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Epilepsy and Behaviour Disorder in Schoolchildren

ABSTRACT

1. The general tendency in the literature is to admit that whilst certain classes epileptics, including institutional patients, temporal lobe cases and patients showing progressive deterioration—show strong evidence of extreme personality disturbance, there is little to show that this "typical" behaviour is in fact due to any "epileptoid personality".
   
2. The main anti-social characteristics which so many epileptics exhibit, for whatever reason, are irritability, temper and aggressiveness, together with a moodiness and emotional changeability.
   
3. It appears established that anti-convulsant medication has no primary effect on the personality, but control of seizures by this means may reveal psychopathic tendencies hitherto less obtrusive.
   
4. Structural cerebral damage may have some part to play in behaviour disorders, but beyond the fact that epilepsy due to temporal lobe foci is largely productive of problem behaviour, we cannot yet localize psychopathic symptoms in the brain.
   
5. A great deal of the disturbance previously thought to be due to epilepsy per se, is now considered a reaction to conditions imposed on the child by reason of its handicap, either as frustration of natural desires or of intolerance of institutional standards, routine or unenlightened treatment.
   
6. Deprivation or maltreatment in early childhood may account for some present disorders, but it is now questioned whether this has necessarily a permanent effect, and often prognosis is relatively better for such children following removal of the deprivation than for controls.
   
7. At least a component of the behaviour disorders seen may be an exacerbation of normal anxiety states which appear to a greater or less extent in normal children.
   
8. The part which personality tests can play in the diagnosis of behaviour disorders is not fully established, but investigations to date offer hope in this direction. The same comment would seem to apply to EEG findings. More conclusive research is needed and proceeding in both fields.
   
9. In spite of great advances in recent years, the treatment of epileptic children with psychoses or behaviour disorders by medication or by surgery is at present still a controversial subject. Although anti-convulsant medication is proving increasingly effective, the field of pharmacological psychiatry in the child deserves closer study.
   
10. It is probable that behaviour disorders of epileptic children spring very largely from their reaction to environment and handling. In addition to adequate and suitably trained staff, a carefully planned scheme of treatment (both anti-convulsant and psychotherapeutic) needs to be considered.
    
11. The contemporary attitude is that the treatment and education of the epileptic child shall, wherever possible, be within the framework of the normal community.