Neuropsychological and Neuropsychiatric Aspects of Clinical Epilepsy Management

Epilepsy is one of the most common and potentially challenging chronic neurological conditions encountered in children. It presents with a range of possible negative effects that can alter the course of a specific child's development. The management of pediatric patients with epilepsy has evolved significantly over the past 50 years, with particular growth in complex care taking place within the past 20 years.[1] [2] With this increase in knowledge concerning seizures and their etiology, and with advancements in diagnosis and treatment for patients with seizure disorders, there has been an accompanying recognition of the need for collateral care by behavioral health physicians and neuropsychologists in particular, to assist patients and their families in meeting better developmental and educational goals.[3] Advancements in approaches to treatment, including neurosurgical and pharmacological interventions, have allowed a greater number of impacted children and adolescents to move forward toward greater opportunities developmentally.[4] [5] [6]

However, there has been accompanying understanding of the broad range of challenges many of these individuals, particularly children affected by more severe epilepsy syndromes, experience. These difficulties can include cognitive disabilities, slowed cognitive and behavioral development, affective lability and behavioral dyscontrol, and alterations in attentional and executive functioning as required for meeting age-appropriate learning, adaptive, and ultimately vocational demands.[2] [7] [8] While many of the patients seen by neurologists in general epilepsy clinics seldom require intervention for specific neuropsychological or neuropsychiatric concerns,[1] a significant number do present with such difficulties that lead to consultation and collaboration in disease management. These are often the patients requiring significant support, with a focus on complex biopsychosocial and environmental interactions.[2] [8] These challenging neurodevelopmental and behavioral needs require a multimodal cross-disciplinary approach, which fosters collaborative consideration regarding how to best support patients, and to develop the most efficacious intervention plan.[2] [6] [8]

This special section, regarding the neuropsychological and neuropsychiatric needs of pediatric epilepsy patients, has been organized to provide a review of current empirically supported approaches to assessment, diagnosis, and collaborative care. Each of the authors of this section is a clinician who specializes in working with patients with epilepsy, often as part of an integrated care team within a pediatric epilepsy center at a major U.S. academic medical center. Review articles were developed by each of the authors to address the best practices at this time for addressing, through a combination of screening and comprehensive neuropsychological assessment across the pediatric lifespan, and ongoing supporting monitoring and intervention regarding neuropsychiatric issues that often appear either in conjunction with seizures, or that are, in the case of many difficult neurobehavioral profiles, such as bipolar disorder, treated with approaches that are commensurate with current seizure care. As such, this section is presented as a guide regarding the identification and treatment of neurobehavioral, affective, and cognitive challenges that the pediatric epilepsy patient may often present. It is hoped that this will support greater development of both clinical research hypotheses for continued research, as well as guide settings seeking to consider a comprehensive, multidisciplinary approach to epilepsy care, that addresses the whole individual, across the pediatric lifespan.

• References

• 1 Sillanpää M, Anttinen A, Rinne JO. , et al. Childhood-onset epilepsy five decades later. A prospective population-based cohort study. Epilepsia 2015; 56 (11) 1774-1783
• 2 Felix L, Hunter SJ. Pediatric aspects of epilepsy. In: Donders J, Hunter SJ. eds. Principles and Practice of Lifespan Developmental Neuropsychology. Cambridge, United Kingdom: Cambridge University Press; 2010: 359-370
• 3 Asato MR, Doss JL, Plioplys S. Clinic-friendly screening for cognitive and mental health problems in school-aged youth with epilepsy. Epilepsy Behav 2015; 48: 97-102
• 4 Law N, Kerr E, Smith ML. Evaluation of behavioral outcomes in children 1 year after epilepsy surgery. Epilepsia 2015; 56 (10) 1605-1614
• 5 Boshuisen K, van Schooneveld MMJ, Uiterwaal CSPM. , et al; TimeToStop cognitive outcome study group. Intelligence quotient improves after antiepileptic drug withdrawal following pediatric epilepsy surgery. Ann Neurol 2015; 78 (01) 104-114
• 6 Shurtleff HA, Barry D, Firman T. , et al. Impact of epilepsy surgery on development of preschool children: identification of a cohort likely to benefit from early intervention. J Neurosurg Pediatr 2015; 16 (04) 383-392
• 7 Seidenberg M, Hermann B. A lifespan perspective on cognition in epilepsy. In: Donders J, Hunter SJ. eds. Principles and Practice of Lifespan Developmental Neuropsychology. Cambridge, United Kingdom: Cambridge University Press; 2010: 370-378
• 8 Camfield PR, Camfield CS. What happens to children with epilepsy when they become adults? Some facts and opinions. Pediatr Neurol 2014; 51 (01) 17-23