Social communication in children with epilepsy

BACKGROUND: This study examined measures of social communication that involve the use of language in formulating and organizing thoughts and its relationship with seizure-related, developmental, cognitive, and behavioral variables in 92 children with complex partial seizure disorder (CPS), 51 with primary generalized epilepsy (PGE), and 117 normal children, aged 5.1-16.9 years. METHODS: Coding the children's speech samples with the Kiddie Formal Thought Disorder Rating Scale (Caplan et al., 1989) and Halliday and Hasan's (1976) analysis of cohesion demonstrated social communication deficits in both seizure disorder groups. RESULTS: The CPS patients had both formal thought disorder and cohesion deficits and the PGE group had mild cohesion deficits. IQ, as well as fronto-temporal and bilateral spike and wave activity were associated with the severity of the social communication deficits of the CPS group. The social communication deficits of the PGE group, however, were related to IQ and seizure control. CONCLUSIONS: Recurrent CPS and PGE and fronto-temporal localization of epileptic activity might impair the development of children's communication skills.     

Blink Rate in Pediatric Complex Partial Seizure Disorder

This study examined spontaneous blink rate, a putative measure of dopamine function, in 30 children with complex partial epilepsy and 61 normal children. The children with epilepsy had significantly lower blink rates than the normal children in a conversation and a verbal recall task, particularly if they had a schizophrenia-like psychosis, EEG evidence for left focal epileptic activity, illogical thinking, discourse deficits, and distractibility. They modulated their blink rates across a listening, a conversation, and a verbal recall task like the normal children. Given previously reported low blink rates in schizophrenic children, these findings suggest that children with complex partial epilepsy or schizophrenia might have similar biological features.     

Factors influencing the academic performance of school children with epilepsy

The academic performance and intelligence quotient (IQ) of 50 children with epilepsy aged between 5 and 14 years, attending normal primary schools in Enugu, were compared with those of their non-epileptic classmates. The academic performance was assessed using the overall scores achieved in terminal examinations in the 2001-2002 academic year. IQ was assessed using the Draw-A-person Test. The influences of school absence rate, Rutter behavioural scores, socio-economic status and seizure-related variables on academic performance were then determined. Twenty-six percent of the children with epilepsy had a low overall score, and therefore poor academic performance, compared with 16% of the controls (p = 0.35). The mean IQ of the children with epilepsy was significantly lower than that of the controls (p = 0.02). The mean school absence rate for the children with epilepsy was significantly higher than that of the controls (p = 0.001). The mean Rutter score of the children with epilepsy was significantly higher than that for the controls (p < 0.001). On multiple linear regression analysis, only IQ (p = 0.01) and seizure type (p = 0.03) had significant predictive effects as risk factors for low overall scores and poor academic performance. It is concluded that the academic performance of epileptic children is influenced by their IQ and type of seizures rather than by other seizure variables or socio-demographic characteristics.     

Children with Schizophrenia-spectrum Disorders: Thought Disorder and Communication Problems in a Family Interactional Context

Thought disorder and communication patterns during an interactional task were examined in families of children with schizophrenia-spectrum disorders (schizophrenia and schizotypal personality disorder), depressed Children, and normal controls. Children with schizophreniaspectrum disorders showed significantly mere thought disorder than their normal peers: levels of though) disorder among depressed children Tell between those observed in the other two groups but did not differ significantly from either of them. Similarly, mothers of Children with schizophrenia-spectrum disorders showed more thought disorder than mothers of normal control children but did not differ from mothers of depressed children. Children with schizotypal personality disorder did not differ from children with schizophrenia. These findings demonstrate that the thought disorder present in childhood-onset schizophrenia and schizotypal personality disorders is manifest in an important social context, the family.     

Formal Thought Disorder in Childhood Onset Schizophrenia and Schizotypal Personality Disorder

The Kiddie Formal Thought Disorder Rating Scale (K-FTDS) was examined in a sample of 29 schizophrenic, 10 schizotypal, and 54 normal children, aged 5-12.5 yrs. The schizophrenic and schizotypal children had significantly more illogical thinking and loose associations than the normal children. There were no significant differences between the illogical thinking and loose associations ratings of the schizophrenic and schizotypal children. Young schizophrenic, schizotypal, and normal children had more illogical thinking and loose associations than older children in their respective groups. The diagnostic, developmental, and cognitive implications of the study's results are discussed.     

Psychiatric evaluation of children with CSWS (continuous spikes and waves during slow sleep) and BRE (benign childhood epilepsy with centrotemporal spikes/rolandic epilepsy) compared to children with absence epilepsy and healthy controls

This investigation examined psychopathology and IQ levels in 30 children with CSWS and 42 children with BRE and compared them with 40 healthy controls and 23 children with absence epilepsy by using the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS) and Wechsler Intelligence Test for Children (WISC-R). The CSWS and BRE groups had the highest rate of psychiatric diagnoses and lowest IQ scores. The BRE group had higher rates of psychopathology and lower IQ scores compared to the healthy controls. While BRE and absence groups did not differ with regard to presence of psychopathology, IQ levels and types of psychopathologies, children with CSWS had more psychiatric disorders and lower IQ scores compared to the patient group with absence epilepsy. These findings suggest that CSWS and BRE are two epileptic syndromes that lead to psychiatric disorders and lower IQ scores. Hence, psychiatric consultation should be a part of the treatment while managing these children.     

Prolactin and seizure activity.

Prolactin secretion after tonic-clonic seizures (10 patients), complex partial seizures (five) and non-epileptic attacks (three) was studied in a group of children aged between 0.3 and 14 years. Seven patients with other subcategories of seizure disorders were also studied. Eight children with tonic-clonic seizures exhibited post ictal concentrations of prolactin greater than 500 mU/l. One of the children, who responded on one occasion, did not do so on another. Three children with complex partial seizures had post ictal prolactin concentrations greater than 500 mU/l, while in two the increased values were more modest (390 mU/l and 420 mU/l). The timing of the peak post ictal prolactin concentration varied from less than 20 minutes to a prolonged plateau for three hours. Other seizure types--simple partial with motor signs (2), absence seizure (1), myoclonic seizure (1), minor epileptic status (3) (with one exception), and non-epileptic attacks (3) were not associated with post ictal concentrations greater than 500 mU/l.     

Prognostic value of hyperkinetic syndrome in children with epilepsy

In a retrospective study the data of 43 children suffering from epilepsy were analysed. The first epileptic seizure was observed in all patients before the age of 6 years. The relationship between behavioral disturbances with hyperactivity, developmental respectively intellectual test scores, and efficiency of antileptic drug therapy have been investigated. Psychological testings were performed two times, at first after the start of drug therapy, and a second time after a period of 1 year 11 months in average. There were behavioral disturbances with hyperactivity in 20 patients. The epileptic seizures were intractable in 26 patients. The developmental respectively intellectual test scores have decreased to values below 85 in 7 patients with and 3 patients without hyperactivity. There was a decline by more than 10 points of the IQ score between first and second psychological testings in 16 patients with and 4 patients without hyperactivity, respectively in 17 patients with intractable seizures, but in one child only with prompt cessation of epileptic seizures. An increasing retardation of mental development was seen in children with hyperactivity at the start of seizures, in children with intractable seizures, but especially in patients with a combination of intractable seizures and hyperactivity.     

Laypeople's attitudes toward drug treatment for behavioral control depend on which disorder and which drug

One hundred four laypeople were asked to rate two vignettes describing the use of psychotropic medication to treat behavior problems in school-aged boys. These problems were described as a result of either an attention deficit disorder (ADD) with hyperactivity or a seizure disorder. Respondents considered the parents of the ADD child less justified in placing and continuing their child on medication than the parents of the epileptic child. They also thought that drug use would exacerbate the behavior problem more for the ADD child than for the epileptic child. It is suggested that by being aware of and acknowledging the existence of these attitudes, clinicians can better deal with concerns that parents may have regarding drug treatment for their children, possibly increasing the chances for a successful outcome.     

视频脑电图监测对儿童癫癎分类诊断的价值

目的探讨发作期视频脑电图监测(VEEG)对癫分类诊断的价值。方法对诊断或临床拟诊癫的73例患儿采用VEEG监测。VEEG监测前由神经专科医师根据患儿的年龄、发作频率、临床表现等资料确定发作类型;VEEG监测后,对同步的视频和脑电信号根据需要随意转换为多种导联方式回放分析,由神经与脑电图专业医师根据患儿的年龄、发作的频率、描记到的发作表现、同步的脑电及间歇期的脑电图表现等资料共同确定发作类型,并将监测前后的分类结果进行对比。结果监测前根据临床表现,确定全面性发作80.8%(59/73),局限性发作19.2%(14/73)。监测后根据描记到的发作表现、同步的脑电及间歇期的脑电,确定全面性发作57.5%(42/73),局限性发作42.5%(31/73)。监测前后类型一致39例,不一致34例。结论发作期的临床表现及VEEG为癫分类诊断提供重要的依据。     

癫痫儿童生活质量的研究

目的研究癫痫儿童的生活质量。方法应用美国癫痫生活质量量表，对１９２例癫痫儿童进行生活质量的评估，探讨影响因素并与正常儿童进行比较。结果癫痫儿童的生活质量明显低于正常儿童，主要表现在对发作的恐惧、长期用药的担忧、认知功能的障碍及社会交往的困难。即使发作已被控制，其生活质量并无明显改善。生活质量高低因发作类型不同而各异。结论对癫痫儿童应加强综合治疗，特别要进行心理干预，才能提高其生活质量。     

Pediatric temporal lobectomy for epilepsy

BACKGROUND: Temporal lobectomy in adults is an accepted form of treatment for patients with intractable complex partial seizures. There have been few long-term studies of children undergoing temporal lobectomy for epilepsy. METHODS: We reviewed the pediatric cases of temporal lobectomy for intractable epilepsy performed by the Comprehensive Epilepsy Program at the University of Alberta Hospitals between 1988 and 2000. All patients had preoperative and postoperative clinical evaluations, seizure charts, drug levels, EEG, CT/MRI, long-term video EEG monitoring and neuropsychological testing. The patients were reassessed at 6 weeks, 6 months and 1 year postoperatively, then yearly. The duration of follow up was 1-10 years (mean 5 years). RESULTS: Forty-two patients were studied (25 males and 17 females). Age at surgery ranged from 18 months to 16 years. The interictal EEG was abnormal in 38 of the 42 patients. Twenty-two patients had focal epileptic discharge and 1 had generalized epileptic discharge. Focal slowing was seen in 9 patients and diffuse slowing in 5 patients. CT scan was abnormal in 17 of 39 patients and normal in 22 of 39. MRI was abnormal in 34 of 42 patients and normal in 8 of 42. Pathology included brain tumors in 14 patients, mesial temporal sclerosis in 8, focal cortical dysplasia in 4, tuberous sclerosis in 4, dual pathology in 4, porencephalic cyst in 1 and normal pathology or gliosis in 6. Thirty-three of 42 patients (78%) were seizure-free following surgery and an additional 5 (12%) had a decrease in seizure frequency. Three patients had complications, but there were no deaths. CONCLUSION: Temporal lobectomy is a safe and effective treatment for children with intractable complex partial seizures. Seventy-eight percent of patients are seizure-free following the surgery and there are few complications. MRI is superior to CT scan for detection of temporal lobe pathology yet failed to detect abnormalities in some patients. The most common pathologies found were brain tumors, mesial temporal sclerosis and developmental lesions. In addition to seizure control, many patients experienced improvement in cognitive and psychosocial function following surgery.     

Cognitive outcome in children and adolescents treated for acute lymphoblastic leukaemia with chemotherapy only

Objective: To examine cognitive outcome in children and adolescents with acute lymphoblastic leukaemia (ALL) in remission, treated with central nervous system prophylactic chemotherapy only.
Method: Thirty-five children and adolescents, age 8.4–15.3 years in long-term remission from ALL, 4.2–12.4 years post diagnosis, without relapse and no prediagnosis history of neurodevelopmental disorder were compared with 35 healthy controls matched for gender and age, on measures of intellectual functioning Wechsler Intelligence Scale for Children-Third Edition (WISC-III).
Results: All but two of the ALL survivors treated by chemotherapy only obtained WISC-III Total Intelligence Quotient (IQ) scores in the normal range (M = 95.3), but their scores were significantly below levels for their matched controls and below normative standards for WISC-III. The difference between patients and controls was significant at the p < 0.001 level for the following measures: Total IQ, Verbal IQ, Verbal Comprehension Index, Freedom from Distraction Index and three verbal subtest scores.
Conclusion: The results indicate long-term sequelae in global cognitive functions, and indicate that verbal function, processing speed, attention and complex visual-spatial problem solving may be affected in the chemotherapy only group.     

伴高热惊厥史的儿童癫痌病例分析

分析伴高热惊厥史的癫痌患儿的临床特点,探讨高热惊厥脑损伤及其与颞叶癫痌的关系。 方法对1996～1999年本院儿科神经病房480例住院癫痌患儿进行回顾性分析,包括首发年龄、家族史、持续时 间、癫痌发作类型、神经影像学及脑电图改变等。结果115例(23.9％)患儿有前期高热惊厥史。伴高热惊厥史 的患儿癫痌发作早且易于出现癫痌持续状态。与无高热惊厥史的患儿相比,伴高热惊厥史的患儿强直-阵挛发作 较多,复杂部分性发作较少。408例患儿曾行影像学检查,4例提示有海马硬化者均无高热惊厥史。在伴高热惊厥史 的癫痌患儿中脑电图局灶起源的异常放电显著低于无高热惊厥史的癫痌患儿。有6.08％(7/115)伴高热惊厥史的癫 痌惠儿和6.84％(25/365)无高热惊厥史的癫痌患儿脑电图表现为单纯颞叶异常放电,二组相比无明显差异。结论 在癫痌患儿中,高热惊厥可能伴有脑损伤,且可能与后期的癫痌发生有关,伴高热惊厥史者不一定发展为颞叶癫痌。     

Improvement of Modem Treatment and Outcome in Childhood Epilepsy in Asia

Epilepsy and epileptic syndromes are one of the major pediatric neurological diseases in Taiwan, R.O.C. In 1984 we investigated 38 elementary schools in Taichung city, in the middle-west part of Taiwan. Among 57,944 school-aged children, 388 had suffered from at least two episodes of afebrile seizures occurring separately over a two-week period. The period prevalence rate was 0.67%. In our clinic, once seizures are diagnosed, the seizure types are then classified as well as possible, in order to develop a rational approach to treatment. We commonly use carbamazepine for partial seizures and some generalized seizures, low dose ACTH (10 I.U.) for infantile spasms, valproic acid for absence seizures and myoclonic seizures, clonazepam for atonic-akinetic and myoclonic seizures, and phenobar-bital for young children with generalized seizures. In the last three years, we have used a ketogenic diet for akinetic-atonic seizures and Lennox-Gastaut syndrome; we have also used temporal lokctomy for complex partial seizures since 1981. Owing to the marked increase in the medical understanding of epileptic seizures and syndromes, and models of treatment, there is no question that children with seizure disorders are better off today than they were ten years ago.     

PATTERNS OF INTELLECTUAL FUNCTIONING IN NON-RETARDED AUTISTIC AND SCHIZOPHRENIC CHILDREN

The WISC-R factor scores of non-retarded children meeting DSM III criteria for autism and schizophrenia were compared. The scores of the schizophrenic children on factor 3 were significantly lower than those of the autistic children, below the range of normal children, and significantly lower than the scores they obtained on the verbal comprehension and perceptual organization factors. The autistic children scored in the superior range on the block design subtest and did not show gross impairments in language function as indexed by scores on the verbal comprehension factor. The only subtest autistic children were impaired on was the comprehension subtest.     

Neonatal hyperviscosity association with lower achievement and IQ scores at school age

A longitudinal study was conducted to determine whether the early neurologic and motor impairment observed in children with neonatal polycythemia and hyperviscosity persisted into school age. Forty-nine children who had neonatal polycythemia and hyperviscosity were evaluated at a mean age of 7 years. Of these, 21 (group 1) received a partial plasma exchange transfusion, whereas 28 (group 2) received symptomatic care. Forty control children (group 3) with a normal neonatal hematocrit were also evaluated. Testing consisted of a battery of measures to evaluate IQ, achievement, neuromotor function, and gross and fine motor skills. Maternal education and IQ were also assessed to avoid potential confounding by differences in the home environment. The neonatal course of the children with polycythemia and hyperviscosity was characterized by an increased number of problems, including hypoglycemia and cyanosis. At 7 years of age, the 49 children who had hyperviscosity (groups 1 and 2) had significantly lower "spelling" and arithmetic achievement test results and gross motor skill scores. Scores for reading, visual motor integration, and neurologic signs did not differ significantly from group 3. Maternal IQ scores were similar for both groups. Left-hand preference was seen in 14% of group 1 and 2 children and 7% of group 3 children (not significant). The scores for IQ, achievement, neuromotor function, and visual motor integration were compared for the hyperviscosity group (groups 1 and 2) and the control group (group 3) by multivariate analysis of variance with sex and hyperviscous group as independent variables and maternal education and maternal IQ as covariates (P = .040).(ABSTRACT TRUNCATED AT 250 WORDS)     

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目的探讨晚发型癫痫性痉挛患儿的临床和脑电图(EEG)特征、治疗反应及预后。方法对北京大学第一医院儿科2000年6月至2007年8月59例晚发型癫痫性痉挛患儿的临床和EEG资料进行回顾性研究,其中37例有随访,随访时间13～90个月,末次随访年龄为2岁6个月至12岁2个月(中位数60个月)。结果59例患儿癫痫起病年龄为12～98个月,中位年龄22个月。以痉挛发作起病36例(61.0%),以其他发作类型起病23例(39.0%)。17例(28.8%)在病程中有部分性发作,22例(37.3%)合并其他全面性发作形式,20例(33.9%)病程中仅有痉挛发作。EEG14例(23.7%)为典型高度失律;2例(3.4%)为一侧性高度失律;43例(72.9%)无典型的高度失律。总计22例(37.3%)表现为局灶性或一侧性临床、影像学和(或)EEG异常。44例(74.6%)为症状性癫痫,围生期脑损伤、中枢神经系统感染、脑结构异常为主要病因。14例(23.7%)符合晚发型West综合征,7例(11.9%)符合Lennox-Gastaut综合征。促肾上腺皮质激素(ACTH)治疗后近期无发作率32.0%,有效率58.0%,复发率为61...     

Complex partial seizure mimicking psychotic reaction in an adolescent

A previously healthy 15-year-old boy initially diagnosed to have acute psychotic reaction had a history of a single generalized seizure and prolonged amnestic states of varying intensity and duration. An ictal electroencephalogram (EEG) showed bitemporal ictal discharges starting from the left side. Carbamazepine was started. A magnetic resonance imaging (MRI) obtained on the 10th day of the antiepileptic therapy showed increased signal intensity on the T2 weighted images. The patient's memory function markedly improved during 10 months' follow-up with antiepileptic treatment, although he described brief attacks of dizziness. A repeat MRI examination showed normal findings. The amnesticstates were thought to be due to frequent complex partial seizures, and transient MRI changes to hippocampal edema. This case illustrates the importance of epileptic disorders in the differential diagnosis of psychiatric conditions.