الفهرس 
Introduction and Aim of the WorkOnly 14 pages are availabe for public view
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Abstract
Over the past years, syndrome-oriented clinical and
EEG diagnosis, and better etiological diagnosis, especially
supported by neuroimaging, has helped to clarify the diversity of
epilepsy in children, and has improved management. Knowledge
of the cause and pathophysiology of childhood epilepsy has
considerably improved with modern neuroimaging and molecular
genetic studies. However, our understanding of the causes and
the reasons why specific syndromes appear with precise agerelatedness
is still very limited.
Children with long-standing epilepsy have behavior
problems at rates almost five times higher than that of the general
population, and studies investigating children with new-onset
epilepsy showed that behavior problems occur early in the course
of the disorder and, in some children, even precede seizure onset.
A number of risk factors for behavior problems in children with
epilepsy have been identified, but many inconsistencies are
observed, including patient status and family variables.
Cognitive dysfunction is frequently encountered in
children with epilepsy. This can be present soon after seizure
onset and seen even in preschool children. While these cognitive
impairments are common in the severe symptomatic epilepsies of
childhood, they are also seen in benign conditions such as
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BECTS, benign occipital lobe epilepsy and childhood absence
epilepsy. In these “idiopathic” or “benign” childhood epileptic
syndromes, normal cognition was previously considered a prerequisite
for diagnosis. There is growing evidence of disturbance
in language processing, visual perception, visuospatial skills,
short-term memory, psychiatric status and general cognitive
functioning in children with epilepsy.
The establishment of routine cognitive monitoring of
pharmacological antiepileptic therapies seems to be a feasible
and promising approach to improve the medical care of patients
with epilepsy. Having been established as an essential tool for
the monitoring of invasive treatments of epilepsy, it is about time
that neuropsychological methods find their way into routine care
of pharmacologically treated patients with epilepsy. In this
regard, future studies will have to demonstrate that this form of
neuropsychological outcome and quality control is a useful tool
to direct treatment decisions thereby leading to beneficial
outcomes for the patient.
Sleep and epilepsy are intimately related, with mutual
and reciprocal interactions. Epilepsy can affect the quantitative
and qualitative profiles of sleep in patients with complex partial
seizures. It also modifies the sleep architecture in patients with
temporal lobe seizures. Polysomnographic studies showed that
there was a significant reduction in the duration of rapid eye
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movement (REM) sleep in the absence of seizures during the
nocturnal period. While sleep or sleep deprivation may result in
deteriorating seizure control, seizures, as well as the interictal
state and AED therapy, may have profound effects on sleep.
Moreover, the relationship between epilepsy, sleep disorders, and
quality of life is intriguing. from the overlapping features of
NFLE and parasomnias to the role of OSA in refractory epilepsy
and SUDEP and the settled role of sleep in memory dysfunction
in epilepsy, there remain many unanswered questions.
Diagnosis based on careful history and neurologic
examination, laboratory studies, screening for other etiological
processes should be done. Using neurophysiological and
neuroimaging studies help to determine whether an epileptic
syndrome is present, to guide the nature and extent of the
evaluation, treatment, and prognosis.
Cognitive and sleep problems also should be evaluated
properly along with other neuropsychiatric co-morbidities of
epilepsy in order to prevent the negative sequelae of those comorbidities
and their negative impact on the epilepsy itself.
The management of epilepsy in childhood is
challenging both in terms of its recognition and diagnosis, and
also in terms of selecting the most appropriate treatment
approach, since - uniquely in the pediatric patient - this has
implications not only for the individual’s current health status,
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but also, potentially, for their longer-term development. Children
with epilepsy have many unmet needs. Clinicians must not target
them as young adult with same disease. Accurate diagnosis is
crucial in order to ensure that the correct type of treatment is
used, and also to guide prognosis and help inform treatment
expectations.