Alternative Therapies
Behavioral Issues in Children with Epilepsy
By Nidia Ortiz, RN, PNP
Many children with epilepsy also have behavioral issues, and parents often ask whether these issues are caused by the epilepsy or by the medications. Unfortunately, there is no simple answer. Behavioral issues can be caused by many factors, such as frequent seizures, large doses of Anti Epileptic Drugs (AEDs), brain abnormalities like scar tissue, and the child’s own anxiety or self-esteem issues. If parents don’t allow the child to exercise their independence, the child may become frustrated and act out. Behavioral side effects are often dose-related, which means that as you increase the dose of the medication, you may increase the behavioral effects of the medication. The effects are different for each child, but the more medications the child is on, the greater the chances that they will experience behavioral side effects.
The most common culprits of behavioral side effects are Barbituates, like Phenobarbital and Primidone, and Benzodiazapines, like Ativan, Klonopan, Frisium, and Valium. These medications are not recommended for long-term use, because they become less effective over time, which causes physicians to keep increasing the dose of the medication. Some of the behavioral sideeffects you might see from these medications include hyperactivity, irritability, difficulty with attention span, memory, sleep problems, and mood changes including depression, slower thinking and movement, decreased motivation, and memory lapses.
It is important that parents know that physicians look at what types of seizure the child has to help determine the best medication for that child. They also consider the drug’s cost, how often it has to be taken, and how it will interact with other medications that the patient is taking. Physicians try to balance the seizures and medication side effects with the child’s quality of life. Sometimes parents don’t realize how badly the medications are affecting their child until the child is taken off the medication. As a parent, you can help your physician determine the best medication for your child by keeping a log or journal of your child’s medications and the side effects they are experiencing. Try to get as much information as possible from your child’s teacher about what side effects the teacher notices in the classroom. At your next visit, you will be better equipped to explain to your neurologist what side effects your child is experiencing. The physician may change the medication schedule by spreading the medication out in smaller doses over the course of the day, or by giving the medication after or with a meal. If the seizures are happening at night or first thing in the morning, the physician might prescribe a higher dose of medications at bedtime.
When beginning a new medication, it’s often better to start with a lower dose and then increase the dose as the child builds up their tolerance to the medication and its side effects. If the child is having significant behavioral issues, the child could also be experiencing symptoms of depression. The depression may need to be treated with medication, counseling or therapy, which may help with the behavioral issues the child might be facing.
To learn more about medications and their behavioral side effects, please see the sidebar, or ask your physician or nurse for more information.
Some of the most common epilepsy medications and their behavioral side effects are:
Zarontin – (used to treat absence seizures) behavioral changes, tiredness and dizziness
Neurontin – irritability, hyperactivity
Keppra - irritability—usually with rapid dose increase, sometimes you have to wait until the child builds up a tolerance to it
Gabitril - concentration, irritability, but may have a positive effect on mood
Topamax – concentration and attention problems, slowing of thought process, word recall problems, memory problems, mood (nervousness, depression or irritability)
Depakote - irritability, reduction in attention, speed of thinking
Sabril - usually used with Tuberous Sclerosis and infantile spasms. Can
cause irritability and depression (can also cause peripheral vision problems)
Phenobarbital - can cause hyperactivity in children, irritability (Phenobarbital stays in the body long, so it is often used for infants)
Benzodiazapines – irritability, drooling, hyperactivity, impaired attention/
memory, aggression, depression, also very sedating
Tegretol – not as bad as far as the side effects of other medications. May
have positive effects on behavior.
Trileptal – a few cognitive side effects
Felbatol – mild cognitive and behavioral side effects
Dilantin – mild or infrequent cognitive and behavioral side effects
Lamictal – can be positive for mood, but you have to increase dose very slowly to avoid life-threatening rash
Peganone – derivative of Dilantin, some patients see fewer side effects on this than Dilantin, but it’s not used very often
Zonegran – can cause sedation, especially if you increase it rapidly
