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Wang S, Yao B, Zhang H, Xia L, Yu S, Peng X, Xiang D, Liu Z. Comorbidity of epilepsy and attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. J Neurol 2023; 270:4201-4213. [PMID: 37326829 DOI: 10.1007/s00415-023-11794-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/17/2023]
Abstract
Epilepsy and attention-deficit/hyperactivity disorder (ADHD) are common neurological and neuropsychiatric disorders, respectively, that can exist as comorbidities. However, the degree of comorbidity between both disorders has never been quantified based on a systematic review with meta-analysis. We performed a systematic search of the literature in Embase, PubMed, PsychINFO and the Cochrane Library on June 20, 2022. In a meta-analysis of 63 studies with a total sample size of 1,073,188 individuals (172,206 with epilepsy and 900,982 with ADHD) from 17 countries, the pooled prevalence of ADHD in epilepsy was 22.3% (95% CI 20.3-24.4%). The highest pooled prevalence was 12.7% (95% CI 9-17.1%) for ADHD-I subtype, whereas the pooled prevalence of epilepsy in ADHD was 3.4% (95% CI 2.53-4.21%). However, substantial heterogeneity in comorbidity rates was observed and partially attributed to the following factors: sample size, sample specification, geographical variations and diagnostic methods. Our study highlights the need for increased awareness of this diagnostic co-occurrence, and research is warranted to elucidate the underlying pathophysiological mechanisms.
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Affiliation(s)
- Shun Wang
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Baozhen Yao
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Haiju Zhang
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Liping Xia
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Shiqian Yu
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Xia Peng
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Dan Xiang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
| | - Zhongchun Liu
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
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Min A, Miller W, Rocha LM, Börner K, Correia RB, Shih PC. Just In Time: Challenges and Opportunities of First Aid Care Information Sharing for Supporting Epileptic Seizure Response. PROCEEDINGS OF THE ACM ON HUMAN-COMPUTER INTERACTION 2021; 5:113. [PMID: 34355131 PMCID: PMC8336724 DOI: 10.1145/3449187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
There are over three million people living with epilepsy in the U.S. People with epilepsy experience multiple daily challenges such as seizures, social isolation, social stigma, experience of physical and emotional symptoms, medication side effects, cognitive and memory deficits, care coordination difficulties, and risks of sudden unexpected death. In this work, we report findings collected from 3 focus groups of 11 people with epilepsy and caregivers and 10 follow-up questionnaires. We found that these participants feel that most people do not know how to deal with seizures. To improve others' abilities to respond safely and appropriately to someone having seizures, people with epilepsy and caregivers would like to share and educate the public about their epilepsy conditions, reduce common misconceptions about seizures and prevent associated stigma, and get first aid help from the public when needed. Considering social stigma, we propose design implications of future technologies for effective delivery of appropriate first aid care information to bystanders around individuals with epilepsy when they experience a seizure.
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Affiliation(s)
| | - Wendy Miller
- Indiana University-Purdue University Indianapolis, USA
| | - Luis M Rocha
- Indiana University Bloomington, USA and Instituto Gulbenkian de Ciência, Portugal
| | | | - Rion Brattig Correia
- Instituto Gulbenkian de Ciência, Portugal, CAPES Foundation, Ministry of Education of Brazil, Brazil, and Indiana University Bloomington, USA
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Frank BB. Psycho-Social Aspects of Educating Epileptic Children: Roles for School Psychologists. SCHOOL PSYCHOLOGY REVIEW 2019. [DOI: 10.1080/02796015.1985.12085163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Attention deficit hyperactivity disorder (ADHD) in children with epilepsy. Ir J Med Sci 2019; 189:305-313. [DOI: 10.1007/s11845-019-02042-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 05/24/2019] [Indexed: 01/08/2023]
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Auvin S, Wirrell E, Donald KA, Berl M, Hartmann H, Valente KD, Van Bogaert P, Cross JH, Osawa M, Kanemura H, Aihara M, Guerreiro MM, Samia P, Vinayan KP, Smith ML, Carmant L, Kerr M, Hermann B, Dunn D, Wilmshurst JM. Systematic review of the screening, diagnosis, and management of ADHD in children with epilepsy. Consensus paper of the Task Force on Comorbidities of the ILAE Pediatric Commission. Epilepsia 2018; 59:1867-1880. [DOI: 10.1111/epi.14549] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/28/2018] [Accepted: 07/31/2018] [Indexed: 01/01/2023]
Affiliation(s)
- Stéphane Auvin
- Department of Pediatric Neurology; Robert-Debré University Hospital; APHP; Paris France
| | - Elaine Wirrell
- Divisions of Child and Adolescent Neurology and Epilepsy; Mayo Clinic; Rochester Minnesota
| | - Kirsten A. Donald
- Division of Developmental Paediatrics; Department of Paediatrics and Child Health; Neurosciences Institute; Red Cross War Memorial Children’s Hospital; University of Cape Town; Cape Town South Africa
| | - Madison Berl
- Division of Pediatric Neuropsychology; Children’s National Medical Center; Washington District of Columbia
| | - Hans Hartmann
- Clinic for Pediatric Kidney, Liver and Metabolic Disorders; Hannover Medical School; Hannover Germany
| | - Kette D. Valente
- Division of Clinical Neurophysiology, Institute and Department of Psychiatry; Clinics Hospital (HCFMUSP); Faculty of Medicine; University of São Paulo; São Paulo Brazil
| | - Patrick Van Bogaert
- Department of Pediatric Neurology and Neurosurgery; University Hospital of Angers; Angers France
| | - J. Helen Cross
- Developmental Neurosciences Programme; UCl Great Ormond Street Institute of Child Health, London & Young Epilepsy; Lingfield UK
| | - Makiko Osawa
- Department of Pediatrics; Tokyo Women’s Medical University; Tokyo Japan
| | - Hideaki Kanemura
- Department of Pediatrics; Faculty of Medicine; University of Yamanashi; Yamanashi Japan
| | - Masao Aihara
- Graduate Faculty of Interdisciplinary Research; Graduate School; University of Amanashi; Yamanashi Japan
| | | | - Pauline Samia
- Department of Paediatrics and Child Health; Aga Khan University; Nairobi Kenya
| | | | - Mary Lou Smith
- Department of Psychology; The Hospital for Sick Children; University of Toronto Mississauga; Toronto Canada
| | - Lionel Carmant
- Department of Neurosciences and Pediatrics; CHU Sainte-Justine; University of Montreal; Montreal Canada
| | - Michael Kerr
- Division of Psychological Medicine and Clinical Neuroscience; Cardiff University; Cardiff Wales UK
| | - Bruce Hermann
- Department of Neurology; School of Medicine and Public Health; University of Wisconsin; Madison Wisconsin
| | - David Dunn
- Section of Child and Adolescent Psychiatry; Departments of Psychiatry and Neurology; Indiana University School of Medicine; Indianapolis Indiana
| | - Jo M. Wilmshurst
- Division of Paediatric Neurology; Neuroscience Institute; Department of Paediatrics and Child Health; Red Cross War Memorial Children’s Hospital; University of Cape Town; Cape Town South Africa
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Lo-Castro A, Curatolo P. Epilepsy associated with autism and attention deficit hyperactivity disorder: is there a genetic link? Brain Dev 2014; 36:185-93. [PMID: 23726375 DOI: 10.1016/j.braindev.2013.04.013] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 04/28/2013] [Accepted: 04/30/2013] [Indexed: 12/26/2022]
Abstract
Autism Spectrum Disorders (ASDs) and Attention Deficit and Hyperactivity Disorder (ADHD) are the most common comorbid conditions associated with childhood epilepsy. The co-occurrence of an epilepsy/autism phenotype or an epilepsy/ADHD phenotype has a complex and heterogeneous pathogenesis, resulting from several altered neurobiological mechanisms involved in early brain development, and influencing synaptic plasticity, neurotransmission and functional connectivity. Rare clinically relevant chromosomal aberrations, in addition to environmental factors, may confer an increased risk for ASDs/ADHD comorbid with epilepsy. The majority of the candidate genes are involved in synaptic formation/remodeling/maintenance (NRX1, CNTN4, DCLK2, CNTNAP2, TRIM32, ASTN2, CTNTN5, SYN1), neurotransmission (SYNGAP1, GABRG1, CHRNA7), or DNA methylation/chromatin remodeling (MBD5). Two genetic disorders, such as Tuberous sclerosis and Fragile X syndrome may serve as models for understanding the common pathogenic pathways leading to ASDs and ADHD comorbidities in children with epilepsy, offering the potential for new biologically focused treatment options.
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Affiliation(s)
- Adriana Lo-Castro
- Neuroscience Department, Pediatric Neurology and Psychiatry Unit, Tor Vergata University of Rome, Italy.
| | - Paolo Curatolo
- Neuroscience Department, Pediatric Neurology and Psychiatry Unit, Tor Vergata University of Rome, Italy
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Enrichment and training improve cognition in rats with cortical malformations. PLoS One 2013; 8:e84492. [PMID: 24358362 PMCID: PMC3866176 DOI: 10.1371/journal.pone.0084492] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 11/15/2013] [Indexed: 11/18/2022] Open
Abstract
Children with malformations of cortical development (MCD) frequently have associated cognitive impairments which reduce quality of life. We hypothesized that cognitive deficits associated with MCD can be improved with environmental manipulation or additional training. The E17 methylazoxymethanol acetate (MAM) exposure model bears many anatomical hallmarks seen in human MCDs as well as similar behavioral and cognitive deficits. We divided control and MAM exposed Sprague-Dawley rats into enriched and non-enriched groups and tested performance in the Morris water maze. Another group similarly divided underwent sociability testing and also underwent Magnetic Resonance Imaging (MRI) scans pre and post enrichment. A third group of control and MAM rats without enrichment were trained until they reached criterion on the place avoidance task. MAM rats had impaired performance on spatial tasks and enrichment improved performance of both control and MAM animals. Although MAM rats did not have a deficit in sociability they showed similar improvement with enrichment as controls. MRI revealed a whole brain volume decrease with MAM exposure, and an increase in both MAM and control enriched volumes in comparison to non-enriched animals. In the place avoidance task, MAM rats required approximately 3 times as long to reach criterion as control animals, but with additional training were able to reach control performance. Environmental manipulation and additional training can improve cognition in a rodent MCD model. We therefore suggest that patients with MCD may benefit from appropriate alterations in educational strategies, social interaction and environment. These factors should be considered in therapeutic strategies.
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Health-related quality of life before and after pediatric epilepsy surgery: the influence of seizure outcome on changes in physical functioning and social functioning. Epilepsy Behav 2013; 27:477-83. [PMID: 23631952 DOI: 10.1016/j.yebeh.2013.03.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 03/06/2013] [Accepted: 03/08/2013] [Indexed: 11/21/2022]
Abstract
Health-related quality of life (HRQOL) is an important outcome in pediatric epilepsy surgery, but there are few studies that utilize presurgical ratings to assess the effect of surgery on HRQOL. We collected parental ratings on the Quality of Life in Childhood Epilepsy (QOLCE) questionnaire for 28 children who participated in neuropsychological assessment before and after epilepsy surgery. Our results revealed significant improvements in overall HRQOL after surgery, especially in physical and social activities. These changes were apparent despite generally unchanged intellectual and psychological functioning. Children with better seizure outcome had more improvement in HRQOL; however, improvements were not statistically different among children with Engel class I, II, and III outcomes. Our results suggest that children can experience significant improvements in HRQOL following epilepsy surgery even when neuropsychological functioning remains unchanged. Moreover, improvements in HRQOL appear evident in children who experience any worthwhile improvement in seizure control (Engel class III or better).
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Correlation between epilepsy and attention deficit hyperactivity disorder: a population-based cohort study. PLoS One 2013; 8:e57926. [PMID: 23483944 PMCID: PMC3590288 DOI: 10.1371/journal.pone.0057926] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 01/27/2013] [Indexed: 11/29/2022] Open
Abstract
Background This study presents an evaluation of the bidirectional correlation between attention deficit hyperactivity disorder (ADHD) and epilepsy using 2 cohorts from the same population database. Methods We used data from the Taiwan National Health Insurance Research Database to establish 2 separate cohort studies with participants <19 years old. We subdivided Cohort 1 in 2 groups: (1) 2468 patients initially diagnosed with epilepsy during the period 1999–2008, and (2) 9810 randomly selected sex- and age-matched non-epileptic controls. We subdivided Cohort 2 into 2 groups: (1) 3664 patients with newly diagnosed ADHD and (2) 14 522 sex- and age-matched non-ADHD patients. We evaluated the risk of subsequent ADHD in relationship to epilepsy and vice versa in the 2 cohorts at the end of 2008. Results The ADHD incidence in Cohort 1 was 7.76 in patients with epilepsy and 3.22 in those without epilepsy (per 1000 person-years) after a median follow-up of 7–7.5 years. The adjusted hazard ratio (HR) for ADHD was 2.54 (95% CI 2.02–3.18) in the epilepsy group compared to the non-epilepsy group. In Cohort 2, the incidence of epilepsy was 3.24 in patients with ADHD and 0.78 in those without ADHD (per 1000 person-years) after a median follow-up of 3–3.5 years and an HR of 3.94 (95% CI 2.58–6.03). Conclusion This study shows a bidirectional association between ADHD and epilepsy in the 2 cohort studies. Causative factors may be common between these 2 disorders, leading to a cascade of transcriptional changes in the brain that alter behavior or cognition prior to seizures.
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Glauser TA, Cnaan A, Shinnar S, Hirtz DG, Dlugos D, Masur D, Clark PO, Adamson PC. Ethosuximide, valproic acid, and lamotrigine in childhood absence epilepsy: initial monotherapy outcomes at 12 months. Epilepsia 2012; 54:141-55. [PMID: 23167925 DOI: 10.1111/epi.12028] [Citation(s) in RCA: 166] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Determine the optimal initial monotherapy for children with newly diagnosed childhood absence epilepsy (CAE) based on 12 months of double-blind therapy. METHODS A double-blind, randomized controlled clinical trial compared the efficacy, tolerability, and neuropsychological effects of ethosuximide, valproic acid, and lamotrigine in children with newly diagnosed CAE. Study medications were titrated to clinical response, and subjects remained in the trial unless they reached a treatment failure criterion. Maximal target doses were ethosuximide 60 mg/kg/day or 2,000 mg/day, valproic acid 60 mg/kg/day or 3,000 mg/day, and lamotrigine 12 mg/kg/day or 600 mg/day. Original primary outcome was at 16-20 weeks and included a video-electroencephalography (EEG) assessment. For this report, the main effectiveness outcome was the freedom from failure rate 12 months after randomization and included a video-EEG assessment; differential drug effects were determined by pairwise comparisons. The main cognitive outcome was the percentage of subjects experiencing attentional dysfunction at the month 12 visit. KEY FINDINGS A total of 453 children were enrolled and randomized; 7 were deemed ineligible and 446 subjects comprised the overall efficacy cohort. There were no demographic differences between the three cohorts. By 12 months after starting therapy, only 37% of all enrolled subjects were free from treatment failure on their first medication. At the month 12 visit, the freedom-from-failure rates for ethosuximide and valproic acid were similar (45% and 44%, respectively; odds ratio [OR]with valproic acid vs. ethosuximide 0.94; 95% confidence interval [CI] 0.58-1.52; p = 0.82) and were higher than the rate for lamotrigine (21%; OR with ethosuximide vs. lamotrigine 3.08; 95% CI 1.81-5.33; OR with valproic acid vs. lamotrigine 2.88; 95% CI 1.68-5.02; p < 0.001 for both comparisons). The frequency of treatment failures due to lack of seizure control (p < 0.001) and intolerable adverse events (p < 0.037) was significantly different among the treatment groups. Almost two thirds of the 125 subjects with treatment failure due to lack of seizure control were in the lamotrigine cohort. The largest subgroup (42%) of the 115 subjects discontinuing due to adverse events was in the valproic acid group. The previously reported higher rate of attentional dysfunction seen at 16-20 weeks in the valproic acid group compared with the ethosuximide or lamotrigine groups persisted at 12 months (p < 0.01). SIGNIFICANCE As initial monotherapy, the superior effectiveness of ethosuximide and valproic acid compared to lamotrigine in controlling seizures without intolerable adverse events noted at 16-20 weeks persisted at 12 months. The valproic acid cohort experienced a higher rate of adverse events leading to drug discontinuation as well as significant negative effects on attentional measures that were not seen in the ethosuximide cohort. These 12-month outcome data coupled with the study's prespecified decision-making algorithm indicate that ethosuximide is the optimal initial empirical monotherapy for CAE. This is the first randomized controlled trial meeting International League Against Epilepsy (ILAE) criteria for class I evidence for CAE (or for any type of generalized seizure in adults or children). (NCT00088452.).
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Affiliation(s)
- Tracy A Glauser
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio 45229, USA.
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Singh H, Aneja S, Unni KES, Seth A, Kumar V. A study of educational underachievement in Indian children with epilepsy. Brain Dev 2012; 34:504-10. [PMID: 21959125 DOI: 10.1016/j.braindev.2011.08.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 08/31/2011] [Accepted: 08/31/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Epilepsy is a chronic disorder that significantly affects learning and behavior. Children with epilepsy are much more vulnerable for educational problems than with any other chronic illness. OBJECTIVES The study was conducted to assess the extent of educational problems and factors associated with educational underachievement in Indian children with epilepsy. METHODS It was a case control study and included 100 cases of 6-16 years age of epilepsy, 50 healthy children (control A) and 50 children with persistent asthma (control B). Their demographic and disease variables were evaluated. The educational performance was assessed by using a predesigned semi structured open ended questionnaire to parents and by teacher's report. Psychological evaluation was done in first step by using a standard questionnaire, childhood psychopathology measurement schedule. In second step, those have shown poor educational performance or significant score in standard questionnaire underwent detailed psychiatric evaluation. RESULTS Educational problems were reported in cases (36%), control A (2%) and control B (16%). Demographic or disease variables were not associated with educational problems in cases except that boys were more affected than girls. On psychiatric evaluation psychopathological illnesses (47%) like attention deficit hyperkinetic disorder, conduct disorder and depression were found to be commonly associated with poor educational performance (47%) followed by decreased learning opportunities (22.2%) and borderline intelligence (19.4%) in children with epilepsy. CONCLUSION Educational problems are commoner in children with epilepsy than with asthma. Psychopathological problems are commonly associated with educational underachievement in children with epilepsy. Therefore periodic psychosocial assessment, counseling and support must be provided to improve the psychosocial adjustment in children with epilepsy.
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Affiliation(s)
- Harpal Singh
- Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India.
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Reilly C, Neville BG. Academic achievement in children with epilepsy: A review. Epilepsy Res 2011; 97:112-23. [DOI: 10.1016/j.eplepsyres.2011.07.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 07/23/2011] [Accepted: 07/31/2011] [Indexed: 11/27/2022]
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Reilly CJ. Attention deficit hyperactivity disorder (ADHD) in childhood epilepsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2011; 32:883-893. [PMID: 21310586 DOI: 10.1016/j.ridd.2011.01.019] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 01/11/2011] [Indexed: 05/30/2023]
Abstract
ADHD and epilepsy common are both common childhood disorders and both can have significant negative consequences on a child's behavioural, learning, and social development. Both conditions can co-occur and population studies suggest that the prevalence of ADHD in childhood epilepsy is between 12 and 17%. The prevalence of epilepsy in ADHD is lower but it is not clear if the rate of epilepsy is higher in ADHD populations than in the general population. There is a higher occurrence of ADHD--Primarily Inattentive subtype in children with epilepsy and the reasons for this are not altogether clear but attention difficulties are very prevalent in childhood epilepsy. Seizure/epilepsy variables do not appear to be important correlates in most cases of ADHD in epilepsy although they may play a role in some cases. Individuals with both epilepsy and intellectual disability may be at higher risk for significant ADHD symptoms although screening and assessment in children with intellectual disability and epilepsy may be challenging. Children with epilepsy and ADHD are likely to be at higher risk for more negative outcomes in school and in terms of quality of life compared with children with epilepsy alone. Published studies on the treatment of ADHD in childhood epilepsy have focussed exclusively on the use of psychopharmacology and particularly methylphenidate. Although methylphenidate appears to be effective for some children with epilepsy the issue of whether it may lower seizure threshold continues to be debated. Children with epilepsy are at significant risk for ADHD and there is a need for more studies focussing on safe and efficacious interventions for symptoms of ADHD in this population.
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Affiliation(s)
- Colin J Reilly
- Research and Psychology Department, National Centre for Young People with Epilepsy, St Piers Lane, Lingfield, Surrey, RH76PW, United Kingdom.
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Killory BD, Bai X, Negishi M, Vega C, Spann MN, Vestal M, Guo J, Berman R, Danielson N, Trejo J, Shisler D, Novotny EJ, Constable RT, Blumenfeld H. Impaired attention and network connectivity in childhood absence epilepsy. Neuroimage 2011; 56:2209-17. [PMID: 21421063 DOI: 10.1016/j.neuroimage.2011.03.036] [Citation(s) in RCA: 124] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Revised: 02/07/2011] [Accepted: 03/14/2011] [Indexed: 10/18/2022] Open
Abstract
Patients with childhood absence epilepsy (CAE) often demonstrate impaired interictal attention, even with control of their seizures. No previous study has investigated the brain networks involved in this impairment. We used the continuous performance task (CPT) of attentional vigilance and the repetitive tapping task (RTT), a control motor task, to examine interictal attention in 26 children with CAE and 22 matched healthy controls. Each subject underwent simultaneous 3T functional magnetic resonance imaging-electroencephalography (fMRI-EEG) and CPT/RTT testing. Areas of activation on fMRI during the CPT task were correlated with behavioral performance and used as seed regions for resting functional connectivity analysis. All behavioral measures reflecting inattention were significantly higher in patients. Correlation analysis revealed that impairment on all measures of inattention on the CPT task was associated with decreased medial frontal cortex (MFC) activation during CPT. In addition, analysis of resting functional connectivity revealed an overall decrease within an 'attention network' in patients relative to controls. Patients demonstrated significantly impaired connectivity between the right anterior insula/frontal operculum (In/FO) and MFC relative to controls. Our results suggest that there is impaired function in an attention network comprising anterior In/FO and MFC in patients with CAE. These findings provide an anatomical and functional basis for impaired interictal attention in CAE, which may allow the development of improved treatments targeted at these networks.
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Affiliation(s)
- Brendan D Killory
- Department of Neurosurgery, Barrow Neurosurgical Institute, 350 Thomas Rd, Phoenix, AZ 85023, USA
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Bennett-Back O, Keren A, Zelnik N. Attention-deficit hyperactivity disorder in children with benign epilepsy and their siblings. Pediatr Neurol 2011; 44:187-92. [PMID: 21310334 DOI: 10.1016/j.pediatrneurol.2010.10.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 08/27/2010] [Accepted: 10/04/2010] [Indexed: 11/30/2022]
Abstract
This prospective study explores the prevalence and characteristics of attention-deficit hyperactivity disorder in children with benign epilepsy, compared with its prevalence in their siblings. Among 40 patients with benign epilepsy, 28 (70%) were diagnosed with attention-deficit hyperactivity disorder: 19 with the inattentive type, one with the hyperactive type, and eight with the combined type. In the control group of 12 siblings, only two (16.7%) were diagnosed with attention-deficit hyperactivity disorder (P<0.03). A trend toward an increased risk for attentional difficulties was evident in children whose seizures were more resistant and required more than one antiepileptic drug for seizure control. Children with more epileptiform features in their electroencephalograms were also more subject to signs of attention deficit hyperactivity disorder. Larger scale studies are required to validate our findings.
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Affiliation(s)
- Odeya Bennett-Back
- Child Neurology and Development Center, Department of Pediatrics, Carmel Medical Center and Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Attentional processes and ADHD-related symptoms in pediatric patients with epilepsy. Epilepsy Res 2011; 93:53-65. [DOI: 10.1016/j.eplepsyres.2010.10.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Revised: 10/10/2010] [Accepted: 10/24/2010] [Indexed: 11/24/2022]
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Jones JE, Siddarth P, Gurbani S, Shields WD, Caplan R. Cognition, academic achievement, language, and psychopathology in pediatric chronic epilepsy: Short-term outcomes. Epilepsy Behav 2010; 18:211-7. [PMID: 20471326 PMCID: PMC2902590 DOI: 10.1016/j.yebeh.2010.03.015] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Revised: 03/22/2010] [Accepted: 03/26/2010] [Indexed: 11/29/2022]
Abstract
Children with epilepsy and control children were followed over a 2-year interval. Comorbidities of epilepsy, often defined as problems related to IQ, academic achievement, language, and psychopathology, were evaluated prospectively. It was hypothesized that over time (1) the presence of comorbidities would predict worse outcomes, and (2) epilepsy variables would negatively impact comorbidities. The study included 39 children with complex partial seizures (CPS), 25 children with childhood absence epilepsy (CAE), and 27 healthy children, aged 7.6-16.1years. The findings were notable for stability over the interval in all three groups. Additionally, baseline seizure variables and change over the interval appear to play a role in IQ and math achievement scores of children with epilepsy with average IQ and in the reading achievement scores of those with below-average IQ. However, seizure variables at baseline and follow-up were not predictors of DSM-IV diagnoses, depression, anxiety, or behavioral problems.
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Affiliation(s)
- Jana E. Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Prabha Siddarth
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, CA
| | - Suresh Gurbani
- Department of Pediatrics, University of California Irvine, CA
| | | | - Rochelle Caplan
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, CA
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Serdari A, Tsalkidis A, Tripsianis G, Vadikolias K, Chatzimichael A, Piperidou C, Livaditis M. Epilepsy impact on aspects of school life of children from different cultural populations in Thrace, Greece. Epilepsy Behav 2009; 15:344-50. [PMID: 19410014 DOI: 10.1016/j.yebeh.2009.04.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Revised: 04/22/2009] [Accepted: 04/27/2009] [Indexed: 11/30/2022]
Abstract
Epilepsy influences the school life of children. The aims of this study were to (1) assess absenteeism and participation in sports activities, (2) investigate whether parents inform school and children inform their classmates, and (3) determine which factors influence these school aspects. Children from both Christian and Muslim families were enrolled and different cultural variables were prospectively documented. A total of 62 children with epilepsy (mean age: 10.2+/-3.3 years, range: 6-18) participated in the present study. Univariate analysis and multivariate logistic regression models were used to explore potential factors that could influence school life. Absenteeism was correlated with shorter disease duration, severity, lower parental educational level, and knowledge of epilepsy. Age>12 was associated with nonparticipation in activities. Schools were informed by 84% of families, and classmates, by 22.6% of children. In conclusion, better knowledge of epilepsy resulted in fewer missed school days. The majority of children did not discuss their disease, and children from the two populations with different religions did not differ significantly in the school aspects examined. These findings suggest a probable positive effect of educational programs on the issue of daily school life.
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Affiliation(s)
- Aspasia Serdari
- Department of Psychiatry and Child Psychiatry, Democritus University of Thrace, University Hospital of Alexandroupolis, Thrace, Greece
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19
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Abstract
Epilepsy is one of the most common diseases encountered among school children. Its effect on school attendance and academic performance is a major cause of concern to both parents and clinicians. In this communication, the absence rate and academic performance of 50 school children with epilepsy attending normal schools was compared with that of their age- and sex-matched classmates using the class attendance register and overall score of the 2001/2002 academic year. The mean and standard deviation of the number of days an epileptic child was absent in the 2001/2002 session was 15.3 + 13.8 days while that of the controls was 9.4 + 9.6 days (x2 = 3.4,df = 49, p < 0.001). There was no significant relationship between the rate of absenteeism and overall score among both epileptic children (x2 = 6.34, df = 2, p = 0.18) and the controls (x2 = 1.43, df = 2, p = 0.49). School absenteeism was therefore more common among epileptic children, though there was no observed negative effect of this increased absence on academic performance.
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Affiliation(s)
- Roland C Ibekwe
- Department of Paediatrics, Ebonyi State University Teaching Hospital, Abakaliki, Ebonyi State.
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20
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Fastenau PS, Dunn DW, Austin JK. Academic underachievement among children with epilepsy: proportion exceeding psychometric criteria for learning disability and associated risk factors. JOURNAL OF LEARNING DISABILITIES 2008; 41:195-207. [PMID: 18434287 PMCID: PMC2748109 DOI: 10.1177/0022219408317548] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This study assessed rates of learning disabilities (LD) by several psychometric definitions in children with epilepsy and identified risk factors. Participants (N = 173, ages 8-15 years) completed IQ screening, academic achievement testing, and structured interviews. Children with significant head injury, chronic physical conditions, or mental retardation were excluded. Using an IQ-achievement discrepancy definition, 48% exceeded the cutoff for LD in at least one academic area; using low-achievement definitions, 41% to 62% exceeded cutoffs in at least one academic area. Younger children with generalized nonabsence seizures were at increased risk for math LD using the IQ-achievement discrepancy definition; age of seizure onset and attention-deficit/hyperactivity disorder (ADHD) were risk factors for reading and math LD using low-achievement definitions. Writing was the most common domain affected, but neither ADHD nor seizure variables reliably identified children at risk for writing LD. Although children with earlier seizure onset, generalized nonabsence seizures, and comorbid ADHD appear to be at increased risk for some types of LD by some definitions, these findings largely suggest that all children with epilepsy should be considered vulnerable to LD. A diagnosis of epilepsy (even with controlled seizures and less severe seizure types) should provide sufficient cause to screen school-age children for LD and comorbid ADHD.
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Affiliation(s)
- Philip S Fastenau
- Indiana University-Purdue University Indianapolis, Indianapolis, Indiana 46202-3275, USA.
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21
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Abstract
Ulcerative colitis (UC) has traditionally been considered to be an inflammatory disease limited to the colonic mucosa. However, since it has been shown that UC is frequently accompanied by various extraintestinal disorders, there is increasing evidence that UC may also manifest in the nervous system. The following review focuses particularly on these possible manifestations of UC, both in the peripheral (PNS), and in the central nervous system (CNS). A systematic literature search according to the MEDLINE database was performed for this purpose. Although a reliable differentiation may clinically not always be possible, three major pathogenic entities can be differentiated: (i) cerebrovascular disease as a consequence of thrombosis and thromboembolism; (ii) systemic and cerebral vasculitis; (iii) probably immune mediated neuropathy and cerebral demyelination. With the exception of thromboembolism and sensorineural hearing loss, evidence for a causal relationship relies merely on single case reports or retrospective case series. Considering the CNS-manifestations, similarities between UC-associated disorders of the white matter and acute disseminated encephalomyelitis (ADEM) are obvious. Epileptic seizures, unspecified encephalopathies and confusional states are most likely epiphenomena that have to be regarded symptomatic rather than as own entities. A prospective study on the neurologic aspects of UC would be very welcome.
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Affiliation(s)
- R Scheid
- Day Clinic of Cognitive Neurology, University of Leipzig, Leipzig, Germany.
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22
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Abstract
PURPOSE The study assessed the school performance of Nigerian adolescents with epilepsy compared with healthy controls and examined the variables correlating with their academic difficulties. METHODS The school grades of adolescents with epilepsy aged 12 to 18 years (n = 73) over the past academic year were compared with the grades of their classmates of the same age and gender. Risk factors possibly associated with school performance, such as adolescent variables (age, gender, perceived stigma, attitude toward epilepsy, and psychopathology), seizure variables (age at onset of illness, years of illness, types of seizures, and frequency of seizures per month), drug variables [types of antiepileptic drugs (AEDs), number of AEDs and side effects of AEDs], and family variables (family's socioeconomic status, family functioning, caretakers' psychopathology, and caretakers' perceived stigma) were assessed. RESULTS The mean school grades of adolescents with epilepsy are significantly lower than are those of their healthy controls (p < 0.001) in all the subjects. The variables that significantly predict poor school performance in adolescents with epilepsy include psychopathology in the caretaker (p < 0.001), adolescents' perceived poor family functioning (p = 0.002), adolescents' attitude toward the illness (p = 0.001), adolescents' felt stigma (p = 0.002), externalizing symptoms in the adolescents (p = 0.004), and duration of illness (p = 0.024). CONCLUSIONS The determinants of poor school performance in adolescents with epilepsy in Nigeria are multivariate, with psychosocial factors most important. These should be noted for early identification and screening of those children at greatest risk for academic failure and the greatest need for appropriate educational remediation services.
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Affiliation(s)
- Abiodun O Adewuya
- Department of Mental Health, Obafemi Awolowo University Teaching Hospitals Complex, Wesley Guild Hospital, ILESA 233001, Osun State, Nigeria.
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23
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Dunn DW, Kronenberger WG. Childhood epilepsy, attention problems, and ADHD: review and practical considerations. Semin Pediatr Neurol 2005; 12:222-8. [PMID: 16780293 DOI: 10.1016/j.spen.2005.12.004] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Children with epilepsy have a significant risk for problems with attention and/or attention deficit hyperactivity disorder. Clinical studies suggest a prevalence of 30% to 40%. Inattention is more common than hyperactivity and impulsivity. Additional central nervous system dysfunction and intractable seizures are major risk factors. Treatment should include psychoeducational interventions and medication. Stimulant drugs are safe and effective in children with epilepsy and currently are first-line agents for treatment of attention problems in this population.
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Affiliation(s)
- David W Dunn
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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Høie B, Mykletun A, Sommerfelt K, Bjørnaes H, Skeidsvoll H, Waaler PE. Seizure-related factors and non-verbal intelligence in children with epilepsy. A population-based study from Western Norway. Seizure 2005; 14:223-31. [PMID: 15893478 DOI: 10.1016/j.seizure.2004.10.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2004] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To study the relationship between seizure-related factors, non-verbal intelligence, and socio-economic status (SES) in a population-based sample of children with epilepsy. METHODS The latest ILAE International classifications of epileptic seizures and syndromes were used to classify seizure types and epileptic syndromes in all 6-12 year old children (N=198) with epilepsy in Hordaland County, Norway. The children had neuropediatric and EEG examinations. Of the 198 patients, demographic characteristics were collected on 183 who participated in psychological studies including Raven matrices. 126 healthy controls underwent the same testing. Severe non-verbal problems (SNVP) were defined as a Raven score at or <10th percentile. RESULTS Children with epilepsy were highly over-represented in the lowest Raven percentile group, whereas controls were highly over-represented in the higher percentile groups. SNVP were present in 43% of children with epilepsy and 3% of controls. These problems were especially common in children with remote symptomatic epilepsy aetiology, undetermined epilepsy syndromes, myoclonic seizures, early seizure debut, high seizure frequency and in children with polytherapy. Seizure-related characteristics that were not usually associated with SNVP were idiopathic epilepsies, localization related (LR) cryptogenic epilepsies, absence and simple partial seizures, and a late debut of epilepsy. Adjusting for socio-economic status factors did not significantly change results. CONCLUSIONS In childhood epilepsy various seizure-related factors, but not SES factors, were associated with the presence or absence of SNVP. Such deficits may be especially common in children with remote symptomatic epilepsy aetiology and in complex and therapy resistant epilepsies. Low frequencies of SNVP may be found in children with idiopathic and LR cryptogenic epilepsy syndromes, simple partial or absence seizures and a late epilepsy debut. Our study contributes to an overall picture of cognitive function and its relation to central seizure characteristics in a childhood epilepsy population and can be useful for the follow-up team in developing therapy strategies that meet the individual needs of the child with epilepsy.
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Affiliation(s)
- B Høie
- Department of Pediatrics, Haukeland University Hospital, 5021 Bergen, Norway.
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25
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McNelis AM, Johnson CS, Huberty TJ, Austin JK. Factors associated with academic achievement in children with recent-onset seizures. Seizure 2005; 14:331-9. [PMID: 15886027 PMCID: PMC1570189 DOI: 10.1016/j.seizure.2005.04.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2004] [Indexed: 10/25/2022] Open
Abstract
Children with chronic epilepsy are more at risk for achievement problems than either children without seizures or children with other chronic disorders. Factors that lead to such problems in children with epilepsy, however, are not well understood. Exploring these factors is important because academic underachievement can lead to poor social outcomes and contribute to underemployment or unemployment in adulthood. This descriptive, cross-sectional study investigated a group of children who had been diagnosed with seizures approximately 12 months previously, providing the opportunity to describe relationships among family and child characteristics; parent, child, and teacher responses; and child academic achievement at the same point in time across the sample. Seventy-two children had standardized test total battery scores, 101 had a teacher's rating of performance, and 67 had scores for both. Data were analyzed using multivariable regression. Child adaptive competency and seizure severity were associated with higher teacher ratings of academic performance (beta=0.73, p<0.0001 and beta=2.38, p=0.0182, respectively). Child adaptive competency was associated with higher total battery scores (beta=0.73, p<0.0001). Contrary to findings in studies of children with chronic epilepsy, mean academic achievement in this sample of children with recent-onset seizures was in the average range; however, 25% of the children were at or below one standard deviation below the mean on the teacher's rating of performance and 10% on the total battery. It is therefore important for health professionals and educators to regularly assess the child's academic functioning and school performance to identify those at risk for problems. Health professionals and educators need to collaborate on assessment and interventions to help maximize child academic success.
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Affiliation(s)
- Angela M McNelis
- Indiana University School of Nursing, 1111 Middle Drive, NU 492, Indianapolis, IN 46202, USA.
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26
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Humphries T, Neufeld M, Johnson C, Engels K, McKay R. A pilot study of the effect of Direct Instruction programming on the academic performance of students with intractable epilepsy. Epilepsy Behav 2005; 6:405-12. [PMID: 15820350 DOI: 10.1016/j.yebeh.2005.01.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2004] [Revised: 01/24/2005] [Accepted: 01/26/2005] [Indexed: 12/01/2022]
Abstract
Fifty-five students with intractable epilepsy and learning difficulties, aged 6.5 to 14.1 years with a mean IQ of 71.25 (SD=13.56), attended a hospital-based classroom of no more than eight students where they received Direct Instruction programming for 3 to 4.5 days a week, typically for up to 16 weeks. Pretest-posttest academic gains were evaluated in comparison to normative test performance. At pretest the students were achieving below test means in reading and mathematics, particularly in calculation. Direct Instruction was associated with significant improvement in all academic areas except word identification in reading. IQ level was related to certain academic gains, but gains were not associated with seizure variables or the number of days students spent in the program. Despite severe learning difficulties, students with intractable epilepsy can make academic gains when taught by highly structured teaching methods such as Direct Instruction.
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Affiliation(s)
- Tom Humphries
- Child Development Centre, The Hospital for Sick Children, Toronto, Canada.
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27
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Aldenkamp AP, Weber B, Overweg-Plandsoen WCG, Reijs R, van Mil S. Educational underachievement in children with epilepsy: a model to predict the effects of epilepsy on educational achievement. J Child Neurol 2005; 20:175-80. [PMID: 15832604 DOI: 10.1177/08830738050200030101] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In this study, we evaluated the impact on educational achievement of four characteristics of epilepsy individually and combined: epilepsy syndrome (type of epilepsy), seizure type, the frequency of epileptiform electroencephalographic (EEG) discharges, and the effect of antiepileptic treatment. Simultaneously, the effect on cognitive function and the relationship between educational underachievement and cognitive impairment were evaluated, focusing on memory, attention, speed of information processing, and intelligence level. This study was an open, controlled, parallel-group, nonrandomized clinical investigation. Eligible patients were selected when referred to our center for assessment of relationships between epilepsy and learning impairment in the years 1997 to 2001. Separately, children without neurologic deficit and without educational delay were assessed with the same tests as the children with epilepsy. This latter group is used in this study as a control group. One hundred seventy-six children with epilepsy and 113 controls were included. Gender distribution and age were comparable for the two groups. All children were in regular primary education. The children were assessed with a test battery consisting of tests for educational achievement, cognitive tests and tests for reaction time, and tests for memory and intelligence. Multivariate analysis of variance for tests of educational achievement showed a statistically significant effect for type of epilepsy (F = 4.386; P = .04), caused by the statistically lower scores for patients with localized epilepsy and symptomatic generalized epilepsy. For the reaction-time tests, a statistically significant effect for epileptiform EEG discharges (F = 3.165; P = .01) and treatment (F = 4.472; P = .001) on both vigilance tests was found, caused by patients with frequent epileptiform EEG discharges and polytherapy. Two-way interactions showed an interaction with type of epilepsy, with more patients with symptomatic generalized epilepsy having frequent epileptiform EEG discharges and polytherapy. For memory, none of the analyses showed statistically significant effects. For intelligence only for type of epilepsy, a statistically significant effect was found (F = 10.174; P = < .001). We propose a model with the type of epilepsy (epilepsy syndrome) as the dominant factor explaining educational underachievement in children with epilepsy. Such educational underachievement is most prominent for the localized and symptomatic generalized epilepsies, which suggests a dominant impact of underlying etiology (brain dysfunction or damage). These epilepsies are characterized specifically by a lower intelligence; hence, this could be the primary cognitive factor mediating between the type of epilepsy and educational underachievement. From the other factors, treatment (the use of polytherapy) and frequent epileptiform EEG discharges are associated with impaired vigilance, which could have an additional influence on educational achievement. These factors are, however, not independent of the type of epilepsy.
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Affiliation(s)
- Albert P Aldenkamp
- Department of Behavioural Research and Clinical Neuropsychology, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands.
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28
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Abstract
Countless studies have demonstrated that patients with epilepsy have a significant increase in behavioral disturbances of all kinds, including hyperactivity and inattention. This finding has been demonstrated in studies utilizing observer questionnaires and behavior rating scales, neuropsychological test batteries, and standardized tests of attention such as continuous performance tests. Multiple factors must be considered in the evaluation of a child with epilepsy and hyperactivity or inattention. For instance, inattention could be due to subclinical seizures, undiagnosed learning disabilities, disturbed sleep as a result of a side effect of antiepileptic medication, or due to an attention deficit disorder. Electroencephalographic monitoring is helpful to distinguish between behavioral inattention and partial complex or absence seizures. Electroencephalographic monitoring can also assess subclinical spike frequency, which may affect attention and other aspects of cognitive functioning in various ways, even in the absence of clinical seizures. Most antiepileptic drugs do not adversely affect attention and behavior in therapeutic doses, with the exception of phenobarbital, gabapentin, and topiramate. Some antiepileptic drugs, such as lamotrigine and carbamazepine, may even have beneficial effects. The preponderance of evidence suggests that stimulants other than bupropion are safe and effective in the treatment of attention deficit disorder in children with epilepsy, although controlled studies of dextroamphetamine in this population are lacking. So far, atomoxetine has not been demonstrated to have any adverse effect in children with epilepsy.
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Affiliation(s)
- Romaine Schubert
- Division of Pediatric Neurology, New York Methodist Hospital, Brooklyn, New York 11215, USA
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29
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Lah S. Neuropsychological outcome following focal cortical removal for intractable epilepsy in children. Epilepsy Behav 2004; 5:804-17. [PMID: 15582827 DOI: 10.1016/j.yebeh.2004.08.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2004] [Revised: 08/06/2004] [Accepted: 08/06/2004] [Indexed: 11/18/2022]
Abstract
In children, surgery for epilepsy has been recognized as a viable treatment option since publication of S. Davidson and M.A. Falconer's outcome study in 1975 [Lancet North Am Ed 5:1260-3], which demonstrated that medical outcome of children who underwent anterior temporal lobectomy paralleled that of adults. Pediatric surgical programs and the literature on medical outcome have grown considerably since that time, with surgery being offered to children with temporal but also extratemporal epilepsy foci. Comparatively little work has been conducted in the area of neuropsychological outcome. This article outlines differences in adult and pediatric outcome studies, reviews the literature on the intellectual and memory outcome in children, and discusses shortcomings of the pediatric outcome research conducted to date.
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Affiliation(s)
- Suncica Lah
- Macquarie University, North Rhyde, NSW, Australia.
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30
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Seager MC, O'Brien G. Attention deficit hyperactivity disorder: review of ADHD in learning disability: the Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities/Mental Retardation[DC-LD] criteria for diagnosis. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2003; 47 Suppl 1:26-31. [PMID: 14516370 DOI: 10.1046/j.1365-2788.47.s1.30.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Attention deficit hyperactivity disorder [ADHD)]is believed to be common among people with learning disabilities. Classification systems in current use have presented diagnostic difficulties in this area, when used for people with learning disability (particularly adults). METHODS A literature search using electronic databases was undertaken, and journals were hand-searched for articles relevant to the diagnosis of mental disorders in adults with intellectual disabilities. RESULTS There is preliminary evidence that ADHD is more common in this population than among the non-learning-disabled population, and indeed that rates of hyperactivity increase with increasing severity of learning disability. There are also associations between ADHD and certain causal syndromes of learning disability. CONCLUSION While available evidence suggests that ADHD may be common among children and adults with learning disabilities, research has been hindered by deficits in currently used diagnostic classification systems. With the recent development of criteria for the diagnosis of ADHD in learning-disabled adults, and the publication of these in Diagnostic Criteria for Learning Disabilities/Mental Retardation[DC-LD] there is scope for an increase in the level of interest in the study of ADHD among adults with learning disabilities.
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Ott D, Siddarth P, Gurbani S, Koh S, Tournay A, Shields WD, Caplan R. Behavioral disorders in pediatric epilepsy: unmet psychiatric need. Epilepsia 2003; 44:591-7. [PMID: 12681010 DOI: 10.1046/j.1528-1157.2003.25002.x] [Citation(s) in RCA: 201] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE This study examined the relation between psychiatric diagnosis and mental health services in children with epilepsy and the associated demographic, cognitive, linguistic, behavioral, and seizure-related variables. METHODS The Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS), the Child Behavior Checklist, the Test of Language Development, and the Wechsler Intelligence Scale for Children-Revised (WISC-R) were administered to 114 children, aged 5 to 16 years, with either complex partial seizures (CPS) or primary generalized with absence (PGE, petit mal). A Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) diagnosis and information regarding mental health services were derived from the K-SADS. RESULTS Although approximately 60% of the subjects had a DSM-IV psychiatric diagnosis, >60% received no mental health treatment. Absence of mental health care was associated with younger age, less parental education, limited number of antiepileptic drugs (AEDs; i.e., one or none), and higher verbal IQ. In addition, children with PGE and a single psychiatric diagnosis were less likely to have a history of mental health treatment. CONCLUSIONS This is the first study to demonstrate unmet mental health need in a large sample of children with CPS and PGE. The study's findings suggest that parents and clinicians should be aware of the mental health needs of children with epilepsy, particularly if they have one or more of the identified risk factors.
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Affiliation(s)
- Derek Ott
- Department of Psychiatry, University of California at Los Angeles, Los Angeles, California, USA.
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Dunn DW, Austin JK, Caffrey HM, Perkins SM. A prospective study of teachers' ratings of behavior problems in children with new-onset seizures. Epilepsy Behav 2003; 4:26-35. [PMID: 12609225 DOI: 10.1016/s1525-5050(02)00642-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The purpose of this study was to explore the association between seizures and behavior problems in children with new-onset seizures using teachers' ratings of behavior. Subjects were 209 children with new-onset seizures and 93 children with asthma. Teacher ratings of behavior were collected prospectively over 24 months to determine differences between children with recurrent seizures, children without recurrent seizures, and children with asthma. During the 2-year period, 155 (74%) children had at least one recurring seizure. Data were analyzed using repeated-measures analysis of variance both with and without covariates. Controlling for covariates, children experiencing recurrent seizures had higher Total (P=0.002) and Internalizing (P=0.018) Behavior Problems scores across all times than those not experiencing recurrent seizures. Children with asthma were similar to children not experiencing recurrent seizures. The association between seizures and behavioral problems was supported using behavioral ratings from teachers.
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Affiliation(s)
- David W Dunn
- Departments of Psychiatry and Neurology, School of Medicine, Indiana University, Indianapolis, IN 46202-5128, USA.
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33
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Tidman L, Saravanan K, Gibbs J. Epilepsy in mainstream and special educational primary school settings. Seizure 2003; 12:47-51. [PMID: 12495649 DOI: 10.1016/s1059131102001711] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
This population based study compared the prevalence, nature and management of epilepsy between primary school children in mainstream education and those attending a special educational placement (children with special needs). The overall prevalence of epilepsy was 4.3/1000, but was 30 times higher in children with special needs, many of whom also had severe physical disabilities. Seizure types and the proportion of subjects with multiple seizures were similar in mainstream children and those with special needs. Epilepsy syndromes were identified in 74% of children. Although seizures were better controlled in children at mainstream school, 44% of these children did not have well controlled seizures. Children with epilepsy are an educationally vulnerable group and both education and health staff need to be aware of the additional support that many of these children require in all types of primary educational settings.
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Affiliation(s)
- L Tidman
- Paediatric Department, Countess of Chester Hospital, Liverpool Road, UK
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34
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Whiting S, Camfield P, Wiebe S, Lassonde M, Sauerwein H, Carmant L. Launching a research initiative: the Canadian Pediatric Epilepsy Network (CPEN). Can J Neurol Sci 2002; 29:364-71. [PMID: 12463492 DOI: 10.1017/s0317167100002237] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The Canadian Pediatric Epilepsy Network is a network of scientists and health care professionals in partnership with organizations which provide education and support to children with epilepsy. The objective of the network is to gain a better understanding of childhood epilepsy through collaborative research conducted with doctors, psychologists, nurses, social workers, educators and scientists across Canada. The network was launched at a meeting in Ottawa in the spring of 2000 where several oral presentations addressed the issues of the fundamental questions of epilepsy, the economic impact and the neuropsychology of childhood epilepsy. The intent was to provoke discussion on future areas of research for the network.
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35
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Dunn DW, Harezlak J, Ambrosius WT, Austin JK, Hale B. Teacher assessment of behaviour in children with new-onset seizures. Seizure 2002; 11:169-75. [PMID: 12018960 DOI: 10.1053/seiz.2001.0612] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
RATIONALE Recent data suggest that children with new-onset seizures may be at increased risk for behaviour problems. Teachers are an excellent source of data about such problems. They do not have the potential bias that a parent worried about a new onset of seizures might have and, furthermore, they are accustomed to comparing performance of children and work in an environment in which the behavioural problems associated with epilepsy may be quite evident. We obtained teachers' reports of behaviour problems in children in the 2 months prior to their first recognized seizure. We also obtained similar data on children with new-onset, moderate severity asthma. In addition to comparing behavioural scores between children with seizures and children with asthma, we compared teachers' assessments of behaviour in children with no prior seizures to those of children with previously unrecognized seizures. METHODS We evaluated 192 children with new-onset seizures, including 129 children with no prior episodes and 63 children with recognized prior seizure-like episodes. The comparison group consisted of 78 children with new-onset, moderate severity asthma. Behaviour was assessed by the teacher's report form (TRF) of the child behaviour checklist (CBCL) or the caregiver-teacher report form for ages 2-5 (C-TRF). Mean scores were compared by two-sample t -tests and analysis of variance (ANOVA). RESULTS The children with new-onset seizures had more thought problems than children with asthma. In comparison to children with no prior seizures, the children with prior unrecognized seizures had higher scores in total behaviour problems, internalizing problems, somatic complaints, anxious/depressed, thought problems, and attention problems. CONCLUSIONS In this sample, children with prior unrecognized seizures were already at increased risk of teacher-rated behaviour problems before starting medication and before any possible stigma effects related to seizures. This sequence suggests underlying neurological problems causing both behavioural problems and seizures.
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Affiliation(s)
- David W Dunn
- Indiana University School of Medicine, Indianapolis, 46202, USA.
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Abstract
Epidemiological studies indicate that there is a high rate of mental retardation and behavioural problems in children with epilepsy. In some cases both the epilepsy and the mental retardation will have a common cause, such as a metabolic disorder or brain trauma. However, in other children, the epilepsy itself may cause either temporary or permanent learning problems. When permanent learning disability can be prevented it is important to treat the epilepsy early and effectively. Children with specific learning difficulties and memory problems can benefit greatly from appropriate management. There are many causes of behavioural disturbance in children with epilepsy. These causes include the epilepsy itself, treatment of the epilepsy, reactions to the epilepsy, associated brain damage/dysfunction and causes that are equally applicable to children who do not have epilepsy. Identifying the cause or causes in each child allows rational management to be provided. Antiepileptic treatment with medication or surgery can either improve the situation or make matters worse. The treatment should be tailored to the needs of the individual child. If surgery is required, there is a strong argument for performing this early in life, both to allow the greatest opportunity for brain plasticity and also to allow the child full benefit from the important developmental and educational years, without the problems that can be associated with the epilepsy. Skilled management of children with epilepsy who have mental retardation and/or behavioural problems can be very rewarding both for the family and for the professionals involved.
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Affiliation(s)
- Frank M C Besag
- Specialist Medical Department, Bedfordshire and Luton Community NHS Trust, Clapham, UK.
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37
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Szot P, White SS, McCarthy EB, Turella A, Rejniak SX, Schwartzkroin PA. Behavioral and metabolic features of repetitive seizures in immature and mature rats. Epilepsy Res 2001; 46:191-203. [PMID: 11518622 DOI: 10.1016/s0920-1211(01)00285-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Seizure incidence varies significantly with age, with seizure susceptibility particularly high during the first few years of life. Of significant concern is what effects do brief, repetitive seizures have on the developing brain. We approached this issue by examining the change in seizure threshold, and related markers of neuronal activity and metabolic activity (c-fos mRNA and 2-deoxyglucose [2DG]), as a function of repetitive seizure episodes in immature and mature rats. Starting on postnatal day 15 (P15) (immature) or P60 (adult) rats were given two flurothyl seizures a day for 5 days (nine or ten seizures). The seizure latency profile, our measure of threshold, in immature versus adult rats across the 5-day testing period was different. In immature rats, threshold for the second seizure on each day was significantly lower than for the first seizure, suggesting that there was little refractoriness after the first seizure of the day. In contrast, the mature animal had a significantly longer threshold latency to the second seizure for the first 3 days of testing. The immature animal was also more likely than the adult to exhibit tonic extension as a feature of the first seizure of the day. Following repetitive seizures, more regions of the CNS showed c-fos mRNA expression in the immature animal than adults, suggesting that repetitive seizures in the immature animal activated a greater percentage of the brain. Compared with the effects of a single seizure, repetitive seizures resulted in less 2DG labeling in most regions of the brain (except the hippocampus); in the immature brain this difference was more distinct than in adults. The consequences of repetitive seizures in the immature animal results in distinctly different seizure behavior and neuronal activity pattern (c-fos expression) than that observed in the mature animal.
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Affiliation(s)
- P Szot
- Geriatric Research, Education and Clinical Center (182B), VA Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA 98108, USA.
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38
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Elliott IM, Lach L, Smith ML. Adolescent and Maternal Perspectives of Quality of Life and Neuropsychological Status Following Epilepsy Surgery. Epilepsy Behav 2000; 1:406-417. [PMID: 12737830 DOI: 10.1006/ebeh.2000.0129] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A convenience sample of 13 adolescents who had undergone epilepsy surgery and their mothers reported their perceptions of change in areas affecting quality of life (physical, affect/behavior, social, cognition/academics, and family). A mixed method approach was used, with self-report and maternal-report narratives (qualitative measures), as well as neuropsychological profiles (quantitative measures). The results demonstrate that change after epilepsy surgery is multifaceted, and that adolescent and maternal perceptions are notably different. Whereas most adolescents experienced positive changes, mothers simultaneously reported many more negative changes along with positive changes. Furthermore, mothers frequently described aspects of their adolescent's life that continued to be of concern, whereas adolescents did not. The findings strongly suggest that the processes involved in postsurgical adjustment are complex. The development of a theoretical model is essential to help build an understanding of factors that contribute to positive and negative outcomes.
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Affiliation(s)
- Irene M. Elliott
- Departments of Nursing, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
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39
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Gülgönen S, Demirbilek V, Korkmaz B, Dervent A, Townes BD. Neuropsychological functions in idiopathic occipital lobe epilepsy. Epilepsia 2000; 41:405-11. [PMID: 10756405 DOI: 10.1111/j.1528-1157.2000.tb00181.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Despite the benign prognoses of idiopathic partial epilepsies, particularly regarding the response of seizures to treatment, some evidence now exists that patients with such disorders may have subtle neuropsychological deficits. This study was designed to investigate several modalities of neuropsychological functioning in a group of 21 patients, ranging from 6 to 14 years of age, with idiopathic occipital lobe epilepsy (IOLE). The case patients were compared with 21 healthy controls matched for age, sex, and socioeconomic status. METHODS A battery of age-appropriate neuropsychological tests was administered individually to all the participants. Tests were chosen on the basis of age-appropriate norms, their ability to represent a wide variety of functional domains, and their appropriateness in a cross-cultural setting. The tests were selected to measure functioning in six domains: intellectual functioning, attention, memory, academic achievement, visual-motor functioning, and executive functioning; some were further subdivided by their verbal-versus-visual modality of functioning. RESULTS The results revealed no significant difference in basic neurophysiological functions between the patient and control groups, although the case patients' performance scores were lower in attention (p < 0.01) and memory (p < 0.01), as well as in intellectual functioning (p <.05). CONCLUSIONS The possibility of subtle cognitive deficits in IOLE patients should always be considered, though further studies are necessary to elaborate their precise and long-term effects.
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Affiliation(s)
- S Gülgönen
- Department of Psychology, Boğaziçi University, and *Child Neurology Department, Cerrahpaşa Medical School, University of Istanbul, Turkey
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40
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Abstract
Intrasubtest scatter (ISS) is a measure of person's tendency toward inconsistency when responding to test items. It has been claimed that ISS may be suggestive of intellectual inefficiency, difficulty with recall of specific information, or fluctuating levels of arousal/attention. The research investigating these claims has been inconclusive, possibly because traditional indices of ISS may not adequately measure inconsistent responding. Item Response Theory (IRT) approaches to the detection of unusual response sequences appear to have a much firmer psychometric foundation but have been largely ignored in the neurodiagnostic literature. This study compares the utility of traditional and IRT-based indices of ISS in identifying children known to be experiencing information-processing difficulties. The WISC-R item responses of 100 children who have received cranial irradiation treatment for leukemia are compared with those of 100 healthy children. Results confirm the diagnostic utility of an IRT-based measure of unusual test behavior in this clinical group.
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Affiliation(s)
- T Godber
- LaTrobe University, Bendigo, Victoria, Australia.
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41
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Aldenkamp AP, Overweg-Plandsoen WC, Arends J. An open, nonrandomized clinical comparative study evaluating the effect of epilepsy on learning. J Child Neurol 1999; 14:795-800. [PMID: 10614566 DOI: 10.1177/088307389901401205] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Children with epilepsy, as a group, have a greater risk for developing learning problems as comorbid disorders. It is unknown which factors contribute to the development of such learning problems; therefore, our current knowledge does not allow the prediction of educational delay in an individual child with epilepsy. This study aimed at excluding as many factors as possible that could interfere with the analysis of the impact of epilepsy on learning. From patients referred to us in 1997 (N = 123), children were included with mild global learning impairment, defined as educational delay between 6 months and 1 year and no other apparent reason for learning impairment except for epilepsy (ie, excluding children with dyslexia, attention-deficit hyperactivity disorder, or mental handicap). A total of 44 patients fulfilled this criterion: 31 also had epilepsy (experimental group); the remaining 13 patients with similar mild learning impairment but without epilepsy were used as controls. In the experimental group two subgroups were distinguished on the basis of onset of learning impairment: in group A (n = 17) the learning problems are not unexpected as they were preceded by mild developmental delay; in group B (n = 14) the problems are unexpected and had a sudden onset. The two experimental groups differed from the control group on a number of variables, such as gender and the incidence of perinatal complications. More differences have been found between the two experimental groups: group B is selected from a larger group: all children with mild global learning impairment with sudden onset. In this group considerably more children with epilepsy have been found compared to the children with developmental delay; moreover the epilepsy is more often characterized in these children as "unexpected," that is, there was no previous established diagnosis of epilepsy, the symptoms were mostly unclear and behavioral in make-up (attentional lapses, etc); the electroencephalogram plays a much greater role in the diagnosis in this group, especially in demonstrating seizures; finally, the children in this group more frequently have neuropsychologic impairment. Children with epilepsy can have mild global learning difficulties, especially in the period after the onset of seizures. This group can be divided in a group with "trait-dependent learning difficulties," that is learning difficulties based on developmental delay, and a group with "state-dependent learning difficulties." The focus in our study was on this latter group, consisting of children with sudden and unexpected decline of results in school. The crucial finding in this group is the relatively frequent demonstration of difficult-to-detect seizures, demonstrating that an uncontrolled epilepsy can cause a decline in school results even when the seizures are of short duration and have subtle symptoms.
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Affiliation(s)
- A P Aldenkamp
- Department of Behavioral Science and Psychological Services, Epilepsy Center Kempenhaeghe, Heeze, University of Amsterdam, The Netherlands.
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Devinsky O, Westbrook L, Cramer J, Glassman M, Perrine K, Camfield C. Risk factors for poor health-related quality of life in adolescents with epilepsy. Epilepsia 1999; 40:1715-20. [PMID: 10612334 DOI: 10.1111/j.1528-1157.1999.tb01588.x] [Citation(s) in RCA: 147] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To examine potential risk factors for poor health-related quality of life (HRQOL) among adolescents with epilepsy by using the newly developed QOLIE-AD-48. Risk factors were derived from sociodemographic, social, academic, and epilepsy- and health-related domains. METHODS The QOLIE-AD-48 was administered to 197 English-speaking adolescents (age 11-17 years from >20 sites in the United States and in Canada). The self-report instrument yields an overall HRQOL score and eight subscale scores. Other data were obtained from family interviews, physician reports, and health records. Multiple regression analyses were conducted to study risk factors for impairment of HRQOL. RESULTS Older adolescents (age 14-17 years), those with more severe epilepsy and more symptoms of neurotoxicity, and those living in households with lower socioeconomic status were more likely to report poor overall HRQOL. Risk factors in the eight HRQOL domains were found as follows: (a) Epilepsy Impact: older age in adolescence, more severe epilepsy and neurotoxicity, more hospitalizations during the past year, and fewer hours of extracurricular activities; (b) Memory and Concentration: longer duration of epilepsy, special education classes, and history of repeating a grade in school; (c) Attitude Toward Illness: older age, female gender, and more severe epilepsy and neurotoxicity; (d) Social Support: younger age, male gender, and fewer hospitalizations in the last year; (e) Stigma: lower socioeconomic status and special-education classes; and (f) Health Perceptions: older age, female gender, and lower socioeconomic status. None of the factors examined was significantly associated with HRQOL in (g) Physical Functioning or (h) School Behavior subscales. CONCLUSIONS We identified several risk factors for poor HRQOL outcomes in adolescents with epilepsy. Age, increased seizure severity, and neurotoxicity were most consistently associated with poor HRQOL across domains. Older adolescents, independent of epilepsy severity, reported worse overall HRQOL than did their younger counterparts. Older adolescents also were more likely to perceive a greater negative impact on life and general health, and had more negative attitudes toward epilepsy. Adolescent boys and girls may show different sensitivities to various quality-of-life domains.
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Affiliation(s)
- O Devinsky
- Department of Neurology, NYU School of Medicine, New York, New York, USA
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43
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Abstract
The purposes of the study were to compare academic achievement between children with epilepsy and those with asthma and to identify child perception, school adaptive functioning, and condition severity factors related to academic achievement. Subjects were 225 children (117 with epilepsy and 108 with asthma) aged between 8 and 12 years. Academic achievement was measured using school-administered group tests. Self-report questionnaires were used to measure child attitudes and school self-concept. Teachers rated school adaptive functioning. Data were analyzed using ANCOVA and multiple regression. Children with epilepsy had significantly lower achievement scores than children with asthma. Boys with severe epilepsy were most at risk for underachievement. Factors related to poor academic achievement in both samples were: high condition severity, negative attitudes, and lower school adaptive functioning scores. Less variance was accounted for in the model for epilepsy (R2=0.25) than for asthma (R2=0.36). Boys with high seizure severity were most at risk for achievement-related problems. Future research in epilepsy should consider additional factors in the model predicting academic achievement.
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Affiliation(s)
- J K Austin
- Indiana University School of Nursing, Indianapolis 46202, USA
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44
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Schneider SC, Tan G. Attention-deficit hyperactivity disorder. In pursuit of diagnostic accuracy. Postgrad Med 1997; 101:231-2, 235-40. [PMID: 9126215 DOI: 10.3810/pgm.1997.04.206] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Attention-deficit behaviors create a substantial burden for healthcare facilities. The incidence of ADHD is estimated at 5% to 10% of school-age children, but it is possible that many diagnoses of ADHD are flawed. At present, because the etiology of the disorder is not well understood, the diagnosis of ADHD by DSM-IV criteria hinges on the presence of inattention, hyperactivity, impulsivity, or a combination of these. Children who do not have ADHD also exhibit such behaviors in certain environments, as do children with learning disorders, family relational problems, and emotional difficulties. Thus it is imperative that physicians take a comprehensive approach to diagnosis when a child presents with behavioral difficulties. Noting that a number of myths about ADHD (eg, that improved behavior after being given stimulant medication proves a diagnosis of ADHD) have recently gained currency, the authors recommend going beyond the first step of behavior checklists in diagnosing the disorder and describe situations in which further assessment is indicated.
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Affiliation(s)
- S C Schneider
- Department of Family Medicine, Texas Tech University Health Sciences Center at Amarillo 79107, USA.
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45
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McCarthy AM, Richman LC, Yarbrough D. Memory, attention, and school problems in children with seizure disorders. Dev Neuropsychol 1995. [DOI: 10.1080/87565649509540604] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Manchanda R, Schaefer B, McLachlan RS, Blume WT. Relationship of site of seizure focus to psychiatric morbidity. ACTA ACUST UNITED AC 1995. [DOI: 10.1016/0896-6974(94)00008-n] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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47
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Abstract
Forty one children (20 boys, 21 girls) aged 6-10.8 years (mean age 8.6 years) who were affected with idiopathic epilepsy underwent neuropsychological (Wechsler Intelligence Scale for Children, Bender test) and behavioural assessment (Personality Inventory for Children; this was also used in a matched control group). Further information was obtained by teachers' reports. School underachievement occurred in 25 children (61%). Statistical analysis showed no influence of sex, social background, age of onset, seizure type, duration of illness, features seen on electroencephalography, and treatment. School failure was due to poor performance in almost all academic fields, and was associated with higher visuomotor impairment; children showing good school performance had a higher mean IQ and less visuomotor impairment. The behaviour of children with epilepsy who had a good academic performance did not differ from that of their healthy peers. Emotional maladjustment (social skill impairment, depression, poor motivation, and low self esteem) was associated with poor school performance. Such problems, that may complicate the course of idiopathic epilepsy and require an appropriate educational programme, should be carefully considered by the clinician.
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Affiliation(s)
- M G Sturniolo
- Department of Child Neuropsychiatry, University of Rome La Sapienza, Italy
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48
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Abstract
We report results from the first data collection on an ongoing longitudinal study aimed at describing the natural history of adaptation to childhood epilepsy and asthma in children and their families. We studied 136 children with epilepsy and 134 children with asthma aged 8-12 years. Data were collected from the children, their mothers, and their school teachers through interviews, school records, and questionnaires. The two samples were compared on four domains of quality of life: physical, psychological, social, and school. Data were analyzed by a 2 x 2 between-subjects multivariate analysis of covariance with type of illness (epilepsy or asthma) as the independent variable and length of time since onset of illness as a covariate. A significant main effect was noted for illness [multivariate F (15, 236) = 11.36, p < 0.001]. Our major finding was that children with epilepsy had a relatively more compromised quality of life in the psychological, social, and school domains. In contrast, children with asthma had a more compromised quality of life in the physical domain. Our findings suggest that attention simply to seizure control in the clinical setting will not address the full range of quality-of-life problems of children with epilepsy.
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Affiliation(s)
- J K Austin
- Department of Psychiatric/Mental Health Nursing, Indiana University School of Nursing, Indianapolis 46202
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49
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Vermeulen J, Kortstee SW, Alpherts WC, Aldenkamp AP. Cognitive performance in learning disabled children with and without epilepsy. Seizure 1994; 3:13-21. [PMID: 8044448 DOI: 10.1016/s1059-1311(05)80157-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Cognitive functioning and educational achievement were examined in learning disabled children with epilepsy (n = 65) and without epilepsy (n = 122) in order to explore whether children with epilepsy show unique types of learning problems, different from those in other learning disabled children. The learning disabled children with epilepsy tended to perform better on tests of verbal intelligence, certain achievement-related abilities and were better in one area of academic achievement, i.e. spelling. Despite their superior performance in these areas, the learning disabled children with epilepsy were slower than those without epilepsy and regular education controls (n = 100) on simple auditory and visual reaction tasks as well as on a multiple decision reaction task and a visual searching task. The results obtained with the school achievement tasks provide no clear evidence for specific types of learning impairment in children with epilepsy. Learning disabled children with epilepsy do not appear to have educational needs different from those of other learning disabled children.
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Affiliation(s)
- J Vermeulen
- Department of Neuropsychology, Instituut voor Epilepsiebestrijding, Heemstede, The Netherlands
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50
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Abstract
Social factors play a major role in determining the impact of epilepsy on families. This paper reviews the literature on the needs of families and their social networks, and services proposed for them. The predominantly negative picture presented in the 'expert' literature is compared with the more positive one presented in first-hand studies of families' views and in the literature on children with other disabilities. The implications of these differing perspectives for service provision are discussed.
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Affiliation(s)
- A Laybourn
- Centre for the Study of the Child and Society, University of Glasgow, UK
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