Children's epilepsy resource for Clinicians

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Signs of learning and behaviour difficulty

 

aetiology:

The aetiology of increased risk for neuropsychological compromise in children with epilepsy is complex and multi-factorial1, with research identifying the following contributing factors:

  • The underlying pathology/syndromal diagnosis giving rise to seizures1
  • Epileptic electro-neurophysiological dysfunction (particularly frequency, severity, and intractability of seizures)1
  • Medical complications (e.g. multiple or prolonged episodes of status epilepticus, falls resulting in head injury etc.)1
  • Anti-epileptic medications 1 (i.e. a complex relationship with cognition)
  • Other factors (e.g. psychosocial variables, age of onset, neurodevelopmental and aging effects)1

 

Signs of possible learning or behaviour difficulty:

The following difficulties are sometimes reported by families or  schools, which may indicate early cognitive or behavioural problems warranting further detailed investigation:

  • Slowed ability to reach developmental milestones compared to siblings/peers
  • Development of or escalation of behaviour problems
  • Increasing difficulty with school work or homework (e.g. a drop in performance compared to previously)
  • Reports from school of poor concentration, not listening, not following instructions, not finishing work, interrupting others, difficulty working independently
  • Increasing frustration in the classroom
  • Getting into trouble with the teacher
  • Increasing dislike of school or school avoidance
  • Reports of difficult behaviour from the school, but good behaviour at home (and vice versa)
  • Moody, emotional outbursts after school
  • Conflict in the home setting

 

 

Typically, neuropsychological compromise is greatest in patients with epileptic encephalopathies (e.g. West’s Syndrome, Lennox-Gastaut Syndrome, Dravet’s syndrome etc.) who commonly exhibit mental retardation, autistic features, and behavioural problems.1 Cognitive compromise may also be pronounced in symptomatic epilepsies (i.e. related to a known structural abnormality).1

 

Research has also documented neuropsychological deficits ranging from subtle to more pronounced, in the so called ‘benign’ generalized idiopathic epilepsies (e.g. Childhood Absence Epilepsy, Juvenile Myoclonic Epilepsy) and in ‘Benign' Rolandic Epilepsy1,2,3.

 

 

 

Attention and ADHD

Attentional compromise is often documented in children with epilepsy - with ADHD reportedly affecting three to five times more children with epilepsy compared to children without.[4] This is especially the case with absence epilepsy.

 

Attentional compromise can affect learning, memory functioning, academic performance, and psychosocial functioning. Consequently, early identification of attention difficulties is important to allow early intervention and improve long-term outcomes for children with epilepsy.

 

 

This page was last reviewed in December 2017.

 

 


[1] Schoenberg et al. (2011). Epilepsy and Seizures. In Schoenberg & Scott (Eds.). The Little Black Book of Neuropsychology, NY: Springer.

[2] Besag, F.M.C. (2006). Cognitive and Behavioural Outcomes of Epileptic Syndromes: Implications for Education and Clinical Practice. Epilepsia, 47(2): 119-125.

[3] MacAllister, W.S. & Schaffer, S.G. Neuropsychological Deficits in Childhood Epilepsy Syndromes. Neuropsychol Review, 17:427-444.

[4] Plioplys, Dunn, & Caplan (2007). 10-year Research Update Review: psychiatric Problems in Children With Epilepsy. J. Am. Acad. Child Adolesc. Psychiatry, 46(11):1389-1402.