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Problematic behavior in children with epilepsy: issues and management

David Taylor1, Frank Besag

  • 1Department of Neurology, Great Ormond Street Hospital for Children, London, UK.

Handbook of Clinical Neurology
|April 30, 2013
PubMed

Insights

Neurologists managing epilepsy must address behavioral problems, recognizing their brain basis and impact on families. Effective care requires negotiation, considering the child's context and associated conditions like ADHD and autism.

Area of Science:

  • Neurology
  • Neuroscience
  • Child Psychology

Background:

  • Epilepsy management often involves addressing behavioral problems, which stem from brain dysfunction due to lesions, genetic factors, or medications.
  • Behavioral issues in epilepsy are frequently reported by parents and observed by neurologists, necessitating a focus on observable behaviors over formal psychiatric diagnoses.
  • The chronic nature of epilepsy and its associated psychosocial factors can lead to psychopathology, including distress and alienation.

Purpose of the Study:

  • To guide neurologists in managing behavioral problems in pediatric epilepsy cases.
  • To emphasize the importance of understanding the neurological underpinnings of behavior in epilepsy.
  • To highlight the need for a contextual and negotiated approach to treatment planning for children with epilepsy.

Main Methods:

  • Review of neurological and psychological literature on epilepsy and behavior.
  • Emphasis on detailed family history taking and contextual assessment.
  • Exploration of the interplay between epilepsy, chronic illness, and psychopathology.

Main Results:

  • Behavioral problems are intrinsically linked to brain function and can manifest due to epilepsy.
  • Conditions such as ADHD, autism, mental handicap, and learning difficulties are frequently comorbid with epilepsy.
  • A negotiated, context-sensitive approach is more effective than a prescriptive one for managing behavioral issues in children with epilepsy.

Conclusions:

  • Neurologists must integrate behavioral assessments into epilepsy care, understanding the neurological basis of these issues.
  • Comprehensive management requires acknowledging the impact of epilepsy on the child and family, including psychosocial stressors.
  • Collaborative treatment planning, considering comorbidities and individual context, is crucial for optimizing outcomes in pediatric epilepsy.

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