Multiple influences on deviant behaviour in children with epilepsy

Treatment of interictal epileptiform discharges can improve behavior in children with behavioral problems and epilepsy

OBJECTIVES

It is generally agreed that children should be treated for epilepsy only if they have clinical seizures. The aim of this study was to examine whether suppressing interictal discharges can affect behavior in children with epilepsy.

STUDY DESIGN

In a double-blinded, placebo-controlled, crossover study, 61 children with well-controlled or mild epilepsy were randomly assigned to add-on therapy with either lamotrigine followed by placebo or placebo followed by lamotrigine. Ambulatory electroencephalographic recordings and behavioral scales were performed during baseline and at the end of placebo and drug phases. The primary hypothesis to be tested was that behavioral scales would improve specifically in patients with a reduction of electroencephalographic discharges during active drug treatment.

RESULTS

Global rating of behavior significantly improved only in patients who showed a significant reduction in either frequency ( P < .05) or duration of discharges ( P < .05) during active treatment but not in patients with without a significant change in discharge rate. This improvement was mainly seen in patients with partial epilepsy ( P < .005).

CONCLUSIONS

Our data suggest that suppressing interictal discharges can improve behavior in children with epilepsy and behavioral problems, particularly partial epilepsy. Focal discharges may be involved in the underlying mechanisms of behavioral problems in epilepsy.

The value of a neuropsychiatric examination of children with complex severe epilepsy

The feasibility and utility of a neuropsychiatric assessment in a cohort of severely impaired children with long-standing epilepsy (n = 96) is tested. This assessment is described, and some results reported in this highly selected group. Substantial difficulties in coordination were present in nearly three-quarters of the sample, and dysarthria identified in two-thirds. Psychiatric interviewing identified cases of mood disturbance that altered overall treatment of that child, and a more systematic behavioural assessment permitted clearer management of behavioural problems already known to staff. This research supports previous findings that a full neuropsychiatric evaluation is both practical and has an important place in the early assessment and ongoing management of complex childhood epilepsy.

The psychological reactions of children with neurological problems

The diagnosis of a neurological disorder can be confusing and frightening to a child, particularly if he is not given a reasonable explanation for his symptoms and the medical procedures that have to be carried out. If such children experience seizures, they frequently identify them with the possibility of death, and they become overly concerned about bodily functioning. A loss of self-esteem often results, particularly if there are school problems. Reactions are varied: some children become extremely cautious in their activities to avoid further seizures; some seem to "defy death" by placing themselves in dangerous situations; some misinterpret fairly benign events in terms of their misconceptions about themselves. Much distress can be avoided by providing adequate information both to the parents and the child and by giving them adequate opportunity to ask questions and ventilate their feelings, perhaps with a therapist, in this time of crisis.