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Convulsive status epilepticus (CSE) is the most common medical neurological emergency in childhood. To ultimately improve the management of CSE, an understanding of its incidence, aetiology, seizure types, treatment and outcome in the general childhood population is required. Using emerging techniques for systematic reviews in observational studies, a systematic review of the epidemiology of status epilepticus was conducted. All eligible studies were based on predominantly or exclusively adult populations. The data from these studies suggest that the epidemiology of CSE in childhood differs from that in adults. Thus, an epidemiological study on CSE in a paediatric population was required. The North London convulsive STatus EPilepticus in childhood Surveillance Study (NLSTEPSS), a prospective study, is the first such study. In NLSTEPSS, children with CSE were identified through a multi-tiered notification system. Data were collected using a standard questionnaire and capture-recapture was used to assess ascertainment. The incidence of CSE in childhood is 18-20/100,000/year (95% CI 17- 23/100,000/yr), with a higher incidence amongst non-white children, children of lower socioeconomic status and younger children. Lack of prehospital treatment, and treatment with more than 2 doses of benzodiazepines independently increase the likelihood of CSE lasting longer than 60 minutes. A third of children with CSE are not given prehospital treatment and only 21% of those treated are given adequate initial doses. Treatment with more than 2 doses of benzodiazepines is associated with respiratory depression. Intravenous lorazepam may be better first line therapy than rectal diazepam and intravenous phenytoin may be better second line therapy than rectal paraldehyde. CSE lasting longer than 60 minutes and CSE associated with respiratory depression independently increase the likelihood of admission to paediatric intensive care (PICU). Thus, strategies to reduce those factors may reduce admissions to PICU. On the basis of the data from NLSTEPSS, treatment guidelines for CSE in childhood may need to be revised and a new treatment guideline is proposed.

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Objective: There is evidence that in patients with epilepsy interictal discharges can be accompanied by transitory cognitive impairment (TCI). However, it is not kno\vn whether interictal discharges and TCI impair day to day psychosocial functioning, and if so whether drug treatment to suppress discharges is effective in the absence of clinical seizures. Aims of study: (1) Effect of lamotrigine on interictal discharges, behaviour and cognition in children with epilepsy. (2) Effect of interictal discharges on behaviour and cognition in children with epilepsy. (3) Effect of suppression of discharges behaviour in children with epilepsy. Method: In a randomised, double-blind, placebo-controlled, cross-over study with lamotrigine ambulatory EEG, cognitive test battery and behavioural scores were measured in 61 patients at baseline, placebo and lamotrigine phase. Results: Interictal discharges are common in children with epilepsy even if seizures are well controlled. Lamotrigine reduced the duration of discharges per hour, but not the total number per hour in this group of patients. Lamotrigine had no significant negative or positive effect on cognitive performance in children with epilepsy. Tel was found in over 500/0 of patients with sufficient discharges for analysis. There was a significant correlation of side of discharges to the type of test (spatial or verbal), when correcting for dominant hemisphere. Interictal discharges were associated with impaired cognitive performance (working memory). During treatment with lamotrigine global rating of behaviour significantly improved in patients with a reduction in discharges rate, but not in patients with without a change in discharge rate. This was independent of randomization or presence of seizures. Conclusion: lnterictal discharges are common even in children with well-controlled epilepsy and associated with cognitive impairment particularly affecting \\orking memory. Our data suggest that suppressing interictal discharges can improve behaviour in children with behavioural problems and epilepsy.

Children with epilepsy are at increased risk of communication and behavioural problems. Previous research has not assessed whether difficulties with social understanding are a contributory factor. This thesis contains three studies that addressed social cognitive reasoning and social attention in a group of children with epilepsy and typically developing children in mainstream education. The studies employed diverse methodologies to explore functioning in a number of cognitive and attention domains known to contribute to social understanding skills. The first study involved 55 children with epilepsy and 69 typically developing children. It employed social cognitive and social perceptual reasoning tasks, standardized assessments of IQ and expressive language and parental report measures of communication and behaviour. The findings suggest that children with epilepsy have difficulty with socio-cognitive reasoning that may be independent of functioning in other non-social domains. The degree of socio-cognitive impairment also predicted increased parental reports of communication and behaviour problems in some children. The second study involved 57 children (34 with epilepsy) and addressed bias in mental states attribution. It provides evidence that atypical mental states attribution is associated with poor executive function and attention in children with epilepsy who have increased reports of behavioural problems. The third study used eye tracking to assess social attention and inhibition to dynamic displays of gaze and emotion. It involved 59 children (25 with epilepsy). The children with epilepsy demonstrated atypical responding to gaze and emotion signals and performance was associated with increased reports of social problems. Overall, the findings suggest that social cognition and social attention are areas of vulnerability in some children with epilepsy.

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No description available.

No description available.

The aim of the study was to investigate the neurobiological and psychosocial factors that influence neuropsychological test performance in children with epilepsy from a non-Western rural background. The sample comprised 100 children with tonic-clonic seizures and 100 children with simple partial seizures between the ages of eight to twelve years. A third group of 100 children with chronic renal problems was used as a comparison to control for the effects of having a chronic illness. The findings of the present study indicate that in the epilepsy groups, seizure variables such as the age of onset, frequency of seizures and duration of seizures have an impact on self-esteem, adjustment and NEPSY scores. However, psychosocial and emotional factors appear to have a greater impact than neurobiological variables on the measured neuropsychological domains (attention/executive, language, sensorymotor and learning/memory functions). These findings are consistent with the theoretical perspectives used, combining the view of Piaget (1955) that cognitive development proceeds as a result of the child’s own activities, with Luria’s (1973) model of brain functioning and the stance of Vygotsky (1978) that development is a socially mediated process. The findings regarding the influence of neurobiological and psychosocial factors on neuropsychological test performance in children with epilepsy from non-Western backgrounds are similar to those of Western studies. Epilepsy presents with unique problems relative to other chronic illnesses. The three groups are separated according to differences in psychosocial (maternal attitudes), emotional (adjustment and self-esteem) as well as neuropsychological functioning (attention/executive, language and visual-spatial skills). The renal group is characterised by the highest levels of psychosocial, emotional and neuropsychological functioning, while the simple partial seizure group have lower levels of psychosocial and emotional functioning, and the tonic-clonic seizure group have the lowest levels of neuropsychological functioning and adjustment. / Psychology / D.Litt et Phil. (Psychology)