Epilepsy

Thomas B. King, M. Ed.

Hospital Education Program

VCU Health Care System

Incidence

Incidence of Epilepsy

2,000,000 people in the United States have some form of epilepsy

30 %, or about 300,000 are under the age of 186/1000, or approximately 0.5 % to 1% of

children in the US are diagnosed with epilepsyLarge numbers of children may have undetected

or untreated epilepsy. (Epilepsy Foundation of America)

Incident Facts

Epilepsy is the most common CNS disorder affecting children

Between 5% and 10% of all children will have a seizure before the age of 20

Educational Implications

Most children with epilepsy test within the average range on IQ tests and will remain within the general educational setting

The majority of children with epilepsy will attend their neighborhood schools.

However, children with epilepsy are at increased risk for learning and behavioral challenges.

Hidden Epilepsy

BECTS “spectrum” (Rolandic epilepsy) About 8% of children with Rolandic

Discharges have epilepsy Most will have cognitive differences or

challenges IQ may not be affected

Problems faced at school

Learning Disabilities are common, but frequently overlooked co-morbid condition (Pellock, 1999 in print).

Almost 1/3 of children with epilepsy are also identified to have ADHD (Kanner, 2001)

Grade retention and special education identification are more common in children with epilepsy (Bailet & Turk, 200)

There is a higher rate of psychiatric disorders in children with epilepsy (Kanner, 2001).

Classification System of Seizures

Two “big” families Generalized seizures Partial seizures

Some Research Considerations

Children with BECTS may have abnormal processing of auditory information at a sensory level (J Neural Transm. 2006)

Significant delays in reading and numeracy and/or spelling ability found in a group of children with BECTS (Epileptic Disord 2006)

BECTS has been found to possibly be related to disruptions in language development with long-term consequences (Brain Lang. 2005)

More research considerations

Children studied had normal IQ’s but “showed inferior performance in the SPT more frequently than “healthy” controls.

Aspects of the epilepsy, such as the # of seizures, time since last seizure, and the # and lateralization of the spikes, showed no correlation with the neuropsychological tests (Arq Neuropsiquiatr 2007).

Temporal Focus

A study of 96 TLE patients found that: 47% were minimally impaired on a battery of

comprehensive neuropsychological tests 24% were memory impaired 29% were memory, executive, and speed

impaired (J Int Neuropsychol Soc. 2007)

Additional Temporal Lobe Epilepsy Findings

Children appear to be more affected than adult onset patients

There is a need to evaluate children with the diagnosis of TLE in the areas of language, memory, socioperceptive competence, and executive functions.

Early detection, and diagnosis is important for proper intervention (Epilepsia, 2006).

Classification system

Generalized seizures– Typical absence– Atypical absence– Myoclonic absence– Tonic (spasms)– Myoclonic– Myoclonic atonic seizures– Atonic seizures

Classification systemgeneralized convulsions

Tonic clonic Clonic atonic

Partial Epilepsy

Complex partial Simple partial These types of seizures are the most

common They can “secondarily generalize) Place kids at risk for subtle but significant

learning challenges Are also called “focal epilepsy.”

Reflex epilepsy

Visual stimuli – such as a flickering light, or pattern or other visual stimuli

Thinking about music Eating Reading Startle

Generalized status

Generalized tonic-clonic status Clonic status Absence status Tonic statusInternational League Against Epilepsy

…and finally

Focal status– Aura continua– Limbic status (psychomotor status)– Nocturnal status (such as Landau-Kleffner)

Partial Epilepsy

Simple Partial Seizures Complex Partial Seizures

“parts of a seizure”

Aura – may actually be a partial seizure Convulsive or non-convulsive event Post ictal stage

Inter-ictal phase

Between seizures (could be hours, days, weeks, years)

No seizure is noted, but abnormal brain activity persists

Another term might be “sub-clinical seizure” Causes Learning Disabilities or processing

disorders

Diagnostics

International classification system International 10 – 20 EEG electrode

placement

The Limbic System

Types of EEG

Routine – lasts about 30 minutes and misses some epilepsy.

Sleep deprived 24 hour EEG Epilepsy Monitoring – Requires a hospital

stay.

Factors that effect school performance

Age of onset The level of control Type of epilepsy Any related medical condition

More school related factors

Focal epilepsy tends to cause focal school difficulties

Generalized epilepsy tends to cause generalized school difficulties

Most forms of epilepsy will adversely affect processing speed, cognitive efficiency, memory, and academic fluency

intervention

Any child with epilepsy probably should have an evaluation of all affected processing systems

This should be done when the seizures are controlled, if possible

Academic assessment is usually NOT sensitive to early difficulties – processing assessment is

Intervention strategies

Intervention strategies are always based on COMPREHENSIVE assessment