Cognitive and Academic Effects

Children and adolescents with seizure disorders experience problems in the classroom and generally demonstrate lower levels of academic achievement and lower IQ scores. Teachers may have lower expectations for children with seizure disorders and may either try to protect them from the typical challenges of the classroom or set low expectations for performance (Bishop and Boag 2006). Seizure frequency can certainly affect a child's attention and mental speed through both interictal and postictal presentations. Poorly controlled seizures can have a cumulative effect on the quality of the child's education. A study of young patients with complex partial seizures and normal IQs noted that psychiatric symptoms were more likely to be related to verbal IQ than to any seizure variable (Caplan et al. 2004). Higher seizure frequency is associated with lower IQ scores, poor attention, and loss of language skills. In addition, patients with severe seizure disorders that present as part of a syndrome, including infantile spasms and Landau-Kleffner syndrome, have mental retardation, hyperactivity, and a range of pervasive developmental disorders (Plioplys et al. 2007).

Inattention and impulsivity are the most consistent and significant psychiatric symptoms noted in children with new-onset epilepsy, even when controlling for demographic and seizure variables. At-tention-deficit/hyperactivity disorder (ADHD) frequently occurs with children who experience a seizure disorder, with prevalence estimates as high as 38%. Patients tend to be inattentive, and it is not unusual for symptoms of ADHD to precede the epilepsy diagnosis. The disorder may be a more accurate predictor of school performance than either social or emotional factors (Williams et al. 2001). The risk factors associated with ADHD in epileptic patients are poor seizure control, additional neurological deficits, and specific antiepileptic medications including phenobarbital, benzodiazepines, topira-mate, vigabatrin, and zonisamide (Aldenkamp et al. 2003; Loring and Meador 2004). There have been concerns that the use of stimulant medication is contraindicated in children with epilepsy, particularly when the disease is poorly controlled. There have been a few open-label studies that consider stimulants safe for the treatment of ADHD in children with epilepsy regardless of whether there is good seizure control (Gucuyener et al. 2003).

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