Epilepsy Thomas B. King, M. Ed. Hospital Education Program VCU Health Care System
Incidence
Incident Facts <ul><li>Epilepsy is the most common CNS disorder affecting children </li></ul><ul><li>Between 5% and 10% of...
Educational Implications <ul><li>Most children with epilepsy test within the average range on IQ tests and will remain wit...
Hidden Epilepsy <ul><li>BECTS “spectrum” (Rolandic epilepsy) </li></ul><ul><li>About 8% of children with Rolandic Discharg...
Problems faced at school <ul><li>Learning Disabilities are common, but frequently overlooked co-morbid condition (Pellock,...
Classification System of Seizures <ul><li>Two “big” families </li></ul><ul><li>Generalized seizures </li></ul><ul><li>Part...
Some Research Considerations <ul><li>Children with BECTS may have abnormal processing of auditory information at a sensory...
More research considerations <ul><li>Children studied had normal IQ’s but “showed inferior performance in the SPT more fre...
Temporal Focus <ul><li>A study of 96 TLE patients found that: </li></ul><ul><li>47% were minimally impaired on a battery o...
Additional Temporal Lobe Epilepsy Findings <ul><li>Children appear to be more affected than adult onset patients </li></ul...
Classification system <ul><li>Generalized seizures </li></ul><ul><ul><li>Typical absence </li></ul></ul><ul><ul><li>Atypic...
Classification system generalized convulsions <ul><li>Tonic clonic </li></ul><ul><li>Clonic </li></ul><ul><li>atonic </li>...
Partial Epilepsy <ul><li>Complex partial </li></ul><ul><li>Simple partial </li></ul><ul><li>These types of seizures are th...
Reflex epilepsy <ul><li>Visual stimuli – such as a flickering light, or pattern or other visual stimuli </li></ul><ul><li>...
Generalized status <ul><li>Generalized tonic-clonic status </li></ul><ul><li>Clonic status </li></ul><ul><li>Absence statu...
…and finally <ul><li>Focal status </li></ul><ul><ul><li>Aura continua </li></ul></ul><ul><ul><li>Limbic status (psychomoto...
Partial Epilepsy <ul><li>Simple Partial Seizures </li></ul><ul><li>Complex Partial Seizures </li></ul>
“parts of a seizure” <ul><li>Aura – may actually be a partial seizure </li></ul><ul><li>Convulsive or non-convulsive event...
Inter-ictal phase <ul><li>Between seizures (could be hours, days, weeks, years) </li></ul><ul><li>No seizure is noted, but...
Diagnostics <ul><li>International classification system </li></ul><ul><li>International 10 – 20 EEG electrode placement </...
 
The Limbic System
 
Types of EEG <ul><li>Routine – lasts about 30 minutes and misses some epilepsy. </li></ul><ul><li>Sleep deprived </li></ul...
Factors that effect school performance <ul><li>Age of onset </li></ul><ul><li>The level of control </li></ul><ul><li>Type ...
More school related factors <ul><li>Focal epilepsy tends to cause focal school difficulties </li></ul><ul><li>Generalized ...
intervention <ul><li>Any child with epilepsy probably should have an evaluation of all affected processing systems </li></...
Intervention strategies Intervention strategies are always based on  COMPREHENSIVE  assessment
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Epilepsy for Educators

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Brief overview of the potential cognitive consequences of epilepsy in school aged populations

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Epilepsy for Educators

  1. 1. Epilepsy Thomas B. King, M. Ed. Hospital Education Program VCU Health Care System
  2. 2. Incidence
  3. 3. Incident Facts <ul><li>Epilepsy is the most common CNS disorder affecting children </li></ul><ul><li>Between 5% and 10% of all children will have a seizure before the age of 20 </li></ul>
  4. 4. Educational Implications <ul><li>Most children with epilepsy test within the average range on IQ tests and will remain within the general educational setting </li></ul><ul><li>The majority of children with epilepsy will attend their neighborhood schools. </li></ul><ul><li>However, children with epilepsy are at increased risk for learning and behavioral challenges. </li></ul>
  5. 5. Hidden Epilepsy <ul><li>BECTS “spectrum” (Rolandic epilepsy) </li></ul><ul><li>About 8% of children with Rolandic Discharges have epilepsy </li></ul><ul><li>Most will have cognitive differences or challenges </li></ul><ul><li>IQ may not be affected </li></ul>
  6. 6. Problems faced at school <ul><li>Learning Disabilities are common, but frequently overlooked co-morbid condition (Pellock, 1999 in print). </li></ul><ul><li>Almost 1/3 of children with epilepsy are also identified to have ADHD (Kanner, 2001) </li></ul><ul><li>Grade retention and special education identification are more common in children with epilepsy (Bailet & Turk, 200) </li></ul><ul><li>There is a higher rate of psychiatric disorders in children with epilepsy (Kanner, 2001). </li></ul>
  7. 7. Classification System of Seizures <ul><li>Two “big” families </li></ul><ul><li>Generalized seizures </li></ul><ul><li>Partial seizures </li></ul>
  8. 8. Some Research Considerations <ul><li>Children with BECTS may have abnormal processing of auditory information at a sensory level (J Neural Transm. 2006) </li></ul><ul><li>Significant delays in reading and numeracy and/or spelling ability found in a group of children with BECTS (Epileptic Disord 2006) </li></ul><ul><li>BECTS has been found to possibly be related to disruptions in language development with long-term consequences (Brain Lang. 2005) </li></ul>
  9. 9. More research considerations <ul><li>Children studied had normal IQ’s but “showed inferior performance in the SPT more frequently than “healthy” controls. </li></ul><ul><li>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). </li></ul>
  10. 10. Temporal Focus <ul><li>A study of 96 TLE patients found that: </li></ul><ul><li>47% were minimally impaired on a battery of comprehensive neuropsychological tests </li></ul><ul><li>24% were memory impaired </li></ul><ul><li>29% were memory, executive, and speed impaired (J Int Neuropsychol Soc. 2007) </li></ul>
  11. 11. Additional Temporal Lobe Epilepsy Findings <ul><li>Children appear to be more affected than adult onset patients </li></ul><ul><li>There is a need to evaluate children with the diagnosis of TLE in the areas of language, memory, socioperceptive competence, and executive functions. </li></ul><ul><li>Early detection, and diagnosis is important for proper intervention (Epilepsia, 2006). </li></ul>
  12. 12. Classification system <ul><li>Generalized seizures </li></ul><ul><ul><li>Typical absence </li></ul></ul><ul><ul><li>Atypical absence </li></ul></ul><ul><ul><li>Myoclonic absence </li></ul></ul><ul><ul><li>Tonic (spasms) </li></ul></ul><ul><ul><li>Myoclonic </li></ul></ul><ul><ul><li>Myoclonic atonic seizures </li></ul></ul><ul><ul><li>Atonic seizures </li></ul></ul>
  13. 13. Classification system generalized convulsions <ul><li>Tonic clonic </li></ul><ul><li>Clonic </li></ul><ul><li>atonic </li></ul>
  14. 14. Partial Epilepsy <ul><li>Complex partial </li></ul><ul><li>Simple partial </li></ul><ul><li>These types of seizures are the most common </li></ul><ul><li>They can “secondarily generalize) </li></ul><ul><li>Place kids at risk for subtle but significant learning challenges </li></ul><ul><li>Are also called “focal epilepsy.” </li></ul>
  15. 15. Reflex epilepsy <ul><li>Visual stimuli – such as a flickering light, or pattern or other visual stimuli </li></ul><ul><li>Thinking about music </li></ul><ul><li>Eating </li></ul><ul><li>Reading </li></ul><ul><li>Startle </li></ul>
  16. 16. Generalized status <ul><li>Generalized tonic-clonic status </li></ul><ul><li>Clonic status </li></ul><ul><li>Absence status </li></ul><ul><li>Tonic status </li></ul><ul><li>International League Against Epilepsy </li></ul>
  17. 17. …and finally <ul><li>Focal status </li></ul><ul><ul><li>Aura continua </li></ul></ul><ul><ul><li>Limbic status (psychomotor status) </li></ul></ul><ul><ul><li>Nocturnal status (such as Landau-Kleffner) </li></ul></ul>
  18. 18. Partial Epilepsy <ul><li>Simple Partial Seizures </li></ul><ul><li>Complex Partial Seizures </li></ul>
  19. 19. “parts of a seizure” <ul><li>Aura – may actually be a partial seizure </li></ul><ul><li>Convulsive or non-convulsive event </li></ul><ul><li>Post ictal stage </li></ul>
  20. 20. Inter-ictal phase <ul><li>Between seizures (could be hours, days, weeks, years) </li></ul><ul><li>No seizure is noted, but abnormal brain activity persists </li></ul><ul><li>Another term might be “sub-clinical seizure” </li></ul><ul><li>Causes Learning Disabilities or processing disorders </li></ul>
  21. 21. Diagnostics <ul><li>International classification system </li></ul><ul><li>International 10 – 20 EEG electrode placement </li></ul>
  22. 23. The Limbic System
  23. 25. Types of EEG <ul><li>Routine – lasts about 30 minutes and misses some epilepsy. </li></ul><ul><li>Sleep deprived </li></ul><ul><li>24 hour EEG </li></ul><ul><li>Epilepsy Monitoring – Requires a hospital stay. </li></ul>
  24. 26. Factors that effect school performance <ul><li>Age of onset </li></ul><ul><li>The level of control </li></ul><ul><li>Type of epilepsy </li></ul><ul><li>Any related medical condition </li></ul>
  25. 27. More school related factors <ul><li>Focal epilepsy tends to cause focal school difficulties </li></ul><ul><li>Generalized epilepsy tends to cause generalized school difficulties </li></ul><ul><li>Most forms of epilepsy will adversely affect processing speed, cognitive efficiency, memory, and academic fluency </li></ul>
  26. 28. intervention <ul><li>Any child with epilepsy probably should have an evaluation of all affected processing systems </li></ul><ul><li>This should be done when the seizures are controlled, if possible </li></ul><ul><li>Academic assessment is usually NOT sensitive to early difficulties – processing assessment is </li></ul>
  27. 29. Intervention strategies Intervention strategies are always based on COMPREHENSIVE assessment
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