DAY 3 | Pediatric Patients with Focal Epilepsy Are at Risk for Clinically Significant Anxiety

A retrospective review presented at the 2025 American Epilepsy Society Annual Meeting in Atlanta, Georgia showed that children and adolescents with focal epilepsy experience a high burden of anxiety and could benefit from mental health screening and targeted interventions. 

Previous research has suggested that children with focal epilepsy experience high levels of clinically significant anxiety in the periods preceding surgical intervention. Moreover, pediatric patients with clinically significant anxiety are more vulnerable to emotional and behavioral problems, including depression, attention deficits, and aggressive behavior. 

Researchers at the Children’s National Hospital in Washington, D.C. and the University of Wisconsin School of Medicine reviewed the records of 603 patients with focal epilepsy undergoing presurgical evaluation at pediatric hospitals in 36 states across the United States, to analyze the influence of clinical and sociodemographic factors on anxiety levels in this vulnerable population. The study included children and adolescents with ages ranging from 6 to 18 years, with an average epilepsy duration of 6.6 years at the time of the evaluation. The Behavior Assessment System for Children (BASC-3) and the Child Behavior Checklist (CBCL), completed by the patients’ parents during the presurgical evaluation, were used to assess emotional and behavioral problems. 

The results revealed that this cohort had a higher risk of clinically significant anxiety symptoms (23.1%) compared to the rates reported in the general youth population (estimated at 5% to 10%). Female patients were more likely to experience heightened anxiety than male patients (28% vs 18%), and white patients were affected to a greater degree than those in other racial groups (26% vs 15%). Adolescents (ages 12-18) had higher anxiety levels compared to children (ages 6-11), and patients who had seizures at least weekly (26.2%) were more likely to have elevated anxiety levels than those who had less frequent seizures (18.3%). The age of epilepsy onset and the number of anti-seizure medications were not significant predictors of elevated anxiety levels. 

The study also showed that children and adolescents with clinically significant anxiety had a higher risk of experiencing behavioral and emotional problems. “Youth with elevated anxiety were more likely to be at risk for clinically-elevated depression, somatic complaints, attention problems, and aggression,” the research team concluded. “Screening for anxiety should be routine and systematic for youth undergoing presurgical epilepsy evaluation.”