Reproduced and adapted with permission from Orrin Devinsky, M.D. Washington, DC: American Psychiatric Press, 2000. Diagnostic and statistical manual of mental disorders. Cognitive and behavioral problems in children with centrotemporal spikes. Yung AW, Park YD, Cohen MJ, Garrison TN.Long-term prognosis of typical childhood absence epilepsy: remission or progression to juvenile myoclonic epilepsy. Wirrell EC, Camfield CS, Camfield PR, Gordon KE, Dooley JM.Evidence against the existence of a temporal lobe epilepsy personality syndrome. Hence, there is a need for the development of systematic approaches to define these disorders and therapeutic interventions to reduce symptom severity. These skills are often lacking in patients with right hemisphere or frontal lobe seizure foci. SPW-Rs fringe on the edge of a shift to epileptic excitation, giving a hint, why the hippocampus is the most epilepsy-prone structure of the brain. False-positive tests will be rare if spike and wave complexes are rigidly defined. For example, the ability to read social cues and respond appropriately in social settings is essential for successful social function. cases, interictal focal spikes were recorded from the mesial frontal region. Some of the most devastating neurobehavioral disorders that complicate epilepsy have neither a defined symptom- nor a syndrome-level diagnosis. Even when patients fit into Diagnostic and Statistical Manual of Mental Disorders (4) categories, they often remain untreated because some physicians believe that using medications to treat other problems might lower the seizure threshold. Encompassing a wide spectrum, these disorders often fit awkwardly into neuropsychiatric categories. These problems are continuous, unlike the seizures, which are intermittent. Interictal cognitive and behavioral disorders profoundly impair the quality of life. The interictal period comprises more than 99% of most patients’ lives. Patients with all forms of epilepsy-including benign rolandic, childhood absence, juvenile myoclonic, and frontal lobe epilepsies-have increased rates of cognitive and behavioral problems (1–3).There is a lack of well-defined incidence and prevalence rates for cognitive and behavioral problems in community epilepsy samples.Few studies have controlled for seizure frequency and severity, medication burden, family history, and other relevant factors.This may be true, but the available evidence does not clearly support this view. A long-standing bias suggests that temporal lobe epilepsy (TLE) is the epilepsy syndrome most often complicated by interictal (the time between seizures) cognitive and behavioral problems.
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