Valproic Acid Treatment of Learning Disorder and Severely Epileptiform EEG Without Clinical Seizures

Gordon, Ken; Bawden, Harry N.; Camfield, Peter; Mann, Shelley; Orlik, Phyllis

doi:10.1177/088307389601100110

Cited by 38 publications

(35 citation statements)

References 11 publications

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“…In two observational studies [33,34] valproate sodium therapy remarkably decreased the clinical symptoms of ADHD, and in a retrospective study by Bakke et al [35] 22 of 35 patients with ADHD showed a more than 50% reduction in spike index after levetiracetam treatment, including 59% with improvements in behavior. However, the use of antiepileptic drugs in children with ADHD is controversial, and further prospective studies are necessary to clarify this issue.…”

Section: Discussionmentioning

confidence: 99%

Electroencephalographic Abnormalities in Non-epileptic Children with Attention-Deficit /Hyperactivity Disorder

Li¹,

Chen²,

Hung³

2018

Neuropsychiatry

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Objective: Attention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in childhood, however few studies have investigated epileptic seizures and electroencephalographic abnormalities in children with ADHD. The aim of this study was to explore the occurrence of epileptiform discharges in children with ADHD. Method:We enrolled children with ADHD who visited the neurology clinic of our hospital between January 2014 and June 2016, all of whom met the DSM-V criteria and underwent awake and sleep electroencephalography examinations. We excluded those with histories of intellectual disabilities, epilepsy, congenital anomalies and substance abuse. None of the patients had a history of seizures before the examination.Results: A total of 121 patients were included (93 males, 28 females, mean age 6.9±2.5 years), of whom 28 (23.1%) had electroencephalographic abnormalities, including three (10.7%) with generalized epileptiform discharges and 25 (89.3%) with focal epileptiform discharges. The focal epileptiform discharges were most prevalent from the rolandic area (15/25), followed by the parietal area (5/25), frontal area (4/25) and occipital area (1/25). Fourteen (50%) of the 28 patients had abnormal electroencephalographic findings only during sleep recordings. Conclusions:Electroencephalographic focal abnormalities were found in 23.1% of our patients, of which 50% appeared only during sleep recordings. We suggest that sleep and awake electroencephalography recordings should be part of the routine assessment of children with ADHD regardless of whether or not they have overt seizures or other neurological conditions. In patients who do not respond well to traditional ADHD drugs, treatment for paroxysmal electroencephalographic abnormalities may be considered.

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Section: Discussionmentioning

confidence: 99%

Electroencephalographic Abnormalities in Non-epileptic Children with Attention-Deficit /Hyperactivity Disorder

Li¹,

Chen²,

Hung³

2018

Neuropsychiatry

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“…We chose VPA because this AED was earlier used successfully (Aarts et al 1984, Marston et al 1993, Gordon et al 1996; it has known spike suppression properties (Bruni et al 1980); the common notion is that VPA is less sedating than other spike-suppressing AEDs (e.g. benzodiazepines); and the contention is that VPA does not have noxious effects on learning (Vinning et al 1987, Calandre et al 1990, Forsythe et al 1991.…”

Section: Discussionmentioning

confidence: 99%

“…Based upon initial promising case reports (Aarts et al 1984) and a single-patient clinical trial (Gordon et al 1996) of the apparent benefit of VPA for children with learning or behavioural problems and EEG abnormalities but no clinical seizures, we undertook a double-blind randomized trial to evaluate the utility of an AED under similar clinical circumstances. We chose the sensitive crossover design, which permits both between-group and within-group analyses, for this relatively small and heterogeneous sample.…”

Section: Discussionmentioning

confidence: 99%

“…A single-patient clinical trial (Gordon et al 1996) on a boy with epileptiform bursts, without clinical seizures and learning difficulties showed improvement in cognitive performance while on VPA. Furthermore, Marston and colleagues (1993) used VPA or clobazam on top of existing AEDs in 10 children with behaviour and learning problems associated with intractable epilepsy, all of whom had reduction in their epileptiform activity.…”

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confidence: 99%

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Can sodium valproate improve learning in children with epileptiform bursts but without clinical seizures?

Ronen

Richards

Cunningham

et al. 2000

Develop Med Child Neuro

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This study aimed to determine whether sodium valproate (VPA) improves cognitive performance and behaviour in children with learning and behavioural problems associated with electrographic epileptiform discharges but without clinical seizures. A randomized, double-blind, single-crossover trial was carried out with VPA or placebo on eight participants with different learning and behaviour problems. Participants also underwent neuropsychological testing under video EEG and the parent and teacher Behaviour Check List (CBCL; Achenbach 1991a, b) during each treatment phase. Clinically none of the children improved on VPA. On formal testing children were more distractable, had increased delay in response time, and showed lower memory scores while on VPA. In addition, parents reported higher internalizing scores on the CBCL while children were on VPA. Our data do not support the use of VPA in similar patients.

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“…This impression was reinforced by our uncovering of a few cases in which frank epilepsy was discovered in our subjects of school age in whom it had been previously unsuspected. Further, Gordon, Bawden, Camfield, Mann, and Orlik (1996) published a very elegant paper from Canada, describing the case of a student presenting with a learning disability in whom an epileptic seizure disorder was recorded. When the epileptogenesis in the EEG disappeared with anti-epileptic drug therapy, there was a concomitant clinical improvement in cognition and academic performance (Gordon et al, 1996).…”

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confidence: 97%

Norman geschwind lecture: Geschwind’s lesson

Duane

2002

Ann. of Dyslexia

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Norman Geschwind had a profound effect on behavioral neurology, not only on the basis of his research and theories expressed during his lifetime, but also through the impact that he had on colleagues privileged to train under him or have their work personally influenced by him. My work falls into the latter category. Novel associations between brain function~structure and behavior characterized his professional contributions, and offer a model for those who follow in his footsteps. He correctly predicted that like aphasic disorders, developmental dyslexia might be associated with deficits in color naming expressed currently as deficits in Rapid Automatized Naming. He stimulated anatomic research regarding patterns of asymmetry and microscopic architecture leading to the establishment of the Orton Dyslexia Neuropathology Laboratory at Beth Israel Hospital, Boston. He predicted an association between autoimmune disorders and reading disorders, an association that proved to be of genetic origin. He further predicted that reading disorders, like language disorders, would be cross-cultural and, similarly, their mechanism of production would be cross-cultural, although affected perhaps by the structure of the language to be learned. His suspicion that the clinical impression of male gender preponderance in dyslexia was accurate and carried biologic significance has recently been reconfirmed by colleagues at the Mayo Clinic in Rochester, Minnesota. Finally, with respect to dyslexia, one should not be surprised that since affect is influenced by brain architecture, developmental disorders characterized by altered brain

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Valproic Acid Treatment of Learning Disorder and Severely Epileptiform EEG Without Clinical Seizures

Cited by 38 publications

References 11 publications

Electroencephalographic Abnormalities in Non-epileptic Children with Attention-Deficit /Hyperactivity Disorder

Electroencephalographic Abnormalities in Non-epileptic Children with Attention-Deficit /Hyperactivity Disorder

Can sodium valproate improve learning in children with epileptiform bursts but without clinical seizures?

Norman geschwind lecture: Geschwind’s lesson

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