Understanding the enigma of neurobehavior in children with epilepsy and the need for mandatory screening: a prospective case control study


  • Sowmya Vernekar Department of Neurodevelopment and Behavioural Paediatrics, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
  • Arun Y. Bylappa Department of Neurodevelopment and Behavioural Paediatrics, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
  • Uddhav Kinhal Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
  • Sanjay K. Shivappa Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India




Epilepsy, Behaviour, Comorbidity, Strength difficulty questionnaire


Background: In epilepsy management, control of seizures is the prime objective and reduction in seizure frequency is the main goal for successful treatment. There is a high prevalence of neurobehavioral problem. Hence, there is a need to screen, and intervene. Aim was to identify the neurobehavioral profile and the impact on children with epilepsy

Methods: After IRB clearance, 100 consecutive school-aged children 4-17 years with normal IQ attending epilepsy clinic were enrolled as cases, and 102 age, gender and socio-economic status-matched children without epilepsy were chosen as controls. The strength and difficulties questionnaire are administered to both groups. It addresses five domains: emotional, conduct, hyperactivity, and peer problems which contribute to the total difficulties score, and fifth dimension prosocial behaviour.

Results: Among the children with epilepsy, emotional issues were observed in 41%, conduct issues in 67%, hyperactivity behaviour in 54%, and peer problems in 64% while pro-social behaviour was only 27%, and total difficulty score was 60%, which was statistically significant with p<0.001 in all domains when compared to control. The impact of the disease was 73%, home environment was affected in 67%, classroom learning 45%, 28% in leisure activities, and 10% in friendship, which was statistically significant with p<0.001 in all domains when compared to control. 

Conclusions: We have identified emotional, conduct, hyperactivity and peer problems having significant impact on children with epilepsy. Hence a screening in various behavioural domains helps in early identification and prompt intervention of neurobehavior. 



Beghi E. The Epidemiology of Epilepsy. Neuroepidemiology. 2020;54(2):185-91.

Fiest KM, Sauro KM, Wiebe S, Patten SB, Kwon CS, Dykeman J, et al. Prevalence and incidence of epilepsy: A systematic review and meta-analysis of international studies. Neurology. 2017;88(3):296-303.

Shorvon SD, Goodridge DM. Longitudinal cohort studies of the prognosis of epilepsy: contribution of the National General Practice Study of Epilepsy and other studies. Brain. 2013;136(11):3497-510.

Berg AT, Rychlik K. The course of childhood-onset epilepsy over the first two decades: a prospective, longitudinal study. Epilepsia. 2015;56(1):40-8.

Giussani G, Canelli V, Bianchi E, Erba G, Franchi C, Nobili A, et al. EPIRES Group. Long-term prognosis of epilepsy, prognostic patterns and drug resistance: a population-based study. Eur J Neurol. 2016;23(7): 1218-27.

Matti S, Dieter S. Natural history of treated childhood-onset epilepsy: prospective, long-term population-based study. Brain. 2006;129(3):617-24.

Kwan P, Sander JW. The natural history of epilepsy: an epidemiological view. J Neurol Neurosurg Psychiatr. 2004;75(10):456.

Trinka E, Rainer LJ, Granbichler CA, Zimmermann G, Leitinger M. Mortality, and life expectancy in Epilepsy and Status epilepticus-current trends and future aspects. Front Epidemiol. 2023;3:108.

Karoly PJ, Freestone DR, Eden D, Stirling RE, Li L, Vianna PF, et al. Epileptic Seizure Cycles: Six Common Clinical Misconceptions. Front Neurol. 2021;12:720328.

Rao VR, Leguia GM, Tcheng TK, Baud MO. Cues for seizure timing. Epilepsia. 2020;62:S15-31.

Karoly PJ, Rao VR, Gregg NM, Worrell GA, Bernard C, Cook MJ, et al. Cycles in epilepsy. Nat Rev Neurol. 2021;17:267-84.

Sridharan R, Murthy BN. Prevalence and pattern of epilepsy in India. Epilepsia. 1990;9:319-26.

Plioplys S, Dunn DW, Caplan R. 10-year research update review: psychiatric problems in children with epilepsy. J Am Acad Child Adolesc Psychiatr. 2007; 46:1389-402.

Kraemer HC, Stice E, Kazdin A, Offord D, Kupfer D. How do risk factors work together? Mediators, moderators, and independent, overlapping, and proxy risk factors. Am J Psychiatr. 2001;158:848-56.

Goodman R. The Strength and Difficulties questionnaire: A research note. J Child Psychol Psychiatr. 1997;38(5):581-6.

Sheel H, Suarez L, Marsh NV. Parents’ Evaluation of Developmental Status and Strength and Difficulties Questionnaire as Screening Measures for Children in India: A Scoping Review. Pediatr Rep. 2023;15(1): 175-96.

Freitag GF, Grassie HL, Jeong A, Mallidi A, Comer JS, Ehrenreich-May J, et al. Systematic Review: Questionnaire-Based Measurement of Emotion Dysregulation in Children and Adolescents. J Am Acad Child Adolesc Psychiatr. 2023;62(7):728-63.

Datta SS, Premkumar TS, Chandy S, Kumar S, Kirubakaran C, Gnanamuthu C, et al. Behaviour problems in children and adolescents with seizure disorder: Associations and risk factors. Seizure. 2005; 14:190-7.

International League Against Epilepsy. Available at: https://www.EpilepsyDiagnosis.org. Accessed on 20 November 2023.

Mishra OP, Upadhyay A, Prasad R, Upadhyay SK, Piplani SK. Behavioural Problems in Indian Children with Epilepsy. Indian Pediatr. 2017;54(2):116-20.

Anita M. Neurobehavioral co-morbidities in children with Epilepsy. J Neurol Neurophysiol. 2016;7:3.

Choudhary A, Gulati S, Sagar R, Kabra M, Sapra S. Behavioural comorbidity in children and adolescents with epilepsy. J Clin Neurosci. 2014;21(8):1337-40.

Tanabe T, Kashiwagi M, Shimakawa S, Fukui M, Kadobayashi K, Azumakawa K, et al. Behavioral assessment of Japanese children with epilepsy using SDQ (strengths and difficulties questionnaire). Brain Dev. 2013;35:81-6.

Novriska D, Sutomo R, Setyati A. Behavioural problems in children with epilepsy. Paediatr Indones 2013;54:324-9.

Gandhi T, Desai V, Surana A. Screening for behavioural abnormality using strength & difficulty questionnaire (SDQ) in children with epilepsy. Natl J Community Med. 2023;14(5):329-34.

Triplett RL, Asato MR. Brief cognitive and behavioral screening in children with new-onset epilepsy: a pilot feasibility trial. Pediatr Neurol. 2015; 52(1):49-55.

Prahbhjot M, Annapoorni A, Pratibha S. Screening Children with Epilepsy for Behavioral Problems: Utility of the Strength and the Difficulties Questionnaire. Ann Indian Acad Neurol. 2022;25(1): 104.

Berg AT, Altalib HH, Devinsky O. Psychiatric and behavioral comorbidities in epilepsy: A critical reappraisal. Epilepsia. 2017;58(7):1123-30.

Austin JK, Caplan R. Behavioral and psychiatric comorbidities in pediatric epilepsy: toward an integrative model. Epilepsia. 2007;48(9):1639-51.

Holmes GL. Effect of Seizures on the Developing Brain and Cognition. Semin Pediatr Neurol. 2016; 23(2):120-6.

Holmes GL. Cognitive impairment in epilepsy: the role of network abnormalities. Epileptic Disord. 2015; 17:101-16.

Holmes GL. What is more harmful, seizures or epileptic EEG abnormalities? Is there any clinical data? Epileptic Disord. 2014;16(1):12-22.

Eddy CM, Rickards HE, Cavanna AE. Behavioral adverse effects of antiepileptic drugs in epilepsy. J Clin Psychopharmacol. 2012;32:362-75

Mula M, Kanner AM, Jetté N, Sander JW. Psychiatric comorbidities in people with epilepsy. Neurol Clin Pract. 2021;11(2):e112-20.

Shu-Hao W, Wang-Tso L. Comorbidity of childhood epilepsy, Taiwan: JFMA. 2015;10:101.






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