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Lee S, Lee J. Interaction between healthcare providers and parents of children or adolescents with epilepsy: A qualitative systematic review and meta-synthesis. Epilepsy Behav 2024; 158:109940. [PMID: 39018680 DOI: 10.1016/j.yebeh.2024.109940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 07/04/2024] [Accepted: 07/04/2024] [Indexed: 07/19/2024]
Abstract
AIMS This study aimed to explore the interactions between healthcare providers and parents of children or adolescents with epilepsy. A qualitative systematic review based on the theory-generating meta-synthesis research approach proposed by Finfgeld-Connett (2018) was applied. MATERIALS AND METHODS We searched for empirical qualitative studies in five electronic databases (PubMed, Embase, CINAHL, Cochrane Library, and Web of Science), from January 1, 2003 to February 9, 2023. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to guide the selection process, and two researchers independently assessed the methodological quality of the articles using the Critical Appraisal Skills Programme Qualitative Studies Checklist. RESULTS Of the 4,768 studies initially imported for screening, 27 studies were reviewed and synthesized. Only one qualitative study directly focused on the interactions between parents and healthcare providers, but various studies mentioning such interaction as themes or sub-themes of other phenomena allowed us to draw out common attributes. Defining attribute, "journey through the three stages of interaction," were derived as follows: Stage 1: trust vs. mistrust; Stage 2: autonomy vs. doubt; Stage 3: adaptation. The antecedents included encounters with healthcare providers and parent empowerment. A patient-centered approach was found to be the consequence. CONCLUSION It is important for parents of children or adolescents with epilepsy to empower themselves and increase their interactions. Considering the stage of interaction, healthcare providers and researchers should explore strategies to promote effective communication. Further research is required to develop strategies aimed at supporting parents and healthcare providers to achieve the tasks at each stage and maintain Stage 3, "adaptation."
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Affiliation(s)
- Sujin Lee
- College of Nursing, Kyungdong University, Wonju, 26495, South Korea.
| | - Juna Lee
- College of Nursing, Catholic University of Pusan, Busan, 46252, South Korea.
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Poole BJ, Phillips NL, Killer BL, Gilmore C, Lah S. Mathematics Skills in Epilepsy: A Systematic Review and Meta-Analysis. Neuropsychol Rev 2024; 34:598-636. [PMID: 37490196 PMCID: PMC11166774 DOI: 10.1007/s11065-023-09600-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 05/25/2023] [Indexed: 07/26/2023]
Abstract
Mathematics incorporates a broad range of skills, which includes basic early numeracy skills, such as subitizing and basic counting to more advanced secondary skills including mathematics calculation and reasoning. The aim of this review was to undertake a detailed investigation of the severity and pattern of early numeracy and secondary mathematics skills in people with epilepsy. Searches were guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Twenty adult studies and 67 child studies were included in this review. Overall, meta-analyses revealed significant moderate impairments across all mathematics outcomes in both adults (g= -0.676), and children (g= -0.593) with epilepsy. Deficits were also observed for specific mathematics outcomes. For adults, impairments were found for mathematics reasoning (g= -0.736). However, two studies found that mathematics calculation was not significantly impaired, and an insufficient number of studies examined early numeracy skills in adults. In children with epilepsy, significant impairments were observed for each mathematics outcome: early numeracy (g= -0.383), calculation (g= -0.762), and reasoning (g= -0.572). The gravity of impairments also differed according to the site of seizure focus for children and adults, suggesting that mathematics outcomes were differentially vulnerable to the location of seizure focus.
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Affiliation(s)
- Belinda J Poole
- School of Psychology, University of Sydney, Sydney, NSW, 2006, Australia
| | - Natalie L Phillips
- School of Psychology, University of Sydney, Sydney, NSW, 2006, Australia
| | - Brittany L Killer
- School of Psychology, University of Sydney, Sydney, NSW, 2006, Australia
| | - Camilla Gilmore
- Centre for Mathematical Cognition, Loughborough University, Loughborough, UK
| | - Suncica Lah
- School of Psychology, University of Sydney, Sydney, NSW, 2006, Australia.
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Lee J, Yoon JY. Development of a parent questionnaire to assess treatment adherence for a child or adolescent with epilepsy. Epilepsy Behav 2023; 140:109112. [PMID: 36780775 DOI: 10.1016/j.yebeh.2023.109112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 01/13/2023] [Accepted: 01/24/2023] [Indexed: 02/13/2023]
Abstract
PURPOSE This study aimed to develop a questionnaire to assess parents' treatment adherence for their child or adolescent with epilepsy (PQ-TAE). MATERIAL AND METHODS Seventy-one preliminary items were developed as a first draft and refined based on reviews from experts and cognitive interviews with parents. Then, an online survey was conducted from June 15 to July 15, 2020, to test the psychometric properties of the questionnaire and to modify it. Reliability and validity were additionally tested using exploratory factor analysis, internal consistency, and statistical relationships including parents' partnership with healthcare providers, educational attainment, and economic status. RESULTS The 4-factor model was adopted as the final factor structure of the PQ-TAE (CMIN/df = 2.15, RMSEA = 0.07, SRMR = 0.04, CFI = 0.93, TLI = 0.90). The reliability of the PQ-TAE was statistically acceptable (Cronbach's alpha = 0.93). The PQ-TAE score was statistically related to the partnership with healthcare providers (r = 0.58, p < 0.001), educational attainment (t = -2.12, p = 0.037), and economic status (t = -4.05, p < 0.001). CONCLUSIONS The PQ-TAE using a 5-point Likert scale consists of 25 items classified into four factors. The higher the score (Range 25-125), the better the treatment adherence of the parent of a child or adolescent with epilepsy.
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Affiliation(s)
- Juna Lee
- College of Nursing, Seoul National University, Seoul 03080, Republic of Korea
| | - Ju Young Yoon
- College of Nursing, Seoul National University, Seoul 03080, Republic of Korea; Center for Human-Caring Nurse Leaders for the Future by Brain Korea 21 (BK 21) Four Project, College of Nursing, Seoul National University, Seoul 03080, Republic of Korea.
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Poole BJ, Lah S. Mathematics difficulties are related to mathematics anxiety in children with epilepsy: An online study. Epilepsy Behav 2023; 139:109068. [PMID: 36628849 DOI: 10.1016/j.yebeh.2022.109068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/14/2022] [Accepted: 12/23/2022] [Indexed: 01/11/2023]
Abstract
AIM Children with epilepsy have an increased risk of difficulties with mathematics. Research into the mathematics difficulties of children with epilepsy, however, is limited. This study sought to determine whether the mathematics difficulties of children with epilepsy are related to mathematics anxiety over and above other previously identified factors (reading difficulties, generalized anxiety, and working memory). METHOD Seventy-nine parents of children with epilepsy and 72 parents of typically developing children completed online questionnaires on their child's mathematics and reading difficulties (CLDQ; Colorado Learning Difficulties Questionnaire), mathematics anxiety (mAMAS; Modified Abbreviated Math Anxiety Scale), general anxiety (SCAS; Spence Child Anxiety Scale), and working memory (BRIEF-2; Brief Rating Inventory of Executive Function-2nd Edition). Questionnaires also collected demographic information and epilepsy variables. RESULTS Children with epilepsy had higher scores on the CLDQ mathematics subscale (CLDQm) and the mAMAS compared to typically developing children. Younger age of epilepsy onset, higher seizure frequency, and a greater number of anti-seizure medications accounted for 20.4% of the variance on the CLDQm. The CLDQ reading subscale (CLDQr) justified an additional 14% of the variance on the CLDQm. Finally, the mAMAS explained 20.2% of the variance on the CLDQm, after controlling for epilepsy variables and CLDQr. In contrast, the BRIEF-2 and SCAS did not account for a significant amount of variance on the CLDQm. SIGNIFICANCE Mathematics anxiety is the most significant contributor to mathematics difficulties experienced by children with epilepsy. Difficulties with reading and epilepsy factors also have significant, albeit smaller contributions to mathematics difficulties in this clinical population. Given the multiplicity of factors contributing to mathematics difficulties, a comprehensive, multidisciplinary treatment is needed.
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Affiliation(s)
- Belinda J Poole
- School of Psychology, University of Sydney, Sydney, NSW, Australia.
| | - Suncica Lah
- School of Psychology, University of Sydney, Sydney, NSW, Australia.
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Bailey K, Im-Bolter N. Language in childhood epilepsy: A systematic review and meta-analysis. Epilepsy Behav 2021; 114:107621. [PMID: 33257294 DOI: 10.1016/j.yebeh.2020.107621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/31/2020] [Accepted: 11/01/2020] [Indexed: 10/22/2022]
Abstract
The abnormal brain activity associated with childhood epilepsy can have an impact on the developmental trajectory of cognitive processes, like language, in this population. However, there is variation in how researchers study language ability in children with epilepsy and the findings that are reported (no differences vs. a significant difference). The current systematic review and meta-analysis uses data from 13 available studies to consider the magnitude of language differences in children with epilepsy compared to their typically developing peers. Seizure classification, age of onset, component of language measured, and instrument used to measure language were all considered as potential moderators of differences in language skill. The results indicate a significant large effect size for language deficits in children with epilepsy compared to their peers. Seizure classification partially, but not fully, accounts for the variability in effect size. In addition, effect sizes differ relative to component of language measured; effect sizes were greatest in magnitude for semantic language and verbal fluency, and minimal for syntax, but only when including all studies of children with epilepsy, regardless of seizure classification. These findings differ when considering language component in children with generalized or focal seizures only. The data reported here also indicate distinct differences in effect size depending on type of instrument used to measure one aspect of language, verbal fluency.
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Affiliation(s)
- Katharine Bailey
- Department of Psychology, Queen's University, Kingston, ON, Canada; Department of Psychology, Trent University, Peterborough, ON, Canada.
| | - Nancie Im-Bolter
- Department of Psychology, Trent University, Peterborough, ON, Canada
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Saravanapandian V, Frohlich J, Hipp JF, Hyde C, Scheffler AW, Golshani P, Cook EH, Reiter LT, Senturk D, Jeste SS. Properties of beta oscillations in Dup15q syndrome. J Neurodev Disord 2020; 12:22. [PMID: 32791992 PMCID: PMC7425173 DOI: 10.1186/s11689-020-09326-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 07/30/2020] [Indexed: 11/21/2022] Open
Abstract
Background Duplications of 15q11.2-q13.1 (Dup15q syndrome) are highly penetrant for autism, intellectual disability, hypotonia, and epilepsy. The 15q region harbors genes critical for brain development, particularly UBE3A and a cluster of gamma-aminobutyric acid type A receptor (GABAAR) genes. We recently described an electrophysiological biomarker of the syndrome, characterized by excessive beta oscillations (12–30 Hz), resembling electroencephalogram (EEG) changes induced by allosteric modulation of GABAARs. In this follow-up study, we tested a larger cohort of children with Dup15q syndrome to comprehensively examine properties of this EEG biomarker that would inform its use in future clinical trials, specifically, its (1) relation to basic clinical features, such as age, duplication type, and epilepsy; (2) relation to behavioral characteristics, such as cognition and adaptive function; (3) stability over time; and (4) reproducibility of the signal in clinical EEG recordings. Methods We computed EEG power and beta peak frequency (BPF) in a cohort of children with Dup15q syndrome (N = 41, age range 9–189 months). To relate EEG parameters to clinical (study 1) and behavioral features (study 2), we examined age, duplication type, epilepsy, cognition, and daily living skills (DLS) as predictors of beta power and BPF. To evaluate stability over time (study 3), we derived the intraclass correlation coefficients (ICC) from beta power and BPF computed from children with multiple EEG recordings (N = 10, age range 18–161 months). To evaluate reproducibility in a clinical setting (study 4), we derived ICCs from beta power computed from children (N = 8, age range 19–96 months), who had undergone both research EEG and clinical EEG. Results The most promising relationships between EEG and clinical traits were found using BPF. BPF was predicted both by epilepsy status (R2 = 0.11, p = 0.038) and the DLS component of the Vineland Adaptive Behavior Scale (R2 = 0.17, p = 0.01). Beta power and peak frequency showed high stability across repeated visits (beta power ICC = 0.93, BPF ICC = 0.92). A reproducibility analysis revealed that beta power estimates are comparable between research and clinical EEG (ICC = 0.94). Conclusions In this era of precision health, with pharmacological and neuromodulatory therapies being developed and tested for specific genetic etiologies of neurodevelopmental disorders, quantification and examination of mechanistic biomarkers can greatly improve clinical trials. To this end, the robust beta oscillations evident in Dup15q syndrome are clinically reproducible and stable over time. With future preclinical and computational studies that will help disentangle the underlying mechanism, it is possible that this biomarker could serve as a robust measure of drug target engagement or a proximal outcome measure in future disease modifying intervention trials.
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Affiliation(s)
- Vidya Saravanapandian
- Center for Autism Research and Treatment, Semel Institute for Neuroscience, University of California Los Angeles, Los Angeles, CA, 90024, USA.
| | - Joel Frohlich
- Center for Autism Research and Treatment, Semel Institute for Neuroscience, University of California Los Angeles, Los Angeles, CA, 90024, USA.,Roche Pharma Research and Early Development, Neuroscience, Ophthalmology and Rare Diseases, Roche Innovation Center Basel, Basel, Switzerland.,Department of Psychology, University of California Los Angeles, 3423 Franz Hall, Los Angeles, CA, 90095, USA
| | - Joerg F Hipp
- Roche Pharma Research and Early Development, Neuroscience, Ophthalmology and Rare Diseases, Roche Innovation Center Basel, Basel, Switzerland
| | - Carly Hyde
- Center for Autism Research and Treatment, Semel Institute for Neuroscience, University of California Los Angeles, Los Angeles, CA, 90024, USA
| | - Aaron W Scheffler
- Department of Biostatistics, University of California Los Angeles School of Public Health, Room 21-254C CHS, Los Angeles, CA, 90095, USA
| | - Peyman Golshani
- Department of Neurology and Semel Institute for Neuroscience, David Geffen School of Medicine, 710 Westwood Plaza, Los Angeles, CA, 90095, USA.,West Los Angeles VA Medical Center, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA
| | - Edwin H Cook
- Department of Psychiatry, University of Illinois at Chicago, 1747 W Roosevelt Road, Chicago, IL, 60608, USA
| | - Lawrence T Reiter
- Department of Neurology, Pediatrics and Anatomy & Neurobiology, The University of Tennessee Health Science Center, 855 Monroe Ave., Link, Memphis, TN, 415, USA
| | - Damla Senturk
- Department of Biostatistics, University of California Los Angeles School of Public Health, Room 21-254C CHS, Los Angeles, CA, 90095, USA
| | - Shafali S Jeste
- Center for Autism Research and Treatment, Semel Institute for Neuroscience, University of California Los Angeles, Los Angeles, CA, 90024, USA
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Sakpichaisakul K, Byars AW, Horn PS, Aungaroon G, Greiner HM, Mangano FT, Holland KD, Arya R. Neuropsychological outcomes after pediatric epilepsy surgery: Role of electrical stimulation language mapping. Seizure 2020; 80:183-191. [PMID: 32604001 DOI: 10.1016/j.seizure.2020.06.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 01/06/2023] Open
Abstract
PURPOSE We studied the association between electrical stimulation mapping (ESM) with a visual naming task and post-operative neuropsychological outcomes after pediatric epilepsy surgery. METHODS Children who underwent epilepsy surgery, having pre- and 1-year post-surgery neuropsychological evaluation (NPE) available, were included. NPE scores were transformed using principal components (PC) analysis. The relationship between post-surgical PC scores, adjusted for pre-surgery PC scores, and ESM was analyzed. Clinical variables influencing this relationship were also sought. RESULTS One hundred and four children (89 patients >5 years-old, and 15 patients 3-5 years-old) were included. Among children >5 years-of-age, a significant effect of language ESM was observed on all 3 post-surgery PC scores adjusted for respective pre-surgery PC scores. Specifically, only 30 % patients who underwent language ESM had a decrease in PC1 scores ≥1-year after epilepsy surgery, compared to 68 % those who did not undergo language ESM (p = 0.001). Seizure outcomes, age at the time of surgery, predominant seizure type, and family history of epilepsy were other significant determinants of post-surgical PC scores including a change in PC scores from pre-surgery baseline. Combinations of pre-surgical variables were able to predict post-surgical PC scores with high specificity. In children aged 3-5 years, no significant effect of language ESM was seen on post-surgery PC scores adjusted for respective pre-surgery PC scores. CONCLUSIONS Speech/language ESM should be performed more widely in patients >5 years-of-age undergoing epilepsy surgery. Also, more efficient brain mapping techniques and language paradigms are needed for younger children.
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Affiliation(s)
- Kullasate Sakpichaisakul
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Division of Neurology, Department of Pediatrics, Queen Sirikit National Institute of Child Health, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Anna W Byars
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Paul S Horn
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Gewalin Aungaroon
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Hansel M Greiner
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Francesco T Mangano
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Katherine D Holland
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ravindra Arya
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Courchia B, Berkovits MD, Kurtom W, Moral TD, Bauer CR. Association Between Neonatal Seizures and Social-Emotional Development and Adaptive Behavior in Extremely Low Birth Weight Infants. J Child Neurol 2020; 35:331-335. [PMID: 32046593 DOI: 10.1177/0883073819901233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
AIM To evaluate social-emotional development and adaptive behavioral outcomes in a cohort of extremely low birth weight infants with a confirmed diagnosis of neonatal seizures. METHODS This is a retrospective cohort study of preterm infants weighing ≤1000 g at birth, with a diagnosis of neonatal seizures, evaluated between 21 and 31 months of age using the Bayley Scales of Infant Development (Bayley-III) in a longitudinal neurodevelopmental follow-up program. Seizures were diagnosed using continuous video electroencephalography interpreted by a pediatric neurologist. RESULTS Nineteen infants meeting criteria were included and were matched with 38 control subjects, without clinical signs of seizures, and similar baseline characteristics. Multivariate analysis revealed significantly lower social-emotional development (-14.8 points; P = .05) and adaptive behavior scores (-10.8 points; P < .01) on the Bayley III in children with seizures compared to controls without clinical signs of seizure.Interpretation: Seizures are associated with impaired adaptive behavior and social-emotional development in this cohort of extremely low birth weight infants. These results highlight the negative association between neonatal seizures and functional development.
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Affiliation(s)
- Benjamin Courchia
- Department of Pediatrics, Division of Neonatology, University of Miami Miller School of Medicine, Holtz Children's Hospital, FL, USA.,Mailman Center for Child Development, Miami, FL, USA
| | - Michelle D Berkovits
- Department of Pediatrics, Division of Neonatology, University of Miami Miller School of Medicine, Holtz Children's Hospital, FL, USA.,Mailman Center for Child Development, Miami, FL, USA
| | - Waleed Kurtom
- Department of Pediatrics, Division of Neonatology, University of Miami Miller School of Medicine, Holtz Children's Hospital, FL, USA
| | - Theresa Del Moral
- Department of Pediatrics, Division of Neonatology, University of Miami Miller School of Medicine, Holtz Children's Hospital, FL, USA
| | - Charles R Bauer
- Department of Pediatrics, Division of Neonatology, University of Miami Miller School of Medicine, Holtz Children's Hospital, FL, USA.,Mailman Center for Child Development, Miami, FL, USA
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Hunter MB, Yoong M, Sumpter RE, Verity K, Shetty J, McLellan A, Chin RFM. Incidence of early-onset epilepsy: A prospective population-based study. Seizure 2019; 75:49-54. [PMID: 31874359 DOI: 10.1016/j.seizure.2019.12.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 06/05/2019] [Accepted: 12/17/2019] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The first five years of life reflect a critical period of development prior to formal education yet few epidemiological studies focus on children with early-onset epilepsy (CWEOE; onset <60 months). This study aimed to determine early-onset epilepsy incidence using a comprehensive case identification strategy, and examined socioeconomic status (SES) and ethnicity as risk factors. METHODS Through a prospective, population-based study, newly diagnosed CWEOE from Fife and Lothian, Scotland, were identified using multiple-source, active surveillance capture-recapture between May 2013 and June 2015. Crude, ascertainment-adjusted, age-adjusted, age- and gender-specific, and epilepsy-type incidence rates were determined. Risk ratios (RR) were calculated to examine SES and ethnicity as risk factors. RESULTS 59 (36 Male) CWEOE were identified. Ascertainment was 98% (95% CI 94-103). Crude annual incidence of epilepsy in children 0-59 months was 60.2 (95% CI 44.8-75.5) per 100,000 per year; ascertainment-adjusted annual incidence was 61.7 (95% CI 46.2-77.3) per year. Cumulative incidence of West Syndrome/Infantile Spasms was 6.7 per 10,000 live births (95% CI 3.6-12.3). Aetiology was unknown in almost two-thirds of CWEOE. Compared to White-British Isles (BI) children, Asian children (RR 2.6 [95% CI 1.2-5.7], p = .02) and White-non-BI children (RR 2.5 [95% CI 1.2-5.2], p = .02) had increased risk. SES was not a risk factor. CONCLUSION The high incidence of early-onset epilepsy is similar to previous studies and demonstrates a substantial disease burden. Cause of epilepsy remains unknown in almost two thirds of CWEOE. Ethnicity but not SES affects early-onset epilepsy risk.
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Affiliation(s)
- Matthew B Hunter
- Muir Maxwell Epilepsy Centre, University of Edinburgh, Edinburgh, UK.
| | - Michael Yoong
- Muir Maxwell Epilepsy Centre, University of Edinburgh, Edinburgh, UK
| | - Ruth E Sumpter
- Muir Maxwell Epilepsy Centre, University of Edinburgh, Edinburgh, UK
| | - Kirsten Verity
- Department of Paediatric Neurosciences, Royal Hospital for Sick Children, Edinburgh, UK
| | - Jay Shetty
- Department of Paediatric Neurosciences, Royal Hospital for Sick Children, Edinburgh, UK
| | - Ailsa McLellan
- Department of Paediatric Neurosciences, Royal Hospital for Sick Children, Edinburgh, UK
| | - Richard F M Chin
- Muir Maxwell Epilepsy Centre, University of Edinburgh, Edinburgh, UK; Department of Paediatric Neurosciences, Royal Hospital for Sick Children, Edinburgh, UK
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10
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Hunter MB, Yoong M, Sumpter RE, Verity K, Shetty J, McLellan A, Jones J, Quigley A, Tallur KK, Chin RFM. Neurobehavioral problems in children with early-onset epilepsy: A population-based study. Epilepsy Behav 2019; 93:87-93. [PMID: 30836323 DOI: 10.1016/j.yebeh.2019.01.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/11/2019] [Accepted: 01/11/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE Neurobehavioral problems (i.e., cognitive impairment/behavior problems) are a major challenge in childhood epilepsy. Yet there are limited data in children with early-onset epilepsy (CWEOE; onset ≤4 years), the period in which the incidence of childhood epilepsy is highest. This study aimed to determine the prevalence, spectrum, and risk factors for neurobehavioral problems CWEOE. METHODS This prospective, population-based, case-controlled study identified children with newly diagnosed early-onset epilepsy in South East Scotland using active multisource capture-recapture surveillance (May 2013 - June 2015). The CWEOE and controls completed an age-appropriate neurobehavioral assessment battery across seven domains: general cognitive ability (GCA), adaptive behavior, externalizing, internalizing, executive functioning, social functioning, and Autism Spectrum Disorder (ASD) risk. RESULTS Fifty-nine CWEOE were identified with an ascertainment of 98% (95% confidence interval [CI] 94, 103). Forty-six (78% [95% CI 65.9, 86.6]) CWEOE (27 male, median age 25.5, range 1-59, months) and 37 controls (18 male, median age 31.5, range 3-59, months) consented for study entry. The CWEOE were similar to controls in gender, age, prematurity, and family history of psychopathology, but not socioeconomic status (Fisher's exact test [FET] < .001). Neurobehavioral assessments were carried out a median of 2.97 (Interquartile range [IQR] 1.51-4.95) months post epilepsy diagnosis. More CWEOE (63% [95% CI 48.6, 75.5]) had neurobehavioral problems compared with controls (27% [95% CI 15.4, 43.0]); p < 0.01. This observation was independent of socioeconomic status. Multidimensional problems were prevalent in CWEOE with 43% having two or more different domain-level problems; GCA impairment, adaptive behavior, internalizing, social functioning, and ASD risk were particularly marked. Risk factors varied by domain. DISCUSSION This novel study using comprehensive psychometric assessments found that neurobehavioral problems in CWEOE were detectable, common, and multidimensional. The degree of cooccurrence implies that problems are the norm, and multidimensional screening should be considered at epilepsy onset. The findings could aid policy development on health and educational provision in CWEOE.
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Affiliation(s)
| | - Michael Yoong
- Muir Maxwell Epilepsy Centre, University of Edinburgh, UK
| | - Ruth E Sumpter
- Muir Maxwell Epilepsy Centre, University of Edinburgh, UK
| | - Kirsten Verity
- Department of Paediatric Neurology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Jay Shetty
- Department of Paediatric Neurology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Ailsa McLellan
- Department of Paediatric Neurology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Jeremy Jones
- Department of Radiology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Alan Quigley
- Department of Radiology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Krishnaraya K Tallur
- Department of Paediatric Neurology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Richard F M Chin
- Muir Maxwell Epilepsy Centre, University of Edinburgh, UK; Department of Paediatric Neurology, Royal Hospital for Sick Children, Edinburgh, UK
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11
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Ronen GM, Rosenbaum PL, Boyle MH, Streiner DL. Patient-reported quality of life and biopsychosocial health outcomes in pediatric epilepsy: An update for healthcare providers. Epilepsy Behav 2018; 86:19-24. [PMID: 30036765 DOI: 10.1016/j.yebeh.2018.05.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/07/2018] [Accepted: 05/09/2018] [Indexed: 11/30/2022]
Abstract
In the 21st century, clinicians are expected to listen to, and understand their patients' views about, their conditions and the effects that these conditions have on their functioning, values, life goals, and welfare. The goals of this review are as follows: (i) to inform, update, and guide clinicians caring for children with epilepsy about developments in the content and new methods of research on patient-reported outcomes, quality of life, and functioning; and (ii) to discuss the value of using these concepts to explore the impact of diverse interventions that are implemented in daily practice. Drawing on the literature and our program of research over the past two decades, we focus on our current understanding of a variety of health concepts and recently acquired knowledge about their significance for the lives of patients and their families. We discuss the advantages of measuring patient-reported outcomes that tell us what is important to patients. We advise on what characteristics to look for when choosing a patient-reported measure, and the relevance of these considerations. In addition, we address gaps in research knowledge and the causes of confusion that have limited their use in our daily clinical practice.
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Affiliation(s)
- Gabriel M Ronen
- Department of Pediatrics, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada.
| | - Peter L Rosenbaum
- Department of Pediatrics, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada
| | - Michael H Boyle
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - David L Streiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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Salomon-Estebanez M, Mohamed Z, Michaelidou M, Collins H, Rigby L, Skae M, Padidela R, Rust S, Dunne M, Cosgrove K, Banerjee I, Nicholson J. Vineland adaptive behavior scales to identify neurodevelopmental problems in children with Congenital Hyperinsulinism (CHI). Orphanet J Rare Dis 2017; 12:96. [PMID: 28532504 PMCID: PMC5440988 DOI: 10.1186/s13023-017-0648-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 05/09/2017] [Indexed: 11/25/2022] Open
Abstract
Background Congenital Hyperinsulinism (CHI) is a disease of severe hypoglycaemia caused by excess insulin secretion and associated with adverse neurodevelopment in a third of children. The Vineland Adaptive Behavior Scales Second Edition (VABS-II) is a parent report measure of adaptive functioning that could be used as a developmental screening tool in patients with CHI. We have investigated the performance of VABS-II as a screening tool to identify developmental delay in a relatively large cohort of children with CHI. VABS-II questionnaires testing communication, daily living skills, social skills, motor skills and behaviour domains were completed by parents of 64 children with CHI, presenting both in the early neonatal period (Early-CHI, n = 48) and later in infancy (Late-CHI, n = 16). Individual and adaptive composite (Total) domain scores were converted to standard deviation scores (SDS). VABS-II scores were tested for correlation with objective developmental assessment reported separately by developmental paediatricians, clinical and educational psychologists. VABS-II scores were also investigated for correlation with the timing of hypoglycaemia, gender and phenotype of CHI. Results Median (range) total VABS-II SDS was low in CHI [-0.48 (-3.60, 4.00)] with scores < -2.0 SDS in 9 (12%) children. VABS-II Total scores correctly identified developmental delay diagnosed by objective assessment in the majority [odds ratio (OR) (95% confidence intervals, CI) 0.52 (0.38, 0.73), p < 0.001] with 95% specificity [area under curve (CI) 0.80 (0.68, 0.90), p < 0.001] for cut-off < -2.0 SDS, although with low sensitivity (26%). VABS-II Total scores were inversely correlated (adjusted R2 = 0.19, p = 0.001) with age at presentation (p = 0.024) and male gender (p = 0.036), males having lower scores than females in those with Late-CHI [-1.40 (-3.60, 0.87) v 0.20 (-1.07, 1.27), p = 0.014]. The presence of a genetic mutation representing severe CHI also predicted lower scores (R2 = 0.19, p = 0.039). Conclusions The parent report VABS-II is a reliable and specific tool to identify developmental delay in CHI patients. Male gender, later age at presentation and severity of disease are independent risk factors for lower VABS-II scores.
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Affiliation(s)
- Maria Salomon-Estebanez
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Central Manchester University Hospitals, Oxford Road, Manchester, M13 9WL, UK. .,Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Zainab Mohamed
- Department of Paediatric Endocrinology and Diabetes, Nottingham Children's Hospital, Nottingham University Hospitals, Derby Road, Nottingham, NG7 2UH, UK
| | - Maria Michaelidou
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Central Manchester University Hospitals, Oxford Road, Manchester, M13 9WL, UK
| | - Hannah Collins
- Paediatric Psychosocial Department, Royal Manchester Children's Hospital, Central Manchester University Hospitals, Oxford Road, Manchester, M13 9WL, UK
| | - Lindsey Rigby
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Central Manchester University Hospitals, Oxford Road, Manchester, M13 9WL, UK
| | - Mars Skae
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Central Manchester University Hospitals, Oxford Road, Manchester, M13 9WL, UK
| | - Raja Padidela
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Central Manchester University Hospitals, Oxford Road, Manchester, M13 9WL, UK
| | - Stewart Rust
- Paediatric Psychosocial Department, Royal Manchester Children's Hospital, Central Manchester University Hospitals, Oxford Road, Manchester, M13 9WL, UK
| | - Mark Dunne
- Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Karen Cosgrove
- Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Indraneel Banerjee
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Central Manchester University Hospitals, Oxford Road, Manchester, M13 9WL, UK.,Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Jacqueline Nicholson
- Paediatric Psychosocial Department, Royal Manchester Children's Hospital, Central Manchester University Hospitals, Oxford Road, Manchester, M13 9WL, UK
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Kampra M, Tzerakis NG, Losidis S, Katsarou E, Voudris K, Mastroyianni S, Mouskou S, Siatouni A, Gatzonis S. Teachers' knowledge about epilepsy in Greece: Information sources and attitudes towards children with epilepsy during school time. Epilepsy Behav 2016; 60:218-224. [PMID: 27240308 DOI: 10.1016/j.yebeh.2016.04.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/18/2016] [Accepted: 04/03/2016] [Indexed: 12/20/2022]
Abstract
AIM The aim of this study was to explore the sources of information for the educators in Greek primary and secondary schools with regard to epilepsy, first aid to seizures, and pupils' health conditions. METHOD A semistructured anonymous 52-item questionnaire was sent to 100 public primary and secondary Greek schools from all districts. Two thousand thirty-seven teachers were approached; 446 questionnaires returned. The data were analyzed with SPSS20. Also, 70 head teachers were phone-interviewed with an open-ended unstructured questionnaire. The derived data were analyzed using mixed methodology. RESULTS Twenty-two percent of the addressed educational community responded to the questionnaire, mostly women (66.6%). More responses came from urban areas (71.5%). The main source for the teachers to obtain information about epilepsy was found to be personal experience (37.75%) and internet (34.93%). Only a small percentage was referred to courses (6.2%). Eighty point three percent of the educators knew what epilepsy is, and 88.1% had the right view about the nature of the illness. However, 92% of the educators replied that they have not had adequate first aid training. Although 80.3% of the teachers believed that the school personnel are aware of the pupils' medical history, 85.48% of the teachers considered that they are informed about the pupils' condition from the parents/carers, and only 5.53% believed that the information came from the family doctor. Ninety-five point seventy percent of the educators declared a wish for further information and training about epilepsy. CONCLUSION Knowledge and attitudes of the educators towards epilepsy are improved compared with those reported in previous studies conducted in Greece. However, there are still areas of uncertainty which need improvement. The necessity for more information about epilepsy and pupils' medical history along with appropriate training about seizure incidents seems crucial for the Greek educational community. Educational campaigns about epilepsy could improve teachers' knowledge of epilepsy to develop a well-informed and tolerant community. Further research in the field is necessary to provide teachers with accurate information about the illness and the ways to cope with it.
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Affiliation(s)
- Matina Kampra
- Ministry of Health, Aristotelous 17, P.C. 10433, Greece.
| | - Nikolaos G Tzerakis
- Department of Neurosurgery, University Hospital of North Midlands NHS Trust, UK.
| | - Sotiris Losidis
- University of Piraeus, Karaoli Dimitriou 80, P.C. 18534 Piraeus, Greece.
| | - Efstathia Katsarou
- Department of Neurology, Children's Hospital of Athens "P. and A. Kyriakou", Thivon and Levadias str, Athens P.C. 115 27, Greece.
| | - Konstantinos Voudris
- Department of Neurology, Children's Hospital of Athens "P. and A. Kyriakou", Thivon and Levadias str, Athens P.C. 115 27, Greece.
| | - Sotiria Mastroyianni
- Department of Neurology, Children's Hospital of Athens "P. and A. Kyriakou", Thivon and Levadias str, Athens P.C. 115 27, Greece.
| | - Stella Mouskou
- Children's Hospital "P & A Kyriakou", Athens 115 27, Greece.
| | - Anna Siatouni
- Department of Neurosurgery, "Evangelismos" Hospital, National and Kapodistrian University, Greece.
| | - Stylianos Gatzonis
- Department of Neurosurgery, "Evangelismos" Hospital, National and Kapodistrian University, Greece.
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Kavanaugh BC, Scarborough VR, Salorio CF. Use of a Cumulative Risk Scale to Predict Poor Intellectual and Academic Outcomes in Childhood Epilepsy. J Child Neurol 2016; 31:831-6. [PMID: 26747083 DOI: 10.1177/0883073815623633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 11/15/2015] [Indexed: 11/16/2022]
Abstract
Discrete risk factors for poor outcomes in childhood epilepsy have been identified, but it is unclear whether the combined effect of several risk factors better predicts outcome. The Epilepsy Cumulative Risk Scale was developed to quantify cumulative risk for poor outcomes in childhood epilepsy. Participants included 156 clinic-referred children with epilepsy. The Epilepsy Cumulative Risk Scale was developed using variables previously associated with functional outcomes. Scale utility was examined through its association with intellectual and academic functioning. All Epilepsy Cumulative Risk Scale variables were significantly associated with functioning. The Total Score (ie, cumulative effect) was most strongly correlated with cognition and academic skills. A Total Score ≥ 5 had the best sensitivity and specificity for differentiating those at high risk for poor outcomes. The Epilepsy Cumulative Risk Scale shows promise as a practical, data-driven tool for quantification of cumulative risk for poor outcomes in childhood epilepsy and may be helpful in detecting those needing referral for additional services.
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Affiliation(s)
- Brian C Kavanaugh
- Emma Pendleton Bradley Hospital, Riverside, RI, USA Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Cynthia F Salorio
- Kennedy Krieger Institute, Baltimore, MD, USA Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Jantz PB, Bigler ED, Froehlich AL, Prigge MBD, Cariello AN, Travers BG, Anderson J, Zielinski BA, Alexander AL, Lange N, Lainhart JE. WIDE RANGE ACHIEVEMENT TEST IN AUTISM SPECTRUM DISORDER: TEST-RETEST STABILITY. Psychol Rep 2015; 116:674-84. [PMID: 25871566 DOI: 10.2466/03.15.pr0.116k24w8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The principal goal of this descriptive study was to establish the test-retest stability of the Reading, Spelling, and Arithmetic subtest scores of the Wide Range Achievement Test (WRAT-3) across two administrations in individuals with autism spectrum disorder. Participants (N = 31) were males ages 6-22 years (M = 15.2, SD = 4.0) who were part of a larger ongoing longitudinal study of brain development in children and adults with autism spectrum disorder (N = 185). Test-retest stability for all three subtests remained consistent across administration periods (M = 31.8 mo., SD = 4.1). Age at time of administration, time between administrations, and test form did not significantly influence test-retest stability. Results indicated that for research involving individuals with autism spectrum disorder with a full scale intelligence quotient above 75, the WRAT-3 Spelling and Arithmetic subtests have acceptable test-retest stability over time and the Reading subtest has moderate test-retest stability over time.
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Affiliation(s)
| | - Erin D Bigler
- 2 Department of Psychology, Brigham Young University
| | | | - Molly B D Prigge
- 4 Department of Pediatrics, School of Medicine, University of Utah, Waisman Laboratory for Brain Imaging and Behavior, University of Wisconsin-Madison
| | | | - Brittany G Travers
- 6 Occupational Therapy Program, Department of Kinesiology, Waisman Laboratory for Brain Imaging and Behavior, University of Wisconsin-Madison
| | - Jeffrey Anderson
- 7 Departments of Radiology and Bioengineering, University of Utah
| | - Brandon A Zielinski
- 8 Department of Pediatrics and Neurology, School of Medicine, University of Utah
| | - Andrew L Alexander
- 9 Department of Medical Physics, Department of Psychiatry, Waisman Laboratory for Brain Imaging and Behavior, University of Wisconsin-Madison
| | - Nicholas Lange
- 10 Departments of Psychiatry and Biostatistics, Harvard University, Neurostatistics Laboratory, McLean Hospital, Belmont, MA
| | - Janet E Lainhart
- 11 Department of Psychiatry, Waisman Laboratory for Brain Imaging and Behavior, University of Wisconsin-Madison
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Impaired performance on advanced Theory of Mind tasks in children with epilepsy is related to poor communication and increased attention problems. Epilepsy Behav 2015; 43:109-16. [PMID: 25601584 DOI: 10.1016/j.yebeh.2014.11.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 10/10/2014] [Accepted: 11/09/2014] [Indexed: 11/20/2022]
Abstract
Children with epilepsy (CWE) have social difficulties that can persist into adulthood, and this could be related to problems with understanding others' thoughts, feelings, and intentions. This study assessed children's ability to interpret and reason on mental and emotional states (Theory of Mind) and examined the relationships between task scores and reports of communication and behavior. Performance of 56 CWE (8-16years of age) with below average IQ (n=17) or an average IQ (n=39) was compared with that of 62 healthy controls with an average IQ (6-16years of age) on cognition, language, and two advanced Theory of Mind (ToM) tasks that required children to attribute mental or emotional states to eye regions and to reason on internal mental states in order to explain behavior. The CWE-below average group were significantly poorer in both ToM tasks compared with controls. The CWE - average group showed a significantly poorer ability to reason on mental states in order to explain behavior, a difference that remained after accounting for lower IQ and language deficits. Poor ToM skills were related to increased communication and attention problems in both CWE groups. There is a risk for atypical social understanding in CWE, even for children with average cognitive function.
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Adaptive skills and somatization in children with epilepsy. EPILEPSY RESEARCH AND TREATMENT 2014; 2014:856735. [PMID: 24592331 PMCID: PMC3922016 DOI: 10.1155/2014/856735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 11/20/2013] [Indexed: 11/17/2022]
Abstract
Objective. Children with epilepsy are at risk for less than optimum long-term outcomes. The type and severity of their epilepsy may contribute to educational, psychological, and social outcomes. The objective of this study was to determine the relation between somatization and adaptive skills based on seizure type that could impact on those outcomes. Methods. This study examined adaptive functioning and somatization in 87 children with epilepsy using archival data from a tertiary care facility. Results. No significant differences in adaptive skills emerged between groups of children diagnosed with complex partial (CP) as compared to CP-secondary generalized (SG) seizures; however, deficits in adaptive behavior were found for both groups. The number of medications, possibly reflecting the severity of the epilepsy, was highly correlated to adaptive function. Conclusions. Identification of deficits in adaptive behavior may represent an opportunity for tailored prevention and intervention programming for children with epilepsy. Addressing functional deficits may lead to improved outcomes for these children.
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Cormack F. Early-onset epilepsy, cognition, and behaviour: continuity and challenge. Dev Med Child Neurol 2013; 55:963-4. [PMID: 23789645 DOI: 10.1111/dmcn.12185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2013] [Indexed: 11/29/2022]
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Ronen GM. Identifying early markers for future school achievement in children with early-onset epilepsy. Dev Med Child Neurol 2013; 55:591-2. [PMID: 23590465 DOI: 10.1111/dmcn.12154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Gabriel M Ronen
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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