Coexisting Disorders in Children with Epilepsy*

Children with epilepsy often manifest comorbid conditions, some causally related to the seizure activity (eg, congenital malformation, injury, metabolic disturbance, tumors) and others due to the epilepsy treatment (eg, behavioral complications due to antiepileptic drugs [AEDs]). Repeated seizure activity is associated with cognitive regression, behavioral disturbance, social disability, and sleep disorders—conditions that may be difficult to recognize in children with epilepsy and other developmental disorders (eg, mental retardation, cerebral palsy, autism) and that coexist in a high proportion of cases. Prompt recognition and treatment of these coexisting disorders is critical to achieving the best seizure control and overall quality of life for patients and their families. The potential for treatment-related disorders must also be carefully considered in this population. Clinicians should be aware of the range of adverse effects of AEDs (eg, behavioral, gastrointestinal, hematologic, neurologic, and renal) and be prepared to reevaluate treatment options as necessary. (Adv Stud Med. 2003;3(7B):S680-S683) T he incidence of epilepsy in children from birth to age 15 years is approximately 5 to 7 cases per 10 000. The range of conditions contributing to pediatric epilepsy includes congenital malformations of the central nervous system, moderate or severe head trauma, central nervous system infections, inherited metabolic conditions, and genetic factors. These factors account for only 25% to 45% of cases, with the etiology of the majority of cases remaining unknown. While most children with epilepsy have a generally good prognosis, those with coexisting neurological disorders experience more difficulties. This review will provide background and highlight current management issues related to these children with epilepsy and coexisting disorders. Epilepsy is one of the main developmental disorders of childhood, the others being cerebral palsy, mental retardation, autism, and the spectrum of learning, attention, and hyperactivity problems. Developmental disorders are defined broadly as conditions in which the antecedents are established before birth. There is considerable overlap between epilepsy and developmental disorders and there are many shared comorbidities. In some instances, comorbidity may be causally related to the epilepsy or an underlying feature of an epilepsy syndrome. In other cases, comorbidity is more related to seizure activity or its treatment. Whatever the suspected relation to the underlying diagnosis of epilepsy and the degree of overlap with coexisting developmental disorders, the prompt recognition and management of coexisting disorders in the seizure-prone child is critical. The symptoms may be difficult to detect, but failure to take action may result in severe medical disability. PROCEEDINGS