Despite seizure control, special education often needed in childhood epilepsy


WESTPORT, CT (Reuters Health) – The need for special education is substantial in childhood epilepsy, and it is more common that poor seizure control, according to a report in the November issue of the Journal of Child Neurology.

Dr. Nathaniel Zelnik and colleagues from Carmel Hospital, Haifa, Israel, analyzed data on age at onset, etiology, presence of underlying brain lesions, seizure type, and electroencephalographic (EEG) patterns in 102 epileptic children in relation to therapeutic and educational outcomes of the children.

Eighty-three subjects achieved seizure control, including 46 who remained seizure-free. Nineteen patients were poorly controlled. "Sixty-five patients were in regular school, and 37 required special education (17 with mental retardation)," the investigators note.

Remote symptomatic seizures, underlying brain lesions, and hypsarrhythmia plus mixed EEG patterns predicted poor seizure control (p < 0.001). Young age at epilepsy onset, remote symptomatic seizures, underlying brain lesions, hypsarrhythmia plus mixed EEG patterns, and poor seizure control predicted special education needs (p < 0.001), according to the team.

"Measures of therapeutic success in epilepsy are shifting toward improved quality of life and psychosocial integration," Dr. Zelnik and colleagues explain. "Scholastic achievement should…be included in these measures."

"Perhaps earlier and more aggressive treatment of 'high-risk' epilepsies, including efforts to reduce prolonged nonconclusive spike-wave activity, better selection of antiepileptic drugs, and the possibility of early surgical intervention, may improve the educational outcome in these patients," the authors note.

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