Michael W. Risinger

Childhood Epilepsy and Asthma: Comparison of Quality of Life

Summary: We report results from the first data collection on an ongoing longitudinal study aimed at describing thenatural history of adaptation to childhood epilepsy andasthma in children and their families. We studied 136 children with epilepsy and 134 children with asthma aged 8–12 years. Data were collected from the children, theirmothers, and their school teachers through interviews, school records, and questionnaires. The two sampleswere compared on four domains of quality of life: physical, psychological, social, and school. Data were analyzed by a 2 × 2 between‐subjects multivariate analysis ofcovariance with type of illness (epilepsy or asthma) as theindependent variable and length of time since onset ofillness as a covariate. A significant main effect was notedfor illness [multivariate F (15, 236) = 11.36, p < 0.001].Our major finding was that children with epilepsy had arelatively more compromised quality of life in the psychological, social, and school domains. In contrast, children with asthma had a more compromised quality of lifein the physical domain. Our findings suggest that attention simply to seizure control in the clinical setting willnot address the full range of quality‐of‐life problems ofchildren with epilepsy.

Adolescents with active or inactive epilepsy or asthma : A comparison of quality of life

Summary: Purpose: We compared quality of life (QOL) in youth with inactive or active epilepsy with that of a similar sample of youth with asthma. We explored 19 different dimensions in three domains (psychological, social, and school) and also determined differences related to illness severity and gender.

Correlates of Behavior Problems in Children with Epilepsy

Summary: We report results from the first part of an ongoing longitudinal study aimed at identifying the relative contributions of demographic, seizure, and family variables in the prediction of behavior problems in children with epilepsy. We studied 127 children with epilepsy aged 8–12 years and their mothers. Self‐report questionnaires, interviews, and medical records were data sources. Backward and forward stepwise elimination procedures using multiple regression indicated five variables that contributed significantly to prediction of behavior problems: female gender, family stress, family mastery, extended family social support, and seizure frequency. These factors accounted for 29% (p < 0.001) of the variation in behavioral problems. Findings suggest that family variables are important correlates of behavior problems and should be considered in clinical management of children with epilepsy.

Performance reassessment of a real-time seizure-detection algorithm on long ECoG series

Summary:  Purpose: Automated seizure detection and blockage requires highly sensitive and specific algorithms. This study reassessed the performance of an algorithm by using a more extensive database than that of a previous study and its suitability for safety/efficacy closed‐loop studies to block seizures in humans.

The Role of the Intracarotid Amobarbital Procedure in Evaluation of Patients for Epilepsy Surgery

Purpose: To examine the role of the intracarotid amobarbital procedure (IAP) in the presurgical evaluation of patients with medically refractory localization‐related epilepsy.

The ictal EEG as a predictive factor for outcome following corpus callosum section in adults

UNLABELLED Published reports have indicated that after callosotomy half or more of all patients will experience a 50% or greater reduction in seizure frequency. Those callosotomy patients whose seizures produce falls appear to have the best results. We studied the value of ictal EEG in 41 patients 18 years or older who had undergone either a total or partial callosotomy at our program. Ictal EEGs were separated into two categories: Type I: generalized slow spike wave, electrodecrement, non-evolving low amplitude fast activity; Type II: all other patterns. Types I and II were then compared to a defined one-year outcome for the targeted seizure type using Chi-square or Fishers Exact Test. Previously identified predictors of good or worthwhile outcome as defined by the literature were also evaluated. RESULTS A significant association was noted for presence of specifically defined EEG patterns and a 90% reduction in seizure frequency but not for other factors analyzed. CONCLUSION The ictal EEG but not other factors is able to identify a group of patients who have a better than 90% chance for total or nearly total resolution of seizures causing sudden falls.

Intracranial ictal recordings in Mesial frontal lobe epilepsy.

Localization of ictal onset in patients with medically refractory frontal lobe epilepsy is challenging even with intracranial monitoring. We present a series of nine patients with presumed mesial frontal lobe epilepsy in whom successful localization of ictal onset was achieved in most cases. Intracranial electrodes were placed over cingulate and supplementary motor cortex bilaterally, with additional electrodes placed over lateral and inferior frontal lobes as part of an evaluation for epilepsy surgery. Localization of the ictal onset was clearly defined in seven of nine patients and was characterized by a pattern of lower amplitude beta/gamma range frequencies noted in one to four adjacent electrodes arising from cingulate cortex or supplementary motor cortex in six patients. In the remaining patient, ictal onset was characterized by periodic high amplitude spike and slow-wave discharges evolving into a higher voltage faster rhythm. Electrographic onset occurred coincident with or preceded clinical findings. Ictal pattern also did not demonstrate a widespread propagation pattern in most of the recordings in which ictal onset was well localized. Precise localization of ictal onset within the mesial frontal lobe is possible. Rapid propagation to regions within and outside the frontal lobe does not always occur.

Relationship of selected seizure variables in children with epilepsy to performance on school-administered achievement tests

This study investigated the relationship of age at onset, epilepsy syndrome, seizure type, and seizure frequency to the performance of children with epilepsy (CWE) on school-administered group achievement tests that measured reading, mathematics, language, vocabulary, and overall achievement. Also assessed was whether the subjects had been retained in a grade at school and if the seizure variables could discriminate between retained and nonretained children. Separate hierarchical regression models using the seizure variables as predictors and the achievement scores as criterion measures were established. Chi-square and discriminant function analyses were used to investigate the relationship of the seizure variables to being retained in a grade. There were no significant relationships between the seizure variables and the achievement scores, with variance accounted for, ranging from 5% to 14%. Children with secondary generalized seizures were more likely to have been retained in a grade, but there was no relationship between being retained and seizure type. The seizure variables could not significantly discriminate between retained and nonretained students. It is suggested that emphasis should be placed on reducing vulnerability of CWE to dropping out of school.

Classroom Performance and Adaptive Skills in Children with Epilepsy.

Abstract The relationships of age at onset, seizure syndrome, seizure type, and seizure frequency, respectively, to the classroom performance and adaptive skills of 131 children with epilepsy were studied. The Teacher Report Form of the Child Behavior Checklist was completed by the childrens teachers. Hierarchical multiple regression analyses were conducted on ratings of academic subject areas and overall adaptive skills. Significant results were obtained for English/Language, Reading, Mathematics, overall School Performance, Learning, Happy, and Total Adaptive skills. Epilepsy syndrome and frequency of seizures were significantly related to some of these analyses, with amounts of variance accounted for ranging from 11% to 23%. Children with secondary generalized epilepsy performed significantly worse than children with other epilepsy syndromes. The results suggest that a seizure disorder associated with a diffuse or multifocal brain insult can produce problems in achievement and school adaptation as manifested on a day-to-day basis. Suggestions for future research are presented.