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Epilepsy and behaviourEEpilepsy and behaviourEpilepsy and behaviourEnglishNeurologyChild (0-12 years);Teen (13-18 years)BrainNervous systemConditions and diseasesCaregivers Adult (19+) EducatorsNA2010-02-04T05:00:00ZIrene Elliott, RN, MHSc, ACNP;Janice Mulligan, MSW, RSW ;Rose Geist, MD, FRCPC12.000000000000041.00000000000001777.00000000000Flat ContentHealth A-Z<p>Varying behaviors can be expected from a child with epilepsy. Parents sometimes notice negative changes triggered by anti-epileptic medication.</p><p>In a recent study of behaviour in children in the six months before a first recognized seizure, almost 25 per cent of the children had higher than expected rates of behavioural problems (particularly attention difficulties). This rate remains fairly static for those children in whom seizures are well controlled and in whom there are no other neurological problems (uncomplicated epilepsy). These findings suggest that seizures alone do not account for the behavioural problems seen in children with epilepsy. For those children who continue to have poorly controlled seizures plus other neurological problems, for example learning difficulties, the rate of behavioural difficulties can be as high as 56%. These findings suggest that epilepsy is a more complex disorder that may manifest itself with behavioural disturbances as well as seizures. </p><h2>Key points</h2><ul><li>Behavioural issues in children with epilepsy may be caused by fear or stress; frustration with learning difficulties; malfunctions in the areas of the brain that monitor and control emotions and behaviour.<br></li><li>Your child's behaviour may be seizure-related or medication-related. Some behavioural changes are normal for any child, while more serious behavioural changes need to be addressed quickly.</li></ul>
L’épilepsie et le comportementLL’épilepsie et le comportementEpilepsy and behaviourFrenchNeurologyChild (0-12 years);Teen (13-18 years)BrainNervous systemConditions and diseasesCaregivers Adult (19+) EducatorsNA2010-02-04T05:00:00ZIrene Elliott, RN, MHSc, ACNP;Janice Mulligan, MSW, RSW ;Rose Geist, MD, FRCPC12.000000000000041.00000000000000Flat ContentHealth A-Z<p>Un enfant épileptique peut présenter divers schémas de comportement. Les parents remarquent parfois que les médicaments antiépileptiques produisent des changements négatifs chez l’enfant.</p><p>Selon une étude récente sur le comportement des enfants au cours des six mois précédant une première crise reconnue, près de 25 pour cent avaient un taux de problèmes de comportement supérieur aux attentes, en particulier des difficultés d’attention. Ce taux demeure plutôt stable chez les enfants dont les crises sont bien contrôlées et qui n’ont pas d’autres problèmes neurologiques (épilepsie non compliquée). Ces conclusions laissent entendre que les crises en tant que telles ne sont pas à l’origine des problèmes de comportement observés chez les enfants atteints d’épilepsie. Pour ceux qui continuent d’avoir des crises mal contrôlées, en plus d’autres problèmes neurologiques, par exemple des troubles d’apprentissage, le taux de problèmes de comportement peut grimper jusqu’à 56 pour cent. Ces constatations laissent croire que l’épilepsie est une maladie complexe qui peut se manifester par des troubles de comportement et des crises.</p><ul><li>Les troubles de comportement chez les enfants atteints d’épilepsie peuvent être causés par la peur ou le stress, la frustration liée aux difficultés d’apprentissage, des anomalies dans des régions du cerveau qui analysent et régulent les émotions et le comportement.</li> <li>Le comportement de votre enfant peut être lié aux crises ou aux médicaments. Certaines modifications de comportement sont normales pour n’importe quel enfant alors que d’autres plus graves doivent être traitées rapidement.</li></ul>

 

 

Epilepsy and behaviour2113.00000000000Epilepsy and behaviourEpilepsy and behaviourEEnglishNeurologyChild (0-12 years);Teen (13-18 years)BrainNervous systemConditions and diseasesCaregivers Adult (19+) EducatorsNA2010-02-04T05:00:00ZIrene Elliott, RN, MHSc, ACNP;Janice Mulligan, MSW, RSW ;Rose Geist, MD, FRCPC12.000000000000041.00000000000001777.00000000000Flat ContentHealth A-Z<p>Varying behaviors can be expected from a child with epilepsy. Parents sometimes notice negative changes triggered by anti-epileptic medication.</p><p>In a recent study of behaviour in children in the six months before a first recognized seizure, almost 25 per cent of the children had higher than expected rates of behavioural problems (particularly attention difficulties). This rate remains fairly static for those children in whom seizures are well controlled and in whom there are no other neurological problems (uncomplicated epilepsy). These findings suggest that seizures alone do not account for the behavioural problems seen in children with epilepsy. For those children who continue to have poorly controlled seizures plus other neurological problems, for example learning difficulties, the rate of behavioural difficulties can be as high as 56%. These findings suggest that epilepsy is a more complex disorder that may manifest itself with behavioural disturbances as well as seizures. </p><h2>Key points</h2><ul><li>Behavioural issues in children with epilepsy may be caused by fear or stress; frustration with learning difficulties; malfunctions in the areas of the brain that monitor and control emotions and behaviour.<br></li><li>Your child's behaviour may be seizure-related or medication-related. Some behavioural changes are normal for any child, while more serious behavioural changes need to be addressed quickly.</li></ul><p>Behavioural problems in children with epilepsy may have several causes, including:</p> <ul> <li>fear, stress, or embarrassment about having epilepsy</li> <li>frustration with learning and language difficulties</li> <li>malfunctions in areas of the brain that monitor and help control emotions and behaviour, because of an abnormality in those areas of the brain; abnormal brain wave (epileptic) activity that disrupts normal brain function; or anti-epileptic drug therapy that alters the balance of chemicals (neurotransmitters) in the brain that regulate behaviour.</li> </ul> <p>The extent to which your child may have behavioural problems depends on many things, including:</p> <ul> <li>the type and location of the epilepsy</li> <li>the frequency and intensity of the seizures</li> <li>the type of medication</li> <li>other people’s reaction and response to their seizures</li> </ul> <p>Together with the epilepsy care team, discuss potential problems to watch out for. Find out how you might obtain help in dealing with these issues should they arise. If you are concerned that your child has a more serious problem, consider seeking professional help for your child, ideally through a mental health professional specializing in children or adolescents. </p> <p>A helpful resource when thinking about ways to deal with behavioural outbursts can be found in the work of Ross Greene, PhD and his Collaborative Problem Solving (CPS) model. The CPS model is based on neuroscience research in over the last 30 years which suggests that challenging behaviour is a form of delay in development and is the by-product of lagging cognitive skills in the areas of flexibility/adaptability, frustration tolerance, and problem solving. For more information, please see the Resources section.</p> <h2>Minor behaviour issues</h2> <p>Many children who have epilepsy learn to adjust to their situation over time, with the right support. But like adults, children have good days and bad days. If your child is having a bad day, it may be hard to tell whether the cause is the epilepsy, the treatment, or your child just being a child. Crying, anger, fussiness, acting out, tantrums, or withdrawing can all be normal behaviours for children at certain times. </p> <p>Having epilepsy can be a very stressful experience. Your child may frequently experience symptoms that make them feel unwell. They may need to be away from home for treatment. Even if your child is familiar with the hospital or treatment centre where they are receiving their care, being away from home is still difficult. Your child may encounter many new people and undergo some treatments that can be painful, uncomfortable, and lead to a general feeling of being unwell. A chronic condition such as epilepsy may mean that these unpleasant experiences become routine, but of course this does not make it any easier for your child. The stress can influence your child's personality. They may, for instance, become fearful or anxious. They may "act out" or do things that are out of character. </p> <p>The best thing you can do to try and understand your child’s experience is talk to them, if they are old enough, and observe their behaviour for signs of how they are coping. Explore what they are thinking, doing, and feeling. Understanding your child’s perspective places you in the best position to offer support and help clarify any inaccurate beliefs your child may have about their health. </p> <p>There are several approaches you can take to reduce minor problem behaviours:</p> <ul> <li>Stick to a routine as much as possible. Children do much better when they know what to expect. Although life has become unpredictable due to the seizures, maintaining a routine will offer some predictability and security. </li> <li>Try to adopt a positive attitude about epilepsy.</li> <li>Try to develop a varied support network (family, friends, support groups, community services, and the epilepsy care team) that you can draw upon. Evidence shows that parents stressed by a child’s illness who have adequate social support are more likely to have children with fewer behaviour problems. </li> <li>Develop a strategy with your child to deal with inappropriate behaviour. For example, if your child is physically acting out when angry, find alternate ways for your child to express these feelings. Include your child as much as possible in finding a solution. Solutions that are developed in conjunction with your child have a greater chance of success because your child feels included and valued for their opinion. In some situations, talking is not always useful, and ignoring the behaviour may be the best strategy. This is something that you will be able to determine, as a parent, through experience with your other children or through trial and error. </li> <li>Acknowledge good behaviour when you see it. A reward could be special time set aside with parents.</li> <li>Respond to inappropriate behaviour with consequences that are suitable for your child’s age and stage of development. Prompt, consistent, and clear responses are useful. </li> <li>Look for opportunities for your child to have control over aspects of their life and make their own decisions.</li> </ul> <h2>Seizure-related behaviours</h2> <p>Some children display changes in behaviour, personality, and mood before or after a seizure, including inattentiveness, hyperactivity, irritability, or verbal or physical aggression. These changes can occur minutes to days before or after a seizure. During this period, certain triggers may further irritate your child and increase their frustration or aggression. </p> <p>Watch your child closely during seizure times to learn what behaviours they may exhibit or emotions they may be feeling. This will help you tell the difference between behaviours that need modifying and those that are seizure-related. During this period you may find that it is also a good idea to reduce stimulation in the school setting, for example, decreasing academic workload. </p> <h2>Medication-related behaviours</h2> <p>Parents sometimes notice sudden negative changes in their child’s behaviour when an anti-epileptic medication is introduced or the dose is increased. For example, a younger child who was typically quiet and well-behaved might become very irritable and start to hit other children. If the behavioural side effects are intolerable, discuss them with your child’s neurologist to see if reducing or discontinuing the anti-epileptic medication while adding another medication might be considered. </p> <p>Some anti-epileptic medications are also used to treat serious behavioural problems and some parents find that certain behaviours may improve when a child is started on a medication for seizures. Likewise, behaviour problems may develop when a child is taken off a seizure medication. </p> <h2>Serious behaviour changes</h2> <p>A small proportion of children with epilepsy may experience sudden outbursts of verbal or physical aggression. The aggressive behaviour may appear with little or no provocation and can go on for some time. These children present special challenges to the family, school and health professionals. </p> <p>The reasons for the outbursts are not clear and there has been little research in this area. One theory is that epileptiform discharges in the brain may affect brain function, which then affects behaviour. Another theory suggests that certain abnormal areas of the brain produce both epileptic activity and behavioural aggression. Some authors also suggest the behaviour may be aggravated by anti-epileptic drug therapy. </p> <p>Clinical observations at The Hospital for Sick Children, as well as conversations with children, parents, and teachers, suggest that these episodes of aggression often follow a pattern: </p> <ul> <li>The child perceives a certain situation as unpleasant or hurtful. For example, some children with epilepsy may have very sensitive hearing. Loud noises or a confusing number of noises in the classroom might precipitate explosive behaviour. </li> <li>Once the trigger stimulates an angry feeling, it is difficult for these children to "put on the brakes." It is not that they "won’t" control their aggression; rather, children say that they "can’t" control the aggressive outbursts. </li> <li>Parents report that children often experience remorse following an aggressive outburst. They may berate themselves, for example, saying, "I’m a bad person." </li> </ul> <p>More serious behaviour changes need to be attended to quickly. Here are some things you should do:</p> <ul> <li>Consult your child's doctor or the epilepsy care team about your child's behaviour. They can assist you in trying to determine the cause of the behaviour, and suggest a course of action. This may involve counselling for your child and/or educating others about your child’s situation. It could also involve reducing the dosage of the medication or changing the medication. </li> <li>Be alert to behavioural changes. Try to identify patterns or triggers that produce increased agitation and lead to verbal or physically aggressive outbursts. It is also helpful to identify when these episodes are likely to occur, for example, just before a seizure; during a period of increased noise or confusion in the classroom; or in the evening when they are tired. Steps can then be taken to reduce the impact of triggers that precipitate a behavioural meltdown. </li> <li>If your child shows signs of escalating agitation or aggression, it is important to quickly remove them from the situations in which a known trigger is present or remove the trigger that is precipitating the episode. If caught earlier on, this strategy can sometimes defuse escalating negative behaviours. </li> <li>Define the behavioural difference between "won’t" (the child is not willing to modify their behaviour) and "can’t" (the child is unable to put on the brakes, and the behaviour seems out of their control). Then define how responsible your child should be held for their behaviour. </li> <li>Try to manage behaviour by using established behavioural techniques. However, for some children standard behaviour management strategies alone do not seem to be effective. In these cases, a combination of strategies is sometimes required. </li> <li>Talk to your child about what the experience is like for them. They may be able to let you know what triggers or situations cause them to become agitated and lead to their behaviour changes. Work with them to identify strategies that they can use to defuse their agitation and anger and help them gain more control over their feelings and behaviour. This information can also help school staff to deal more effectively with your child’s behaviour. Involving a counsellor who has experience in working with children with epilepsy and who has dealt with such issues may be helpful. </li> <li>In some instances, evaluation by a social worker or psychiatrist may be required to determine the degree of the problem and whether your child requires further intervention. This intervention could include intensive behavioural therapy and/or medications that will help reduce or alleviate episodes of behavioural outbursts. </li> <li>Keep an open line of communication with your child’s teacher so that they can also watch out for and inform you of any concerns. Talk to them often and find out how your child is doing. </li> </ul>https://assets.aboutkidshealth.ca/AKHAssets/epilepsy_and_behaviour.jpgEpilepsy and behaviour

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