Epilepsy and Neuropsychological Outcomes in Children
Seizures versus Epilepsy in Children
A seizure is caused by abnormal electrical activity in the brain, and this can lead to changes in attention, cognition, behavior, sensory, and motor functioning. A child may or may not lose consciousness during a seizure. A seizure can be triggered by many causes (e.g., injury to the brain, genetic disorder, high fever), but is not always known.
A diagnosis of epilepsy may be given after 2 or more unprovoked seizures occur (i.e., occurring without a cause, such as a fever or brain injury). Medical testing is necessary and includes an electroencephalogram (EEG) that records electrical activity alongside observation of the seizure episodes. An abnormal EEG following one seizure may also lead to an epilepsy diagnosis. The medical team will likely want imaging of the brain, such as brain MRI or head CT scan, and genetic testing.
If your child has only had one seizure or has not been diagnosed with epilepsy (or another neurological condition) there are minimal to no neuropsychological risks. For children diagnosed with epilepsy, they can experience early developmental delays and ongoing neuropsychological concerns that need to be monitored and supported.
Factors that Affect Neuropsychological Outcomes
Age of Seizure Onset – The age that seizures began and how long they have occurred can affect neuropsychological outcomes. Seizures during infancy and toddler years can disrupt foundational skills in feeding, sleep, early communication skills (both talking and understanding), and early motor development (sitting up, walking, grasping toys, holding a crayon).
Seizures that begin later in development can affect a number of cognitive skills, such as attention, learning and memory, and processing speed. Reading, math, and handwriting can also be impacted in the classroom. Executive functioning skills tend to be very sensitive to neurological changes (e.g., inhibition, working memory, organization, planning, problem solving, prioritizing, time management, initiation).
Frequency of seizures – A critical risk factor for epilepsy is how well the seizures are controlled and how often they occur. When the seizures occur frequently, the risk for developmental and neuropsychological deficiencies will increase. Psychological symptoms also need to be monitored, including behavior problems and emotional symptoms. This is why the medical team wants to reduce and control the seizures with treatment, even when there are side effects.
Treatment – Anti-epileptic medications can be associated with side effects that can be monitored with neuropsychological testing. Most commonly, a child may experience slowed processing speed. Other side effects include mood and behavioral changes. Be sure to communicate closely with your medical team if you have concerns, and especially if you would like to discontinue or change the dosage of medication because this can cause seizures to worsen.
In some cases, medications are not effective for reducing seizures. Depending on the cause and location of the seizures in the brain, some children may undergo neurosurgery. Successful surgery can reduce or control the seizures, and therefore improve quality of life and neuropsychological functioning. However, neurosurgery is not guaranteed to control seizures. The neuropsychologist will closely follow your child along with the medical team to understand any changes in neuropsychological functioning before and after neurosurgery.
Quality of Life and Psychosocial Support
Children and families affected by epilepsy can experience significant anxiety and stress when seizures are ongoing. Caregivers may worry about separating and the child may require additional supervision for safety. Sometimes children must avoid certain activities and sports (i.e., swimming). Teens and young adults need to be seizure free for an extended time period (and cleared by their medical team) to drive. School staff may need a Seizure Action Plan so they are prepared and know what to do if your child has seizures at school. These stressors can contribute to worry, frustration, sadness, and feelings of being overwhelmed.
But the community affected by epilepsy is well connected and there are many resources to help! Ask your neuropsychologist or check your local area for support groups for children and families. Contact us to learn more!
