COGNITION AND ACHIEVEMENT IN CHILDREN WITH SEIZURE DISORDERS

European Scientific Journal January 2014 edition vol.10 COGNITION AND ACHIEVEMENT IN CHILDREN WITH SEIZURE DISORDERS Lydia Barza 0 0 Zayed University , United Arab Emirates School personnel can help to identify, monitor and accommodate students with seizure disorders. This article describes the general characteristics of seizure disorders and reviews research on implications for cognition and achievement among children. Despite methodological limitations of research in this area, a few trends are observed. Localization of seizure activity in the brain and age of onset have a major impact on cognition. A synthesis of major studies show that deficits often involve one or more of the following: verbal memory, visual memory, reaction time, and attention. Challenges in reading comprehension are well documented. Poor school performance, in general, may be due to frequent lapses of awareness. Recommendations are for school personnel to monitor and document symptoms at school. achievement; Chronic illness; epilepsy; seizure - Introduction School personnel, including teachers, school counselors, school nurses and special education needs coordinators (SENCos), play a vital role in informing educators and parents about chronic illnesses, such as seizure disorders. Epilepsy, the term used for recurrent seizures, is one of the most common neurological disorders of childhood. An understanding of the condition and its impact on cognition and achievement will afford the practitioner the knowledge to advocate for relevant services and provide appropriate social and academic support. The purpose of this article is to describe the prevalence and general characteristics of seizure disorders and then systematically review research on its implications for cognition and achievement among children.Finally, guiding principles for practice are discussed. Effectively working with students with seizure disorders first involves a general understanding of the condition, particularly due to commonly held misconceptions about individuals with such illnesses(Jacoby, Snape& Baker, 2005).School performance issues reviewed from the literature on students with seizure disorders provide some guidance as to how they may be placed in the least restrictive and most appropriate schooling environment, especially since some studies show higher rates of grade retention and placement in special education programs (Bailet & Turk, 2000; Berg et al., 2005). Prevalence and characteristics of seizure disorders A seizure is characterized by uncontrollable, excessive electrical activity in the central nervous system (CNS). It results from sudden electrical discharge of neurons in the brain (Black & Hynd, 1995). Rutecki explained that such abnormal synchronization of cortical neurons results in a change in perception or behavior(Rutecki, 1993, p. 275). It is thought that recurrent seizures are caused by an inherent brain abnormality. Nevertheless, no evidence is found for an underlying cause in 50-60% of cases. Recurrent seizures may subject the individual to transient and chronic brain electric and neurochemical disturbances (Jokeit & Ebner, 1999). Consequences of abnormal electrical activity in the brain most often include loss of consciousness, an altered state of consciousness, cessation of motor activity, abnormal motor activity, abnormal sensory perceptions, and loss of bladder and bowel control(Wiederholt, 1995, p. 211). Symptoms vary depending on seizure type. Recurrent seizures in an otherwise healthy individual are a symptom of epilepsy. Peak ages of onset are the first two years of life and the onset of puberty (Black & Hynd, 1995).It is hypothesized that hormonal changes stress the CNS and may precipitate seizures in susceptible individuals (Wiederholt, 1995). The incidence of epilepsy is about 1% of the population and 75% experience onset before age 20. Epilepsy is estimated to affect up to 50 million people globally and 2.5 million people in the United States with predominance among males. Approximately 145 diseases are associated with seizures. Seven to ten percent of the population will have a seizure at some point in their lives (CDC, 2011; WHO, 2001). Types of Seizures Seizures are categorized based on three factors: localization in the brain, loss of consciousness, and type of muscular activity. According to the International Classification of Epileptic Seizures (see Table 1), a distinction is made between partial and generalized seizure types. Partial seizures involve localized discharges in the brain. They begin focally, meaning onset is from one brain region or one cerebral hemisphere only. Generalized seizures involve discharges from both cerebral hemispheres and subcortical connections and structures (Black & Hynd, 1995). Abnormal electrical activities begin in both hemispheres at the same time (Wiederholt, 1995). This distinction is of importance because some research findings on cognition and achievement are idiosyncratic based on this factor. A seizure is described as complex if it is associated with a loss of consciousness. Conversely, a seizure is described as simple if it is not associated with a loss of consciousness. Muscular activity is characterized as tonic, clonic, or both. Tonic muscular activity refers to muscle contraction or tension. For example, the arms and legs may be extended rigidly for several seconds. Clonic muscle activity involves alternation between contraction and relaxation. Tonic-clonic or grand mal types are most easily identified as a seizure because of their dramatic physical expression. This type of seizure is characterized by a sudden cry then unconsciousness, body rigidity, muscle jerking, clenched teeth, and possible suspended breathing. The seizure commonly lasts for about 2-3 minutes, while the entire seizure and recovery period may span about 10-20 minutes. Nevertheless, typical absence or petit mal seizures are the most common type of seizure in children. They are characterized by losses of awareness without changes in muscle tone, vacant stare, rapid eyelid blinking at about 3 per second, and no recollection of the seizure. Typical absence seizures classically occur between the ages of 3 and 12 (Wiederholt, 1995). Such seizures last for less than 15 seconds per episode and can be difficult to diagnose because of their subtle physical manifestations. In the classroom, a seizure episode of this type is often mistaken for inattention, ignoring, or daydreaming. However, an awareness of the condition combined with keen observation by social workers and teachers may aid in the diagnosis and subsequent medical and educational intervention. This article synthesizes the results of studies on the cognitive implications of seizure disorders in children. The methods used to collect the literature for this paper included a comprehensive literature search of published literature since 1970 and a review and retrieval of references from relevant articles. (...truncated)