Parental expectations for their epileptic children

A importância do envolvimento parental no desenvolvimento de crianças e adolescentes com epilepsia

A epilepsia é um distúrbio crónico caracterizado pela presença de crises recorrentes, resultantes de descarga excessiva dos neurónios. Salienta-se a dialética entre epilepsia, família e a escola, partindo do estudo comparativo de cinco casos. Os resultados indicam que as crianças/adolescentes epiléticos denotam predisposição para problemas nas tarefas de aprendizagem e insucesso escolar; autonomia/ajuste satisfatório nas rotinas diárias; limitações nas relações sociais. O envolvimento parental assume total importância. Existe antagonismo: os pais revelam preocupação e procuram assegurar a toma da medicação; mas, desvalorizam a prevenção da ocorrência das crises. A Escola responsabiliza-se por estruturar, implementar e avaliar as respostas educativas.

Child psychiatry

This paper first summarizes the main findings of clinical studies conducted over the past two and a half decades on psychopathology (i.e., psychiatric diagnoses, behavior and emotional problems) in children with new onset and chronic epilepsy both with and without intellectual disability who are treated medically and surgically. Although impaired social relationships are core features of the psychiatric disorders found in pediatric epilepsy, few studies have examined social competence (i.e., social behavior, social adjustment, and social cognition) in these children. There also is a dearth of treatment studies on the frequent psychiatric comorbidities of pediatric epilepsy, attention deficit hyperactivity disorder, anxiety disorders, and depression. Drs. Hamiwka and Jones then describe their current and planned studies on social competence and cognitive behavioral treatment of anxiety disorders, respectively, in these children and how they might mitigate the poor long-term psychiatric and social outcome of pediatric epilepsy.

Social skills in children with epilepsy: how do they compare to healthy and chronic disease controls?

Studies have shown poor long-term social outcomes in adults with childhood-onset epilepsy. Our goal was to compare social skills in children with epilepsy with those of healthy and chronic disease controls. Children (8-16 years) with epilepsy (n=59) were compared with age- and gender-matched children with chronic kidney disease (n=40) and healthy controls (n=41). Parents completed the Social Skills Rating System (SSRS) questionnaire. Children with epilepsy had significantly poorer SSRS total scores when compared with healthy controls (P=0.002); however, their scores did not differ from those of children with chronic kidney disease (P=0.52). Children with epilepsy were less cooperative (P=0.02), less assertive (P=0.004), and less responsible (P=0.05) and displayed poorer self-control (P=0.005) than healthy controls. Our results suggest that having a chronic disease plays a role in the social functioning of children with epilepsy. The impact of epilepsy itself on social functioning should be further elucidated through detailed prospective assessments over time.

Psychopathology and psychological adjustment in children and adolescents with epilepsy

BACKGROUND

Epilepsy is the most common chronic neurological illness in childhood and adolescence, and this condition may increase the risk of psychopathology at these ages.

DATA SOURCES

A literature review, including MEDLINE and PsychLIT database, was made covering the period of 1966-2007. Research studies were included if they were concerned with children suffering from epilepsy and measures of psychopathology.

RESULTS

Studies found a more elevated rate of psychological and psychiatric disorders, both behavioral and emotional, in these samples compared to general population or children with other chronic conditions. The problems presented in children and adolescents with epilepsy are quite similar to those in general population with a slight increase of hyperkinetic and attention problems likely related to both direct brain damage and anticonvulsant treatment. There is no evidence of psychotic disorders and/or specific personality traits associated with epilepsy at these ages.

CONCLUSIONS

Family factors, specially those related to psychopathology in other family members and parent-child relationships, appear to have stronger influence on children psychopathology than illness factors themselves. Some guidelines are provided in order to improve future research.

Social difficulties in children with epilepsy: review and treatment recommendations

Children with epilepsy are at increased risk for social difficulties compared with other children. This review investigated the types of social difficulties that children with epilepsy experience, the risk factors for their social difficulties and possible interventions for treating their social difficulties, such as social skills training, educational and speech and language interventions, and psychopharmacotherapy. Recommendations for future research on social difficulties in children with epilepsy are discussed.

Quality of life among Brazilian children with epilepsy: Validation of a parent proxy instrument (QVCE-50)

PURPOSE

To analyze the validity and reliability of an epilepsy specific health related quality of life (HRQL) instrument (QVCE-50), constructed for Brazilians. The QVCE-50 comprises the following domains: physical (9 items), psychological (18 items), social/familial (7 items), and cognitive/educational (16 items). Items were scored on a four point scale. Domains were equally weighted using percent scores. The questionnaire ends with a quality of life scale scored 0-10 and a space for free observations.

METHODS

A total of 77 children with epilepsy were consecutively seen in a neuropaediatric ambulatory unit. Parents or caregivers responded to the QVCE-50 and a Portuguese version of ICIS (Impact of Childhood Illness Scale). QVCE-50 was analyzed for internal consistency, reliability, content and concurrent validity. Clinical and socio-demographic variables were also analyzed.

RESULTS

Socio-demographic and clinical variables that differed in at least one domain were age, sex, time since diagnosis, epilepsy family history, and antiepileptic drug used. Internal consistency, analyzed by Cronbach's alpha, showed good results for total and domain scores: physical (0.68), psychological (0.86), socio-familiar (0.70) and cognitive-educational (0.91). Total scores on the QVCE-50 and ICIS are inversely correlated (Pearson's r=-0.74, p<0.0001). The Intraclass Correlation Coefficients for test-retest reliability were acceptable: physical (0.51), psychological (0.62), socio-familiar (0.66), cognitive-educational (0.85) and total (0.77), p<0.0001.

CONCLUSIONS

QVCE-50 has good psychometric properties. It is a useful tool for analyzing HRQL in children with epilepsy for Portuguese speakers, especially Brazilians. Other properties should be further tested, such as responsiveness to drug and surgical treatment, capacity of distinguishing among seizure control categories and etiology (with a larger sample) and impact of psychiatric and cognitive co-morbidities.

Temperament, family environment, and behavior problems in children with new-onset seizures

Children with epilepsy, even those with new-onset seizures, exhibit relatively high rates of behavior problems. The purpose of this study was to explore the relationships among early temperament, family adaptive resources, and behavior problems in children with new-onset seizures. Our major goal was to test whether family adaptive resources moderated the relationship between early temperament dimensions and current behavior problems in 287 children with new-onset seizures. Two of the three temperament dimensions (difficultness and resistance to control) were positively correlated with total, internalizing, and externalizing behavior problems (all P<0.0001). The third temperament dimension, unadaptability, was positively correlated with total and internalizing problems (P<0.01). Family adaptive resources moderated the relationships between temperament and internalizing and externalizing behavior problems at school. Children with a difficult early temperament who live in a family environment with low family mastery are at the greatest risk for behavior problems.

Development and validation of a health related quality of life questionnaire for Brazilian children with epilepsy: preliminary findings

PURPOSE: To construct a multidimensional questionnaire that analyses the epileptic child quality of life from the parental point of view. METHOD: The pilot questionnaire was composed of 157 questions distributed in several dimensions. Fifty-one epileptic children's parents answered the questionnaire. The instrument was tested in its diverse properties: frequency of endorsement, homogeneity (Cronbach alpha), criterion and face validity, and later it was reduced. RESULTS: Endorsement frequency excluded 65 questions that did not attain a minimum of 5% response per item. Cronbach alpha was as follows: physical (0.93), psychological (0.91), social (0.91), familiar (0.70), cognitive (0.92), medical (0.30) and economical (0.37). Patient groups, in relation to seizure control, significantly differed only in physical domain and total score, although there was a trend to differences in other domains. The final questionnaire (QVCE50) has 50 items, with good homogeneity in the physical, psychological and cognitive domains. CONCLUSION: QVCE-50 is a promissing Brazilian HRQL questionnaire for children with epilepsy.It needs to be applied in a larger population to confirm its psychometric properties.

Family factors and psychopathology in children with epilepsy: a literature review

PURPOSE

From a social interactional and ecological framework, studies were reviewed that (1) compared family factors in children with epilepsy with those in children from normative groups, healthy children, children with a chronic illness, or siblings; and (2) examined the relationship between distinct family factors and child psychopathology.

RESULTS

Compared with control groups, families with a child with epilepsy generally fare worse on the whole range of family factors, indicating lower parent-child relationship quality, more depression in mothers, and problems with family functioning. Significant associations were apparent between distinct family factors, especially parental psychological control, parental attributions about epilepsy, and family members' satisfaction with family relationships, and psychopathology in children with epilepsy.

CONCLUSION

Future childhood epilepsy research might benefit from the examination of the simultaneous contribution of distinct family factors to child psychopathology, within a broad multifactorial framework that also includes neurological and medication factors.

Psychopathology in Children with Epilepsy: A Meta-Analysis

OBJECTIVE

To examine the types and severity of psychopathology in children with epilepsy.

METHODS

A series of meta-analyses were conducted to review 46 studies, including 2,434 children with epilepsy.

RESULTS

Effect sizes were medium to large for comparisons with children from the general population, which indicates that children with epilepsy are at increased risk for psychopathology, including internalizing and externalizing behavior problems. Comparisons with children with another chronic illness revealed small to medium effect sizes, indicating that psychopathology in children with epilepsy may partly be attributed to chronicity of the disease. Attention problems, thought problems, and social problems proved to be relatively specific to epilepsy. Comparisons with siblings suggested that psychopathology in children with epilepsy may be associated with family factors, especially where behavioral disorders appear to be more generic.

CONCLUSIONS

Clinicians should consider both neurological and psychosocial factors, including the family system, when treating psychopathology in children with epilepsy.

[Epilepsy, epileptics, the work: conflicting relations]

Participation in the workplace by people with epilepsy is conditioned by various interrelated issues concerning epilepsy itself, the epileptic individual, and society's implicit cultural codes. In order to analyze how such conflictive participation interferes decisively in the quality of life of people with epilepsy, a survey was conducted with 339 patients at the University Hospital of Universidade Federal Fluminense. Patients answered questionnaires including level of schooling, professional qualifications, employment situation, frequency, type, and duration of seizures, associated phenomena, and prejudice towards epilepsy. We observed that satisfactory management of seizures is decisive for their success at work. All patients with daily seizures and 9.3% of those with weekly seizures had never been employed. We conclude that any intervention in this context must include the implementation of multiprofessional and intersectorial therapeutic programs and legislation to protect epileptic patients' rights in a broad effort at demystification of epilepsy.

Epilepsy and the family: a review of current literature

Although the negative effect of epilepsy on patient's psychosocial well-being has been increasingly documented in the last decade, the influence of the condition on the family has attracted much less interest. This paper reviews the present state of family research, examining the influence of both childhood and adulthood epilepsy on the psychological and social well-being of family members. Studies indicate that epilepsy may cause high levels of psychosocial difficulties for all family members, including stigmatization, stress, psychiatric morbidity, marital problems, poor self esteem and restriction of social activities. Studies also suggest that the family environment may be an important intervening factor between the condition and the outcome for the family unit, and a number of family factors are reviewed which have been suggested to mediate this relationship, with recommendations being made for their use in intervention studies. Shortcomings of the family studies to date are discussed and these include: concentration on examination of issues around family life, studies being based on reports from single members of the family and the selection of subjects from clinical populations. Recommendations are made concerning methodological and conceptual issues that need addressing for future research.

Depression in epilepsy: etiology, phenomenology, and treatment

A history of depression or depressive symptomatology has been reported in up to two-thirds of patients with medically intractable epilepsy, whereas community studies have demonstrated affective disorder only in a quarter of these patients. Depression has been reported peri- and interictally. However, differentiation may be difficult in patients with frequent seizures. Most authors have found no correlation between depression and epilepsy variables. However, complex partial seizures, especially of temporal lobe origin, appear to be etiologic factors, particularly in men with left-sided foci. Depression is also more common in patients treated with polytherapy especially with barbiturates, phenytoin, and vigabatrin. Depression has also been described de novo after temporal lobectomy. Psychosocial factors also play a part, but underlying risk factors (e.g., genetic, endocrine and metabolic) may explain the increased rates of depression in people with epilepsy compared to those with other neurologic and chronic medical conditions. The depression appears to be endogenous. Patients tend to exhibit fewer neurotic traits and more psychotic symptoms such as paranoia, delusions, and persecutory auditory hallucinations. Treatment approaches include psychotherapy, rationalization of antiepileptic drug medication, antidepressant treatment, and ECT. The tricyclic and related antidepressants appear to be epileptogenic, especially in people at high risk (personal or family history of seizures, abnormal pretreatment EEG, brain damage, alcohol or substance abuse/withdrawal and concurrent use of CNS-active medication). Seizures tend to occur early in treatment or after dose increments, especially if rapidly titrated. There is little evidence that the newer antidepressants, e.g., selective serotonin reuptake inhibitors, moclobemide, venlafaxine, or nefazodone are more epileptogenic than placebo.

Psychiatric disorder and cognitive function in children with epilepsy in Kerala, South India

The cognitive and psychiatric associations of childhood epilepsy have not been studied in developing countries. Children with epilepsy were identified during a population-based epidemiological study of 1403 8- to 12-year-old children in Kerala, South India. They were compared with age-, sex- and social class-matched controls on measures of reading, vocabulary, non-verbal reasoning and school performance. In addition, psychiatric symptoms were measured using standard questionnaires and the presence or absence of psychiatric disorder was established by interview. Patients performed as well as controls on the non-verbal test, but performed worse on tests of vocabulary and reading, suggesting a specific disadvantage in the area of education. Psychiatric disorder was more prevalent in the children with epilepsy. It was concluded that epilepsy in the population studied is accompanied by a significant burden of cognitive and psychiatric disorders which need recognition and adequate service provision.

Academic achievement in children with epilepsy or asthma

The purposes of the study were to compare academic achievement between children with epilepsy and those with asthma and to identify child perception, school adaptive functioning, and condition severity factors related to academic achievement. Subjects were 225 children (117 with epilepsy and 108 with asthma) aged between 8 and 12 years. Academic achievement was measured using school-administered group tests. Self-report questionnaires were used to measure child attitudes and school self-concept. Teachers rated school adaptive functioning. Data were analyzed using ANCOVA and multiple regression. Children with epilepsy had significantly lower achievement scores than children with asthma. Boys with severe epilepsy were most at risk for underachievement. Factors related to poor academic achievement in both samples were: high condition severity, negative attitudes, and lower school adaptive functioning scores. Less variance was accounted for in the model for epilepsy (R2=0.25) than for asthma (R2=0.36). Boys with high seizure severity were most at risk for achievement-related problems. Future research in epilepsy should consider additional factors in the model predicting academic achievement.

Sexual function in women with epilepsy

PURPOSE

To examine certain aspects of sexual behaviour and attitudes in a group of women with epilepsy using a validated questionnaire (Sexuality Experience Scales), and effects of antiepileptic drugs (AEDs) on sex hormone binding globulin (SHBG), total testosterone (TT), and free testosterone (FT).

METHODS

One hundred ninety-five women all attending a hospital-based epilepsy clinic were recruited. One hundred fifty-nine received AED therapy and 36 women did not. A control group of 48 women was also recruited. All women completed the first two Sexuality Experience Scales (SES 1 and SES 2), and those women in stable heterosexual relationships completed SES 3 and SES 4. At the same time blood was taken for TT and SHBG levels. FT was calculated using the method of Nanjee and Wheeler (22).

RESULTS

Women receiving AED therapy achieved significantly higher SES 1 and SES 2 scores than the rest of the women, suggesting that they adhered to a stricter sexual morality and were less open to psychosexual stimulation than the rest of the women treated. Women in the treated group were less likely to have received further education than the controls, a factor that influences SES 1 and SES 2 scores. There were no significant differences between the three groups on SES 3 or SES 4, with the exception of the orgasmic adequacy (OE) scale of SES 3 where those women in the treated group attained a higher mean score than the controls, suggesting that they found orgasm less satisfying. Women receiving AEDs had significantly higher SHBG and TT than controls and untreated patients. There were no differences in FT between the groups. Those women receiving AEDs also exhibited the expected midcycle rise in FT. There was no significant correlation between FT and the desired frequency of intercourse or enjoyment of it for the three groups.

CONCLUSIONS

Women in the treated group appeared to be more "moral" and less open to sexual approach, but those who had regular partners appeared to desire and enjoy intercourse as much as the control and untreated groups. This could be explained by differences in demographic characteristics of the study groups or be indicative of a bimodal distribution of sexual interest in these women. As FT was within physiological norms for each study group this cannot be cited as a cause for hyposexuality.

Patterns of academic competence in adults with epilepsy: a cluster analytic study

Cluster analysis was used in the attempt to derive a meaningful taxonomy of academic competence in 117 adults with temporal lobe epilepsy. Reading, spelling and arithmetic achievement scores from the Wide Range Achievement Test-Revised were subjected to hierarchical complete linkage cluster analysis, and the stability of the obtained solution was examined by the application of two additional clustering procedures. A six cluster solution was obtained, and tests of internal validity showed membership in four of the clusters to be extremely stable (Moderate and Marked Reading/Spelling Underachievement, Above Average Achievement, Reading/Arithmetic Underachievement), while the remaining two clusters showed some exchange of cases (Arithmetic Underachievement, Average Achievement). Modest evidence of external validity was found through the comparison of specific clusters to the Average Achievement group on measures of neuropsychological function, neurological and demographic characteristics. It is concluded that cluster analysis may be helpful in developing taxonomies of psychosocial impairment in epilepsy, and may facilitate an understanding of the determinants of variable quality of life outcomes associated with epilepsy.

Predicting behavior problems in children with epilepsy: child factors, disease factors, family stress, and child-mother interaction

This study examines the relative role of parent-child relationships, family stress, and disease factors in predicting behavior problems in children with epilepsy. It extends existing literature on parent-child relationships and behavior problems by examining children with biological risk. Child-mother interaction was observed for 51 children with epilepsy ages 7-13 years and related to teacher- and parent-reported behavior problems. Child's self-reliance correlated with parent-reported problems; expression of affect related to teacher-reported externalizing problems. A child self-reliance factor accounted for behavior problems after partialing age, gender, IQ, epilepsy variables, and family stress. The term child gender x quality of mother-child interaction predicted teacher-reported externalizing problems, with mother-child interaction correlated with behavior problems for boys. Child-parent relationships predict the development of behavior problems over and above the influence of disease-related factors, even for children at considerable biological risk.

Idiopathic epilepsy and school achievement

Forty one children (20 boys, 21 girls) aged 6-10.8 years (mean age 8.6 years) who were affected with idiopathic epilepsy underwent neuropsychological (Wechsler Intelligence Scale for Children, Bender test) and behavioural assessment (Personality Inventory for Children; this was also used in a matched control group). Further information was obtained by teachers' reports. School underachievement occurred in 25 children (61%). Statistical analysis showed no influence of sex, social background, age of onset, seizure type, duration of illness, features seen on electroencephalography, and treatment. School failure was due to poor performance in almost all academic fields, and was associated with higher visuomotor impairment; children showing good school performance had a higher mean IQ and less visuomotor impairment. The behaviour of children with epilepsy who had a good academic performance did not differ from that of their healthy peers. Emotional maladjustment (social skill impairment, depression, poor motivation, and low self esteem) was associated with poor school performance. Such problems, that may complicate the course of idiopathic epilepsy and require an appropriate educational programme, should be carefully considered by the clinician.

Cognitive performance in learning disabled children with and without epilepsy

Cognitive functioning and educational achievement were examined in learning disabled children with epilepsy (n = 65) and without epilepsy (n = 122) in order to explore whether children with epilepsy show unique types of learning problems, different from those in other learning disabled children. The learning disabled children with epilepsy tended to perform better on tests of verbal intelligence, certain achievement-related abilities and were better in one area of academic achievement, i.e. spelling. Despite their superior performance in these areas, the learning disabled children with epilepsy were slower than those without epilepsy and regular education controls (n = 100) on simple auditory and visual reaction tasks as well as on a multiple decision reaction task and a visual searching task. The results obtained with the school achievement tasks provide no clear evidence for specific types of learning impairment in children with epilepsy. Learning disabled children with epilepsy do not appear to have educational needs different from those of other learning disabled children.

Children with epilepsy and their families: needs and services

Social factors play a major role in determining the impact of epilepsy on families. This paper reviews the literature on the needs of families and their social networks, and services proposed for them. The predominantly negative picture presented in the 'expert' literature is compared with the more positive one presented in first-hand studies of families' views and in the literature on children with other disabilities. The implications of these differing perspectives for service provision are discussed.

The quality of life of children with chronic epilepsy and their families

This paper describes the study investigating the quality of life among 108 school children with chronic epilepsy attending the epilepsy clinic at a children's hospital. Quality of life measurement was assessed with two questionnaires completed by the parents. The results showed clearly that epilepsy has the greatest impact among children who not only had intractable epilepsy but also had additional disabilities. The adverse impact was evident in three main areas: the management of epilepsy including the side effects from anticonvulsants; the deleterious effects on the child's adjustment and development and the restrictions on family life and activities. It would seem sensible to concentrate scarce professional resources on this group of children and their families.

Social adjustment in young adults with absence epilepsies

A long-term follow-up of 58 young adults, aged 18-27 years, with persisting absence epilepsies since childhood or early adolescence, was performed to assess psychosocial outcome and the patients' own concept of their epilepsy. They were well adjusted in the areas of family status and employment, but had more unqualified jobs as compared with a reference group. They were also inclined to lead very regular lives in a way that led to social isolation. At least one of the following factors was considered by 74% of the group to have been affected by their epilepsy: schooling, occupation, routines of daily life, relations with friends, leisure time activities, and housing, this was independent of whether or not they had achieved seizure control. In treating absence epilepsies, it is important that one considers psychosocial aspects, even if a medically satisfying result with seizure control is obtained.

Role of child-mother interaction in predicting competence of children with epilepsy

Child-mother interaction in two problem-solving situations was observed in 59 children with epilepsy aged 7-13 years and was related to their psychosocial adjustment in school and in an independent problem-solving activity. Mothers' support for their child's task completion, the availability of affective expressions in the interaction, and the child's self-reliance in interacting with the mother were significantly correlated with the adjustment measures. Factor scores based on the ratings of child-mother interaction accounted for significant increments in the adjustment measures after child age, gender, IQ, epilepsy variables, and family life stress were partialled out. The results support the view that child-parent relationships are important predictors of adjustment for children with epilepsy.

Cerebral-palsied children's interactions with siblings--I. Influence of severity of disability, age and birth order

Sixty-four Greek cerebral-palsied children, aged 2-13, and their siblings were observed in a semi-structured play situation at home. Compared to matched control dyads, disabled children were passive and lacking in assertiveness, while their siblings were correspondingly more directive. Interaction in disabled dyads was predominantly hierarchical in nature with disabled children assuming the role of the younger child regardless of age or birth order. Control dyads were more egalitarian, with members taking turns in initiating the interaction. Maternal intervention was higher in disabled dyads, particularly among younger groups where social skills were poorly developed.

Helping parents and children with epilepsy cope successfully: the outcome of a group programme for parents

This paper describes a study to determine the effectiveness of a group programme for parents designed to reduce the psychosocial morbidity among children with epilepsy and their families. The participants were the parents of 108 children attending the seizure clinic at a children's hospital. The first part of the project had shown that half of the children and their families had considerable morbidity. Despite the high rate of psychosocial morbidity among these children and their families, only 35% of the parents expressed an interest in participation in the intervention programme, with only 12% attending any meetings. The latter were mainly the small number of parents whose children had severe intractable epilepsy as well as educational and family problems. Many parents did, however, request more information about epilepsy and for the provision of a counselling service. The latter is likely to be most beneficial in the months following diagnosis.

Determinants of IQ profile in children with idiopathic generalized epilepsy

To determine the IQ profile of children with epilepsy and the influence of various epilepsy-related variables on IQ scores, we studied 50 children with idiopathic generalized epilepsy of > 1-year duration, 25 of their siblings, and 30 healthy controls. IQ assessments were made with Malin's Indian modification of the Wechsler Intelligence Scale for Children. The mean +/- SD IQ scores of children with epilepsy (85.6 +/- 12) and their siblings (93.2 +/- 11) were significantly lower than those of the controls (101.6 +/- 9). The IQ scores of the children with epilepsy were also significantly lower than those of their siblings (p < 0.05). The IQ scores showed a significant correlation with socioeconomic status (SES) score (r = 0.33), a history of status epilepticus (r = -0.38), duration of seizure disorder (r = -0.31), and total number of seizures (r = -0.31). On multiple regression analysis, status epilepticus emerged as the most significant variable, accounting for 14% variance, followed by SES score (9% variance), duration of seizure disorder (6% variance), and sex of the child (5% variance). Genetic or environmental factors that probably lead to cognitive deficit in children with epilepsy and their siblings require further study.

Psychiatric aspects of epileptic children and adolescents

Epilepsy is the most prevalent neurological disorder of childhood and adolescence and a very heterogenous disease with a diverse course of illness. It may be a benign disease for the majority of children and adolescents, who recover spontaneously or are managed well medically; however, a sizeable group of children and adolescents with epilepsy, at least one-third, do manifest various difficulties--seizure control, academic, emotional, behavioral, and family problems. As a group, they have a much higher rate of psychiatric disorder than healthy children and children with other chronic illnesses. This review is undertaken to summarize the literature on epilepsy in children and adolescents, especially with respect to epidemiology, developmental and psychiatric problems, and psychiatric treatment issues.

Impact of the Children's Epilepsy Program on parents

A randomized controlled trial was conducted in Santiago, Chile to test the efficacy of the Children's Epilepsy Program, a child-centered, family-focused intervention developed and pilot tested in Los Angeles, CA, U.S.A., using a counseling model for parents of children with seizure disorders to help them (a) deal with their anger, resentment, and grief related to the loss of a normal child; (b) increase their knowledge about caring for their child; (c) reduce anxieties related to having a child with a seizure disorder; and (d) improve their decision-making skills. All parents were pretested and then retested 5 months after the educational interventions. Parents in the experimental group (n = 185) and their children separately attended four 1 1/2-h sessions and then met together at the end of each session to share learning experiences. Comparison group parents (n = 180) and their children jointly attended three 2-h lecture sessions followed by question-and-answer periods. Although parents' overall knowledge of epilepsy was relatively high initially, it improved considerably in both comparison and experimental groups. With regard to anxiety, at the 5-month evaluation, experimental group parents and mothers in particular were more likely than control parents to state that they were less anxious (p less than 0.001), and their anxiety, as measured by the Taylor Manifest Anxiety scale, was significantly reduced (p less than 0.01).

Psychosocial adjustment of children with chronic epilepsy and their families

A cross-sectional study was undertaken of psychosocial morbidity among 108 children with chronic epilepsy and their families. Approximately half the children showed evidence of significant psychological disturbance. Neurotic or emotional disturbance was the most common diagnostic category, with similar rates of disturbance among boys and girls; findings not reported previously. Behavioural disturbance was strongly associated with epileptic variables, family factors, individual characteristics of the child and with maternal anxiety about epilepsy. Several factors are responsible for this increase, and further study is needed to elucidate these and to reduce the incidence of psychosocial morbidity among these children.

Academic underachievement in children with epilepsy

Academic achievement was studied in 78 children with epilepsy, ages 5 to 13 years, to determine how seizures, treatment of seizures, and sociocultural factors influence academic achievement. Cognitive abilities were assessed with either the McCarthy Scales of Children's Abilities or the Wechsler Intelligence Scale for Children--Revised. Achievement was measured with the Peabody Individual Achievement Tests. Achievement scores were corrected for cognitive ability (IQ), and underachievement was defined as achievement score 1/2 standard deviation or more below IQ. Information regarding seizure history (severity, duration) and treatment with anticonvulsant drugs was obtained. In addition, the family was extensively interviewed regarding the child's environment, behavior, and demographic background. The Home Observation for Measurement of the Environment (HOME) scale was completed on a home visit. Underachievement was frequent, ranging from 16% (Reading Recognition) to 50% (General Knowledge), but there was no relationship between severity or duration of seizure disorder or total exposure to anticonvulsant medications and achievement. Major determinants of achievement included subscales of the HOME scale, age (older children more likely to be underachieving), and parental education. An equal proportion of newly diagnosed and/or untreated subjects were underachieving compared to those with longstanding epilepsy and anticonvulsant drug treatment.

Neuropsychological aspects of learning disabilities in epilepsy

Cognitive impairment is regarded as the link between epileptic conditions and the inability to learn in school. The neuropsychological approach to learning disabilities in epilepsy, therefore, first concentrates on analyzing the differential effects of epileptic factors on cognitive function. The impact of seizure activity, localization of epileptogenic foci, and antiepileptic treatment on cognitive functioning can be evaluated based upon the results of continuous assessment with a computerized neuropsychological test system. Second, learning disabilities may be evaluated on observations made during classroom performance. Three issues seem to predominate in learning studies among disabled children with epilepsy: test-retest variability, deterioration, and the supposed specificity of the learning disabilities.

Randomized trial of a program to enhance the competencies of children with epilepsy

A randomized, controlled trial was conducted in Santiago, Chile to test the impact of a child-centered, family-focused educational program for children aged 7-14 years with epilepsy and for their parents. The objectives of the program developed and pilot-tested in Los Angeles, California were to increase the children's knowledge, perceptions of competency, and skills related to dealing with seizures. Children in the experimental group (n = 123) and their parents separately attended four 1 1/2-h sessions and then met together at the end of each session to share learning experiences. Control children (n = 113) and their parents attended three 2-h sessions with a traditional lecture followed by question-and-answer format. All participants were pretested and then retested 5 months after completion of the educational intervention. Although there was some knowledge increase among children in the control group, the knowledge of children in the experimental group was significantly enhanced in a variety of areas related to management of their seizures and unnecessary restriction of their social and play activities. There was a significant increase in the self-perceptions of social competency of children in the experimental group. Children in the experimental group without serious behavioral problems also reported significantly better behavior after the intervention than did control children. There was no impact on children's disclosure of their diagnosis to friends and others.