Medical therapy in childhood psychocognitive problems

ABSTRACT

Neurodevelopmental disability is one of the most common problems of children referred to Pediatric Neurology Clinics. These children may suffer from speech delay, intellectual deficiency and behavioral disorder. Some patients with neurodevelopomental delay, especially those with intellectual disability and speech problems, have abnormal electroencephalograms, without clinical seizure. It seems that treating these patients with antiepileptic drugs normalizes the EEG, thereby preventing the electrical paroxysmal discharges that could be harmful for the developing brain. Several studies reported the use of Valproate, Lamotrigine and Corticosteroid in suppression of subclinical epileptiform discharges and improvement of developmental behavioral conditions. In our experiences, oral Na-Valproate was effective in developmental behavioral condition of children with neurodevelopmental delay and elimination of subclinical EEG discharges after 18 months of treatment. Also we used high dose intravenous methyl - prednisolone in a group of children with neurodevelopmental delay and electrical status epilepticus during slow - wave sleep without clinical seizure. In these children results of the appropriate neuro-metabolic tests and magnetic resonance imaging of the brain revealed no abnormality. Because no underlying etiology could be determined, isolated non convulsive status epilepticus was established. After treatment no significant response was observed in these group of children. In another study we used Lamotrigine in children with neurodevelopmental delay, abnormal epileptiform discharges but without clinical seizures. Our results revealed Lamotrigine provides effective control of both subclinical epileptiform discharges and behavioral disorder, without improvement in their cognition. Further studies are needed to investigate and confirm the cognitive and behavioral effects of Lamotrigine in children with psychomotor retardation