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1.
Children with epilepsy are at increased risk for deficits in social functioning, though the underlying causes are not well-understood. We examined multiple seizure-related, demographic, and cognitive variables in a group of 93 pediatric patients with intractable seizures who were at risk for social skills deficits and social problems at home and in the classroom. Verbal intelligence and parental anxiety about epilepsy were found to be the two primary predictors of social functioning in children with epilepsy as reported by parents and teachers. Though other social variables and secondarily generalized seizures were significantly correlated with certain aspects of parent-reported social functioning, the impact of these variables appeared to be mediated through verbal intelligence and/or parental anxiety about epilepsy. These findings emphasize the importance of family characteristics on social functioning in children with epilepsy and also suggest that parental anxiety about their child's epilepsy may be a specific risk factor for this population. The findings from this study suggest that the factors associated with social functioning in children with epilepsy are similar regardless of whether social functioning is assessed by the parent or the classroom teacher.  相似文献   

2.
ObjectiveOur prospective study aimed at exploring attention and executive functions in children with new-onset epilepsy prior to and during the early course of antiepileptic treatment. Sociodemographic and epilepsy-related factors were analyzed as potential predictors both of impaired cognitive functions as well as for changes in cognitive functioning in the early course of illness.MethodsFrom a total group of 115 children aged six to 17 years without major disabilities, 76 children were assessed longitudinally with a screening tool for attention and executive functions (EpiTrack Junior®). Sociodemographic variables (gender, age at epilepsy onset, need of special education) and epilepsy-related variables (etiology of epilepsy, semiology of seizures, number of seizures) were considered as potential predictors for impaired functions prior to treatment and for deterioration/amelioration in cognitive functions in the early course.ResultsAttention and executive functions of children with new-onset epilepsy were significantly more often impaired when compared with a healthy population, but less often when compared with children with chronic epilepsy. The majority of children showed stable cognitive functioning in the early course of treatment. The risk of impaired cognitive functions was significantly heightened when etiology of epilepsy was unknown or not classifiable. The chance for improvement of functioning was lowered by having a genetic epilepsy, or an unknown semiology of seizures.ConclusionsChildren with new-onset epilepsy are at high risk for impaired attention and executive functions even prior to antiepileptic treatment, especially when etiology of their epilepsy remains unclear. The high stability of cognitive functioning in the early course can be used in counseling of families who worry about negative side effects of drug treatment. Finally, a systematic assessment of cognitive functions in children with new-onset epilepsy is necessary to detect subtle deficits in the early course and adjust treatment accordingly.  相似文献   

3.
Mental Deterioration in Epilepsy   总被引:11,自引:8,他引:3  
Summary: A variety of factors could potentially influence the occurrence of mental deterioration in epilepsy, including seizure type, age of seizure onset, seizure duration, and seizure severity. The available literature suggests that measures of severity are more predictive of progressive decreases in intellectual functioning. There is also evidence suggesting that seizure severity and cognitive deterioration might both be the result of underlying pathophysiologic abnormalities in some cases. In the majority of patients with epilepsy, however, with relatively less severe disease, there is little evidence for cognitive deterioration. Total seizure number also has an inverse correlation with level of psychosocial functioning in some studies, whereas others have found that patients with emotional difficulties have fewer seizures. In the case of emotional deterioration, the impact of interpersonal relationships and other environmental factors upon psychosocial outcome seems clear, and the evidence for specific pathophysiologic explanations for emotional deterioration, less convincing.  相似文献   

4.
Aldenkamp A  Arends J 《Epilepsia》2004,45(1):54-63
PURPOSE: This study addressed whether cognitive impairment in children with epilepsy is caused by disease-related stable factors, such as the type of epilepsy, or by acute effects of paroxysmal epileptic activity such as epileptic EEG discharges. We studied a nonselected group with short nonconvulsive seizures, as these seizures may elude detection and may therefore persist over a longer period. In this group, the diagnostic issue is to differentiate between the combined effects of several epilepsy-related factors on cognition. METHODS: All children were assessed with 32-channel EEG, synchronized with a computerized cognitive test system and a video-monitoring system. Recording time was 2 h. The primary inclusion criteria were unclear seizures and fluctuations in cognitive performance and/or frequent epileptic EEG discharges in a recent EEG. RESULTS: One hundred fifty-two patients met the inclusion criteria; 31 patients appeared not to have a diagnosis of epilepsy and were used as a nonepilepsy control group. Our results show that type of epilepsy has an impact on stable cognitive functions, such as educational achievement. Paroxysmal epileptic activity (acute effects of seizures and epileptic EEG discharges) affects primarily transient mechanistic cognitive processes (alertness, mental speed). CONCLUSIONS: These results suggest that the effects of paroxysmal epileptic activity on transient cognitive mechanisms may accumulate over time and consequently affect the more stable aspects of cognitive function such as educational achievement. The clinical relevance is that early detection of the cognitive impact of seizure-related activity and subsequent treatment may prevent its detrimental impact on cognitive and educational development.  相似文献   

5.
Catastrophic Epilepsy in Childhood   总被引:8,自引:2,他引:6  
Summary: Although for most children epilepsy is a relatively benign disorder, for some, epilepsy can be designated as "catastrophic" because the seizures are so difficult to control and because they are strongly associated with mental retardation. The catastrophic childhood epilepsies include uncommon disorders such as early infantile epileptic encephalopathy with suppression burst, severe myoclonic epilepsy of infancy, and epilepsy with myoclonic-astatic seizures. There are other syndromes that are relatively common such as infantile spasms, Lennox-Gastaut syndrome, and Sturge-Weber syndrome. Many children with catastrophic epilepsy have the seizures as a result of underlying brain abnormalities that will inevitably lead to mental retardation whether or not they have seizures. In some patients, however, the mental retardation appears to be caused by the seizures. Developmental plasticity provides children with an opportunity to recover from significant brain injuries. However, the plasticity may also be the cause of the mental retardation. In such patients, control of the seizures may lead to more normal intellectual development. Thus, every effort should be made to control seizures in children with catastrophic epilepsy.  相似文献   

6.
Mctfm de Krom 《Seizure》2006,15(4):264-266
Cognitive dysfunction in people with epilepsy is a frequently encountered but also easily overlooked problem. In this article three patients with epilepsy are presented with cognitive problems due to a relapse of seizures, due to continuing absence seizures or as a consequence of deteriorating mental functions resulting from frequent complex partial seizures. In the last patient the decline in mental functioning was also demonstrated in a disseminated activation pattern on her fMRI, which contrasts with the localised activity as seen in controls on fMRI. Suggestions how to handle these problems in daily practice are given.  相似文献   

7.
Purpose: Educational difficulties or even severe cognitive deterioration is seen in many childhood epilepsy syndromes. Many of those cognitive deficits are related directly to the brain disorder underlying the epilepsy syndrome. However, in other types of epilepsy, the epileptic seizures and/or epileptiform activity can be the dominant factor. This is especially unknown for the more “subtle” short nonconvulsive seizure types. For this reason, we analyzed a new cohort of children. Methods: A cross‐sectional study of 188 children with epilepsy. Electroencephalography (EEG)–video recordings and cognitive testing were performed simultaneously. The results of children with short nonconvulsive seizures during a 2‐h testing session were compared with all children with epilepsy without seizures during the 2‐h cognitive testing session and with controls without epilepsy. In a second analysis the cognitive effects of frequency of epileptiform EEG discharges were analyzed. Key Findings: The cognitive effects of short nonconvulsive seizures were large, ranging from 0.5 to 1 standard deviation and concerned global cognitive function, speed of central information processing, and memory function. In children without seizures during cognitive testing, the occurrence of frequent epileptiform discharges showed more subtle effects. These effects were independent from the occurrence of short nonconvulsive seizures. Significance: We concluded that although the effect is less pronounced in number of areas involved and magnitude, the type of association between frequent epileptiform activity (>1% of the time) and cognitive function in children with epilepsy is comparable to the association between short nonconvulsive seizures and cognitive function.  相似文献   

8.
目的探讨儿童病毒性脑炎继发癫痫(PEE)的脑电图(EEG)及影像学特点,进一步探讨其临床高危因素。方法以明确诊断的34例PEE患儿为观察组,选取同时期就诊的同年龄段病毒性脑炎未继发癫痫(no-PEE)患儿102例为对照组。收集患儿病毒性脑炎(VE)急性期临床资料,并进行随访。结果单因素分析得出2组病脑急性期痫性发作≥2次、癫痫持续状态(SE)、昏迷,EEG癫痫样放电、广泛或弥漫性慢波,影像学单纯皮层受损、皮层及皮层下受损、丘脑基底节受损差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,病毒性脑炎急性期痫性发作≥2次、SE、昏迷、EEG癫痫样放电、影像学皮层及皮层下同时受损差异有统计学意义(P<0.05),为PEE危险因素。2组患儿随访期间智力发育落后差异有统计学意义(P<0.001)。结论病毒性脑炎急性期EEG癫痫样放电、影像学皮层及皮层下同时受损、痫性发作≥2次、SE、昏迷为PEE危险因素。PEE患儿远期多有智力发育落后,应密切随访,及时干预治疗。  相似文献   

9.
Summary: Purpose: The characteristics of seizures were analysed in a population-based study of active epilepsy in 6-to 13-year-old mentally retarded children. Methods: The search procedure included diagnostic registers, EEG registers, and registers of the Education of the Subnormal. Medical files were scrutinized, and clinical examinations and interviews with parents or caretakers or both were performed. Results: The median age of seizure onset was 1·3 years, 3·1 for children with mild retardation and 0·8 for children with severe retardation. Among the 98 children identified, current seizure groups were partial in 20, generalized in 59, and mixed in 19. The prevailing seizure types were tonic-clonic, myoclonic, atypical absences, and partial complex seizures, present in 42, 33, 23, and 23 children, respectively. A total of 46 children had more than one seizure type. Seizures every day/week occurred in 44 children. There was a constancy between seizure type at onset and later seizure type. Neonatal seizures (n = 25), infantile spasms (n = 12), and status epilepticus (n = 37) occurred independent of one another. Prognostic factors for poor neurologic outcome were early onset of epilepsy, infantile spasms as onset type, and prior neonatal seizures. Children with only partial seizures less frequently had severe mental retardation, cerebral palsy, and visual impairment than those with only generalized seizures. Conclusions: Epilepsies in children with mental retardation are characterized by severe seizure manifestations. The brain damage giving rise to mental retardation and epilepsy is probably the main factor in terms of seizure outcome.  相似文献   

10.
Clusters of seizures, prolonged seizures, and status epilepticus occur more frequently in children with multiple disabilities, and chronic seizures are more likely to be refractory to treatment. In many patients, the seizures appear to contribute to the mental retardation. Thus, if the lives of these children are to improve, seizure control is essential. However, medical treatment can interfere with cognition and cause behavioral disturbances, making life very difficult for the child and the child's family. With the introduction of 10 new antiepileptic drugs in the last decade, the treatment of epilepsy in multiply handicapped children has significantly advanced. These new antiepileptic drugs may improve seizure control, medication tolerance, or both. Although the ultimate therapeutic goal is to keep children seizure free and alert, compromises regarding medication choice and dosage are still necessary in many cases. Novel treatment options, such as the vagus nerve stimulator, may decrease seizure frequency without behavioral or cognitive side effects. In carefully selected children with specific epilepsy syndromes, epilepsy surgery can provide partial or complete relief from seizures.  相似文献   

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