MDNews - Cleveland-Akron-Canton

++++++++++++++++++++++++++++++++++++++++ + +++ + +++ ++++++++++++++++++++++++++++++++++++++++ SPECIAL SECTION: NEUROSCIENCES R E C E I V I N G A D I A G N O S I S of idiopathic generalized epilepsy (IGE) for a child can be a relief and a source of confusion for patient families. Parents can find it reas- suring to know that their concerns about a child's health are the result of a medical condition – yet without knowing the underlying cause of the child's seizures, families may wonder what course of action to take when seeking treatment. For chil- dren with IGE, an integrated approach to care can help address the child's medical needs, along with the behavioral and cognitive issues that so often accompany this condition. According to the Epilepsy Foundation, epilepsy is the most prevalent childhood disorder of the central nervous system, impacting around 326,000 under the age of 15 in the U.S. While patient families may be familiar with observable behaviors associated with tonic-clonic (grand mal), myoclonic, and other types of seizures with movements, they may not be aware of absence seizures. Absence (petit mal) seizures may appear as a child daydream- ing or being otherwise inattentive. These seizures may last just a few seconds and occur numerous times throughout the day, with the child appearing to be normal but actually missing a significant amount of information. For these children, the onset of sei- zures is the symptom – not the source – of unidentified brain dysfunction. What's important for patient families to understand is that children with a diagnosis of IGE, whether they are on medication or not, will likely still require other assistance. To explain, human and animal data consistently implicate involvement of the thalamus and cortex in generation of spike-wave discharges in IGE. Because the thalamus acts as a relay station for nearly all input and output of the brain, thalamic involvement broadens the possibilities of types of cognitive or behavioral difficul- ties such children may have. However, there are several primary cognitive and behavioral findings: + Inattention and executive dysfunc- tion – working memory, nonverbal reasoning, inhibition and symptoms of ADHD are among the most common cognitive impairments + Long-term memory consolidation impairment + Subtle leftward shift in IQ – in average range, but slightly below that of peers + Academic difficulties – although the findings are somewhat mixed + Fine motor impairment + Mood disorders and, to a lesser extent, anxiety + Social difficulties Cognitive deficits are often subtle, but consistent and meaningful in that they impact daily activities, especially in the school setting or participation in extra- curricular activities. Given high rates of cognitive, behavioral and medical comor- bidities, children with IGE need to be evaluated on an ongoing basis, as treatment of comorbidity significantly affects quality of life. Poor seizure control can result in worse cognitive and social outcomes; but fortunately IGE is not characterized by progressive cognitive deterioration. Neuropsychologists can bridge the gap in terms of assessing and treat- ing t he cog nit ive, behav iora l a nd psychosocia l aspects of the child 's care, from behavioral and social issues to cognitive/learning challenges. For example, children with IGE often need an Individualized Education Program (IEP) to provide customized academic support. Parents and educators, along w ith hea lthcare professiona ls, can be part of the team that gives input toward developing the child 's IEP. Using standardized cognitive tests, neuropsychologists are often a part of this effort, explaining the brain-behavior relationship to inform why a child may be having difficulties in class, and also giving specific directions as to how to ensure that a child is responsive. This understanding can be instructive in developing a more effective IEP, plus in working with the child at home or in other settings. Managing IGE involves multiple facets of care. A neuropsychologist can provide patient families with direction and sup- port to ensure their child's diagnostic and treatment needs are being addressed. Dalin P ulsipher, Ph D, is a pediat- r ic ne urops ycholog i st in the A kron Children's Hospital NeuroDevelopmental Scie nce Ce nte r. He i s a me mbe r of the A m e r ic an A c a de m y of C linic a l Neuropsycholog y and the International Neuropsychological Society. ■ Supporting Patient Families of Children with Idiopathic Generalized Epilepsy By Dalin Pulsipher, PhD 1 6 | Cleveland/Akron/Canton MD NEWS ■ M D N E W S . CO M ■ J U LY/AU G U S T 2 0 1 4

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