Eleanor Finch
Epilepsy is a condition that affects the brain and causes seizures. It is a relatively common condition, with around 83 patients with absence epilepsy included in a study. The statement that is incorrect concerning epilepsy is that it is associated with intellectual impairment. Several studies have been conducted on the long-term prognosis of childhood epilepsy, focusing on the pathophysiologic mechanisms and therapeutic targets of the condition.
| Characteristics | Values |
|---|---|
| Statement | Epilepsy is associated with intellectual impairment |
| Correct Answer | Incorrect |
| Study | Long-term follow-up of childhood epilepsy with absences |
| Sample Size | 83 patients |
| Condition | Absence epilepsy with generalized tonic-clonic seizures |
| Treatment | Standard therapy with ethosuximide and valproate |
| Outcome | 80% of patients treated became seizure-free |
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What You'll Learn
Epilepsy is associated with intellectual impairment
Epilepsy is indeed associated with intellectual impairment. The prevalence of epilepsy in people with intellectual disabilities (ID) is higher than in the general population. Studies have shown that epilepsy is associated with low levels of understanding, and children with epilepsy and an intellectual disability or cerebral palsy present a wider range of problems than children with uncomplicated epilepsy.
Intellectual impairment can manifest in various ways, including poor understanding, communication difficulties, problems with social functioning, and challenges with problem-solving. Mental handicap or intellectual disability occurs in approximately 9% of children with epilepsy and is more common when seizures begin at an early age, especially before 2 years old. Additionally, epilepsy in adults with intellectual disabilities can lead to compounded challenges in neurological, psychiatric, medical, and social domains, often requiring specialized and multidisciplinary care.
The presence of both epilepsy and intellectual disability can further lead to a range of associated problems. For instance, in adults with epilepsy and ID, there are higher rates of wetting, soiling, walking difficulties, daily living skills impairments, poor speech, lack of empathy, mood swings, uncooperativeness, attention-seeking behaviour, and nocturnal disturbances. These associations highlight the complexity of managing epilepsy in individuals with intellectual impairments.
Furthermore, the management of epilepsy in children with intellectual disabilities or cerebral palsy requires a multidisciplinary approach involving doctors, therapists, education specialists, and parents. The evaluation of these children's cognitive abilities may require specialized assessments by neuropsychologists, considering their individual strengths and weaknesses to make appropriate recommendations for their education.
While epilepsy is associated with intellectual impairment, it is important to note that the relationship between the two conditions is complex and varies from person to person. The presence of intellectual impairment in individuals with epilepsy can impact their understanding, communication, and management of the condition, requiring tailored approaches to care and support.
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Childhood epilepsy
Epilepsy is a brain condition that causes recurring seizures over time. These seizures are not linked to short-term illnesses or injuries. When a child has two or more seizures with no known cause, they are diagnosed with epilepsy. The type of seizure depends on which area of the brain is affected and how much of it is impacted. Focal seizures, for instance, occur when abnormal electrical brain function occurs in one or more areas of one side of the brain. Before a focal seizure, children may experience an aura, such as feelings of deja vu, fear, or changes in their senses.
The goal of epilepsy treatment is to control, stop, or reduce the frequency of seizures. Treatment is typically done with medication, and medicines are selected based on the type of seizure, age, side effects, and ease of use. While seizures usually respond well to medication, allowing children to lead normal and active lives, surgery may be an option for children with hard-to-control seizures that always start in one part of the brain that does not affect speech, memory, or vision.
Some common types of epilepsy syndromes in childhood include Childhood Absence Epilepsy (CAE), which occurs between ages 2 to 12, and Juvenile Absence Epilepsy (JAE), which starts between ages 8 to 20. CAE seizures are brief, with children suddenly staring blankly before resuming their activity, and they are typically well-controlled with medication. Other types of epilepsy syndromes include Childhood Epilepsy with Centrotemporal Spikes (Rolandic) and Juvenile Myoclonic Epilepsy (JME), which tends to run in families.
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Tonic-clonic seizures
First aid for a person experiencing a tonic-clonic seizure should focus on ensuring the person's breathing is okay and that they don't injure themselves. It is important to protect the person from injury by helping them to the floor and clearing away any furniture or other items that could hurt them. Do not attempt to hold the person still or put anything in their mouth, as this may lead to injury. Time the seizure, and if it lasts more than 5 minutes, call for emergency medical help.
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Thalamocortical circuits in generalized epilepsy
Thalamocortical circuits are an emerging therapeutic target in generalized epilepsy, which affects 24 million people globally. The thalamus, with its widespread connections throughout the brain, plays a critical role in generalized epilepsy. The thalamus is involved in generating different firing patterns that influence brain states. Transitions from tonic firing to highly synchronized burst firing mode in thalamic neurons can cause seizures that rapidly generalize and lead to altered awareness and unconsciousness.
There are two distinct populations of neurons in the thalamus implicated in generalized epilepsy: TC neurons and nRT neurons. TC neurons are intrinsically oscillatory due to the alternating activation and deactivation of specific channels. They are glutamatergic projection neurons that innervate neocortical neurons in layer 4 and receive glutamatergic input from corticothalamic (CT) neurons in neocortical layers 5 and 6. The glutamate signal from CT neurons acts on ionotropic glutamate receptors expressed on the TC neurons' surface, which are essential for information flow through the thalamocortical circuit.
NRT reticular thalamic neurons, on the other hand, regulate GABAergic input to TC neurons, thus influencing firing mode in the thalamocortical circuit. GABA reuptake has been implicated in absence epilepsy, with reduced GAT-1 function in thalamic astrocytes prolonging neuronal GABAA and GABAB receptor activation and promoting spike-and-wave discharges. Thalamic astrocytes have been found to proliferate and take on a reactive phenotype in various models of epilepsy, downregulating glutamate and GABA transporters and decreasing potassium uptake while spontaneous seizures develop.
Understanding the thalamocortical circuits in generalized epilepsy is crucial for developing effective treatments. By studying the underlying networks that generate and spread epileptic activity, researchers can identify potential therapeutic targets. For example, TASK and TREK channels should be explored as targets for much-needed treatments, as they influence the firing mode in thalamocortical circuits.
In summary, thalamocortical circuits play a significant role in generalized epilepsy, with the thalamus influencing brain states and seizure activity. Further research into the thalamocortical interactions will lead to a better understanding of the pathophysiology of epilepsy and potentially lead to the discovery of novel therapeutic targets.
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Pediatric epilepsy
Seizures occur when there is a sudden change or burst of abnormal electrical activity in the brain, which temporarily interrupts normal brain function. This can cause a person to stare, collapse, shake, or become unaware of their surroundings. There are two main types of epileptic seizures: focal (partial) seizures and generalized seizures. Focal seizures occur when abnormal electrical activity takes place in one or more areas of one side of the brain. Before a focal seizure, a child may experience an aura, such as feelings of deja vu, fear, or changes in their senses. Generalized seizures affect both sides of the brain.
After a child experiences a seizure, physicians may perform additional tests, such as brain imaging or an electroencephalogram (EEG), to determine the type of epilepsy and inform treatment. The goal of treatment is to control, stop, or reduce the frequency of seizures, and medication is often used to achieve this. The type of medication and dosage are chosen based on the type of seizure, the child's age, side effects, cost, and ease of use. It is important for parents and caregivers to administer the medication as directed to effectively manage the seizures and reduce the risk of Sudden Unexpected Death in Epilepsy (SUDEP).
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Frequently asked questions
No, this statement concerning epilepsy is incorrect.
Childhood epilepsy with absences is a type of epilepsy that starts with generalized tonic-clonic seizures.
About 80% of patients treated with standard therapy for absence epilepsy became seizure-free.
Some studies on epilepsy include "Thalamocortical circuits in generalized epilepsy: Pathophysiologic mechanisms and therapeutic targets" and "Long-term prognosis for childhood and juvenile absence epilepsy".
