Behavioral Problems in Children with Newly Diagnosed Idiopathic or Cryptogenic Epilepsy Attending Normal Schools Are in Majority Not Persistent

Oostrom, Kim J.; Schouten, A.; Kruitwagen, Cas; Peters, A. C. B.; Jennekens‐Schinkel, A.

doi:10.1046/j.1528-1157.2003.18202.x

Cited by 82 publications

(61 citation statements)

References 45 publications

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“…These include: (1) mental handicap in 21-34% Sillanpaa, 1992); (2) learning disorder in 51-57% (Sillanpaa, 1990(Sillanpaa, , 1992Camfield et al, 1993;Oostrom et al, 2003); (3) mental health problems in 25-34% (Rutter et al, 1970;Oostrom et al, 2003;Austin et al, 2001), and (4) attention deficit disorder in 10% (Austin et al, 2001;Hesdorffer et al, 2004; Dunn & Kronenberger, 2005). These difficulties may reflect an underlying brain abnormality or family dysfunction, and they have important effects on later outcome children with epilepsy.…”

Section: Discussionmentioning

confidence: 99%

Long‐term social outcomes for children with epilepsy

Camfield

2007

Epilepsia

109

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SUMMARYChildren with epilepsy often grow into adults with significant social problems including decreased employment, marriage, social relationships, and independent living arrangements. These problems are noted in population-based longitudinal and crosssectional studies from many countries. Learning disorder and mental handicap are the most consistent predictors of poor social outcome. Epilepsy variables, even remission, appear to have little effect. The influence of epilepsy on social outcome is greater than found in other childhood chronic disease control groups. More attention and research is needed to correct these unfortunate outcomes. KEY WORDS: Prognosis, Population-based, Psychosocial, Long-term follow-up.At the time of diagnosis of childhood epilepsy psychosocial problems and comorbidities are common. These include: (1) mental handicap in 21-34% Sillanpaa, 1992); (2) learning disorder in 51-57% (Sillanpaa, 1990(Sillanpaa, , 1992Camfield et al., 1993;Oostrom et al., 2003); (3) mental health problems in 25-34% (Rutter et al., 1970;Oostrom et al., 2003;Austin et al., 2001), and (4) attention deficit disorder in 10% (Austin et al., 2001;Hesdorffer et al., 2004; Dunn & Kronenberger, 2005). These difficulties may reflect an underlying brain abnormality or family dysfunction, and they have important effects on later outcome children with epilepsy. Surprisingly, the continued social problems in normally intelligent children with epilepsy are not clearly related to remission or any other biologic factor except learning disorder. The social outcomes are worse in children with epilepsy than in either community or chronic illness controls.Published studies that address the long-term social outcome of childhood epilepsy are not easily compared because they have used varying definitions for predictor variables (such as mental handicap, neurological deficit and type of syndrome) and varying definitions of what constitutes a satisfactory long-term outcome. INITIAL SUGGESTIONS OF POOR SOCIAL OUTCOME FROM POPULATION-BASED STUDIESTwo excellent British prevalence studies, the Isle of Wight study (Rutter et al., 1970) and the British Child and Adolescent Mental Health Survey (Davies et al., 2003), found that over 25% of children aged 5-14 years with epilepsy had "psychiatric difficulties" as compared with 7-9% of normal controls. The mental health survey also found that only 11% of children with diabetes, a chronic disease control, had behavioral difficulties. In addition, psychiatric difficulties were experienced by 56% of children with epilepsy plus comorbid neurological problems. LARGE POPULATION-BASED LONG-TERM FOLLOW-UP STUDIES FROM MANY REGIONS OF THE WORLD Oulu Finland (Kokkonen et al., 1997)This population-based Finnish series began as a prevalence cohort of all noninstitutionalized children with epilepsy (n = 92) born between 1964-67. When these patients were 22 years of age, they were compared with 211 controls from same birth cohort by interview or questionnaire. Those with childhood onset epilepsy had signifi...

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Section: Discussionmentioning

confidence: 99%

Long‐term social outcomes for children with epilepsy

Camfield

2007

Epilepsia

109

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“…In fact, several recent studies of children with epilepsy have used it, making it possible to compare results directly with these studies. 7,9,29 The CBCL is relatively easy to use and is highly appropriate for large-scale research projects such as this one. While we might have attempted a more intensive and lengthy diagnostic interview, that was not feasible within the context of the assessment that we performed.…”

Section: Discussionmentioning

confidence: 99%

Behavior and social competency in idiopathic and cryptogenic childhood epilepsy

Berg

Vickrey

Testa

et al. 2007

Develop Med Child Neuro

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Behavioral and related disorders are frequently reported in association with childhood epilepsy but the reasons for this are unclear. In a long-term prospective, community-based study of newly-diagnosed childhood epilepsy, behavioral assessments (Child Behavior Checklist) were performed in children 8 to 9 years after the initial diagnosis of epilepsy to determine the impact of remission and medication status on behavioral problems. Children with epilepsy were also compared with sibling controls. A total of 226 children (108 females, 118 males; mean age 13y 1mo [SD 2y 8mo], range 8-17y) with idiopathic or cryptogenic epilepsy were included in the analyses. One hundred and twenty-eight matched pairs were included in analyses of case-sibling differences. Lack of remission and current medication use were associated with worse behavioral problem and competency scores. Lack of remission generally had a greater effect than medication use, except for attention problems; medication status had the more deleterious effect (p<0.001). Children with epilepsy had significantly worse behavioral problems and competency scores relative to sibling controls. Even in pairs in which the patient was seizure-free and off medication, significant case-sibling differences persisted for most scales (p=0.05 to p=0.001). Lack of remission and continued use of antiepileptic drugs have a negative influence on behavioral problems in children with epilepsy but do not fully explain the worse scores relative to siblings. This suggests an independent effect associated with the epilepsy itself.Studies conducted in the 1970s demonstrated high rates of behavioral disturbances associated with symptomatic or severely uncontrolled epilepsy. 1,2 More recent studies of pediatric epilepsy have focused on cryptogenic and idiopathic epilepsy. [3][4][5][6][7][8][9][10][11] These studies have demonstrated an unusually high occurrence of a wide range of social, cognitive, behavioral, and psychiatric difficulties during the active phase of the disorder. It is not fully clear, however, whether adverse associations with epilepsy are seen just in association with ongoing seizures and current use of antiepileptic drugs (AEDs). Some studies found that poorer than expected social and educational outcomes occur even in individuals with excellent seizure control who are no longer on medication. [12][13][14] The independent contributions of seizure control, medication, and epilepsy itself on behavior or related outcomes have not been clearly distinguished. We have addressed this issue in the context of a long-term, prospective, community-based study of children initially recruited when first diagnosed with epilepsy. The focus of the current analyses was to: (1) assess the relative contributions of type of epilepsy, seizure control, and medication status to behavioral problems and to social competencies in children with idiopathic or cryptogenic epilepsy; (2) determine whether children with epilepsy had higher levels of behavioral symptomatology and lower social competenci...

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“…An impact on at least one academic area is identified in 50% of children with epilepsy (Vinayan et al 2005;Fastenau et al 2008). It is important to note that even those children functioning at or near an average IQ often underachieve with respect to performance expected for that IQ (Oostrom et al 2003). In the school setting, 45% of children with epilepsy and an IQ of at least 80 require special education services, and 16% of these children repeat a year of education (Aldenkamp et al 1990;).…”

Section: The Nature Of Cognitive Impairments In People With Epilepsymentioning

confidence: 99%

Mechanisms Responsible for Cognitive Impairment in Epilepsy

Lenck-Santini

Scott

2015

Cold Spring Harb Perspect Med

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Epilepsy is often associated with cognitive and behavioral impairments that can have profound impact on the quality of life of patients. Although the mechanisms of cognitive impairment are not completely understood, we make an attempt to describe, from a systems perspective, how information processing is affected in epilepsy disorders. The aim of this review is to (1) define the nature of cognitive deficits associated with epilepsy, (2) review fundamental systems-level mechanisms underlying information processing, and (3) describe how information processing is dysfunctional in epilepsy and investigate the relative contributions of etiology, seizures, and interictal discharges (IDs). We conclude that these mechanisms are likely to be important and deserve more detailed scrutiny in the future.T he epilepsies are a group of disorders defined by the propensity for an individual to have epileptic seizures (Fisher et al. 2014). In addition to seizures, these common and serious neurological disorders are associated with cognitive and behavioral impairments (Berg and Scheffer 2011). The cognitive and behavioral impairments are critical determinants of the reductions in quality of life observed in patients with epilepsy (Ronen et al. 2003;Loring et al. 2004). It is, therefore, of major importance that the mechanisms underlying cognitive impairments are characterized as this is likely to lead to novel interventions that will ultimately improve the quality of life of people with epilepsy. Epilepsy is associated with a variety of physiological and molecular alterations at the level of changes in the genome, gene expression, receptor characteristics, peptides, and brain injury. These changes are not only responsible for seizures but also for functional abnormalities underlying cognitive impairment. It is likely that several of these mechanisms are occurring in concert, and, therefore, it is important to study the net effects of these alterations at the level of neural networks as this may also lead to novel interventions that could improve outcomes. The aims of this article are to (1) define the nature of cognitive deficits associated with epilepsy, (2) review fundamental systems-level mechanisms underlying information processing, and (3) describe how information processing is dysfunctional in epilepsy and investigate the relative contributions of etiology, seizures, and interictal discharges (IDs).

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Behavioral Problems in Children with Newly Diagnosed Idiopathic or Cryptogenic Epilepsy Attending Normal Schools Are in Majority Not Persistent

Cited by 82 publications

References 45 publications

Long‐term social outcomes for children with epilepsy

Long‐term social outcomes for children with epilepsy

Behavior and social competency in idiopathic and cryptogenic childhood epilepsy

Mechanisms Responsible for Cognitive Impairment in Epilepsy

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