Childhood epilepsy in relation to mental handicap and behavioural disorders

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.

Speech, language, and cognition in preschool children with epilepsy

“…This is in agreement with Svoboda, who reported that difficulties with auditory discrimination in a noisy background were seen in 24%, and difficulties with short-term memory in 61% of children referred to the Kansas City Epilepsy Center, 5 and such difficulties have also been reported by others. 4,23 However, our results in different subtests of auditory attention and narratives were contradictory and could reflect different demands in these subtests or fluctuating ability.…”

Autistic characteristics in adults with epilepsy

“…In a thorough review of children with behavioural problems, MR and epilepsy, Besag summarised that many children with epilepsy have global or specific learning difficulties, and that generally, the greater the degree of pre-existing MR, the higher the risk of developing epilepsy (Besag, 2002). Besag questions whether lower intellectual functioning in epilepsy reflects a pre-existing genetically determined deficit or a consequence of having epilepsy.…”

“…Notably though, the younger twin was treated with AED intervention. This is important as Besag (2002) states that a learning disability [LD] must be distinguished from MR, as MR is a permanent learning disability, while a state-dependant LD is potentially reversible. Besag defines state-dependant LD as "a learning disability that is caused by factors currently affecting the individual that are potentially reversible or treatable" and severe LD with autistic symptomology can be profoundly reversed by appropriate treatment strategies such as AEDs (ibid., p.110).…”

EEG in Childhood Psychiatric Disorders

“…It is characterised by hypsarrythmia, learning problems and infantile spasms, with psychiatric disorders manifesting in up to a third. Autistic regression has been observed amongst those with behavioural disorder, and more than half of those with West syndrome associated with TS have reportedly remained autistic [30].…”