Epilepsy Neurocognitive Assessment & Remediation

General information about epilepsy

Seizures or convulsions are fairly common, occurring in about 3-5% of children. Epilepsy, having two or more seizures of unknown cause, is less common and only occurs in about 1% of children. It begins in childhood in about 70% of cases. Seizures in children can range from febrile seizures and occasional non-febrile seizures to infantile spasms that can occur daily and are difficult to treat. Seizures, especially the first seizure that a child has, can be very frightening for both children and their parents.

Although seizures can sometimes be caused by specific medical problems, including fever, head trauma, poisonings, infections, especially meningitis and encephalitis, and brain tumors, the cause of most seizures is often not found (idiopathic seizures).

Types of childhood epilepsy

The main types of seizures are Partial Seizures and Generalized seizures.
Generalized seizures include the convulsive, tonic-clonic, or Grand mal, type of
seizures which people are most familiar, in which a child falls down and has jerking movements. Other types of generalized seizures include atonic seizures, which cause 'drop attacks', and absence seizures (petit mal). Absence seizures cause a brief loss of awareness and are one of the causes of staring spells. These staring spells are usually brief, lasting only about 10-15 seconds, with a return to normal awareness after the seizure and they may occur several times a day. Absence seizures can be brought on by hyperventilation and they have a characteristic EEG, with a 3-per-second spike and wave pattern.

The other main type of seizures are the partial seizures, which have a focal or local onset (starting in the right leg, for example, in contrast to a generalized seizure, which begins in all parts of the body at the same time). Partial seizures may be simple, in which there is no loss of consciousness, including seizures in which a child jerks one arm or deviates his eye to one side. Children can also have partial complex seizures, which also have a focal onset, but which do involve a loss of consciousness. They are similar to absence seizures in that they also cause staring spells, but with partial complex seizures, the staring spell is usually longer, lasting about 30 seconds to several minutes and the child may be confused after the seizure. In addition to just staring, these children may seem confused during the episode and may wander around.

Cognitive/neuropsychological complications of childhood epilepsy

From a neuropsychological standpoint, epilepsy is a very heterogeneous condition. Epilepsies are divided into two categories (focal and generalized) that are differentiated by the neuropsychological symptoms that are present. Cognitive difficulties present in children suffering from focal epilepsy are usually specific to the cerebral area involved, while generalized epilepsies are linked to a diffuse neuropsychological deficit profile as well as to a more limited intellectual functioning.

Much research on children with epilepsy has demonstrated an association between epilepsy and cognitive deficits. Some research has indicated that intelligence scores of children with epilepsy are in the normal range, tending to cluster towards the lower end, especially in symptomatic epilepsy. The frequency of mental retardation in children with epilepsy has been reported to be 24–41%.

In childhood epilepsy several seizure-related characteristics have been reported to be associated with impaired cognitive performance: non-controllable seizures or high seizure frequency, long duration and severe seizures, symptomatic aetiology, early onset of epilepsy and treatment related factors. Atypical absences and other minor-motor seizures have also been found to be frequently associated with cognitive problems.

Emotional, social & behavioral complications of epilepsy

There is significant emotional distress experienced by children with epilepsy. Children are often concerned about social embarrassment, fear of seizures, and injuries. Peer acceptance is an important concern in children with epilepsy. Children with epilepsy often report being teased about their seizures and bullied by their peers. The unpredictable nature of seizures may contribute to the development of a more general sense of helplessness and loss of control. In an effort to avoid potential embarrassment and stigma, children may socially withdraw from their peers, isolating themselves and limiting their social interaction.Limitations in activities and feelings of being different may also result in social isolation.

Children may have some difficulty regulating affect and behavior. Low affect, irritability, and frustration are symptoms that are risk factors for depression and anxiety. Under-diagnosis of depression in epilepsy is unfortunately common.