Learning Disability in Childhood-Onset Epilepsy

J Millichap

doi:10.15844/pedneurbriefs-19-2-6

Author:

J Gordon Millichap

Northwestern University Feinberg School of Medicine, US

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Abstract

The occurrence of learning disability (LD) in adults with childhood-onset epilepsy and its impact on medical and social outcome were analyzed in a study at the University of Turku, Finland.

How to Cite: Millichap, J.G., 2005. Learning Disability in Childhood-Onset Epilepsy. Pediatric Neurology Briefs, 19(2), pp.14–14. DOI: http://doi.org/10.15844/pedneurbriefs-19-2-6

The occurrence of learning disability (LD) in adults with childhood-onset epilepsy and its impact on medical and social outcome were analyzed in a study at the University of Turku, Finland. The study group of 242 patients included all children aged less than 16 years having active epilepsy, resident in a geographically defined area of the University Hospital in 1964, and followed for 45 years. Data were retrospective for the first 10 years and then prospective by examination every 5^th year for the last 35 years of follow-up. LD was present in 182 (76%) patients and was related to the IQ level. LD occurred in 57% of subjects with IQ>85, and in 67% of those with IQ of 71-85; 51% of patients with LD were mentally retarded. Of the total subjects, 78% attended regular classes, 12% attended special classes at ordinary schools, and 9% attended training schools for mentally handicapped. Mentally near-normal subjects had hyperkinetic behavior more often than mentally normal subjects (44% vs 8%, P<0.0001). Reading, writing, and speech problems in mentally nonretarded patients occurred in 19, 19, and 40%, respectively. Reading disability occurred less often in patients with rolandic epilepsy than with other epilepsies. Speech problems were associated with temporal lobe and minor motor epilepsies. A symptomatic etiology of epilepsy was the only predictor of LD in mentally nonretarded patients. LD and seizure outcome were closely related. A 5-year or longer seizure-free period was achieved in 90% of patients with no LD compared to 70% with LD and in 54% of mentally retarded subjects. Patients with LD or MR relapsed more often than non-LD or nonretarded patients. Risk factors for MR and LD were the occurrence of cerebral palsy, onset of epilepsy before age 6 years, and early resistance to antiepileptic drugs. The degree of LD significantly impacted medical, social, and educational long-term outcomes. [1]

COMMENT. Learning disability is a common complication of childhood-onset epilepsy and it adversely affects medical, social, and educational outcomes. Neurophysiological mechanisms involved in epilepsy that may interfere with learning include the following: 1) disturbance of attention to incoming information, its storage or retrieval during seizures; 2) damage to neural tissue: 3) antiepileptic drug toxicity; 4) cognitive impairment related to subclinical generalized spike wave discharges (Ped Neur Briefs Feb 1991) [2]. Speech delay due to a prelinguistic regression of epileptic origin has been described. [3]

Recovery of cognitive function may occur in children with rolandic-epilepsy, when patients are followed and retested at 5 years after onset, at a time when most have become seizure-free. [4]

References

Sillanpää, M (2004). Learning disability: occurrence and long-term consequences in childhood-onset epilepsy. Epilepsy Behav Dec 20045(6): 937–944, DOI: https://doi.org/10.1016/j.yebeh.2004.08.008 [PubMed]

Binnie, CD, Channon, S and Marston, D (1990). Learning disabilities in epilepsy: neurophysiological aspects. Epilepsia 31 Suppl 4: S2–8, DOI: https://doi.org/10.1111/j.1528-1157.1990.tb05864.x [PubMed]

Dubois, CM, Gianella, D, Chaves-Vischer, V, Haenggeli, CA, Deonna, T and Roulet Perez, E (2004). Speech delay due to a prelinguistic regression of epileptic origin. Neuropediatrics Feb 200435(1): 50–53, DOI: https://doi.org/10.1055/s-2004-815792 [PubMed]

Lindgren, S, Kihlgren, M, Melin, L, Croona, C, Lundberg, S and Eeg-Olofsson, O (2004). Development of cognitive functions in children with rolandic epilepsy. Epilepsy Behav Dec 20045(6): 903–910, DOI: https://doi.org/10.1016/j.yebeh.2004.08.004 [PubMed]

[CIT0001] Sillanpää, M (2004). Learning disability: occurrence and long-term consequences in childhood-onset epilepsy. Epilepsy Behav Dec 20045(6): 937–944, DOI: https://doi.org/10.1016/j.yebeh.2004.08.008 [PubMed]

[CIT0002] Binnie, CD, Channon, S and Marston, D (1990). Learning disabilities in epilepsy: neurophysiological aspects. Epilepsia 31 Suppl 4: S2–8, DOI: https://doi.org/10.1111/j.1528-1157.1990.tb05864.x [PubMed]

[CIT0003] Dubois, CM, Gianella, D, Chaves-Vischer, V, Haenggeli, CA, Deonna, T and Roulet Perez, E (2004). Speech delay due to a prelinguistic regression of epileptic origin. Neuropediatrics Feb 200435(1): 50–53, DOI: https://doi.org/10.1055/s-2004-815792 [PubMed]

[CIT0004] Lindgren, S, Kihlgren, M, Melin, L, Croona, C, Lundberg, S and Eeg-Olofsson, O (2004). Development of cognitive functions in children with rolandic epilepsy. Epilepsy Behav Dec 20045(6): 903–910, DOI: https://doi.org/10.1016/j.yebeh.2004.08.004 [PubMed]

Reading: Learning Disability in Childhood-Onset Epilepsy

Learning and Cognitive Disorders

Learning Disability in Childhood-Onset Epilepsy

Author:

J Gordon Millichap

Northwestern University Feinberg School of Medicine, US

X close

Abstract

References