Cognitive Behavior Therapy for Epilepsy in Children

Epilepsy, according to MedlinePlus, is a brain disorder characterized by "repeated, spontaneous seizures of any type." Seizures vary in intensity but involve a disturbance in brain function that affects behavior and cognition. In addition to the seizures themselves, there is evidence that anti-convulsant drugs taken to control seizures can also adversely impact cognition and behavior. As a result, increased attention is focused on the role that cognitive behavioral therapy can play in easing these effects, particularly in children.

Impact of Anti-convulsants

• If you have an epileptic child, you'll want to know more about the effects that some anti-convulsant drugs can have. In "Anticonvulsants & Pregnancy: A Call to Action," a report published by the Epilepsy Foundation, a number of anti-convulsants commonly used to control seizures were tested for their impact on cognition and behavior. Phenobarbital was found to have the most negative effect on cognition in both adults and children, while phenytoin, topiramate and valproate had slightly less but still significantly negative impacts. Carbamazepine and lamotrigine were considerably milder in their impact on cognition and behavior. The most notable effects observed were impaired vigilance, attention and psychomotor speed.

Depression in Adolescents

• Given the dual impact of the underlying disorder and the medications taken to control its symptoms, you and other parents of epileptics may be concerned about the increased incidence of depression in adolescents with epilepsy. A study published in a 2006 issue of Epilepsy & Behavior evaluated the effectiveness of cognitive-behavioral interventions (CBI) in epileptic teenagers at high risk for depression. The study, conducted by doctors at the Institute of Mental Health in Belgrade, Serbia and Montenegro, focused on a group of 30 test subjects, who were divided into two groups. The first group received intensive cognitive-behavior therapy, while the second was given conventional counseling, or treatment as usual (TAU). At the end of the study period, the teens in the CBI group showed significantly less depressive symptoms than those in the TAU group.

Harvard Study

• Further underlining the need for cognitive behavior therapy in epileptic children is a Harvard Medical School study, published in a 2008 issue of Epilepsy & Behavior that showed a high incidence of attention-deficit/hyperactivity disorder (ADHD) among children with epilepsy. The study recommends that cognitive behavior therapy be combined with drug therapy, most notably methylphenidate, in a program that takes a comprehensive biopsychosocial approach to the problem. If your epileptic child shows signs of ADHD, you may want to discuss these findings with your doctor.

Psychogenic Seizures

• A study at Rhode Island Hospital found that cognitive behavioral therapy significantly reduced the incidence of seizures in patients diagnosed with psychogenic nonepileptic seizures (PNES), a condition that often is misdiagnosed as epilepsy. The seizures of PNES, unlike those of epilepsy, are not caused by disruptions of electrical signals in the cerebral cortex. The Rhode Island study, also published in Epilepsy & Behavior, showed that PNES patients, whose seizures often are triggered by anxiety and depression, responded well to cognitive behavioral therapy, which reduced seizure activity.