Behavioral aspects of pediatric epilepsy syndromes
Behavioral aspects of pediatric epilepsy syndromes
复制标题
DOI：
10.1016/j.yebeh.2003.11.002
复制
发表时间：
2004-02-01
影响因子：
2.6
通讯作者：
Besag, FMC
中科院分区：
文献类型：
--
作者：
Besag, FMC
除了控制癫痫发作外，决定癫痫儿童独立性进展的两个最重要因素是认知和行为。正确的癫痫综合征的诊断通常提供关于良好的癫痫控制和智力结果的可能性的信息。然而，相对较少已发表的各种癫痫综合征的行为方面。在West综合征中，有新的证据表明，早期有效的治疗可能会改善认知和行为方面的结果。对结节性硬化症儿童的这种综合征的研究已经证明了颞叶结节和自闭症之间的联系。在Dravet综合征中，已经报道了各种精神障碍，包括多动和自闭症特征。这是另一种癫痫综合征，往往是耐药的治疗，这意味着预后必须谨慎。Lennox-Gastaut综合征报告的行为问题还包括自闭症特征，以及通常的迟缓行为。这些特征很可能在很大程度上反映了持续发作活动的影响。自闭症特征、攻击性和运动过度被描述为Landau-Kleffner综合征。通过适当的药物治疗或多次软膜下横断后，行为可能会显著改善。虽然良性部分性癫痫发作伴中央颞叶或罗兰棘波综合征的预后很好，但越来越明显的是，可能会发生行为问题，如注意力集中困难、脾气暴躁、多动和冲动。青少年肌阵挛性癫痫与非常多变的行为特征相关，有时还伴有不成熟的人格特征和不良的社会适应，提示额叶功能障碍。由于许多与癫痫综合征相关的行为障碍的报告都是轶事，不包括有效的行为措施，因此在现阶段从中得出明确的结论是不明智的。需要进行仔细的前瞻性研究，特别注意癫痫治疗成功后发生的任何行为改善。(C)2003年爱思唯尔公司All rights reserved.
Apart from control of the seizures, two of the most important factors in determining how well a child with epilepsy progresses toward independence are cognition and behavior. The diagnosis of the correct epilepsy syndrome often provides information with regard to probability of good seizure control and intellectual outcome. However, relatively little has been published on the behavioral aspects of the various epilepsy syndromes. In West syndrome there is emerging evidence that early effective treatment might improve outcome in terms of both cognition and behavior. The work on this syndrome in children with tuberous sclerosis has demonstrated an association between temporal lobe tubers and autism. In Dravet syndrome, a variety of psychiatric disorders have been reported, including hyperactivity and autistic features. This is another epilepsy syndrome that tends to be resistant to treatment, implying that the prognosis has to be guarded. The behavioral problems reported with Lennox-Gastaut syndrome also include autistic features, as well as generally sluggish behavior. It is very likely that these characteristics largely reflect the effect of ongoing seizure activity. Autistic features, aggression, and hyperkinesis have been described with Landau-Kleffner syndrome. The behavior may improve dramatically with appropriate medical treatment or after multiple subpial transection. Although the syndrome of benign partial seizures with centrotemporal or rolandic spikes is said to have a very good prognosis, it is becoming increasingly evident that behavioral problems such as concentration difficulties, tempers, hyperactivity, and impulsivity might occur. Juvenile myoclonic epilepsy has been associated with very variable behavioral traits, sometimes with immature personality features and poor social adjustment suggesting frontal lobe dysfunction. Because many of the reports of behavioral disturbance associated with epilepsy syndromes are anecdotal and do not include validated measures of behavior it would be unwise to draw firm conclusions from them at this stage. Carefully conducted prospective studies, paying particular attention to any behavioral improvements that occur with successful treatment of the epilepsy, are required. (C) 2003 Elsevier Inc. All rights reserved.