CO-MORBIDITIES OF THE EPILEPTIC ENCEPHALOPATHIES

Children and adolescents with epilepsy are known to have high rates of behavior, psychiatric and other co-morbidities. Apart from seizure control, two of the most important factors in determining how well a child progresses toward independence are cognition and behavior. For no other type of epilepsy is it more severe than for children with epileptic encephalopathies.

One of the earliest of the age dependent encephalopathies, infantile spasms, has long been associated with a high incidence of mental retardation even in patients who become seizure free by treatment and whose EEG becomes normal. There is emerging evidence that early effective treatment may improve outcome in terms of cognition and behavior. Autism has been reported in cryptogenic cases and an association with temporal lobe tubers in tuberous sclerosis described. In Severe Myoclonic Epilepsy of Infancy, Dravet Syndrome, a variety of psychiatric disorders have been reported including hyperactivity and autistic features. The behavioral problems reported with Lennox-Gastaut Syndrome at disease onset include hyperkinesias, autistic and even psychotic traits. There is often an arrest in development with progressive intellectual impairment. They rapidly develop difficulties with motor speed, apathy, slowness and slow expression. Autistic features, aggression, and hyperkinesis described with Landau-Kleffner Syndrome had often shown dramatic improvement with appropriate treatment.

Conclusion: In many children, these co-morbidities are more problematic than the epilepsy itself, and result in poor quality of life for both the child and family. Behavioral and emotional co-morbidities may hinder social integration, which is already problematic in children with epilepsy due to stigma. Difficulties with attention may further limit academic achievement in a population already at risk of developmental delay.