Epilepsy
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Tina is an eleven-year-old fifth grader with an entirely normal developmental, medical and psychological history who had a generalized seizure while at a sleepover at a friend's house. There was a loss of consciousness from the start with stiffening and extension of her arms and legs lastly about one minute. During this event she lost control of her bladder. When the seizure stopped she gradually became alert but was disoriented, confused and very tired. The on call pediatric neurologist at the local hospital was contacted. After discussion it was determined that Tina was not in any immediate danger and that she could be seen in the neurologist's office the next day. The evaluation the next day included a careful and detailed history, a neurological examination and an EEG. Because of the neurologist's findings of right side motor incoordination and word finding difficulties an MRI was also obtained. The EEG showed abnormal electrical activity in the left temporal lobe of the brain. The MRI did not show any abnormalities. The neurologist diagnosed Tina has having a complex partial seizure disorder with secondary generalization (i.e. the seizure was thought to start out in the left temporal lobe but spread to the entire brain). It was decided to place her on a sustained release anti-seizure medication
Because Tina had a pre-existing history of difficulty learning to read and spell, a neuropsychological evaluation was requested. The evaluation was conducted four weeks after the start of her anti-epileptic medication (AED). The evaluation revealed mild abnormalities in verbal learning and object naming with reading, math and spelling abilities two grades below her current placement. Fine motor dexterity was abnormal with both right and left hands; motor speed was reduced with her dominant right hand. Her arousal, focus and sustained attentional abilities, sensory perceptual functions, verbal and non-verbal intelligence, spatial and non-verbal problem solving abilities were viewed as normal (i.e. in the average range). Because successful school performance depends on verbal learning, reading, etc., it was recommended that she be have an Individualized Educational Plan (IEP) and provide special education services. The latter included individualized services in remediating her reading and spelling problems. Because of her language and motor abnormalities, it was decided to monitor her written production (e.g. notetaking, written homework, essay exams) and intervene if necessary. Voice recognition computer software was considered a possible option. Initially Tina was reluctant to return to school as she was fearful that she would have another seizure and loose control of her bladder. She was also unhappy that she would have to go to the Nurses office each day to take her noon dose of medication. The diagnosis of epilepsy also had an impact on Tina's parents. Out of worry and fear that Tina would have another seizure, they placed more restrictions on her social and recreational activities than was recommended by the neurologist. As a consequence Tina began to lose contact with her peer group and outside school activities. Because of these issues, the neurologist referred Tina and her parents to a psychologist who had experience with the psychosocial aspects of epilepsy.