Epilepsy
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Evaluation of the Child with Seizures
Neurological
It is uncommon for a physician to witness an actual seizure. Therefore, physicians depend on the observations of parents, educators and others to provide information about what occurred. The diagnosis of epilepsy in a child is commonly based on the neurologist or physician obtaining a detailed history, physical and neurological examination of the child and electroencephalography (EEG). The neurological examination assess gait, coordination, cranial nerves, and motor, sensory and deep tendon reflexes. Blood tests are routinely taken to identify infections, liver abnormalities and/or blood cell disturbances that might be causing seizures. The physician will inquire as to the events before, during and after the seizure to help differentiate what is a seizure and what may be something else (see previous section "Events that may be mistaken for seizure activity" ). Seizures begin and end abruptly and there are characteristic behaviors that occur during the seizure. How the patient behaves after the seizure (coma, agitiated, fatigued, etc) also help characterize the type of seizure. Electroencephalography (EEG) provides the physician information about the spontaneous electrical activity of the brain. EEG allows detection of both diffuse and focal brain abnormalities. The pattern of abnormal activity defines the type of seizure and where the seizure is located. While EEG's are often administered to children who are awake and rested, sometimes there is a need for the child to be sleep deprived for the night before the EEG. This "stresses" the child's physiology and can make abnormal electrical activity more likely to be seen.
Neuroimaging
Neuroimaging allows the brain's sturucture to be visualized. Both CT and MRI are routinely used in the evaluation of a child suspected of having epilepsy. Magnetic resonance imaging (MRI) is useful in providing more anatomic detail of brain structures such as the hippocampus (which often can be atrophied in some types of epilepsy) and lower grade tumors. CT scans are often more helpful when there is concern that the epilepsy is due to a brain hemorrhage or other type of vascular disorder. A newer procedure that is available in larger medical research centers is called functional magnetic resonance imaging (fMRI). fMRI helps identify blood flow changes in different brain regions in response to cognitive tasks (e.g. naming, drawing, problem solving.
Neuropsychological
"Epilepsy and Neuropsychology" by Michael Westerveld, Ph.D. details the role of neuropsychology in the evaluation and treatment of epilepsy's associated problems.
Neuropsychological, psychiatric and psychosocial aspects of epilepsy.
Abnormal neuropsychological functioning and/or psychiatric/psychosocial problems in a child with epilepsy may be due to primary or secondary factors. At first, it should be remembered that seizures are a symptom of some type of known (e.g. traumatic brain injury) or unknown brain dysfunction. Hence, the problems may be due to the underlying brain dysfunction. For example, if a child has a scarring in their temporal lobe from a TBI, it is possible that the child may have problems in emotional control or memory. The second possible reason for the child's problems may be due to psychological problems (e.g. depression or anxiety) and/or the effects of medication. Oftentimes learning problems occur as a result of both primary and secondary factors.
Common neuropsychological problems seen with children with epilepsy include:
- slow information processing
- difficulty learning new information
- reduced reaction time
- problems with alternating or divided attention
- problems with acquiring academic skills
- problems in executive functions
- reduced fine motor skills
- changes in affect, mood & personality
Neuropsychological and/or psychosocial impairment in the child with epilepsy can be due to any number of factors including:
- seizure characteristics
- type (eg generalized vs partial)
- frequency of seizure activity
- duration of the seizure
- age of onset
- the underlying brain dysfunction causing the seizure (e.g. tumor or TBI)
- effects of antieplieptic drugs (AED's)
- social stigma
- psychological adjustment factors (e.g. depression)
- disruption of sleep from seizures leading to fatigue and inattention
- subclinical seizure activity causing transient cognitive impairment (TCI).