Impairments, Disabilities and Handicap in Children with Epilepsy

Abstract

Motor and sensory function were evaluated in 269 children with epilepsy. The EB test, the Bruininks Oseretsky Test of Motor Proficiency, the Cailler Asuza Scale and the International Classification of Impairments, Disabilities and Handicap (WHO) were used.An evaluative measure of motor and sensory function, the EB test, was developed for children aged 6–16 years with epilepsy. The new physiotherapy protocol included gross motor function, balance, coordination, strength, range of motion, velocity, fine motor function, sensation, perception and performance in neurological tests. The quality and level of sensorimotor function were scored and classification of handicap was performed. The reliability of the test was found to be good, r8 = 0.9, as well as validity and responsiveness to change.In 72 children with intractable epilepsy, sensorimotor impairments were found in 88% and also present in the absence of major disorders such as mental retardation and cerebral palsy.The motor and sensory function of 50 children were investigated before and 6 months, after epilepsy surgery, in 34 children also 2 years after surgery. Significant motor and sensory improvements were found in 72% of the children, including those with multiple disabilities. Improvements were seen in 95% in the seizure-free group (n = 20) and in 64% in those with reduced seizure frequency (n = 22). The younger children (n = 13) benefited more (85%) from surgery as regards sensorimotor function than did older children and adolescents (n = 37) (68%).In 88 mentally retarded children with epilepsy, motor and sensory impairments, resulting in disabilities and handicap, were found in 97%. The severity of the mental retardation and of the epilepsy correlated with the severity of the motor and sensory dysfunction. In another 84 children and adolescents with epilepsy but without additional neurodisorders, deficits in gross motor function—balance, coordination and speed—were found in about 30%. Boys performed better than girls. Motor function scores improved with age but motor problems persisted in the teenage years. The children on monotherapy performed significantly better than those on polytherapy.The pattern of handicap was assessed in 217 children and adolescents with epilepsy. Handicap was most severe in the dimensions of physical independence and orientation. It was more severe with a long duration of epilepsy and when the onset of seizures was early in life. Handicap was significantly reduced after epilepsy surgery.