Pediatric epilepsy, febrile seizures raise neuropsychiatric risk

Pediatric epilepsy, febrile seizures raise neuropsychiatric risk

Children who have epilepsy or febrile seizures may have increased risk for later neuropsychiatric conditions.

Neuropsychiatric conditions are mental disorders that are typically attributed to diseases that originate from the nervous system. These diseases greatly impair the health of those affected by them and impact their ability to learn, work, and emotionally cope.  Common neuropsychiatric disorders include seizures, attention deficits, cognitive deficits, palsies, uncontrolled anger, migraine headaches, addictions, eating disorders, depression, and anxiety and others. They can range widely in cause, course, and severity.

Epilepsy seems tied to greater risk than febrile seizures, and events in the first decade of life were tied to greater neuropsychiatric vulnerabilities in adolescence and adulthood.

Why does this matter

Authors of a recent study say that these associations are “more modest” than previously reported for some conditions.

What are the symptoms of neuropsychiatric disorders?

The key component of neuropsychiatric disorders is that the symptoms tend to impact brain function, emotion and mood. These can range from problems with focus and learning in the case of ADHD to sadness, irritability, memory problems, mood problems, depression to a variety of other psychiatric and/or neurological symptoms.

What are neuropsychiatric disorder care options?

Medications, psychological and/or psychiatric therapy are common treatments for neuropsychiatric disorders. Specific treatments will vary based on the precise cause, clinical presentation and severity.

Key results

  • With epilepsy, risk increased for (HRs; 95% CIs):
    • Any psychiatric disorder: 1.34 (1.25-1.44).
    • Schizophrenia spectrum disorders: 1.50 (1.26-1.78).
  • With febrile seizures, risk increased for:
    • Any psychiatric disorder: 1.12 (1.08-1.17).
    • Schizophrenia spectrum disorders: 1.23 (1.11-1.35).
  • With both, risk increases were:
    • Any disorder: 1.50 (1.28-1.75).
    • Schizophrenia spectrum disorders: 2.75 (2.03-3.73).
  • No increased risk for substance abuse disorders.
  • Febrile seizure-associated risks increased with number of events involving hospital contact.
  • Seizure etiology, onset type (i.e., focal vs generalized) did not change associations.

The study used a Danish registry of 1,291,679 individuals (43,148 febrile seizure history; 10,355 epilepsy; 1696 both), born January 1, 1978 through December 31, 2002 and was funded by the Novo Nordisk Foundation and the Danish Epilepsy Association along with some others.

Pediatric epilepsy may be misdiagnosed as GI disease

Pediatric epilepsy may be misdiagnosed as GI disease

More than 2% of children with West syndrome, temporal lobe epilepsy, or Panayiotopoulos syndrome initially were misdiagnosed with gastrointestinal disorders, according to the results of a large single-center retrospective study.

Such misdiagnoses caused substantial diagnostic delays, increased the risk of cognitive deterioration, and exposed children to inappropriate radiation and invasive procedures, reported Giulia Carbonari and her associates at the University of Bologna, Italy.

The results of this study suggest that epileptic spasms of West syndrome often are misdiagnosed as symptoms of gastroesophageal reflux disease (GERD). Thus, clinicians should consider epilepsy in the differential diagnosis of atypical gastroesophageal reflux in young children, the researchers wrote. The report was published online in Epilepsy & Behavior.

Several recent case reports have described pediatric epilepsies that were misdiagnosed and treated as gastrointestinal (GI) disorders. To better frame the problem, the investigators reviewed the medical records of 858 consecutive children with epilepsy treated at their center between 2010 and 2015.

A total of 21 patients (2.4%) were initially misdiagnosed with GI disease. Most were younger than 1 year old. Notably, 7 of 27 children (26%) with West syndrome were misdiagnosed – in six cases with GERD, and in one case with infant colic. In addition, 10 of 24 children (42%) with temporal lobe epilepsy were misdiagnosed with GERD (five cases), recurrent abdominal pain (two cases), or cyclic vomiting, gastric pain, or dysfunctional elimination syndrome (one case each). Finally, 4 of 38 children (11%) with Panayiotopoulos syndrome were misdiagnosed with cyclic vomiting (three cases) or GERD (one case).

Misdiagnoses typically caused at least a 3-month diagnostic delay (interquartile range, 2-18 months), and half of misdiagnosed children received inappropriate abdominal ultrasonography, upper alimentary canal radiography, or esophagogastroduodenoscopy. Eight patients also received inappropriate antireflux therapy, and one patient underwent inappropriate surgery, the researchers said.

They shared tips for avoiding these misdiagnoses. Epileptic spasms of West syndrome involve brief contractions (flexion or extension) of the neck, trunk, and extremities, usually in clusters. Psychomotor slowing also is common. Seizures in temporal lobe epilepsy often involve automatisms, mental status changes, and changes in skin color, blood pressure, and heart rate. Signs of Panayiotopoulos syndrome include emesis, cyanosis, pallor, changes in intestinal motility, gaze deviation, hypotonia, confusion, and unresponsiveness.


Parental coping and its role in predicting health-related quality of life in pediatric epilepsy

Parental coping and its role in predicting health-related quality of life in pediatric epilepsy

Psychosocial difficulties are known to greatly impact the health-related quality of life of a child with epilepsy. Parental coping is a unique aspect of having a child with epilepsy that has not been examined in relation to health-related quality of life in the child with epilepsy until now.

Parental coping with the condition is shown to be significantly related to the child’s health-related quality of life in a youth with epilepsy. Elevated feelings of helplessness, along with epilepsy severity, predict lower health-related quality of life. The study’s findings are the first to demonstrate the unique role of parental coping in on health quality among youth with epilepsy, and, they highlight the importance of providing support to the whole family during pediatric epilepsy treatment.

Highlights From The Study

  • Parental coping is associated with Health-Related Quality of Life (HRQOL) in pediatric epilepsy.
  • Seizure frequency, gender, and number of Anti-epileptic Drugs (AEDs) also relate to parental coping.
  • Higher parental helplessness accounts for the most variance in HRQOL ratings.
  • Sociodemographic factors are not significant contributors to parental helplessness.
  • Higher parental helplessness was significantly associated with female gender of the child.
  • The longer duration of epilepsy was significantly associated with parental acceptance.

We highly recommend that parents of children with epilepsy participate in a support and epilepsy education program.  They may also want to seen programs to educate of parenting a child with health concerns.

Study Source:

Epilepsy in Children

Epilepsy is the most common neurological disorder affecting children, and may be characterized by sudden, recurrent episodes of uncontrolled motor activity and, in some cases, impaired consciousness (seizures). Any condition that triggers disruptive electrical discharges in the brain can produce epilepsy. Although the underlying abnormality may not be correctable, seizures themselves can usually be controlled through drug therapy. There are a number of relatively benign genetic epilepsies of childhood, some but not all of which may be outgrown.

Common Causes of Epilepsy

Seizures may develop as a result of a head injury, brain infection, brain tumor, drug or alcohol withdrawal or intoxication, stroke, birth trauma or metabolic imbalance. In most cases, the underlying cause of a child’s epilepsy is never discovered.

Types of Epileptic Seizure

Epileptic seizures fall into two broad categories: generalized and partial. Generalized seizures, which involve the whole brain, fall into several subtypes. The least dramatic of these are absence seizures (also known as petit mal seizures), which consist of brief episodes of altered awareness during which the child may appear to be daydreaming. During an absence seizure, all motor activity stops, and the child stares blankly or blinks rhythmically and does not respond when touched or called by name. Absence seizures may last five to ten seconds and recur many times a day.

The Two Main Types of Seizure

At the other extreme are generalized tonic-clonic seizures (also known as grand mal seizures) during which the child abruptly ceases activity, falls and loses consciousness. During the initial phase of the seizure, lasting only a few seconds, the muscles stiffen. In the subsequent phase, the muscles undergo rhythmic, alternating contractions and partial relaxations, causing uncontrollable jerking motions (tonic-clonic seizures). Breathing may become irregular. After the seizure, which usually ends in less than five minutes, muscles relax, and the child may be confused and sleepy.

Partial seizures are categorized as simple or complex. A simple partial seizure may involve abnormal twitching, tingling and sensory hallucinations. Consciousness is preserved and the child can often recount details of the seizures, which generally last several minutes. Complex partial seizures have a variety of manifestations, including staring, complex involuntary movements and hallucinations. They may involve a loss of consciousness.

Tonic-clonic seizures are impossible to miss. Some of the more subtle types of seizures, however, may occur several times before parents or teachers recognize them. If the child occasionally seems unaware of his surroundings or experiences involuntary muscle contractions in one area of the body, he may have a seizure disorder.

It is important to note that the seizures some children have in association with fever do not constitute epilepsy. In addition, febrile seizures in early childhood are not usually associated with the later development of epilepsy.

Diagnosis of Epilepsy

After an initial seizure, the pediatrician (or pediatric neurologist) may order several tests, the most important of which is an electroencephalogram (EEG), a painless test that record the brain’s electrical activity. It is often necessary to perform several EEG’s in different circumstances (while the child is sleeping and while the child is looking at flashing lights, for example) to identify the type of seizure disorder present.

Treatment of Epilepsy

In the majority of cases, children’s seizures can be satisfactorily controlled or reduced in frequency with drug therapy. The success of the therapy depends chiefly on the severity of the seizure disorder, as well as on the child’s compliance in taking his medication, and on careful monitoring of blood levels by the physician.

One or more of about six different agents, called antiepileptic drugs, are generally prescribed for the treatment of epilepsy in children. Each of the drugs is useful in specific types of seizure disorders, and each has different dosage requirements and side effects that the physician takes into consideration before deciding which one to prescribe. In many cases, finding the proper medication and correct dosage level takes some time. Recent developments in specific types of brain surgery for intractable seizures offer new hope for very severe cases of epilepsy.

Looking After a Child with Epilepsy

A child who has a seizure disorder should be treated the same way you would treat any other child. Certain precautions should be taken while the threat of seizures exists.

  • Make sure the child is well supervised in the bathtub, and at the beach or swimming pools.
  • Teach the child to recognize the signs of an impending seizure and seek help.
  • Have the child wear a MedicAlert bracelet that identifies his condition.
  • Most important, be sure the child continues to take medication at the prescribed doses, even after seizures are under control. The doctor may recommend tapering off the medication after the child has been free of seizures for two or three years, but close medical supervision is needed for this process.

SOURCE: by J. Furst

Scientists pinpoint the cause of a rare childhood seizure disorder

Scientists pinpoint the cause of a rare childhood seizure disorder

Early Infantile Epileptic Encephalopathy (EIEE) is a rare disease that causes intractable seizures within the first few months of life. Over 50 genes have been linked to EIEE, meaning the condition is difficult to diagnose.

Now, bioinformatics experts from the University of Utah Health have created a set of high-tech, computational tools that can pinpoint the cause of the condition.

Photo Credit: By Mama Belle Love kids

If EIEE is not diagnosed and treated early on, the seizures can interrupt normal development and lead to early death.

Researchers have identified 50 genes linked to EIEE, but standard genetic testing often fails to detect the cause of the disease, meaning treatment approaches are limited to managing a child’s symptoms.

Now, rather than undergoing multiple tests, the new tools could be used to deliver results quickly and ultimately at a lower cost, says senior author Aaron Quinlan: “These tools let us peek in the dark corners and under the rug of the genome that other methods do not.”

As reported in the journal Nature Genomic Medicine, Quinlan and colleagues developed a suite of computational tools that used algorithms to assess the genome of 14 patients and their parents, to pinpoint the genomic abnormalities that lead to EIEE.

The technique led the researchers to a spontaneous mutation that caused EIEE in 12 of the 14 patients.

In one patient, the mutation was located on a gene that had not previously been linked to EIEE.

In the remaining two patients, the team identified significant structural changes that affected genes already known to be linked to EIEE, but that were not identifiable using routine genetic testing.

These families have been drifting through expensive prolonged testing with little hope of finding an answer. We can now identify the genetic cause of EIEE and select medications best suited to each patient to decrease the frequency of seizures earlier and hopefully prevent developmental delays.”

Source: By B. Ostrander, Eurekalert

The tools that were developed for the study are now available to researchers on the USTAR Center for Genetic Discovery website.