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This book is devoted to the neuropsychological description of childhood epilepsy, a neurolo- cal condition that constitutes one of the most prevalent forms of chronic and disabling childhood illnesses. Indeed, one child out of 20 experiences one or more seizures before the age of 5, and one in a hundred develops epilepsy as a chronic disorder. Approximately half of these children with epilepsy display academic difficulties and/or behavioral disorders. Moreoever, it is now believed that a sizable proportion of children with learning disability suffer from undiagnosed epilepsy. While a great number of textbooks have been devoted to various medical aspects of chi- hood epilepsy (diagnosis, genetics, etiology, drug and surgical treatment, etc.), there have been no comprehensive accounts of the cognitive consequences of this condition. Advance of medical knowledge has shown that childhood epilepsy should not be considered as a single disorder but encompasses a whole range of different conditions that exhibit specific clinical EEG and outcome characteristics. It is not becoming apparent that these various clinical entities have different cognitive expression that yet need to be specified. The purpose of this book is to provide a complete up-to-date analysis of this multi-faceted pathology.
Classification of epilepsy disorders -- Epilepsy syndromes -- Diagnostic tests in epilepsy -- Medical treatment of epilepsy -- Neuropsychological assessment in epilepsy -- Psychological and psychiatric disorders in epilepsy -- Psychogenic nonepileptic seizures -- Neuropsychological assessment in epilepsy surgery -- Other neuropsychological procedures in epilepsy surgery -- Medical aspects of epilepsy surgery.
Having appeared in the 1930s in Montreal, standardised neuropsychological evaluation has become an essential tool in the clinical diagnosis and evaluation of surgical epileptic patients. Nevertheless, despite great progress over the last 20 to 30 years in the diagnosis and medical treatment of epilepsy, clinical neuropsychology still remains largely associated with surgical epilepsy, particularly surgery of the temporal lobe. Clinical neurology has still not managed to clear a way in the daily practice with patients with all types of epilepsy despite significant advances in cognitive neuroscience and a large number of clinical studies on epilepsy and cognition. How is it that there are only rarely major advances in the field of clinical neuropsychology? It has long been time for this question to be asked, and for an attempt to be made to bring about changes. This was the aim of the Toronto workshop and the result of this book. Every approach was debated, providing important elements to reflect on and allowing a great forum for exchanges. This book includes the communications from the main participants and comments from some others on specific subjects.
This was an exciting project to work on, and I attempted to obtain a broad sampling of current research on the neuropsychology of epilepsy. Because the emphasis of the book takes a neuropsychological perspective on epilepsy, the coverage is not redundant with previous texts on this topic. The book is organized around three themes, although individual chapters certainly often extend beyond the part in which they are located. The three major topics are the nature of epilepsy, cognitive and emotional consequences of epilepsy, and treatment approaches to epilepsy and outcome. In Part I, following a historical overview of epilepsy in Chapter 1 by Sandra D. Haynes and me, Gerald C. McIntosh presents a conceptualization of the epilepsies from a neurologist's perspective. The characteristics of seizure types are discussed, and the etiology of secondary epilepsies is described. Epileptic syndromes are considered. McIntosh outlines clinical seizure patterns associated with seizures originating from different cortical regions.
Once feared and misunderstood even among the medical community, epilepsy has since largely been demystified. Besides the characteristic seizures, various cognitive, behavioral, and emotional difficulties are recognized as associated with the condition, and patients are finding relief in medical management and/or surgical intervention. Not surprisingly, neuropsychology has emerged as a major component in treatment planning, program development, and assessment of surgical candidates. Geared toward beginning as well as veteran clinicians, the Handbook on the Neuropsychology of Epilepsy offers readers a skills-based framework for assessment and treatment, using current evidence and standardized terminology. Expert coverage reviews widely-used methods for evaluating key aspects of patient functioning (MRI, MEG, electrocortical mapping, the Wada test), and presents guidelines for psychotherapeutic and cognitive remediation strategies in treating comorbid psychiatric conditions. Given the diversity of the patient population, additional chapters spotlight issues specific to subgroups including high- and low-functioning as well as geriatric and pediatric patients. This integrative hands-on approach benefits a range of practitioners across medical and neurological settings. Topics featured in the Handbook: Neuropsychological assessment across the lifespan. Evaluating the epilepsy surgical candidate: methods and procedures. The Wada test: current perspectives and applications. Assessing psychiatric and personality disorders in the epilepsy patient. Evaluation and management of psychogenic non-epileptic attacks. Neuropsychological assessment with culturally diverse patients. Practical and flexible in its coverage, the Handbook on the Neuropsychology of Epilepsy serves not only neuropsychologists and neurologists but also primary care physicians such as internists, family physicians, and pediatricians.
Childhood epilepsy may cause cognitive disorders and the intellectual quotient is indeed not normally distributed in epileptic children, a fair proportion of whom show an IQ in the deficient range. Some epileptic syndromes happen during vulnerability periods of brain maturation and interfere with the development of specific cognitive functions. This is the case for the Landau–Kleffner syndrome, which generally appears during speech development and affects language. Similarly, West syndrome – or infantile spasms – is an epileptogenic encephalopathy appearing during the first years of life and induces a major delay in social and oculo-motor development. Specific impairments can also be identified in partial childhood epilepsies in relation with seizure focus localization. For instance, left temporal and frontal epilepsies are frequently associated with verbal impairments. Moreover, episodic memory disorders have been described in children suffering from temporal lobe epilepsy whereas executive deficits (planning, self-control, problem solving) have been reported in frontal lobe epilepsy. In most cases, including its mildest forms, childhood epilepsy induces attention deficits, which may affect academic achievement. These observations militate in favor of individual neuropsychological assessments as well as early interventions in order to provide the child with an optimal individualized treatment program.
Research into the neuropsychiatry of epilepsy has become a central focus of interest in the last five years. Comorbidity of epilepsy with behavioral problems is now recognized widely, and the neuroscientific basis for such comorbidity is an active area of investigation. With an expanded international team of authors, this fully revised new edition builds on the strengths of its predecessor, examining in detail the subtleties of behavioral changes in patients with seizure disorders and offering both a diagnostic and a management perspective. New chapters cover genetic disorders, the effects of epilepsy on social behavior as viewed through theory of mind, a discussion of the precuneus, the importance and nature of peri-ictal psychiatric symptoms, depression and the interictal dysphoric disorder, and the relationship between antiepileptic drugs and suicide. This new edition is a must for anyone involved in diagnosing or managing epilepsy.
In the recent literature, the most influential case study books in neuropsychology are in the adult realm. Pediatric neuropsychology is a rapidly developing field with increasingly greater influence in the assessment, diagnosis, early identification, and treatment of childhood illnesses. This book will provide the first centralized, comprehensive resource for case studies in pediatric neuropsychology. Not only will this supply a valuable compilation for the growing numbers of professionals in this field, but will also serve as an innovative and appealing resource for therapists, teachers, and others interested in child development. This book will be structured in such a way that readers can easily access individual cases of interest, as well as related areas of dysfunction. Section breakdowns will be provided in order to highlight the combined focus of case presentations in acquired neuropsychological dysfunction as well as developmental disorders. Each section will begin with an introductory chapter, highlighting the salient feature of the concept and providing brief, up to date reviews of the current research and theories. Within each global section, individual case studies will serve as stand-alone chapters. Contributing authors will be provided extensive guidance and coaching with regards to the standard format and information to be included in each chapter. The first section of this book will present cases involving neurological disorders. The intention of this section is to provide not only “classic” examples of neurological dysfunction in children, but also to provide interesting cases of unique or remarkable presentations. The second section will present an accumulation of cases representing both common and progressive conceptualizations of developmental disabilities. Section three has been designed to highlight cases which often present complex issues to neuropsychologists. The case examples in this section will highlight the use of alternative treatments, pathologies that are often a source of inquiry, and situations that lack the more rigorous scientific data often utilized in other diagnostic procedures. Additionally, this section may include chapters on common differential diagnosis dilemmas in clinical practice. Often multifaceted and even contradictory evidence can arise during evaluations, resulting in complex or problematic situations for the clinician. Such examples are difficult, by their nature, to forecast, but rather would be added during the book’s development, as they occur.
A comprehensive, accessible synthesis of current information on epilepsy for medical trainees and physicians preparing for board certification.
Addresses the psychosocial and cognitive aspects of childhood epilepsy. Covers behavioral and emotional problems and their determinants, effects of the epilepsy on the family unit, prognosis of cognitive and behavioral functioning, academic achievement, and the effects of anti-convulsant drugs on behavior. Includes a section devoted to intervention procedures for special problems--the multiply-handicapped child, adjunct approaches to seizure control, and vocational and surgical problems.