Behavioral problems in children

with epilepsy
By :
Muhamad Adi Apriliana
30101206672

Supervised :
dr. Chatarina Rini Pratiwi, Sp.A

1
BACKGROUND
ADHD,
conduct
Children with disorder,
epilepsy autism
BEHAVIORAL
DISORDER
Cause :
Children with multifactorial
seizures (4.7x) (neurobiologic and
psycological
Prevalence : factors)
Thailand 54% INDONESIA??
(2007), India
52.8% (2004)
60% of epileptic children were
diagnosed with psychiatric
and behavior disorders, only
33% of them had a history of
receiving mental health
services before the study
2
outcome
To compare behavioral disorders in children with
epilepsy to those in normal children, and to
assess for possible factors associated with the
occurrence of behavioral disorders.

3
METHODS

4
 Method

Cross-sectional study
Pediatric Outpatient Clinic of Dr. Sardjito
Hospital, Yogyakarta
from June to July 2013
Subjects consisted of 2 groups: children with
and without epilepsy

5
 Inclusion Criteria
Epilepsy Group
Children aged 3 to 16 years
who had been diagnosed with
epilepsy and treated in the
Pediatric Neurology Clinic at
DR. Sardjito Hospital
Non-epilepsy Group
Children aged 3 to 16 years
who did not have epilepsy, a
history of febrile seizures or
other chronic diseases.

EXCLUSION CRITERIA
Children with severe physical or mental disabilities (e.g., unable to walk without
the aid of tools or unable to communicate), had been previously diagnosed with
AD/HD, autism, or other psychiatric disorders, had other chronic diseases or did
not live with their parents.
6
 The questionnaires contained
identity information and
Behavioral problems were statements about the behavior of
assessed using SDQ children to be answered as
Indonesian version that untrue, somewhat true or true.
divided into two sections:
one completed by Secondary data, such as number
parents/ teachers (3 - 10 of anti-epileptic drugs (AEDs) and
years), and one completed EEG descriptions were taken from
by the children medical records.
themselves (11 - 16 years).

7
Independent variable External variables
epilepsy -Age
-Gender
-Maternal education
-Age at onset of
Dependent variable epilepsy
behavioral disorders -Duration of epilepsy
based on SDQ scores -Type of epilepsy
-The number of AEDs
-EEG description.

8
The SDQ score consisted of 6
subsets of behavior assessment:
total difficulties
hyperactivity
conduct problems
emotional problems
peer problems
prosocial scores
9
Examination using SDQ in terms of the total
score and were considered to be abnormal for

Total difficulty scores The emotional problems

17 - 40 3-10 years
20 - 40 11-16 years
The hyperactivity
7 - 10 for all groups of
age
The conduct problems
4 - 10 3-10 years
5 - 10 11-16
5 - 10 3-10 years
7 - 10 11-16 years
The peer problem
4 - 10 3-10 years
6 - 10 11-16 years
Prosocial behavior
0 to 4 for all age groups.
10
11
12
13
DISCUSSION

14
We found that behavioral problems were more common
in children with epilepsy than in children without epilepsy
(19.1% vs 2.2%, respectively).

Multivariate analysis using logistic regression revealed

that the factors associated with behavioral disorders in
children with epilepsy were uncontrolled epilepsy and
focal EEG. We also found that uncontrolled epilepsy was a
factor related to emotional and conduct problems.

15
 A limitation of our study was that we did not
use multiple informants to fill out the SDQs,
which could be completed by both parents
and teachers. In addition, there is a significant
association between cognitive impairment
and behavioral problems. However, we did
not measure IQ to analyze cognitive factors in
our study.

16

Since our study design was cross-
sectional, we were not able to infer
a causal relationship between
epilepsy and behavioral disorders.
Psychiatric disorders in children
with epilepsy are assumed to be
triggered by psychosocial factors
due to the lack of adaptation to
chronic illness, including the
presence of a significant stigma.
However, studies have found
that epilepsy and psychiatric
disorders were concurrent
phenomena rather than a
causal factor.
A study reported that one-third
of children with new onset of
epilepsy displayed behavioral
problems prior to the onset of
seizures.
17
 Tanabe et al. found that epileptic
children had higher total difficulty,
hyperactivity disorder, and peer problem
scores of 23.7%, 32.9% and 15.8%,
respectively, compared to non-epileptic
children.
Kariuki et al. evaluated 108 epileptic
children in 2010 using CBQFP. They found
that epileptic children had significantly
higher percentages of behavioral
disorders compared to controls (49% vs.
26%; P<0.001).
McDermott et al. evaluated 121 epileptic
children in 1995 using BPI. They found that
epileptic children had higher percentages of
the following disorders compared to those of
non-epileptic children: behavioral disorders
(31.4% vs. 8.5%), hyperactivity disorders
(28.1% vs. 4.9%), peer problems (14.9% vs.
4.1%), and anxiety disorders (24% vs. 7.5%).
Datta et al. reported that 53.8% of behavioral
disorders occurred in 132 children with
epilepsy using the Child Behaviour Checklist
(CBCL).

Langunju et al. (2012) reported that out of 84 epileptic children, behavioral disorders,
conduct problems, emotional disorders, and hyperactivity disorders occurred in 46.4%,
27.3%, 11.9% and 20.2% of the children, respectively, using the Rutter A2 scale.

18
 We found that 29.8% of children in the
epilepsy group had emotional disorders, and
was significantly associated with
uncontrolled epilepsy (PR 6.7; 95%CI 1.66 to
26.76; P=0.007). Psychological factors such
as fear of the occurrence of seizures that
could not be predicted and controlled in Seizure frequency, duration of
addition to the perceived stigma, lead to epilepsy, teen age, and polytherapy
anxiety in children with epilepsy. were found to be risk factors for
emotional disorders, especially
anxiety, in epilepsy. However, in our
study uncontrolled epilepsy was
the only factor associated with this
emotional problem.

19
 In conclusion, behavioral problems are
more common in children with epilepsy
than in normal children, especially conduct
and emotional disorders.
Uncontrolled epilepsy and focal EEG
appaearance are significant factors related to
behavioral problems in children with epilepsy.

20
21
 SDQ_Indonesian_pt4-17single.pdf
SDQ_Indonesian_s11-17single.pdf

22
 PICO analisis

P Behavioral problems in children with epilepsy

I Behavioral problems were assessed using SDQ

Indonesian version

C Behavioral problems in children without epilepsy

O Behavioral problems are more common in

children with epilepsy than in normal children

9/11/17
 Critical Appraisal
Judul : Behavioral problems in children
with epilepsy
sudah sesuai dengan isi penelitian
penulisan judul < 12 kata
Abstrak :
terdiri dari 4 paragraf
komponen : terdiri dari background,
methode, results, conclusion
lebih dari 250 kata (269)
Teknik sampling : simple random sampling
 Identitas Jurnal
No Kriteria Ya (+), Tidak (-)
1. Jumlah kata dalam judul, +
< 12 kata
2. Deskripsi judul Menggambarkan isi
utama penelitian dan
tanpa singkatan
3. Daftar penulis sesuai +
aturan jurnal
4. Korespondensi penulis +
5. Tempat & waktu Tempat (+), waktu (+)
penelitian dalam judul
 Abstrak

No. Kriteria Ya (+), tidak

(+)
1. Abstrak 1 paragraf -
2. Mencakup IMRC +
3. Secara keseluruhan informatif +
4. Tanpa singkatan selain yang +
baku
5. Kurang dari 250 kata -(269)
 Pendahuluan

No. Kriteria Ya (+), Tidak (+)

1. Terdiri dari 2 bagian atau 2 (-)
paragraf
2. Paragraf pertama (+)
mengemukakan alasan
dilakukan penelitian
3. Paragraf ke 2 menyatakan (-)
hipotesis atau tujuan
penelitian
4. Didukung oleh pustaka yang (+)
relevan
5. Kurang dari 1 halaman (+)
 Metode
No. Kriteria Ya (+), tidak (-)
1. Jenis dan rancangan penelitian (+)
2. Waktu dan tempat penelitian (+)
3. Populasi sumber (+)
4. Teknik sampling (-)
5. Kriteria inklusi (+)
6. Kriteria Eksklusi (+)
7. Perkiraan dan perhitungan besar (-)
sampel
8. Perincian cara penelitian (+)
9. Blind (-)
10. Uji statistik (+)
11. Program komputer (+)
12. Persetujuan subjektif (+)
 Hasil Penelitian

No. Kriteria Ya (+), Tidak (-)

1 Jumlah subjek (+)
2 Tabel Karakteristik (+)
3 Tabel Hasil Penelitian (+)
4 Komentar dan Pendapat (+)
Penulis ttg hasil
5 Tabel Analisis data dengan Uji (+)
 Kesimpulan dan Daftar Pustaka
No. Kriteria Ya (+), Tidak (-)
1 Pembahasan dan kesimpulan (-)
terpisah
2 Pembahasan dan kesimpulan (+)
di paparkan dengan jelas
3 Pembahasan mengacu dari (+)
penelitian sebelumnya
4 Pembahasan sesuai dengan (+)
landasan teori
5 Keterbatasan penelitian (+)
6 Simpulan berdasarkan penelitian (+)
7 Saran Penelitian (-)
8 Penulisan daftar pustaka sesuai (+)
aturan
 Validitas
Apakah alokasi pasien pada penelitian ini (-)
dilakukan secara acak?

Apakah pengamatan pasien dilakukan (-)

secara cukup panjang dan lengkap?

Apakah semua pasien dalam kelompok (-)

yang diacak, dianalisis?

Apakah pasien dan dokter tetap blind (-)

dalam melakukan penelitian, selain dari
terapi yang diuji

Apakah ada kelompok kontrol? (+)

 Aplikasi
Apakah pada pasien kita terdapat -
perbedaan bila dibandingkan dengan
yang terdapat pada penelitian sebelumnya
sehingga hasil tersebut tidak dapat
diterapkan pada pasien kita?

Apakah penelitian tersebut mungkin dapat +

diterapkan pada pasien kita?
Apakah pasien memiliki potensi yang +
menguntungkan apabila penelitian
diterapkan?
Kesimpulan

Hasil penelitian tidak valid

Hasil penelitian penting

Hasil penelitian dapat diterapkan