Epilepsy and Learning

Many children, especially boys with epilepsy (25-50%) will experience learning difficulties. Children with epilepsy have high levels of underachievement and make less progress than would be expected for their age and intelligence level. Due to the episodic nature of epilepsy, a child’s ability and knowledge may be variable. For example they may know something one day and have forgotten it the next. Some of these learning difficulties are directly related to epilepsy, while others are related to treatment and psychosocial factors. The types of cognitive difficulties most often reported are slowing of performance in speeded tasks, difficulty with tasks that require complex information processing, memory impairment and difficulties in concentration and attention.

Seizure variables associated with cognitive impairment include:

Type of seizure:
Seizures that are associated with loss of consciousness can disrupt mental functioning this can last for several days.
Absence seizures may produce temporary memory problems. They can also account for inconsistency in the pattern of a child’s learning patterns.
Tonic Clonic seizures are often followed by a period of tiredness or inattentiveness.
Complex partial seizures are associated with memory problems.
Generalized seizures can impair sustained attention.
Partial seizures can impair selective attention, memory, dysonomia (difficulty in finding words) and psychomotor speed.
Mixed seizure types are associated with higher cognitive impairment.
Children with left temporal lobe seizures show learning and memory deficits on delayed recall of verbal material.
Children with right temporal lobe seizures have greater difficulty with recalling tasks involving visuospatial ability.

Seizure frequency

Repeated tonic clonic seizures, complex partial seizures and to a lesser extent absence seizures are associated with cognitive impairment.

When seizures are very frequent, the time between seizures may not be long enough for recovery from the effects of the previous seizure.

Children may also be psychologically affected by frequent seizures.

Age of onset of seizures

An early age of onset, especially before the age of ten years is thought to be the
strongest seizure-related predictor of cognitive dysfunction.

Seizures that begin in older children may produce a period of instability, while they
undergo testing and begin taking medication. This may lead to some acting out behaviours that were not present before the seizures began.

For students experiencing their first seizure in adolescence the effect can be devastating. This is a period of life when social acceptance is paramount, it may also lead to a need to review their career aspirations.

Early onset of partial epilepsy is associated with poorer language skills.

Location of seizure focus

Children with left temporal lobe epilepsy may experience difficulties with verbal
processing including comprehension, rote learning and memory.

Children with right temporal lobe epilepsy may experience difficulty with independent
work and sequencing of tasks.

Underlying neurological impairment

The underlying neurological problem causing the seizure may also have an impact on learning and behaviour.

The underlying condition in the brain may interfere with the way the brain processes information. This may show up in mathematics, reading and tasks involving memory.

These seizures may be difficult to treat.

Sub-clinical discharges causing transitory cognitive impairment

Epileptiform EEG discharges can occur without clinical symptoms.

Even children who appear to be seizure free may be experiencing epileptic discharges in the brain, where there is no physical indication of a seizure.

These discharges may produce restlessness, distractibility, inability to focus, decreased capacity for taking in new information, and behavioural changes.

Sub-clinical discharges can also impair social interactions and social competence.

Disruption of sleep by seizures and discharges

Seizures occurring at night during sleep have an effect on learning ability the next day.

The cumulative effect of chronic Epileptiform discharges during sleep can disrupt brain function.

Seizures that occur some time after the information has been acquired may prevent the processes of encoding and storage.

Unrecognized seizures

Absence seizures may not always be apparent, or they may be misinterpreted as day dreaming, inattentiveness, poor concentration or even hearing problems.

Unrecognized seizures may account for inconsistency in the pattern of a child’s learning performance.

Children with unrecognized seizures may have considerable difficulty in learning. As a result they may withdraw, become frustrated and aggressive and lose confidence.

Presences of an epilepsy syndrome

Some epilepsy syndromes are known to be associated with cognitive deterioration.

Syndromes associated with cognitive and developmental delay are Lennox Gastaut syndrome, continuous spike and wave discharges during slow sleep, West syndrome and Landau Kleffner syndrome.

Status epilepticus

Status epilepticus may cause permanent damage to neural tissue and reduce its ability to react to new information.

The cumulative effect of status epilepticus may disrupt cognitive functioning.

Non-convulsive status is often unrecognized.

Repeated episodes of non-convulsive status may result in significant cognitive deterioration.

Other reasons for impaired cognitive function in epilepsy include:

Side effects of medication on attention, cognitive function, memory and motor skills.
Intellectual ability.
Child’s attitude to school.
Teacher’s attitude towards epilepsy.
Attitude of fellow class mates.
Teasing and bullying.
Poor self image.
Poor school attendance due to frequent seizures.

Information reproduced by kind permission of EQI. Source: ‘Epilepsy: A Resource for Teachers’ (Copyright 2002 Epilepsy Queensland Inc. Author: Anne Little)For further information or to purchase this book, please contact Epilepsy Queensland Inc.