Behaviour Problems in Children with Epilepsy

1. Behaviour Problems in Children with Epilepsy Ann Brown Children’s Neurology Specialist Nurse

2. INTRODUCTION • Isle of Wight Study, Rutter et al. 1970 • Austin, 1989, Hoare, 1984a, Mc Dermott et al. 1995 • Hoare, 1984a

3. Definition of Epilepsy

4. HISTORICAL BACKGROUND • 1494 – witch hunting • 18th century – Cullen • 19th century – asylums for psychiatric and epileptic patients • 19th century – Reynolds • 20th century – divergent views • Eugenic Laws – 1895 • 1951 - Gibbs

5. COMPLEX PARTIAL SEIZURES • Vulnerable to emotional activation of seizure activity – reducing emotional distress may decrease the occurrence of the seizures. • Attempts to restrain a child during or after a TC seizure or complex partial seizure may result in defensive or aggressive behaviour. • Poor memory and memory loss are frequent complaints of the child with complex partial seizures. • A psychosis resembling paranoid schizophrenia has been noted in some children.

6. ICTALLY RELATED BEHAVIOUR • Irritability or changes in the mood are common in the prodrome period (the period leading up to the seizure) which invariably remits once the seizure has occurred. • The aura may affect behaviour if the subjective experience is of an unpleasant emotional sensation such as extreme fear or anxiety. • Automatisms are movements or actions occurring in the ictal or post ictal phase of which the individual is unaware and over which they have no voluntary control.

7. ICTALLY RELATED BEHAVIOUR • Focal discharges may be manifest as odd and apparently bizarre behaviours which are not under their control. • Frequent subtle seizures may not be accompanied by any obvious clinical activity but will inevitably interrupt an individuals consciousness and impair their ability to make sense of what is going on around them. • In the post-ictal phase a child may remain in a confused state for some considerable time, as a result of which their powers of reasoning and understanding may be much reduced.