volumes of gray matter structures. In children with epilepsy and an anxiety disorder, the volume of the amygdala was increased and the thickness of orbitofrontal cortices was reduced . Widespread changes in gray matter are also observed in children with epilepsy and ADHD .…”

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“…Severity of depression post mild TBI was correlated with reduced volume in the anterior cingulate, temporal lobe and insula. Jones et al (2015) found larger volume of the amygdala as derived from FreeSurfer to be associated with increased levels of anxiety in children with epilepsy. Reduced OFC was also related to higher levels of reported anxiety which would be consistent with poorer emotional control as reported in the Krueger et al (2011) study previously discussed.…”