Psychiatric Aspects of Epilepsy in Children

Abstract

This report of about 150 children is based on recent experience gained in the Maudsley Hospital Children's Department, in which epileptic children are investigated at special sessions. Most of the patients were examined in the usual way on their first visit to the Department. A full psychiatric history was taken from the mother or other relation. Intelligence tests, electroencephalogram (E.E.G.) and physical examinations were carried out. Later, as indicated, further special tests, such as air encephalograms, were done.It is important to note the type of patients discussed in this report, in view of the notorious difficulty of obtaining reliable statistics in such a subject as epilepsy, whose manifestations are so varied that any one hospital or clinic cannot expect to see a truly unbiased sample. Children referred to the Maudsley Hospital nearly always show some behaviour disorder, but lack gross neurological signs and symptoms. Even in the case of epileptics a behaviour problem is frequently the presenting complaint, the actual seizures being a secondary problem. As the facilities for investigation are better than in many other clinics, cases are frequently referred from other hospitals for special investigation. This material, therefore, is undoubtedly heavily weighted by epileptics with behaviour problems. There are, on the one hand, disproportionately too few mentally normal children with epilepsy, and on the other, too few with epilepsy in association with grosser neurological disorders. No attempt is made, therefore, to give any statistics on the incidence of a particular symptom or sign within this group, as it is meaningless in relation to the whole body of epilepsy in children. The recent outstanding book by Bridge (1950) gives a very fair picture of epilepsy in childhood.The aetiological factors may be divided into two groups: those within the social situation and those within the child.