Diagnosis and management of pediatric epilepsy are challenging for a variety of reasons; however, one of the most common yet difficult situations involves treatment of the patient with pediatric epilepsy with coexistent cognitive impairment or psychiatric disturbance. The etiologies and presentations of these comorbidities are myriad, making diagnosis problematic ; furthermore, interactions between epilepsy and its treatments and the neuropsychiatric problem and its treatments add another layer of complexity to the management of these patients. Antiepileptic drugs are often blamed for cognitive or behavioral problems in children treated for epilepsy, but the actual contribution to such problems in a particular child can be difficult to ascertain. (J Child Neurol 2004;19(Suppl 1):S1-S5).
Get full access to this article
View all access options for this article.
References
1.
Shinnar S., Pellock JM: Update on the epidemiology and prognosis of pediatric epilepsy. J Child Neurol2002;17(Suppl 1):S4-S17.
2.
Hauser WA, Annegers JF, Kurland LT: Incidence of epilepsy and unprovoked seizures in Rochester, Minnesota: 1935-1984 . Epilepsia1993;34:453-468.
3.
Hauser WA: Incidence and prevalence, in Engel J Jr, Pedley TA (eds): Epilepsy: A Comprehensive Textbook. Philadelphia, Lippincott-Raven Publishers, 1997, 47-57.
4.
Goulden KJ, Shinnar S., Koller H., et al: Epilepsy in children with mental retardation: A cohort study . Epilepsia1991;32:690-697.
5.
Kudrjavcev T. , Schoenberg BS, Kurland LT, Groover RV: Cerebral palsy: Survival rates, associated handicaps, and distribution by clinical subtype (Rochester, MN, 1950-1976) . Neurology1985 ;35: 900-903.
6.
Wong V.: Epilepsy in children with autistic spectrum disorder. J Child Neurol1993;8:316-322.
7.
Olsson I., Steffenburg S., Gillberg C.: Epilepsy in autism and autisticlike conditions. A population-based study. Arch Neurol1988;45:666-668.
8.
Volkmar FR, Nelson DS: Seizure disorders in autism. JAm Acad ChildAdolesc Psychiatry1990;29:127-129.
9.
Dodson WE: Epilepsy, cerebral palsy, and IQ, in Pellock JM, Dodson WE, Bourgeois BFD (eds): Pediatric Epilepsy: Diagnosis and Therapy, 2nd ed. New York , Demos Publishing, Inc, 2001, 613-627.
10.
Steffenburg U., Hagberg G., Viggedal G., Kyllerman M.: Active epilepsy in mentally retarded children. I. Prevalence and additional neuroimpairments . Acta Paediatr1995;84:1147-1152.
11.
Rutter M., Graham P., Yule W.: The prevalence of psychiatric disorder in neuro-epileptic children , in: A neuropsychiatric study in childhood. Philadelphia , JB Lippincott Co, 1970, 175-185. Clinics in Developmental Medicine, vol 35/36.
12.
Ott D., Siddarth P., Gurbani S., et al: Behavioral disorders in pediatric epilepsy: Umnet psychiatric need. Epilepsia2003;44:591-597.
13.
Caplan R., Arbelle S., Magharious W., et al: Psychopathology in pediatric complex partial and primary generalized epilepsy. Dev Med Child Neurol1998;40:805-811.
14.
Ott D., Caplan R., Guthrie D., et al: Measures of psychopathology in children with complex partial seizures and primary generalized epilepsy with absence. J Am Acad Child Adolesc Psychiatry2001;40:907-914.
15.
Ettinger AB, Weisbrot DM, Nolan EE, et al: Symptoms of depression and anxiety in pediatric epilepsy patients . Epilepsia1998;39:595-599.
16.
Oguz A., Kurul S., Dirik E.: Relationship of epilepsy-related factors to anxiety and depression scores in epileptic children. J Child Neurol2002 ;17:37-40.
17.
Williams J. , Griebel ML, Dykman RA: Neuropsychological patterns in pediatric epilepsy. Seizure1998 ;7:223-228.
18.
Hempel AM, Frost MD, Ritter FJ, Farnham S.: Factors influencing the incidence of ADHD in pediatric epilepsy patients, abstract. Epilepsia1995;36(Suppl 4):122.
19.
Semrud-Clikeman M., Wical B.: Components of attention in children with complex partial seizures with and without ADHD. Epilepsia1999;40:211-215.
20.
Hemmer SA, Pasternak JF, Zecker SG, Trommer BL: Stimulant therapy and seizure risk in children with ADHD. Pediatr Neurol2001;24:99-102.
21.
Gross-Tsur V., Manor O., van der Meere J., et al: Epilepsy and attention deficit hyperactivity disorder: Is methylphenidate safe and effective?J Pediatr1997;130:670-674.
22.
Caplan R., Arbelle S., Guthrie D., et al: Formal thought disorder and psychopathology in pediatric primary generalized and complex partial epilepsy. J Am Acad Child Adolesc Psychiatry1997;36: 1286-1294.
23.
Weissman MM , Wolk S., Goldstein RB, et al: Depressed adolescents grown up. JAMA1999;281:1707-1713.
24.
Angold A., Costello EJ, Messer SC, et al: Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents. Int J Methods Psychiatr Res1995;5: 237-249.
25.
Kovacs M.: The Children's Depression Inventory (CDI). Psychopharmacol Bull1985;21:995-998.
26.
Reynolds CR , Richmond BO: What I think and feel: A revised measure of children's manifest anxiety. J Abnorm Child Psychol1978;6:271-280.
27.
Conners CK: The computerized Continuous Performance Test. Psychopharmacol Bull1985;21:891-892.
28.
Achenbach TM , Edelbrock C.: Manual for the Child Behavior Checklist and Revised Child Behavior Profile . Burlington, VT, Queen City Printers , 1983.
29.
Aldenkamp AP , Vermeulen J.: Cognitive side effects of antiepileptic drugs, in Pellock JM, Dodson WE, Bourgeois BFD (eds): Pediatric Epilepsy: Diagnosis and Therapy, 2nd ed. New York , Demos Publishing, Inc, 2001, 629-635.
Bourgeois BDF : Determining the effects of antiepileptic drugs on cognitive function in pediatric patients with epilepsy. J Child Neurol2004;19(Suppl 1):S15-S24.
32.
Dunn DW, Austin JK: Behavioral issues in pediatric epilepsy. Neurology1999;53(5 Suppl 23):S96-S100.
33.
Kanner AM, Balabanov A.: Depression and epilepsy: How closely related are they?Neurology2002;58(8 Suppl 5):S27-S39.
34.
Brent DA, Crumrine PK, Varma RR, et al: Phenobarbital treatment and major depressive disorder in children with epilepsy. Pediatrics1987;80:909-917.
35.
Glauser TA: Behavioral and psychiatric adverse events associated with antiepileptic drugs commonly used in pediatric patients. J Child Neurol2004; 19(Suppl 1):S25-S38.
36.
Weckerly J. : Pediatric bipolar mood disorder. J Dev Behav Pediatr2002;23:42-56.
37.
Kim EY, Miklowitz DJ: Childhood mania, attention deficit hyperactivity disorder and conduct disorder: A critical review of diagnostic dilemmas. Bipolar Disord2002;4:215-225.
38.
Ryan ND, Puig-Antich J., Ambrosini P., et al: The clinical picture of major depression in children and adolescents . Arch Gen Psychiatry1987;44:854-861.
39.
Trevathan E. : Seizures and epilepsy among children with language regression and autistic spectrum disorders. J Child Neurol2004;19(Suppl 1):S49-S57.
40.
Shields WD: Management of epilepsy in mentally retarded children using the newer antiepileptic drugs, vagus nerve stimulation, and surgery. J Child Neurol2004;19(Suppl 1):S58-S64.
41.
Rajna P., Veres J.: Correlations between night sleep duration and seizure frequency in temporal lobe epilepsy. Epilepsia1993; 34:574-579.
42.
Cortesi F., Giannotti F., Ottaviano S.: Sleep problems and daytime behavior in childhood idiopathic epilepsy . Epilepsia1999;40: 1557-1565.
43.
Vaughn BV, D'Cruz OF, Beach R., Messenheimer JA: Improvement of epileptic seizure control with treatment of obstructive sleep apnoea. Seizure1996;5:73-78.
44.
Hudson JI, Lipinski JF, Keck PE Jr, et al: Polysomnographic characteristics of young manic patients. Comparison with unipolar depressed patients and normal control subjects. Arch Gen Psychiatry1992;49:378-383.
45.
Ohayon MM, Caulet M., Lemoine P.: Comorbidity of mental and insomnia disorders in the general population . Compr Psychiatry1998;39:185-197.
46.
Owens JA, Maxim R., Nobile C., et al: Parental and self-report of sleep in children with attention-deficit/hyperactivity disorder. Arch Pediatr Adolesc Med2000;154:549-555.
47.
Amir N., Gross-Tsur V.: Paradoxical normalization in childhood epilepsy. Epilepsia1994;35:1060-1064.
48.
Ebert U.: Basic mechanisms of psychotropic drugs. Epilepsia2002;43(Suppl 2):2-7.
49.
Pisani F., Oteri G., Costa C., et al: Effects of psychotropic drugs on seizure threshold. Drug Saf2002;25:91-110.
50.
Efron D., Jarman F., Barker M.: Side effects of methylphenidate and dexamphetamine in children with attention deficit hyperactivity disorder: A double-blind, crossover trial . Pediatrics1997;100: 662-666.
51.
Fischer JH: Drug interactions with antiepileptic drugs. 2001. Available at: http://www.cnsnewsse.com/indexpub.cfm?pubid=13 . Accessed September 10, 2003.
52.
Shorvon S.: Antiepileptic drugs, in Shorvon S: Handbook of Epilepsy Treatment. Oxford, UK, Blackwell Science Ltd, 2000 , 85-172.
53.
Kanner AM, Dunn DW: Diagnosis and management of depression and psychosis in children and adolescents with epilepsy. J Child Neurol2004;19(Suppl 1):S65-S72.
54.
Wheless JW, Ng Y.: Levetiracetam in refractory pediatric epilepsy. J Child Neurol2002;17:413-415.
55.
Sankar R., Holmes GL: Mechanisms of action for the commonly used antiepileptic drugs: relevance to antiepileptic drug-associated neurobehavioral adverse events. J Child Neurol2004;19(Suppl 1):S6-S14.
56.
Lamictal, package insert. Research Triangle Park, NC, Glaxo-SmithKline. 2003 .
57.
Depakote, package insert. North Chicago. IL, Abbott Laboratories, 2002.
58.
Wheless JW, Bourgeois BFD: Choosing antiepileptic drugs for developmentally normal children with specific epilepsy syndromes and behavioral disorders. J Child Neurol2004;19(Suppl 1):S39-S48.
