Learning disorders in children with epilepsy

Poor School Academic Performance and Benign Epilepsy with Centro-Temporal Spikes

BACKGROUND

Poor academic performance of students with epilepsy seems to be a multifactorial problem related to difficulties in reading, writing, math, and logic skills. Poor school and academic performances refer to learning problems in a specific academic area due to learning disorders and learning difficulties not excluding the ability to learn in a different manner during school and academic life. Sometimes, school, academic difficulties, and Rolandic epilepsy can coexist together, and there may be comorbidities. Consequently, the risk of impaired academic performance in people with epilepsy is high.

METHODS

This review analyzed the relationship between Benign Epilepsy with Centro-Temporal Spikes (BECTS) and poor school and academic performance (PSAP) in children and adolescents (aged 6 to 19), and in adults (aged 20 to no age limit). The PRISMA guideline was used to guide our review strategy.

RESULTS

This research shows that Benign Epilepsy with Centro-Temporal Spikes (BECTS) and poor school and academic performances are strongly correlated. An early onset age, as well as a long persistence of seizures, correlate more closely with PSAP. On the other hand, it appears that good pharmacological control of seizures and remission from the acute phase of the pathology support better school performance.

CONCLUSIONS

This review highlights how neuropsychological aspects are also involved in patients with BECTS and PSAP, both in the greater predisposition to the establishment of other neuropsychiatric conditions and in the possibility that stigma conditions and poor academic results may have repercussions on the adaptation and functioning of these subjects. Global management of the subject with BECTS and PSAP is essential, which also pays attention to the aspects of social and scholastic inclusion, both to achieve age-appropriate educational and behavioral objectives, to give the necessary tools for the growth of the individual, and to allow a serene transition to adulthood, favoring autonomous learning and better outcomes.

Chronic pediatric diseases and risk for reading difficulties: a narrative review with recommendations

Literacy is a major social determinant of health, rooted in skills that develop during early childhood. Children arriving at kindergarten unprepared to learn to read are more likely to have low reading proficiency thereafter. General and health literacy are highly correlated, affecting understanding of health conditions, treatment adherence, and transition to self-care and adult healthcare services. The American Academy of Pediatrics (AAP) recommends literacy and school readiness promotion during well-visits and neurodevelopmental surveillance is emphasized across primary and subspecialty care. While genetic and environmental risk factors for reading difficulties are well-established, risks related to complex and chronic medical conditions are less appreciated and under-researched. This review applies an eco-bio-developmental framework to explore literacy across five complex chronic conditions affecting millions of children worldwide: asthma, cancer, congenital heart disease, epilepsy, and sickle cell disease. In each, integration of an efficient reading brain network may be impacted by direct factors, such as ischemia, anesthesia, and/or medications, and also indirect factors, such as altered parent-child routines, hospital stays, and missed school. By integrating literacy into care management plans for affected children, pediatric primary care and specialty providers are poised to identify risks early, target guidance and interventions, and improve academic and health outcomes. IMPACT: While genetic and environmental risk factors for reading difficulties are well-established, risks related to complex and/or chronic medical conditions such as asthma, cancer, congenital heart disease, epilepsy, and sickle cell disease are substantial, less appreciated, and under-researched. General and health literacy are highly correlated, with implications for the understanding one's health condition, treatment adherence, and transitioning to self-care, which is especially important for children with complex and/or chronic illness. Pediatric primary care and specialty providers are poised to integrate reading and literacy into care management plans for children with complex and/or chronic illness, including early screening, guidance, support, and interventions.

Mobility, educational, and social performance of children with learning problems in Taiwan: A 3-year follow-up study

AIM

This study evaluated the performance of children with learning problems in Taiwan by using the Taiwan Data Bank of Persons with Disability.

METHOD

We included 3854 children (2343 males, 1511 females; mean [SD] age 9y 11mo [2y 4mo]) with specific learning disorder (SLD), attention-deficit/hyperactivity disorder (ADHD), autism, epilepsy, or intellectual disabilities for analysis. We used the Functioning Scale of the Disability Evaluation System-Child version to investigate performance at follow-up for at least 3 years.

RESULTS

These participants demonstrated improvement across all the domains of the International Classification of Functioning, Health, and Disability including for mobility, learning, social participation, and daily living. The children with SLD (p=0.3) and epilepsy (p=0.442) did not demonstrate significant improvement in learning, whereas those with ADHD (p<0.001), autism (p<0.001), and intellectual disabilities (p<0.001) did. The children with epilepsy displayed the most impairment and least improvement.

INTERPRETATION

This cross-diagnostic study of learning problems indicated the children with autism or ADHD received more structural education. However, education strategies for those with SLD or epilepsy required improvement. Finally, SLD is possibly underdiagnosed in children, and children with epilepsy are affected in multiple aspects.

WHAT THIS PAPER ADDS

Specific learning disorder (SLD), ADHD, autism, epilepsy, and intellectual disability can cause learning problems in children. Children with ADHD and autism showed more improvement in academic performance. SLD has been neglected and underdiagnosed, resulting in poor improvement. Children with epilepsy have multiple impairments and exhibited minimal improvement.

Overview on Emotional Behavioral Testing in Rodent Models of Pediatric Epilepsy

Psychiatric and cognitive disturbances are the most common comorbidities of epileptic disorders in children. The successful treatment of these comorbidities faces many challenges including their etiologically heterogonous nature. Translational neurobehavioral research in age-tailored and clinically relevant rodent seizure models offers a controlled setting to investigate emotional and cognitive behavioral disturbances, their causative factors, and potentially novel treatment interventions. In this review, we propose a conceptual framework that provides a nonsubjective approach to rodent emotional behavioral testing with a focus on the clinically relevant outcome of behavioral response adaptability. We also describe the battery of neurobehavioral tests that we tailored to seizure models with prominent amygdalo-hippocampal involvement, including testing panels for anxiety-like, exploratory, and hyperactive behaviors (the open-field and light-dark box tests), depressive-like behaviors (the forced swim test), and visuospatial navigation (Morris water maze). The review also discusses the modifications we introduced to active avoidance testing in order to simultaneously test auditory and hippocampal-dependent emotionally relevant learning and memory. When interpreting the significance and clinical relevance of the behavioral responses obtained from a given testing panel, it is important to avoid a holistic disease-based approach as a specific panel may not necessarily mirror a disease entity. The analysis of measurable behavioral responses has to be performed in the context of outcomes obtained from multiple related and complementary neurobehavioral testing panels. Behavioral testing is also complemented by mechanistic electrophysiological and molecular investigations.

Methods in Electrode Implantation and Wiring for Long-Term Continuous EEG Monitoring in Rodent Models of Epilepsy and Behavioral Disturbances

Rodent seizure models that pathologically and behaviorally recapitulate age-tailored epileptic disorders are used by us and others to advance our understanding of the chronobiology and mechanisms of epileptic seizure emergence and their comorbidities and to investigate potential novel treatment strategies. Obtaining prolonged continuous electroencephalogram (EEG) tracings over months is essential in this line of translational research, particularly to assess the relation between electrographic changes and the development of seizures and their various psychiatric and cognitive comorbidities in models where seizures gradually emerge over weeks following brain insults. Here we describe our approach to electrode implantation and wiring in order to successfully obtain high-quality continuous EEG tracings in rats for prolonged periods. A detailed stepwise methodological description is provided with a special focus on the details that help most in avoiding notorious pitfalls such as premature EEG cable disconnections and a poor signal to noise ratio.

Attention profile in children with epilepsy compared to healthy children using computer-based ForamenRehab program

Attention is a key component in cognitive functioning. Attention impairment is often present in children with epilepsy, which is one of the most common neurological disorders in children and adolescents. Evaluating the attention profiles is important for describing the patients' cognitive weaknesses and planning individual-based cognitive neurorehabilitation. The aim of this study was to assess the attention profiles of children with epilepsy and compare the results to neurologically healthy children. Twenty-nine children with epilepsy aged 8-12 years and 19 neurologically healthy age-matched comparison group participated in assessments with baseline tasks of the Attention module of ForamenRehab computer-program. Four separate attention components were measured - focused, sustained, complex, and tracking - to reveal the most impaired aspects of attention. At the baseline level, patients showed impairments in different attention function components compared to comparison group. Children with epilepsy had significantly lower results in sustained, complex attention, and tracking components (p < 0.05). The patients had similar results with comparison group only in one component - focused attention. All children had quicker visual reaction times compared to their auditory reaction times. The results emphasize the need for attention rehabilitation in children with epilepsy and help to focus on specific components of attention in planning the intervention process.

Methods in Emotional Behavioral Testing in Immature Epilepsy Rodent Models

Pediatric epilepsy is associated with prominent comorbid psychiatric and cognitive disturbances. Neurobehavioral testing is employed to characterize the cognitive and emotional behavioral derangements that accompany seizures in age-tailored and clinically relevant immature rodent seizure models. In addition to dissecting the causes of the etiologically multifaceted psychiatric and cognitive comorbidities of the epilepsies, neurobehavioral panels are essential in investigating potential neuroprotective strategies, especially during neurodevelopment. Here we describe a battery of behavioral testing panels that we tailored to our rodent seizure models with prominent amygdalo-hippocampal involvement. The panels include the open field and light-dark box tests for exploratory, hyperactive, and anxiety-like behaviors, the forced swim test for depressive-like behaviors, the Morris water maze for visuospatial navigation, and the modified active avoidance test for emotionally relevant learning and acquisition of adaptive behaviors. The behavioral laboratory setup and the employed methodologies are reviewed in details, with a special focus on the potential pitfalls that should be avoided.

Children with well controlled epilepsy possess different spatio-temporal patterns of causal network connectivity during a visual working memory task

Using spectral Granger causality (GC) we identified distinct spatio-temporal causal connectivity (CC) patterns in groups of control and epileptic children during the execution of a one-back matching visual discrimination working memory task. Differences between control and epileptic groups were determined for both GO and NOGO conditions. The analysis was performed on a set of 19-channel EEG cortical activity signals. We show that for the GO task, the highest brain activity in terms of the density of the CC networks is observed in α band for the control group while for the epileptic group the CC network seems disrupted as reflected by the small number of connections. For the NOGO task, the denser CC network was observed in θ band for the control group while widespread differences between the control and the epileptic group were located bilaterally at the left temporal-midline and parietal areas. In order to test the discriminative power of our analysis, we performed a pattern analysis approach based on fuzzy classification techniques. The performance of the classification scheme was evaluated using permutation tests. The analysis demonstrated that, on average, 87.6 % of the subjects were correctly classified in control and epileptic. Thus, our findings may provide a helpful insight on the mechanisms pertaining to the cognitive response of children with well controlled epilepsy and could potentially serve as "functional" biomarkers for early diagnosis.

Depression screening in pediatric epilepsy: evidence for the benefit of a behavioral medicine service in early detection

Despite the increased risk and prevalence of depression in youth with epilepsy, only one-third receive mental health services. Untreated depression can contribute to negative outcomes and increased health-care utilization and medical cost. Proactive behavioral medicine screening may facilitate identification of depressive symptoms and necessary interventions in efforts to optimize behavioral health and health-related quality of life (HRQOL). Primary study aims included the examination of 1) rates of self-reported depression in youth with epilepsy, 2) differences in depression by demographic and medical variables, 3) the impact of depression on HRQOL, and 4) changes in depression and suicidal ideation following a behavioral medicine consultation. As part of routine clinic care over a 24-month period, youth with epilepsy of 7-17years of age completed the Children's Depression Inventory-Second Edition. Parents completed the PedsQL. A chart review was conducted to ascertain demographics, medical variables, and behavioral medicine visits and recommendations. A subsample with Time 1 and Time 2 depression data was examined. Time 1 participants included 311 youth with epilepsy (Mage=11.9years, 50% female, 84% Caucasian, 46.0% with localization-related epilepsy, 71.0% with seizure control in the past 3months). Elevated depression was identified in 23% of youth, with 14% endorsing suicidal ideation. Depression significantly varied by age, antiepileptic drug, and insurance. After controlling for seizure status, HRQOL worsened with elevated depression. Depression significantly decreased from Time 1 to Time 2 (n=159), particularly for those referred for behavioral medicine services at Time 1. Systematic assessment and early detection of depression and/or suicidal ideation in youth with epilepsy can improve HRQOL and decrease depression. Depression screening can be implemented through clinic-based behavioral medicine services.

Are children affected by epileptic neuropsychiatric comorbidities?

Childhood-onset epilepsy is associated with psychiatric and cognitive difficulties and with poor social outcomes in adulthood. Some antiepileptic drugs adversely affect behavior in susceptible children with easy-to-control or refractory epilepsies, contributing to a high risk of psychological and psychiatric disturbance. Studies had demonstrated that patients with benign rolandic epilepsy and absence epilepsy had more aggressive behavior, depression, and anxiety disorders than control children. Psychiatric comorbidities are strongly associated with a poor long-term health-related quality of life in childhood-onset epilepsy, which suggests that comprehensive epilepsy care must include screening and long-term treatment for these conditions, even if seizures remit.

Feasibility of pedometer use to assess physical activity and its relationship with quality of life in children with epilepsy: a pilot study

BACKGROUND

Children and youth with epilepsy have lower rates of self-reported and parent-reported physical activity as well as quality of life when compared with their peers. Increased physical activity may be associated with improved health and quality of life in children and youth with epilepsy through biopsychosocial mechanisms; however, supportive evidence is lacking.

METHODS

This pilot study aims to determine the feasibility of pedometer use-an objective method-to assess daily steps and ability to complete quality of life-related questionnaires in children and youth with epilepsy. Feasibility was determined by percentage of study completion and participant enjoyment of physical activity in the form of walking as determined by the Childhood Self Adequacy and Predilection in Physical Activity. Secondary measures included the KidScreen 27 Quality of Life questionnaire, Childhood Depression Index, Body Mass Index, Harter's Self Perception Scale, and Parental Stress Index.

CONCLUSIONS

Eight of 12 eligible participants completed the study. Step counts ranged from 266 to 17,220 steps per day. Seven participants found physical activity enjoyable regardless of step count, suggesting they would be amenable to participate in a future physical activity program.

Computer-assisted cognitive behavioral therapy for children with epilepsy and anxiety: a pilot study

Anxiety disorders are prevalent in children with epilepsy. The purpose of this study was to evaluate the efficacy, adaptability, and feasibility of a manual-based, computer-assisted cognitive behavioral therapy (CBT) intervention for anxiety disorders in children with epilepsy. Fifteen anxious youth (aged 8-13 years) with epilepsy completed 12 weeks of manualized computer-assisted CBT. The children and parents completed a semi-structured interview at baseline, and questionnaires assessing symptoms of anxiety, depression, and behavior problems were completed prior to treatment, at treatment midpoint, after treatment completion, and at three months posttreatment. There were significant reductions in the symptoms of anxiety and depression reported by the children at completion of the intervention and at the three-month follow-up. Similarly, the parents reported fewer symptoms of anxiety and a reduction in behavior problems. No adverse events were reported. This CBT intervention for children with epilepsy and anxiety disorders appears to be safe, effective, and feasible and should be incorporated into future intervention studies.

[Assessment of education needs of adolescents and parents of children with epilepsy]

INTRODUCTION

Education program for patients (EPP) is now a part of the management of patients with chronic disease. According to WHO, the EPP is designed to help patients to maintain or gain self-care skills and adaptive skills necessary to improve their health and their quality of life. Patient education programs have been developed in recent years in several chronic diseases such as diabetes and asthma. In the field of epilepsy, however, adult and child programs have been developed only recently in France. We evaluate the interests for the establishment of an EPP and the topics that the parents and the adolescents would like to be discussed in such courses.

METHODS

We conducted a qualitative survey, based on interviews of parents of epileptic children and adolescents. The survey was conducted between April and November 2010 in pediatric neurology services of four French university hospitals: Amiens, Nancy, Marseille, and in Robert Debré (Paris) hospital. We investigated the following issues: treatment and self-management, and seizure management, psychosocial difficulties related to epilepsy, anatomical and physiological knowledge of epilepsy and lifestyle.

RESULTS

Two topics seem to have the greatest interest for parents of children with epilepsy and adolescents: knowledge about seizures and knowledge of anatomy and physiology of the brain. Adolescents involved in this study gave consistently lower scores in all items compare to parents of children.

CONCLUSION

The medical management of children and adolescents with epilepsy, and their caregivers, is a comprehensive care including the EPP in order to provide a full management of all issues raised by epilepsy. The survey identified key-points that parents and their children would like to learn in an EPP. These data would be helpful to design an EPP.

Disrupted functional brain connectivity in partial epilepsy: a resting-state fMRI study

Examining the spontaneous activity to understand the neural mechanism of brain disorder is a focus in recent resting-state fMRI. In the current study, to investigate the alteration of brain functional connectivity in partial epilepsy in a systematical way, two levels of analyses (functional connectivity analysis within resting state networks (RSNs) and functional network connectivity (FNC) analysis) were carried out on resting-state fMRI data acquired from the 30 participants including 14 healthy controls(HC) and 16 partial epilepsy patients. According to the etiology, all patients are subdivided into temporal lobe epilepsy group (TLE, included 7 patients) and mixed partial epilepsy group (MPE, 9 patients). Using group independent component analysis, eight RSNs were identified, and selected to evaluate functional connectivity and FNC between groups. Compared with the controls, decreased functional connectivity within all RSNs was found in both TLE and MPE. However, dissociating patterns were observed within the 8 RSNs between two patient groups, i.e, compared with TLE, we found decreased functional connectivity in 5 RSNs increased functional connectivity in 1 RSN, and no difference in the other 2 RSNs in MPE. Furthermore, the hierarchical disconnections of FNC was found in two patient groups, in which the intra-system connections were preserved for all three subsystems while the lost connections were confined to intersystem connections in patients with partial epilepsy. These findings may suggest that decreased resting state functional connectivity and disconnection of FNC are two remarkable characteristics of partial epilepsy. The selective impairment of FNC implicated that it is unsuitable to understand the partial epilepsy only from global or local perspective. We presumed that studying epilepsy in the multi-perspective based on RSNs may be a valuable means to assess the functional changes corresponding to specific RSN and may contribute to the understanding of the neuro-pathophysiological mechanism of epilepsy.