5. Age.

In general, the earlier in life seizures begin, the more likely that learning and behaviour will be affected. Parts of the child’s brain continue to develop until just before adolescence, so functions attributed to these developing parts may be disrupted by seizure activity. Children with epilepsy should be assessed for learning difficulties, especially if their seizure cause is symptomatic or their seizures are severe and frequent.

6. Psychosocial Factors.

Learning difficulties associated with epilepsy are affected by a variety of social and psychological factors. Some of these factors include family attitudes towards epilepsy and those living with epilepsy, family relationships, expressed emotion and communication of feelings and attitudes, expectations of those with epilepsy, and self-esteem.

The individual’s environment (at home and in society), thus plays a key role in learning. Positive social support networks are crucial for those with epilepsy in order to lessen the emphasis of these psychosocial factors on learning and cognition. Society’s negative attitudes towards people with seizures (especially children), and the stresses placed upon them at school, in their home (for example, parental separation), or in their work environment can contribute a great deal to disturbances in mood, behaviour, and ability to function.

For school-age children, seizures at school can be socially challenging, detrimental to self-confidence and self-esteem. Peer education can improve both quality of life and academic performance, by reducing problems like ridicule and fear from classmates. Teachers and parents need to be aware of the psychosocial influence of epilepsy on a child’s academic success and adjustment to the school atmosphere.

7. Anti-epileptic drugs.

As long as sound, common sense principles are followed, anti-convulsant drugs are unlikely to be primarily or exclusively responsible for cognitive or behavioural dysfunction in those living with epilepsy. We are not aware of any drug that is guaranteed not to have cognitive or behavioural side-effects. However, the side-effect profiles are different amongst the various drugs. The majority of those with epilepsy will be controlled on one anti-epileptic drug and function well. A few may require two. Fewer still may require three or four. The benefits of any combination must be weighed against the potential adverse effects, including those on cognition and behaviour, which are more likely to occur with polypharmacy (use of multiple drugs for treatment). On the next pages you will find a table indicating major anti-epileptic drugs and known cognitive side-effects. Keep in mind that not everyone experiences these side-effects and that they are usually most apparent at higher doses.

One is more likely to have negative side-effects if more than one drug is used. Furthermore, ‘herbal remedies’ should be used only with a great deal of caution as they can interact with prescribed drugs and further disturb learning.

In general, the newer anti-convulsant drugs have a much smaller negative effect on learning than the ‘older’ ones (e.g. phenobarbitol, benzodiazepines, etc.), but they may have other side-effects. Individuals with epilepsy should discuss the treatment options for his or her situation with their physician. Because everyone responds differently to a given drug, every case is unique.