The nature of cognitive dysfunction in school-children with epilepsy.

Abstract

The literature on cognitive dysfunction in children with epilepsy is scattered and diverse in its nature. A review of it [ l ] indicates at least four types of reports. Some consist mainly ofinipressions. These are an important source of ideas, but insufficient in themselves and not necessarily in agreement with each other. Other reports are more empirically derived but are based on relatively crude ratings, usually by teachers or parents. In other accounts, measurements have been made of the performance ofchildren on laboratory or formal psychological tests, or of school attainments. These various reports leave certain fundamental issues unresolved. The meaning of some of the central concepts remains confused. The same term may cover different types of behaviour not necessarily closely correlated. Both “inattentiveness” [2] and “poor memory” [3] are ofthis type. Another problem is that, although laboratory or formal psychological tests may be convenient to use, their predictive value for real life behaviour has rarely (if ever) been satisfactorily demonstrated. The need for “real life” measures of dysfunction in adults has recently been recognized in cognitive psychology [4-61. These studies have emphasized the use of appropriately constructed questionnaires. An additional problem, which runs through behavioural studies in epilepsy, is that many different factors may affect the behaviour of the epileptic child. Type of epilepsy, drug treatment, emotional state, home and school environment, and even the child’s sex may all be relevant [ I ] . These factors may opcrate in combination and their relative effects are oftcn difficult to disentangle. The present study addresses all thrrc types ofproblem. It is an attempt to clarify the type of cognitive dysfunction in children with epilepsy by means of a measure of behaviour in the rcal life situation of the classroom. It is also concerned with assessing the relevance to such behaviour of some of the confounding factors just mentioned. The details of this study will be published elsewhere (Bennett-Levy & Stores. in preparation).