A 2025 multi-site study published in Epilepsy & Behavior aimed to examine depressive symptoms in children and youth with epilepsy (CYE) who completed measures of emotional and behavioral functioning as part of a presurgical neuropsychological evaluation. Overall, findings from the analysis indicated that CYE are at risk of comorbid depressive symptoms, particularly those with temporal lobe epilepsy (TLE).1
The study also noted that other seizure-related and sociodemographic factors did not significantly increase risk or resilience, underscoring the need for routine depression screening during epilepsy care, including those CYE with low IQ. The research was conducted to help clarify previously reported prevalence rates of depressive symptoms in CYE, which have ranged from 12% to 41% across studies.
To gain further insight into the clinical implications of these findings, NeurologyLive® spoke with study authors Shannon Brothers, PhD, Janelle Wagner, PhD, and Cortney Wolfe-Christensen, PhD, all of whom work in pediatrics. Brothers is a pediatric epilepsy psychologist at Cincinnati Children’s Hospital Medical Center, Wagner is a pediatric psychologist at Medical University of South Carolina, and Wolfe-Christensen is a pediatric psychologist at Children’s Medical Center in Fort Worth, Texas.
In the Q&A interview below, the authors provide additional insight into the study’s findings, limitations, and implications for clinical practice. In terms of study limitations, the trio highlighted reliance on caregiver-reported measures and variability across participating sites, and highlighted areas for future research, such as incorporating self-report tools, using more targeted assessments of depression, and improving early identification and intervention strategies. Overall, the investigators further expressed optimism that integrating behavioral health services into epilepsy clinics could improve quality of life, reduce stigma, and potentially lead to better mood and seizure outcomes for pediatric patients.
NeurologyLive: What were the main goals and findings of your study regarding depressive symptoms in youth with refractory epilepsy?
Shannon Brothers, PhD: The overall goal of the study was to assess depressive symptoms in a large sample of youth with refractory epilepsy and to examine the role of sociodemographic and epilepsy-specific factors, as prior research findings have been quite mixed. A specific focus was placed on patients with low IQ, as this population has historically been excluded from research.
Consistent with prior studies in both refractory and nonrefractory epilepsy, depressive symptoms were found to be fairly substantial. Approximately 29% of patients with epilepsy or refractory epilepsy experienced some level of depressive symptoms, indicating a higher overall risk for mood symptoms. This risk was particularly elevated among patients with temporal lobe epilepsy.
Although no significant differences in depressive symptoms were observed between children and youth with epilepsy with and without low IQ, both groups experienced similar levels of mood symptoms. To put this in perspective, about 14% of individuals without epilepsy who have low IQ experience mood symptoms, compared with nearly 29% in this epilepsy population. This suggests that youth with epilepsy and low IQ are experiencing depressive symptoms at rates comparable to their peers with epilepsy who do not have low IQ.
Why is it important to include patients with low IQ in this kind of study? Why have they been excluded in the past?
Shannon Brothers, PhD: Historically, patients with low IQ are often excluded because they can’t always report their own symptoms, especially mood and anxiety symptoms. Teens are usually better at self-reporting their mood, but patients who are not very verbal or have lower IQ may not be able to do that as well.
Most of the measures we use to screen for depression are designed for typically developing kids with higher IQ. But a substantial portion of our refractory epilepsy population has some kind of cognitive or developmental delay. If we don’t assess and treat them, we’re missing a big chunk of patients who really need help.
Cortney Wolfe-Christensen, PhD: In our sample, 30% of the kids had an IQ below 70, so that’s a significant part of this population. Behavioral health resources for kids with epilepsy are already limited. We have to figure out which kids are at highest risk for depressive or anxiety symptoms so we can focus our efforts and practice at the top of our licenses. When we exclude kids with lower IQs, we’re basically not even looking at about a third of our population.
What were some of the main limitations of this study?
Cortney Wolfe-Christensen, PhD: We used a large national dataset with more than 400 kids from 30 sites. That’s a strength, but every center does their own epilepsy workups and uses different measures. For behavior, the two most common caregiver questionnaires were the BASC (Behavior Assessment System for Children) and the CBCL (Child Behavior Checklist). As a group, we had to figure out how to merge those two so we could get the best estimate of depressive symptoms without running into psychometric problems.
We also had missing data, and we only looked at caregiver reports. We didn’t include self-reports from kids. We know teens are often better at reporting their mood than caregivers, so that’s a limitation.
Janelle Wagner, PhD: Intellectual disability is also very complex. A child with an IQ in the high 60s might be able to report how they’re feeling pretty well, while a child in the 30s or 40s would not. There’s a wide range of abilities. The measures we used, even though they’ve been used with youth with intellectual disabilities, are still based on chronological age norms. A 10-year-old who functions more like a 7- or 8‑year‑old may not be a great fit for those tools. We don’t have great measures tailored to this group, and that’s a limitation of the field that carries over into our study.
Given your results, what do you think needs to be studied further?
Cortney Wolfe-Christensen, PhD: We can always improve how we identify kids at greatest risk. We looked at sociodemographic variables and seizure or surgery variables, but we still don’t know exactly which specific factors really predict depression. There’s room to dig deeper and see what we might be missing. We also need to better understand how developmental limitations and low IQ affect how we assess mood symptoms.
Janelle Wagner, PhD: I’d like to see more self-report, especially in teens with typical cognitive functioning and intractable epilepsy. We chose caregiver report here so we’d have a larger sample and enough power for the analyses, but we did have some self-report data. It would be great to use more depression-specific tools, like the Children’s Depression Inventory, which focuses just on depression. That could help us see whether certain depressive symptoms are more common in kids with epilepsy, and how those might overlap with seizure medication side effects.
Looking ahead, what does the future look like for patients with epilepsy who are experiencing depressive symptoms?
Shannon Brothers, PhD: Ideally, I’d love to see more psychologists and behavioral health clinicians embedded in epilepsy clinics at major comprehensive centers. We know depressive symptoms are substantial in this population. The more we can intervene early, before it becomes full-blown depression, the better chance we have to help these patients—both those with low IQ and those with typical development—have a good quality of life despite epilepsy.
Janelle Wagner, PhD: There have been adult studies showing that when you treat the depression, seizures can improve as well. Treating mood may help both quality of life and seizure severity. That’s really important for teens who want to drive and need to be seizure‑free for a period of time. We also have to think about suicide risk, which is higher in people with depression. Early identification and having behavioral health embedded in epilepsy clinics can reduce stigma and make it easier for families to access care, instead of sending them somewhere else.
Transcript edited for clarity.
REFERENCES
1. Brothers S., Wolfe-Christensen C., Loblein H., et al. Depressive symptoms in youth with refractory epilepsy: Exploration of seizure, sociodemographic and cognitive factors. Epilepsy & Behavior. 2025; 171:110608 Doi: https://doi.org/10.1016/j.yebeh.2025.110608.