“Peter has been a terror for years now. We’ve had him to several psychologists, and we’re on our third psychiatrist. Now he’s in a residential school for further evaluation. Something has to be done to control these outbursts before he kills someone. They did an EEG, and now they say that this is epilepsy because the EEG is abnormal. I’ve read about epilepsy, and Peter has never had a seizure. It’s just that when someone frustrates him, or does something he doesn’t like, he erupts like a volcano. There’s no controlling him. He hits and bites and punches. I’m afraid he’ll hurt somebody. Gradually he’ll calm down and act as if he’s sorry. Could this be epilepsy? I almost hope so, since then we’ll have medicine to treat him.”
Sudden outbursts of bizarre, often violent behavior are not uncommon among emotionally disturbed children and also among those who are mildly or moderately retarded. Psychiatrists often ask their neurological colleagues if such episodes can be seizures. The answer is virtually always no! Studies have shown that apparently intentional violence almost never occurs during a seizure. If, during the confusion that commonly occurs during the “post-ictal” state, that is, after the seizure, a child is restrained or threatened, a child may react in a combative but random fashion. In this post-ictal, confused state, the child does not mean to fight back or even understand what he is doing.
Episodic behavioral outbursts are almost always precipitated by an event or by frustration. Seizures never are. Seizures usually have a postictal state in which the child is tired or confused. Behavioral outbursts never do. However, the EEG obtained between seizures or behavioral episodes may be either normal or abnormal and, therefore, does not help differentiate seizures from behavioral outbursts. Spikes on an EEG (see Chapter 7) can be observed in children who never have seizures.
Repeated episodic behavioral changes, in the absence of obvious seizures, are virtually never seizures and, therefore, do not respond to anticonvulsants.
Rare patients have confused even the best neurologists. In these cases, trying to capture the episode on video-EEG monitoring may be the only method of ascertaining what is a seizure and what is not. Needless to say, the same individual may experience behavioral problems and seizures also.
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“This was the third time this fail that the teacher has called us in for a meeting. She says that Joshua is disruptive to the class. He bites, fights, and won’t sit still. His reading is terrible, and I’m afraid that he is going to be expelled. What should we do? Can they expel someone from the second grade? I think that the real problem is that the teacher is afraid that he’ll have a seizure in class and really just wants him out.”
We would begin to analyze this problem by asking the parents to tell us more about Joshua. What sort of a child is he? Is he having these types of behavior problems at home? Are they new? When did they first start? Was he having similar problems in the first grade last year? Was there anything particular which might have caused them? What was the relationship of the onset of these problems to the onset of his seizures and to the initiation of his anticonvulsant medication?
Behavioral problems such as biting, fighting, and other disruptive behavior can come from many different sources. Any of the anticonvulsant medications can cause behavioral changes such as this. If the change began shortly after the start of a new anticonvulsant, then perhaps a different medication should be tried. However, behavioral changes rarely occur weeks or months after the child has been on the same medicine, unless there has been a change in the dose. New behavior problems can be caused by psychological disturbances initiated by problems at home or in school; they could be caused by the teacher’s behavior towards the child and the child’s reaction to his teacher’s behavior. Does Joshua know about his seizures? Is he afraid or embarrassed by them? Perhaps a careful explanation of the seizures would alleviate some of his fears, and this might allow him to be less aggressive in school.
Discussing the problems and concerns with the teacher (or the principal) and with your physician can help you to sort through these different causes. Whatever the cause, the recent change in Josh’s behavior certainly is reason for concern and investigation. It is a common symptom of problems that require solutions. It could be Joshua’s psychological way of asking for help.
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LIVING WITH EPILEPSY/SCHOOL: LEARNING AND BEHAVIOR –JOSHUA’S PSYCHOLOGICAL AND SOCIAL PROBLEMS”This was the third time this fail that the teacher has called us in for a meeting. She says that Joshua is disruptive to the class. He bites, fights, and won’t sit still. His reading is terrible, and I’m afraid that he is going to be expelled. What should we do? Can they expel someone from the second grade? I think that the real problem is that the teacher is afraid that he’ll have a seizure in class and really just wants him out.”We would begin to analyze this problem by asking the parents to tell us more about Joshua. What sort of a child is he? Is he having these types of behavior problems at home? Are they new? When did they first start? Was he having similar problems in the first grade last year? Was there anything particular which might have caused them? What was the relationship of the onset of these problems to the onset of his seizures and to the initiation of his anticonvulsant medication?Behavioral problems such as biting, fighting, and other disruptive behavior can come from many different sources. Any of the anticonvulsant medications can cause behavioral changes such as this. If the change began shortly after the start of a new anticonvulsant, then perhaps a different medication should be tried. However, behavioral changes rarely occur weeks or months after the child has been on the same medicine, unless there has been a change in the dose. New behavior problems can be caused by psychological disturbances initiated by problems at home or in school; they could be caused by the teacher’s behavior towards the child and the child’s reaction to his teacher’s behavior. Does Joshua know about his seizures? Is he afraid or embarrassed by them? Perhaps a careful explanation of the seizures would alleviate some of his fears, and this might allow him to be less aggressive in school.Discussing the problems and concerns with the teacher (or the principal) and with your physician can help you to sort through these different causes. Whatever the cause, the recent change in Josh’s behavior certainly is reason for concern and investigation. It is a common symptom of problems that require solutions. It could be Joshua’s psychological way of asking for help.*248\208\8*
The answer depends on the child’s level of retardation. The natural tendency of most parents and grandparents is to overprotect a child with epilepsy. However, overprotection, particularly of a mentally retarded child, leads to infantilization, ultimately a greater handicap to a child than the seizures themselves. It is crucial for such a child to be as independent as possible. The retarded child needs every opportunity to achieve his optimal potential.
When your child has multiple problems, such as mental retardation and epilepsy, the family has a lot of compensating to do. With epilepsy alone, you can usually maintain your expectations for his future— assuming, of course, they were realistic to begin with—since most epilepsy can be controlled or outgrown. Even when epilepsy occurs in children with retardation, your expectations for your child should rarely be changed.
Helping your child to cope with mental retardation depends greatly on the degree of retardation. The severely retarded child may not be clearly aware of his disability. Today many moderately retarded individuals function in noncompetitive employment, are able to live in the community with assistance, and engage in a variety of social activities. The process of developing these capabilities begins in childhood with mainstreaming in schools and socialization through churches, scouting, and athletics. Developing these capabilities begins within the family as well—seeing a child’s potential, encouraging him to learn to participate, helping him to achieve his full worth.
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COPING WITH THE UNCERTAINTIES OF SEIZURES AND EPILEPSY: COPING WITH LABELS – HOW SHOULD I TREAT MY CHILD WHO HAS BOTH RETARDATION AND EPILEPSY?The answer depends on the child’s level of retardation. The natural tendency of most parents and grandparents is to overprotect a child with epilepsy. However, overprotection, particularly of a mentally retarded child, leads to infantilization, ultimately a greater handicap to a child than the seizures themselves. It is crucial for such a child to be as independent as possible. The retarded child needs every opportunity to achieve his optimal potential.When your child has multiple problems, such as mental retardation and epilepsy, the family has a lot of compensating to do. With epilepsy alone, you can usually maintain your expectations for his future— assuming, of course, they were realistic to begin with—since most epilepsy can be controlled or outgrown. Even when epilepsy occurs in children with retardation, your expectations for your child should rarely be changed.Helping your child to cope with mental retardation depends greatly on the degree of retardation. The severely retarded child may not be clearly aware of his disability. Today many moderately retarded individuals function in noncompetitive employment, are able to live in the community with assistance, and engage in a variety of social activities. The process of developing these capabilities begins in childhood with mainstreaming in schools and socialization through churches, scouting, and athletics. Developing these capabilities begins within the family as well—seeing a child’s potential, encouraging him to learn to participate, helping him to achieve his full worth.*197\208\8*
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