Abstract
A marked prevalence of mental health dysfunction in childhood epilepsy has been documented
in the literature. While several individual risk factors have been identified, which
are statistically associated with an impaired mental health outcome, there is a lack
of knowledge on the pathways taken by these risk factors on disease development and
treatment. The relevant literature of the last decade will be reviewed in this paper
to provide evidence for the conceptual framework presented here. Thus, the emergence
of mental health dysfunction in childhood epilepsy is analyzed under three levels.
Pathogenetic causes. These involve both the underlying CNS pathology and the associated epilepsy disorder
characterized by specific time of onset duration type and severity.
Mediators and moderators connecting causes to outcomes. These comprise, firstly, the differentiation between the intervening role of anti-epileptic
drugs and their positive psychotropic impact via suppression of seizure activity and
transient cognitive impairments, as against their negative psychotropic side-effects;
secondly, the psychological processes of adaptation which entail responding to three
major demands (adherence to treatment requirements, exercising self-control and lifestyle
modification to reduce seizure activity, and coping with the psychosocial stressors
secondary to living with epilepsy); thirdly, the age-dependent level of neurocognitive
and behavioral functioning; and, fourthly, contextual risks and protective factors
within the family and social environment.
Mental health outcome. This encompasses three major domains: risks for learning disability, for impairments
of health-related quality of life, and for psychopathology.
The proposed framework serves the development and validation of hypotheses and can
be applied to testing procedures aimed at investigating the emergence of mental health
dysfunction in childhood epilepsy. On the scientific level, it provides an appropriate
tool to approach childhood epilepsy in general, whereas on the clinical level, it
facilitates the assessment and management of individual patients.
Keywords
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Article info
Publication history
Accepted:
February 26,
2004
Received in revised form:
February 20,
2004
Received:
July 17,
2003
Identification
Copyright
© 2004 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
