Cognition and Behaviour in Childhood Epilepsy edited by Lieven Lagae
Book Review by Ram Kumar
Alder Hey Children’s Hospital, Liverpool, UK.
Published in Developmental Medicine and Child Neurology, November 2017
This book gives a state-of-the-art description of clinical research on comorbid cognitive and behavioural issues in children with epilepsy. The authors are leading researchers and clinicians in Europe and North America, drawn from the disciplines of paediatric neurology, neuropsychiatry, neuropsychology, and neuroimaging.
The unique approach taken in this book is to delineate and differentiate the cognitive and behavioural issues in key genetic and syndromic groups of childhood epilepsy. This modern approach is necessary given the advances in mainstream clinical practice, including developments in molecular genetics testing, diagnosis and treatment of neonatal seizures, availability of advanced neuroimaging, and accessibility of interventions such as epilepsy surgery.
A repeated theme is the attempt to answer the overiding concerns of many parents and treating clinicians: why do some children with epilepsy appear not to make the developmental and educational gains that one would have expected when the child was younger, and indeed why do some children appear to deteriorate in terms of their cognition, behaviour, and mood? All the important contributory factors are addressed, including the underlying brain network disorder that predisposes to epilepsy, age at onset in a critical developmental phase, seizure frequency, transient electrophysiological dysfunction, adverse effects of medications, and other non-biological factors.
The initial chapters provide an overview of the relevant issues in childhood epilepsy including epidemiological evidence of the burden and impact of cognitive and behavioural problems, before discussing specific issues in neuropsychological testing and interpretation in children. There is a chapter on the prevalence and treatment of specific psychiatric and neurodevelopmental comorbidities, including attention-deficit–hyperactivity disorder, autism spectrum disorder, and mood and non-epileptic attack disorders.
There are specific chapters on lessons from long-term longitudinal epidemiological studies, functional neuroimaging (including resting-state functional magnetic resonance imaging), and neurophysiological studies including animal models. There is a useful chapter synthesizing the evidence available on the cognitive and behavioural adverse effects of specific antiepileptic drugs.
The remaining chapters consider the issues in specific subgroups or syndromes of childhood epilepsy of vital prognostic significance. These include consideration of the long-term outcomes of neonatal-onset seizures and the varied outcomes of the more benign epilepsy syndromes (e.g. benign epilepsy with centrotemporal spikes and benign infantile epilepsies) and more malign epilepsies (e.g. infantile spasms, continuous spikes and waves in slow-wave sleep, Lennox-Gastaut syndrome, and Dravet syndrome).
The final chapter on the cognitive and behavioural outcomes of epilepsy surgery in children considers the nature and incidence of areas of specific improvement and decline after surgery, including cognitive functions such as memory.
Overall, the book achieves its stated aim and more. It will certainly be a valuable resource for researchers wishing to revise or identify gaps in the established literature in these areas as each chapter includes detailed references (up to 2015) to the major primary research papers in each area.
I kept the book by my side during some of my epilepsy clinics. Before or after seeing individual children, I also found it useful to refer to specific chapters on questions arising from the consultation. For example, is ethosuximide causing cognitive problems in a child with absence epilepsy or is it unwitnessed absence seizure activity – or perhaps the underlying condition? The book will also be a practical aid for clinicians wishing to take a modern evidence-based approach to treating and counselling children with epilepsy and their families.