Behavioral consequences of epilepsy in children. Developing a psychosocial vocabulary.
In this chapter we have described some of the experiences of a special psychiatric clinic for children with epilepsy, drawing our examples from a series of 50 children. The behavioral consequences of epilepsy cannot be adequately described within the limited nosology available for classifying the behavior disorders of children. As an alternative, a series of behaviors which children actually require in order to maintain their social existence have been identified; furthermore, impairments of those behaviors have been pointed to, and consequences of these behavioral impairments have been outlined. The behavioral consequences of epilepsy are often multiple and are sometimes mutually interactive. The extent to which these behavioral deviations depend both upon the exhibition of seizures and the presence of structural abnormalities in the brain is made most evident by the marked changes in behavior which can be achieved when epilepsy is relieved and a lesion is removed. Unfortunately, such a stratagem is not available to the majority of children with epilepsy. For the time being, their cerebral impairment and the continuation of their epilepsy have to be taken for granted, and intervention then consists of the best possible management of their impairments and their distressing behaviors. Such management clearly requires psychiatric and psychological skills, although these skills do not necessarily lead to greater success than does the use of anticonvulsants or the use of surgery. Success is not an adequate measure of the appropriateness of the endeavor. It goes without saying that not all children with epilepsy suffer behavioral consequences along these lines, and indeed behavioral disturbances were not universal even in this highly selected series. Some children were seen merely as a way of improving their medical status or achieving surgical treatment. These more traditional medical maneuvers are easier to undertake and are more understandable to parents than are complex strategies of psychiatry. In any event, parents deserve considerable support. The language of psychiatry for children with organic cerebral impairments is extremely limited; this chapter has been an attempt to improve our vocabulary, which will be a necessary underpinning in order to improve the quality of our classification. Finally, we return to Bridge's statement. Firstly, we do not regard epilepsy as a disease any more than we would regard cough as a disease, and we find that orientations in that direction are likely to thwart our attempt at piece-by-piece dismantling of the many sorts of disease which might be associated with seizures.(ABSTRACT TRUNCATED AT 400 WORDS)