Management

Cognitive and behavioural findings suggest the importance of early intervention to prevent negative outcomes. The behavioural and psychiatric problems should be treated with the same approach used in children who are neurologically intact and include educational, family, and pharmacological approaches. The indications and choice of psychiatric drugs is similar; epilepsy is not a strong contraindication for the use of neuroleptic or antidepressants, even though some of these medications may increase the frequency of seizures. Dexedrine may be the treatment of choice for hyperkinetic behaviour because it may increase the seizure threshold. ^ Although caution is needed in those with more severe neurological involvement, there is no strong evidence for an increased risk for neuroleptic-induced tardive dyskinesia. When there are behavioural problems one must consider the behavioural effects associated with anticonvulsant medications. In some instances, reducing the dose or changing the medication may be helpful and this should be discussed with the referring physician.

The major drugs used for treatment include carbamazepine, valproic acid, gabapentin, vigabatrin, and topiramate. These medications are used for the various forms of epilepsy described above including temporal lobe seizures and Lennox-Gastaut syndrome. Lamotrigine is also used, but with caution because severe dermatological side-effects may occur. In some instances, temporal lobectomy has been successful in the control of behavioural dysfunction and illogical thinking when performed in children with intractable temporal lobe seizures. In tuberous sclerosis complex the seizure medication vigabatrin may be helpful (and more so than corticosteroids) for infantile spasms.(65)

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