Researchers from Columbia University, New York; UCLA; Northern Illinois University, DeKalb, IL; and Northwestern Children’s Memorial Hospital, Chicago have examined whether the first-degree family history of unprovoked seizures in 308 probands with childhood onset epilepsy is associated with behavioral disorders. The association was assessed separately in uncomplicated and complicated epilepsy and for febrile seizures. Median age at onset was 4.2 years, and age at time of 9-year interview was 13.5 years. Epilepsy was uncomplicated in 213 (69.2%) and complicated in 95 (30.8%). Family history of unprovoked seizure was present in 24 probands with uncomplicated epilepsy (11.3%) and 9 probands with complicated epilepsy (9.5%). Family history of febrile seizures was present in 21 probands with uncomplicated (9.9%) and in 8 with complicated epilepsy (8.4%).

In probands with uncomplicated epilepsy, first-degree family history of unprovoked seizure was significantly associated with internalizing disorders, withdrawn/depressed, affective and anxiety disorders, aggressive and delinquent behavior, conduct disorder and oppositional defiant disorder. In probands with complicated epilepsy, family history of unprovoked seizure and behavioral problems were not associated. Also, first-degree family history of febrile seizure was not associated with behavioral problems in probands with uncomplicated or in those with complicated epilepsy. The familial clustering of these disorders suggests that behavioral disorders may be another manifestation of the underlying pathophysiology involved in or related to epilepsy. [1]

COMMENT. Epilepsy and behavioral disorders appear to have a common underlying genetic predisposition, whereas in the above study febrile seizure had no significant familial association with behavioral disorders. Previous reports of behavior disorder in children with febrile seizure have varied findings. Friderichsen C and Melchior J [2] found behavior disorders in 12 (4%) of 282 febrile seizure patients, and Millichap JG et al [3] in a prospective study of 110 febrile seizure patients reported recurrent episodes of aggressive behavior, temper tantrums, and hyperactivity in 35% patients. Patients with a history of birth trauma and those with cryptogenic epilepsies were excluded from the Friderichsen and Melchior series of febrile seizures but not from the study by Millichap and colleagues.

Risk of behavioral, developmental, and physical comorbidities with epilepsy/seizure disorder in a nationally representative sample of US children [4]. Estimated lifetime prevalence of epilepsy/seizure disorder was 1%, and of current epilepsy/seizure disorder was 6.3/1000. Children with current epilepsy/seizure disorder were significantly more likely than those never affected to have ADHD (23% vs 6%), developmental delay (51% vs 3%), autism (16% vs 1%), and headache (14% vs 5%). Those with prior but not current seizures had lesser risks.