Search

Some children with autism spectrum disorder (ASD) experience seizures and associated staring episodes, loss of consciousness, weakened muscle tone, and myoclonic jerking. Data recording of seizure frequency, duration, and co-occurring behavior is necessary to document the effects of anti-epileptic medications, identify contextual influences on seizure expression, and differentiate seizures from other movement disorders. We describe the design and operation of a computer-assisted system for recording seizures among children with ASD in a social validity study that revealed uniform approval and acceptance of the system from practitioners, clinicians, and nurse (N = 22), parents (N = 11), and neurologists (N = 7). The objectives and benefits of targeting the social validity of technology-based seizure tracking are discussed are discussed.

To assess the role of clinical features in diagnosing seizures in children with autism spectrum disorder who present with staring spells. A 10-year retrospective chart analysis of autism spectrum disorder patients aged 3-14 years was performed at a tertiary care children's hospital. Patient demographics, clinical presentation, and epileptic seizure versus non-epileptic spell diagnosis were assessed. Target episodes of staring spells were captured during a long-term electroencephalogram monitoring record. Multilevel likelihood ratios and a receiver operating characteristic curve were determined using 8 of the 11 clinical variables. Among the cohort of 140 patients with autism spectrum disorder, 16% were diagnosed with epileptic seizures with the most common seizure being atypical absence seizures (64%). Clinical semiology differed between those diagnosed with epileptic seizures versus those diagnosed with non-epileptic spells in the average duration of episodes (42 s vs 87 s), frequency of spells per week (6 vs 11.5 spells), increase in frequency of staring spells over time (100% vs 40%), and response to verbal stimulation (0% vs 100%), respectively. Multilevel likelihood ratios based on the receiver operating characteristic curves and clinical semiology features may be helpful in differentiating epileptic seizures from non-epileptic spells in children with autism spectrum disorder.

The effect associated with the presence of seizures in 2 to 5-year-old autistic children was investigated in the largest and the longest observational study to-date. Parents assessed the development of 8461 children quarterly for three years on five orthogonal subscales: combinatorial receptive language, expressive language, sociability, sensory awareness, and health. Seizures were reported in 958 children (11%). In order to investigate the effect of seizures, children with seizures were matched to those with no seizures using propensity score based on age, gender, expressive language, receptive language, sociability, sensory awareness, and health at the 1st evaluation. The number of matched participants was 955 in each group. Children with no seizures developed faster compared to matched children with seizures in all subscales. On an annualized basis, participants with no seizures improved their receptive language 1.5-times faster than those with seizures; expressive language: 1.3-times faster; sociability: 2.3-times faster; sensory awareness: 6.2-times faster; and health: 20.0-times faster. This study confirms a high prevalence of seizures in ASD children and informs on the effect of seizures on children's longitudinal developmental trajectories.

Background: Psychogenic nonepileptic seizures (PNES) are attacks that often look like epileptic seizures (ES). Unlike ES, PNES are not triggered by underlying neurological factors. PNES are relatively rare in the general population; however, their prevalence in people with learning disabilities is much higher--up to 10%. Individuals with PNES and learning disabilities often have psychiatric comorbidities, such as anxiety disorders, depression and posttraumatic stress disorder. There are currently no treatment guidelines for PNES in people with or without learning disabilities. However, talking therapies, such as cognitive-behavioural therapy (CBT), are recommended. This study explores the effectiveness of CBT for the treatment of PNES in a woman (Susan) with PNES and learning disabilities. Methods: We used a single-case experimental design (SCED) to investigate the effectiveness of CBT intervention. Specifically, the withdrawal (also known as ABA) design was applied. The patient's average PNES frequency, as well as idiosyncratic mood measure and standardised outcome measures for people with learning disabilities (Glasgow Anxiety Scale for People with an Intellectual Disability and Mini-Maslow Assessment of Needs Scale-Learning Disabilities), were used to assess the effectiveness of treatment. Findings: Results show that Susan's monthly PNES frequency reduced from phase A1 (assessment phase) to phase B (treatment phase), and this persisted to the follow-up phase (phase A2). However, the reduction was not statistically significant. The intervention was associated with improvements in Susan's mood, anxiety and quality of life. Reduction of Susan's anxiety was clinically significant. Conclusions: This SCED study demonstrates that CBT might be associated with reduction of PNES frequency and improvements in general functioning in people with PNES and learning disabilities; however, further research, especially around confounding variables is needed.

Sex education rarely covers disability. This paper uses autoethnography to reflect on how being epileptic impacted the author's understanding of sex and sexuality. The paper grapples with disability narratives and internalised ableism surrounding sex. The paper seeks to engage with conceptions of "who" sex education is for, and how disabled people are treated when it comes to sexuality.

There are many case reports of seizures apparently associated with the prescription of antipsychotics. This study aimed to examine whether there is an association between the prescription of antipsychotics and incident seizures in individuals with autism spectrum disorder using retrospective data based on patients' chart review. A cohort study was conducted to compare the rate of incident seizure between 3923 users of antipsychotics with 10,086 users of other psychotropics. This was followed by a self-controlled case series (SCCS) analysis of 149 patients to eliminate the effect of time-invariant confounders. The results showed no evidence of increased risk of seizure after exposure to antipsychotic agents (Hazard Ratio 1.28, 95% CI 0.74-2.19) compared to other psychotropics.

Self-management support has been identified as an effective nursing intervention for improving outcomes for people with chronic conditions, yet this concept lacks a clear definition. Furthermore, the concept has not been used in school nursing literature despite the clear connection between school nursing practice and tenets of self-management support. Additionally, the concept has not been explored in the context of difficult-to-manage mental health concerns, such as psychogenic nonepileptic seizures. A conversion disorder in which seizure events in the absence of abnormal brainwave activity result from stress, psychogenic nonepileptic seizures affect the quality of life and school experience for students experiencing them and could be addressed through self-management support. This hybrid concept analysis included a review of extant literature and semi-structured interviews with school nurses to ascertain a definition of self-management support in the context of school nursing using care of students with psychogenic nonepileptic seizures as an exemplar.

Stuttering and other developmental disorders are known to affect more male than female children. The present study compared: (1) stuttering prevalence in males and females at discrete ages and (2) prevalence of coexisting developmental disorders in male and female children who stutter (CWS). Data were obtained from the National Health Interview Survey (from 2010 to 2015). The sample comprised 62,450 total children, ages 3 to 17 years. Children in the current sample were those identified by their caregivers as having stuttered in the past 12 months. Rate of stuttering and data on five concomitant disorders (attention deficit hyperactivity disorder--ADHD; autism spectrum disorder; intellectual disability; learning disability; and seizures) were compared between male and female CWS and across three age categories: 3-5, 6-10, and 11-17 years. There were 1231 CWS, 852 males and 379 females, in the sample. Overall prevalence rates were 1.3%, 95% [CI 1.0, 1.6] for females, and 2.6%, 95% [CI 2.1, 3.2] for males, where prevalence rates decreased as age increased. For the total sample, male-to-female ratio was 2.0:1, 95% [CI 1.9, 2.5]. For coexisting developmental disorders, male CWS were at greater odds of having ADHD (OR = 2.32, 95% CI [1.62, 3.31]) and at lower odds than females of experiencing seizures (OR = 0.370, 95% [CI 0.214, 0.638]). Prevalence data at discrete ages revealed a different course of stuttering in early childhood for female and male children. Implications of sex differences, on the presence of ADHD and seizures/epilepsy among CWS, are discussed.

Parents of children with ASD who had attended an Australian emergency department (ED; n = 421) completed a questionnaire relating to their experiences in the ED, including (1) child's reason for presentation and existing comorbidities, (2) quality of care during the visit (3) child's behaviour during visit, e.g. sensory responses to the ED environment, and disruptive behaviours. Children with comorbid ASD and intellectual disability were more likely to present with gastrointestinal issues and seizures, while those with comorbid ASD and oppositional defiant disorder were more likely to present with self-injury. ED staff awareness of ASD-related issues, including communication and expression of pain, were common difficulties for parents. The ED environment (e.g. lights, sounds, waiting areas), exacerbated child anxiety and led to disruptive behaviour.

Differences in the learning associated transcriptional profiles between mouse strains with distinct learning abilities could provide insight into the molecular basis of learning and memory. The inbred mouse strain DBA/2 shows deficits in hippocampus-dependent memory, yet the transcriptional responses to learning and the underlying mechanisms of the impairments are unknown. Comparing DBA/2J mice with the reference standard C57BL/6N mouse strain we verify an enhanced susceptibility to kainic acid induced seizures, confirm impairments in hippocampus-dependent spatial memory tasks and uncover additional behavioral abnormalities including deficits in hippocampus-independent learning. Surprisingly, we found no broad dysfunction of the DBA/2J strain in immediate early gene (IEG) activation but instead report brain region-specific and gene-specific alterations. The learning-associated IEGs "Arc," "c-Fos," and "Nr4a1" showed no DBA/2J deficits in basal or synaptic activity induced gene expression in hippocampal or cortical primary neuronal cultures or in the CA1, CA3, or retrosplenial cortex following spatial object recognition (SOR) training in vivo. However, the parietal cortex showed reduced and the dentate gyrus showed enhanced SOR-evoked induction of most IEGs. All DBA/2J hippocampal regions exhibited elevated basal expression of inhibin [beta] A ("Inhba") and a learning-associated superinduction of the transcription factor neuronal Per-Arnt-Sim domain protein 4 ("Npas4") known to regulate the synaptic excitation-inhibition balance. In line with this, CA1 pyramidal neurons of DBA/2J mice showed fewer inhibitory and more excitatory miniature postsynaptic currents but no alteration in most other electrophysiological properties or gross dendritic morphology. The dysregulation of "Npas4" and "Inhba" expression and synaptic connectivity may underlie the cognitive deficits and increased susceptibility to seizures of DBA/2J mice.

Purpose: This case series documents developmental changes over time and in response to a novel intervention, Sitting Together and Reaching to Play (START-Play), in children with early-life seizures. Methods: Thirteen children with early-life seizures were included from a subset of participants in the START-Play multisite, randomized controlled trial. Seven received 3 months of twice weekly START-Play intervention; 6 continued with usual care early intervention. Bayley Scales of Infant Development-III (Cognitive Composite), Gross Motor Function Measure-66 Item Set, Assessment of Problem-Solving in Play, and reaching assessments were administered at baseline, 3, 6, and 12 months postbaseline. Change scores are reported at 3 and 12 months postbaseline. Results: Over time, plateau or decline was noted in standardized cognition measures; motor development improved or was stable. Children receiving START-Play showed positive trends in problem-solving (71.4%) and reaching behaviors (57.2%). Conclusions: Interventions such as START-Play that combine motor and cognitive constructs may benefit children with early-life seizures.

Psychogenic nonepileptic events (PNEE) are paroxysmal changes in behavior resembling epileptic seizures but with no electrographic correlate and are instead caused by psychological factors. In this qualitative study, semistructured interviews were conducted with 10 school nurses to identify how they perceive the experience of caring for a student with PNEE as well as supportive factors and barriers to optimal management of PNEE in schools. Several themes were identified: lack of diagnosis awareness by school staff leading to impressions that the student was "faking" the events, inadequate information provided by a health-care provider regarding the diagnosis in general and specifically about the individual student leading to a reliance on information from the student's family, feelings of doubt and insecurity about the diagnosis and management of the events, and reliance on the school nurse to develop a response plan and to manage the events which can be very time-consuming.

Background: This study explored antiepileptic drug use, frequency of seizures, and the effect of psychotropic drugs with the potential to lower the seizure threshold in persons diagnosed with epilepsy and intellectual disability. Methods: Data for this study were drawn from Wave 3 of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA). Psychotropic drugs were categorised for potential seizure threshold-lowering risk (low, moderate, high). Binary logistic regression was performed to identify factors associated with seizure frequency. Results: Epilepsy prevalence was 35.8% (n = 196), of which 57.7% reported a mental health condition. Participants with seizure data classified as taking at least one moderate-/high-risk medication were significantly less likely to experience a seizure compared to participants taking no potential seizure threshold-lowering medication. Conclusions: Psychotropic drugs recommended to be avoided or used with caution did not provoke increased seizure frequency in this cohort.

Meta-analyzing count data can be challenging when follow-up time varies across studies. Simply pooling aggregate data over time-periods would result in biased estimates, which may erroneously inform clinical decision-making. In this study, we exploit the convolution property of the Poisson distribution to develop a likelihood for observed cumulative counts over varying follow-up periods, where different Poisson distributions are used to represent the data generating processes for the latent counts in pre-defined successive intervals of follow-up. We illustrate this approach using an example of poststroke seizures, a case in which risk may change over time, and mimic its survival duration with time-varying hazard. Data were extracted from observational studies (1997-2016) reporting poststroke seizures over a maximum of 10 years of follow-up. Three clinically meaningful follow-up time intervals were considered: 0 to 7 days, 8 to 365 days, and 1 to 10 years poststroke. External validation was performed using claims data. Results suggest the incidence rate of seizures was 0.0452 (95% confidence interval: 0.0429, 0.0475), 0.0001 (0, 0.016), and 0.0647 (0.0441, 0.0941) for the three time intervals, respectively, indicating that the risk of seizures changes over time poststroke. We found that the model performed well against the incidence rate of seizures among actual retrospective cohort from claims data. The piecewise Poisson model presents a flexible way to meta-analyze count data over time and mimic survival curves. The results of the piecewise Poisson model are readily interpretable and may spur meaningful clinical action. The method may also be applied to other diseases.

The paucity of scientifically rigorous school nursing clinical practice guidelines (CPGs) presents barriers to evidence-based care of students with special health-care needs. A "Model for Developing Evidence-Based Clinical Practice Guidelines for School Nursing" (School Nursing CPG Model) was developed under the auspices of the National Association of School Nurses (NASN) to address this need. To test and validate this School Nursing CPG Model, a trial CPG development project was conducted to (1) identify structure and process gaps and areas for improvement within the School Nursing CPG Model and (2) develop an evidence-based CPG for school nursing practice that addresses a priority student health condition: seizures and epilepsy. The School Nursing CPG Model was validated through a trial CPG project which followed the systematic, standardized process of the School Nursing CPG Model while responsively implementing quality improvement measures through the Plan-Do-Study-Act cycle. Both specific aims were accomplished.

Epilepsy is a heterogeneous collection of neurological conditions and syndromes characterized by recurrent, unprovoked, paroxysmal seizure activity. It is estimated that 10.5 million children under 15 years have active epilepsy, representing about 25% of the global epilepsy population. Of the 3.5 million people who develop epilepsy annually, 40% are younger than 15 years, and more than 80% live in developing countries. Epilepsy is an important cause of neurological morbidity in children. Family history of epilepsy, neonatal complications, perinatal brain damage, congenital cerebral malformations, intracranial infection, neonatal seizures, febrile seizure were found as predictors of childhood seizure disorder in many of the studies. In early onset epilepsy perinatal asphyxia, neonatal meningitis and neonatal seizure was found to be the important predictors little research has been done on childhood epilepsy in Aseer region. Greater knowledge on risk factors of epilepsy in the early years of life could help to improve understanding of epilepsy, can tell us about its prognosis and allow early intervention. Objectives: This research aimed to determine the prevalence of epilepsy among the school children and determine the risk factors associated with epilepsy Methodology: A case control study was conducted among school students aged 6 up to 18 years. Primary, preparatory and secondary schools was randomly selected in Abha and Khamis Mushait. Results: 20 cases of epilepsy was detected among the studied group. The identified major etiologic factors of the epilepsies were cerebral trauma, febrile convulsions, A family history of epilepsy was a risk factor of the cases, and the consanguinity rate among the parents was high. Conclusion: The most important risk factors for epilepsy in this study only head trauma, febrile convulsions, consanguinity and family history of epilepsy were significant.

Little is known about the role of family characteristics in sleep disturbance for children with autism spectrum disorder (ASD). This study involved an exploratory analysis of the association between 17 child, parent, and socioeconomic characteristics and sleep disturbance using data from 203, 2-18--year-old children with ASD whose families participated in the Western Australian Autism Biological Registry. Results suggest that greater ASD symptom severity; child seizures; maternal autism traits, anxiety, and depression; lower paternal education; and lower family income were related to increased sleep disturbance. All these characteristics, aside from maternal depression, were significant predictors within a regression model, which accounted for 33% of the total variance. Thus, child characteristics alone may not adequately explain sleep disturbance in children with ASD.

This study examined lifetime medical and psychiatric morbidity reported by caregivers of 2917 autistic adults participating in the US research cohort SPARK. Participants were 78.4% male, 47.3% had intellectual disability, and 32.1% had persistent language impairments. Childhood language disorders (59.7%), speech/articulation problems (32.8%), sleep (39.4%) and eating problems (29.4%), motor delays (22.8%) and history of seizure (15.5%) were the most frequently reported clinical features. Over two thirds (67.2%) had been diagnosed with at least one psychiatric disorder (anxiety disorders: 41.1%; ADHD: 38.7%). Compared to verbally fluent participants, those with language impairments had lower frequencies of almost all psychiatric disorders. Female sex and older age were associated with higher medical and psychiatric morbidity. [This article was written with the SPARK Consortium.]

Aggressive behaviors in those with intellectual disability (ID) and autism (ASD) have been linked to a variety of factors including ID level, age, sex, psychiatric disorders, and medical conditions but these factors have not been studied, in large samples, in terms of how they affect the stimuli that trigger aggression. In this survey of 2243 adults, four triggers of aggression associated with frustration, discomfort, change in the physical/social environment, and defensive reactions were analyzed for their relation to ID level, ASD, age, sex, number of psychiatric diagnoses, sleeping problems, seizures, visual impairment, ear infections and gastrointestinal problems. All four triggers were associated with increasing number of psychiatric disorders, with frustration, discomfort, and change intolerance commonly linked to sleeping problems and ASD. Implications for assessment and intervention are discussed.

Memory deficits significantly decrease an individual's quality of life and are a pervasive comorbidity of epilepsy. Despite the various distinct processes of memory, the majority of epilepsy research has focused on seizures during the encoding phase of memory, therefore the effects of a seizure on other memory processes is relatively unknown. In the present study, we investigated how a single seizure affects memory reactivation in C57BL/6J adult mice using an associative conditioning paradigm. Initially, mice were trained to associate a tone (conditioned stimulus), with the presence of a shock (unconditioned stimulus). Flurothyl was then administered 1 h before, 1 h after, or 6 h before a memory reactivation trial. The learned association was then assessed by presenting a conditioned stimulus in a new context 24 h or 1 wk after memory reactivation. We found that mice receiving a seizure 1 h prior to reactivation exhibited a deficit in memory 24 h later but not 1 wk later. When mice were administered a seizure 6 h before or 1 h after reactivation, there were no differences in memory between seizure and control animals. Altogether, our study indicates that an acute seizure during memory reactivation leads to a temporary deficit in associative memory in adult mice. These findings suggest that the cognitive impact of a seizure may depend on the timing of the seizure relative to the memory process that is active.

Many randomized trials evaluate an intervention effect on time-to-event outcomes. Individual participant data (IPD) from such trials can be obtained and combined in a so-called IPD meta-analysis (IPD-MA), to summarize the overall intervention effect. We performed a narrative literature review to provide an overview of methods for conducting an IPD-MA of randomized intervention studies with a time-to-event outcome. We focused on identifying good methodological practice for modeling frailty of trial participants across trials, modeling heterogeneity of intervention effects, choosing appropriate association measures, dealing with (trial differences in) censoring and follow-up times, and addressing time-varying intervention effects and effect modification (interactions).We discuss how to achieve this using parametric and semi-parametric methods, and describe how to implement these in a one-stage or two-stage IPD-MA framework. We recommend exploring heterogeneity of the effect(s) through interaction and non-linear effects. Random effects should be applied to account for residual heterogeneity of the intervention effect. We provide further recommendations, many of which specific to IPD-MA of time-to-event data from randomized trials examining an intervention effect.We illustrate several key methods in a real IPD-MA, where IPD of 1225 participants from 5 randomized clinical trials were combined to compare the effects of Carbamazepine and Valproate on the incidence of epileptic seizures.

Millions of students with mental health concerns attend school each day. It is unknown how many of those students experience psychogenic nonepileptic seizures (PNES); however, quality of life, academic, and mental health outcomes for students experiencing PNES can be bleak. Currently, no authors have addressed potential school nurse interventions for students with PNES. Because PNES is a mental health condition and is often influenced by underlying anxiety and/or depression, an integrative review of school nurse interventions and outcomes for students with general mental health concerns was conducted. An integrative review resulted in the identification of 13 quantitative and 2 qualitative studies that met inclusion criteria. The findings from this review suggest school nurses, following principles from the Framework for 21st Century School Nursing Practice, play an active role in mental health interventions and should be involved in replicating and testing known mental health interventions to investigate their effectiveness for students with PNES.

Introduction: Intellectual disability (ID) is characterized by limitations in cognitive and adaptive functioning. The aim of this study is to examine sociodemographic characteristics, perinatal and childhood risk factors, and prevalence of psychiatric and biomedical comorbidities in children with ID. Methods: 260 patients with ID were included in the study (mean age: 8.42 [plus or minus] 3.59, 61% male, 75% mild ID). The Ankara Developmental Screening Inventory, the Wechsler Intelligence Scale for Children--Revised, and the Porteus Maze Test were used to assess the intelligence of the participants. An additional questionnaire was used to investigate their sociodemographic characteristics and birth, developmental, and medical histories. Results: Adverse perinatal/neonatal events (p < 0.001), biomedical comorbidities (p < 0.001) and seizure/convulsion history (p < 0.001) were strongly associated with the moderate-severe ID. The children with mild ID had more emotional-social deprivation (p = 0.022). Low socioeconomic situation, parental education, and teenage parenthood were risk factors for stimulus deficiency. While internalizing disorders were more common in those with mild ID and among girls, externalizing disorders were more common in those with moderate-severe ID and among boys. Conclusion: Interventions to perinatal/neonatal events may reduce the rate of moderate-severe ID. Evaluation of psychiatric and medical comorbidities and elimination of emotional-social deprivation should be fundamental components of the services offered to children with ID.

The most common chronic neurological condition in children is epilepsy. Because it often occurs in childhood, epilepsy is likely the most common neurological condition encountered by school professionals including teachers. Given the impact that epilepsy can have on academic functioning and specifically on the day-to-day performance of a student in the classroom, it is important for teachers to be aware not only of the presence of the disorder but also of the potential consequences and appropriate ways to handle these consequences should they arise. Herein we synthesize recommendations from several scientific sources to provide specific, evidence-based strategies that teachers of students with epilepsy can employ in the classroom as part of their naturally occurring instructional routines. These practical tips have useful application for both general and special education teachers.

Spatial memory, the aspect of memory involving encoding and retrieval of information regarding one's environment and spatial orientation, is a complex biological function incorporating multiple neuronal networks. Hippocampus-dependent spatial memory is not innate and emerges during development in both humans and rodents. In children, nonhippocampal dependent egocentric (self-to-object) memory develops before hippocampal-dependent allocentric (object-to-object) memory. The onset of allocentric spatial memory abilities in children around 22 mo of age occurs at an age-equivalent time in rodents when spatially tuned grid and place cells arise from patterned activity propagating through the entorhinal-hippocampal circuit. Neuronal activity, often driven by specific sensory signals, is critical for the normal maturation of brain circuits This patterned activity fine-tunes synaptic connectivity of the network and drives the emergence of specific firing necessary for spatial memory. Whereas normal activity patterns are required for circuit maturation, aberrant neuronal activity during development can have major adverse consequences, disrupting the development of spatial memory. Seizures during infancy, involving massive bursts of synchronized network activity, result in impaired spatial memory when animals are tested as adolescents or adults. This impaired spatial memory is accompanied by alterations in spatial and temporal coding of place cells. The molecular mechanisms by which early-life seizures lead to disruptions at the cellular and network levels are now becoming better understood, and provide a target for intervention, potentially leading to improved cognitive outcome in individuals experiencing early-life seizures.

The rates of epilepsy among children with autism spectrum disorders (ASD) are higher than that of the general population. The exact prevalence and aetiology of the comorbidity of autism and epilepsy are not well understood; however, the connection is well-documented. This common comorbidity makes the treatment of epilepsy increasingly complex for children with ASD. The purpose of this article is to provide an overview of the relevant literature for individuals with epilepsy with a particular focus on individuals with both ASD and epilepsy according to the following framework: (a) evaluation procedures, (b) child characteristics and outcomes and (c) treatment options. Thirty articles met specific inclusion criteria. Several treatment options for epilepsy in children with ASD were uncovered, including medications, vagus nerve stimulation and surgery. Still, more research is needed to identify comprehensive treatments that have been empirically proven to be successful for children with ASD.

Purpose: We sought to estimate the prevalence of isolated epileptiform activity (IEA) in children with speech and language impairments and discuss the utility of an electroencephalogram (EEG) in assessing these children. Method: We conducted a systematic review and searched for eligible studies in 8 databases. All languages were included, and meta-analyses were performed. Results: We found 55 prevalence estimates (8 with control group). The odds of having IEA were 6 times greater for children with speech and language impairments than for typically developing children. The overall pooled prevalence of IEA was 27.3%. A wide variation between the prevalence estimates was, to a certain degree, explained by type of impairment (8.1% in speech impairments, 25.8% in language impairments, and 51.5% in language regression). Sleep EEGs detected a significantly higher prevalence than awake EEGs. Although the presence of epilepsy gave a significantly higher prevalence than if epilepsy was not present, 33.5% of children with language impairment but without epilepsy were found to have IEA in sleep EEGs. Conclusions: This systematic review shows that IEA is 6 times more prevalent in children with speech and language impairment than in typically developing children. However, the prevalence rates vary to a great extent. Uncovering IEA will, in addition to information from other clinical assessments, provide a more comprehensive understanding of the child's impairments. We argue that, although EEG is of questionable value when assessing children with speech impairments, sleep EEG could be valuable when assessing children with language impairments and, in particular, children who experience language regression.

Background: Epilepsy and challenging behaviour are both highly prevalent in the intellectual disability (ID) population and it is thus crucial to understand any possible associations between the two. Method: PsycINFO, MEDLINE, Embase, CINAHL and Web of Science were searched for quantitative data about epilepsy and any forms of challenging behaviour in adults with ID. Results: A total of 25 articles were included in the review. Overall the evidence suggests that while epilepsy is not a good explanatory variable for the presence of challenging behaviour; the relationship is complex. However, for some people with epilepsy and for certain types of challenging behaviour a link may exist. Conclusions: Given the possible link between epilepsy-related factors such as seizure type and specific subgroups of challenging behaviour, investigating these relationships further and particularly exploring how to best measure challenging behaviour in people with epilepsy could be of great clinical benefit.

Background: As both epilepsy and challenging behaviour are highly prevalent in adults with intellectual disability (ID) it is important to explore any potential relationships between the two to inform patient care. The aim of the present study was to investigate the relationship between epilepsy factors and challenging behaviour in adults with ID. Method: The sample was drawn from a clinical trial cohort (n = 246), with all participants displaying challenging behaviour across the range of ID. We described sociodemographic and clinical status (seizure types, seizure frequency and drug burden) in 70 participants with epilepsy (EP). We investigated differences in and predictors of challenging behaviour and mental ill-health, measured by the Aberrant Behaviour Checklist-Community and the Mini Psychiatric Assessment Schedule for Adults with Developmental Disabilities respectively, between participants with and without epilepsy (NEP). Results: More male participants were identified with epilepsy (EP = 76% and NEP = 61%, p = 0.026) and the EP group had lower adaptive behaviour scores than their NEP counterparts (Mean (SD) EP = 44.4 (24.1), NEP = 51.7 (25.0), p = 0.04). EP participants showed significantly less lethargy as measured by the Aberrant Behaviour Checklist-Community than NEP participants (Mean (SD) EP = 11.9 (7.4) and NEP = 15.1 (9.9); t-test p = 0.02). Younger age and poorer adaptive functioning were associated with challenging behaviour (beta=-0.520, p < 0.001 and beta=-0.30, p < 0.001, respectively). Conclusions: These findings indicate that epilepsy does not appear to be associated with challenging behaviour in adults with ID. Therefore, while management of epilepsy is very important in a clinical context, it is essential that professionals should further elucidate reasons for the presentation of such behaviours in order to provide timely and targeted interventions.

Epilepsy represents a common neuropsychological disorder in children, which presents a myriad of cognitive, neuropsychological, social, emotional, behavioral, and learning problems. School psychologists are in a unique position to provide psychoeducation, assessment, intervention, and general supports for students with epilepsy and their families. Understanding the characteristics of epilepsy, types of seizures, and the impact on learning and behavior is essential to providing a supportive educational environment for these students.

Epilepsy is a neurologic disorder that results in recurrent, unprovoked seizures. The biomedical burden of epilepsy can be substantial, but for many the social consequences may be just as extreme, with epilepsy victims suffering from social abandonment as well as economic and physical vulnerabilities. Since its founding in 2000, the Chikankata Epilepsy Care Team, a collaborative project between Michigan State University and the rural Zambian community of Chikankata, has worked to improve the lives of people with epilepsy. What began as a local nurse-medical student partnership in one small rural Zambian hospital has grown into a program that supports and enriches clinical services and advocacy programs throughout Zambia. Recognizing the imperative for knowledge to influence policy, this university-community partnership works tirelessly to inform key stakeholders and policy makers of its findings. The program received the 2011 Outreach Scholarship/W. K. Kellogg Foundation Engagement Award for the North Central region.

In Canada, approximately three out of every 1,000 children have epilepsy, making it one of the most commonly diagnosed neurological conditions affecting children. It is therefore highly probable that educators will work with this population at some point in their careers. Epilepsy is linked to academic underachievement and social isolation, but little is known about how students with epilepsy experience school, making their unique needs less familiar to school personnel. The purpose of this phenomenological study is to identify the school experiences of children with epilepsy. Specifically, this study identified children's perceptions and experiences of having epilepsy at school and acquired insights to inform future studies. Participants were six students (ages 7-12 years) who have a diagnosis of epilepsy and reside in Victoria, British Columbia, Canada. Data were gathered through open-ended, semi-structured interviews. These interviews were transcribed and analyzed to obtain the essential experiences of school children with epilepsy. Four categories emerged from these interviews: (a) seizures, (b) academics, (c) social belonging and (d) awareness. Implications for schools and directions for future research are discussed. (Contains 1 table.)

Since the early 1970s, neuroscientists recognized that it was possible for patients to re-regulate brain wave activity. Much of this early work focused on helping persons with epilepsy control their seizures and was later extended toward helping children with attention deficit hyperactivity disorder (ADHD) with concentration. This brainwave training is called quantitative electroencephalography (QEEG) biofeedback or neurofeedback. Today, there is increasing scientific evidence that neurofeedback training can help address a variety of cognitive and behavioral issues in children and adults; particularly in the area of ADHD. In addition, neurofeedback is being employed in the treatment of those persons with alcohol and drug dependency, anxiety disorders, traumatic brain injury, chronic pain, depression, and autism spectrum disorders. Further, there appears to be a growing public awareness and support of this technology. This article explores the history of QEEG, reviews the biological basis for neurofeedback training, identifies how this technology appears to help clients with a variety of psychological and physiological disorders, and offers a critique concerning the state-of-research regarding neurofeedback efficacy. Strategies on the part of health educators to responsibly engage emergent developments in the field of neurofeedback are offered. (Contains 2 tables.)

Fixed momentary schedules of differential reinforcement of other behavior (FM DRO) generally have been ineffective as treatment for problem behavior. Because most early research on FM DRO included presentation of a signal at the end of the DRO interval, it is unclear whether the limited effects of FM DRO were due to (a) the momentary response requirement of the schedule per se or (b) discrimination of the contingency made more salient by the signal. To separate these two potential influences, we compared the effects of signaled versus unsignaled FM DRO with 4 individuals with developmental disabilities whose problem behavior was maintained by social-positive reinforcement. During signaled FM DRO, the experimenter presented a visual stimulus 3 s prior to the end of the DRO interval and delivered reinforcement contingent on the absence of problem behavior at the second the interval elapsed. Unsignaled DRO was identical except that interval termination was not signaled. Results indicated that signaled FM DRO was effective in decreasing 2 subjects' problem behavior, whereas an unsignaled schedule was required for the remaining 2 subjects. These results suggest that the response requirement per se of FM DRO may not be problematic if it is not easily discriminated. (Contains 4 figures, 1 table, and 1 footnote.)

The purpose of this study was to survey special and regular educators as to their knowledge and attitudes about a newly developed drug for seizure control, Diastat. Recently the administration of this drug by school personnel has been mandated as a related service under IDEA. A total of two hundred schools were surveyed in four different areas of the United States. The results showed that a majority of both special and regular educators were unaware of the use of this drug and many were reluctant to administer it. Implications and suggestions for future research are put forth. (Contains 1 table.)

Well-prepared school nurses are more likely to handle emergencies properly. Thus, assessing crisis management preparedness is important. In August 2014, a questionnaire was sent to 275 nurses in a large Texas school system to collect data about nurse and school characteristics, emergency frequency and management, and equipment availability. Completed surveys (201, 73%) were analyzed. Fisher's exact test was used to evaluate comparisons among nurses' confidence levels, school characteristics, emergencies, and medical emergency response plans (MERP). Logistic regression was used to estimate associations between characteristics and nurses reporting less confidence. Most respondents were experienced nurses. Shortness of breath was the most common event faced. Odds of less confidence were significantly higher among nurses with <5 years' experience, working at elementary schools, schools without a MERP or where it was not practiced, or caring for <10 schoolchildren weekly. Overall, recommended emergency management guidelines were met.

We examined how demographic and clinical characteristics differ between emergency department (ED) visits for epilepsy (EP cohort) and ED visits for other reasons (non-EP cohort) in children with ASD. The data were drawn from the 2009 and 2010 Nationwide Emergency Department Sample. We performed both univariate and multivariate analyses to compare and contrast similarities and differences between EP cohort and non-EP cohort among children with ASD. The results showed ED visits in EP cohort were more likely to occur among adolescents aged 13-17 years, less likely to occur among children with co-occurring psychiatric conditions, and were more likely to co-occur with injury. We discussed some unique challenges for managing children with both ASD and epilepsy.

This systematic review examines the effectiveness of Mozart's music in decreasing seizures in children with epilepsy (Mozart Effect) using the Johns Hopkins Nursing Evidence-Based Practice rating scale©. A search for articles with "Mozart Effect," "child*," and "epilepsy" was conducted in CINAHL Complete, Science Direct, Cochrane, and PubMed databases. Eight studies were selected based on the exclusion and inclusion criteria after removal of duplicates (n = 17) and others (n = 46). Studies included were English language, peer reviewed, published between April 2010 and February 2017, and available in full text with an abstract. Quasi-experimental studies demonstrate that the Mozart Effect May reduce epileptiform discharges or seizures in children and has potential as an adjunct to medical management of seizure activity or alone when medication or surgery is not accepted. A causal relationship between the music of Mozart and decreased seizure activity has yet to be demonstrated.

Little has been reported about how to improve health care access and delivery for adolescents and adults with autism spectrum disorder. To understand the contributions to the health disparities in the autism spectrum disorder population, we conducted two independent research approaches to learn about current medical needs. A retrospective chart review was performed to evaluate medical comorbidities and medication use. A focus group was also created to address barriers faced in providing medical care. Of 126 charts reviewed, 49% (n = 62) had intellectual disability, 49% (n = 62) had attention-deficit hyperactivity disorder, 52% (n = 65) had anxiety, 41% (n = 52) had obesity, 31% (n = 39) with a history of aggressive behavior, 31% (n = 31) had depression, 22% (n = 28) had seizures, and 9% (n = 11) had hypertension. A Medical Regimen Complexity Index score was determined to examine medication use trends in the autism spectrum disorder population. Medical Regimen Complexity Index scores were significantly higher for patients with intellectual disability, patients with seizures, and patients with a history of aggressive behavior. Both the focus group and our pre-visit assessment identified the waiting room and waiting time as barriers to care. Understanding the comorbidities, polypharmacy, and medical barriers should provide a better understanding of the current health care access and delivery needs of adolescents and adults with autism spectrum disorder.

Introduction: In view of the limited studies on the psychosocial environment of children presenting with conversion disorders, the present study was carried out to study the psychosocial factors in children with conversion disorders. Method: 40 patients of Conversion Disorder, who presented with "pseudo seizures" and were diagnosed according to DSM IV criteria, comprised the sample. They underwent detailed psychiatric assessment. The psychosocial events and factors and were elicited by administering the PSLES and by interviewing the parent and child by a semi-structured interview, which covered details of school history, family environment, psychosexual and other behavior: The intellectual level of the patients was assessed by a battery of psychological instruments. Relevant investigations, hormonal assays, radiological, EEG etc. were done wherever necessary. Results: Majority of the patients were educated up to 5th class, had rural domicile and belonged to poor and lower middle SES. They were about equally represented in the two sexes. Borderline Intellectual functioning, improper schooling, family stress and current past/physical illness were present in 37.5-40 % (N=15-16) of the cases. Incidental radiological and EEG findings and unusual status of the child; only son, only child or the youngest child; were present in 33% (N=13) of the cases. Conversion/epilepsy in family/neighbour/friend and improper parenting was encountered in 22.5-20.5% (N=8-9) of the cases. Lastly, recent loss of loved one and sibling rivalry were seen to be significant in 7.5 to 12.5% (N=3-5) of the cases. 80 % of the patients had 2-3 contributory factors; the remaining had either 4 or 5 contributory factors. Conclusion: Stress was apparent in the areas of school, family and body. Greater attention must be paid both by teachers and parents by supervising the children's studies more closely. Parenting skills need to be sharpened for the better functioning of the child. Attention needs to be paid to better physical health during infancy and early childhood. (Contains 3 tables.)

Little is known about Autism Spectrum Disorder (ASD) in persons over age 50. In a retrospective, naturalistic review of 74 individuals aged 30 and older meeting DSM-5 criteria for ASD, the point prevalence of behavioral and neuropsychiatric symptoms (BNPS) declined significantly for 12 of 13 BNPS over a mean of 25 years while many other features of ASD remained stable. GI disorders (68.9%) and seizure disorders (23%) were common, and 25.7% of the sample had a BMI >30. Females were more likely to engage in screaming (p < 0.05) and oppositional behavior (p < 0.05). Current age did not have a significant effect on BNPS prevalence.

Children and adolescents in the United States spend many hours in school. Students with chronic health conditions (CHCs) may face lower academic achievement, increased disability, fewer job opportunities, and limited community interactions as they enter adulthood. School health services provide safe and effective management of CHCs, often for students with limited access to health care. A systematic review to assess the role of school health services in addressing CHCs among students in Grades K-12 was completed using primary, peer-reviewed literature published from 2000 to 2015, on selected conditions: asthma, food allergies, diabetes, seizure disorders, and poor oral health. Thirty-nine articles met the inclusion criteria and results were synthesized; however, 38 were on asthma. Direct access to school nursing and other health services, as well as disease-specific education, improved health and academic outcomes among students with CHCs. Future research needs to include standardized definitions and data collection methods for students with CHCs.

A rundown of presymptomatic hazard elements is set up in view of audit of current writing. Distinguishing proof of such hazard variables may possibly help with prophylactic treatment; be that as it may, minimal exact research exists around there and treatment rules are up to this point to a great extent in view of master conclusion. Advance, while the neurobiology of schizophrenia progressing at fast step, to great extent because of advances in hereditary qualities, the pathophysiology of Postictal psychology rests generally obscure. Bearing in mind the advance in schizophrenia explore with regards to the medical elements of postictal psychology and prevailing studies, possible neurobiological systems for postictal psychology in these projected and more hereditary examinations, which distinguish those defenseless.