Epilepsy, Development and Executive Functioning

Transcription

1 Epilepsy, Development and Executive Functioning Amy Morgan, Ph.D., APBB Pediatric Epilepsy Program Massachusetts General Hospital Harvard Medical School November 4, 2017

2 How the Brain Learns Neurons transmit information via electricity, called action potentials Electricity moves along the cell s axon, which allows one cell to communicate with the next and so on. 2

3 Neurotransmitters are released and travel from one cell to the next causing electrical impulses that moves through the cells. As these pathways are repeatedly activated, they become more sensitized and can transmit information more efficiently. THIS IS LEARNING!

4 Abnormal EEG Abnormal EEG (subclinical discharges) may more dramatically affect learning Transient Cognitive Impairment Longer term disruptions in development As a result: Attention can be compromised Reaction times may be longer Working memory may be disrupted Fine motor control/handwriting may become more difficult 4

5 Status epilepticus When a seizure lasts too long (> 5 min) or when seizures occur close together and the child doesn't recover between seizures. Associated with more dysfunction than single seizures Prolonged episodes most associated with cognitive dysfunction Associated with regressions in attention, language and behavior Improvements are often evident but the degree is individual 5

6 What parents and schools should know about epilepsy and learning 1. Abnormal electrical activity in the brain can disrupt connections between neurons. The disruptions can make retrieval of memories and information difficult. Regular disruptions might affect the formation of new connections, making it harder for a student to learn. 2. As a result, learning problems range from very mild difficulties that may not be readily identified but STILL impact development of learning/cognitive skills - to severe cognitive and psychosocial disabilities 3. Children can grow into the learning difficulty; even seemingly mild difficulties can become severe if left unaddressed. 4. The brain also has plasticity.. meaning that the brain can create new connections and continue to learn 5. More support from the environment will be required for the brain to do so AND 6. The brain is most plastic at younger ages THEREFORE 7. Early diagnosis and appropriate interventions are important to a child s success 6

7 Therefore, many children with epilepsy will require supports, even those children without readily observable difficulties Although small or large disruptions in development may have occurred, each child s brain continues to develop and so his/her potential is not yet known. 7

8 Executive Functioning One of the most important cognitive/behavioral skills for a child s success Adversely affected by disruptions in brain functioning AND/OR stressors/anxiety Behavior Regulation / Self-control ranging from managing impulsive actions or responses to planning and organizing how to get things done Working memory refers to the ability to hold information in our minds while we re working and to think and make decisions based on that information Mental flexibility refers to our ability to shift attention or our actions in response to changing demands or to apply different rules in different settings.

9 Because seizures happen so unexpectedly, they can also affect a child s sense of predictability and control, which are important to the development of sense of self Creates stress, affects their sense of competence and expectation of success This also affects development of Executive Functioning

10 Executive Functions are critical to a child s success The environment (home, schools) must provide structure, scaffolding, modeling and direct instruction to help children build the necessary skills Important factors include directing attention, managing anxiety, physical activity, building social relationships engaging in effective goal directed activities

11 Sarah Ward treatment of executive functioning deficits, with information on specific classroom supports Mark Mautone applied behavioral analysis for children with autism and/or developmental disabilities and later about assistive technology to support learning Andrew Kelley meditation and mindfulness, which are important for managing anxiety and for the development of executive functions