Neuropsychological and educational outcomes of childhood epilepsy

Epilepsy is the most common neurological disorder affecting children globally. Childhood epilepsy can be accompanied by severe neuropsychological impairments that can have lifelong impact. While the cascading effects of ongoing seizure activity on cognition is well-evidenced in childhood, less is known of how childhood epilepsy impacts educational outcomes. Moreover, while the broader social impact of epilepsy has been examined, few studies have specifically explored this impact among adults who experienced childhood epilepsy. These research gaps form the basis for the four empirical studies comprising this thesis. Study 1 consisted of a systematic review of academic attainment following paediatric epilepsy surgery, aimed at outlining the content and context of research concerning academic attainment following a prominent treatment for epilepsy in children. This study revealed that although children reported low attainment scores before surgery, academic attainment predominantly remained at preoperative levels following epilepsy surgery. Study 2 sought to examine academic attainment following the other most prominent treatment option in childhood epilepsy, antiseizure medication treatment, using a medical chart review of a cohort of nonsurgical patients being treated for epilepsy in an acute illness hospital in Ireland. Specifically, Study 2 explored the mediating effect of working memory on the relationship between antiseizure medications (ASMs) and academic attainment. Mirroring findings from Study 1, all participants reported significant underachievement across academic domains. Empirical findings revealed that while working memory was not a significant mediator, ASMs predicted working memory, which in turn predicted academic attainment. In order to ascertain the long-term impact of childhood epilepsy more generally, Study 3 sought to examine the long-term psychosocial and functional outcomes of adults with epilepsy during childhood, specifically, comparing outcomes for seizure-free and seizure-recurrent adults in Ireland and the UK. Results of this online survey highlighted how those who continued to have seizures into adulthood self-reported greater unemployment rates, lower driving rates, and poorer physical health and mobility than their seizure-free counterparts. All participants reported diminished quality of life and daily functioning as adults. To further understanding these experiences, Study 4 sought to qualitatively capture the retrospective insights of adults into the impact of epilepsy on their childhood. Findings from these interviews highlighted feelings of disenfranchised grief associated with an epilepsy diagnosis, needing to belong within a social environment and more broadly, the importance of developmentally appropriate practice in the treatment of children with epilepsy. Findings from this body of research have enhanced understandings of the impacts of epilepsy throughout childhood and into adulthood, and have provided key insights into how children with epilepsy and their families might be supported as they navigate life with the diagnosis. Collectively, these studies identify academic and social challenges experienced by those with childhood epilepsy, both during childhood and beyond. In addition, these studies identify practical proposals for interventions that may ameliorate some of these challenges.