Neurological and psychiatric comorbidities in children with epilepsy

Comorbidity in children with epilepsy is an important issue in current medical literature. Neurological and psychiatric diseases play a key role among accompanying conditions. The most common neurological comorbidities found in children with epilepsy include cerebral palsy (CP), headache, congenital abnormalities of the central nervous system, hydrocephalus, tumors, and sleep disorders. Autism spectrum disorders, attention deficit hyperactivity disorder, intellectual disability, depression, and anxiety are prominent among psychiatric comorbidities. This work describes the neurological and psychiatric comorbidities in a population of Bulgarian children with epilepsy, with results similar to those published by other authors

Brain Abscess in a Child. Case Report

Brain abscesses in children are rare, but can lead to severe complications, especially if they are not recognized and treated promptly.We present the clinical case of a four-year-old girl who was admitted in the Second pediatric clinic at St. Marina University hospital in Varna because of attacks of severe frontal headache, sometimes accompanied by vomiting. The child was first hospitalized at the Infectious disease clinic for a bacterial intestinal infection, but during the hospital stay the attacks became more frequent. After the child was discharged, the parents noticed that the movements of the left limbs were severely impaired, with the left leg being swayed during walking. At the Second pediatric clinic, the child was conscious, afebrile, with normal general exam, but with pronounced syndrome of meningeal irritation and with left hemiparesis. Blood tests showed evidence of bacterial infection. Computed tomography was performed, where a large cystic formation (70/50 mm) was visualized in the right cerebral hemisphere, corresponding to an abscess with severe dislocation, requiring surgery to be performed urgently. The child had a smooth post-operative period, with no evidence of infection and no seizures. The focal neurological signs regressed over the following few days. A repeat CT scan of the head showed complete evacuation of the abscess and reduction of the edema. The girl was discharged on the fifteenth day, in good overall condition, with no headaches, and with fully restored motor activity. We discuss the diagnosis, differential diagnosis, the role of timely imaging and the treatment applied for the good prognosis of the patient

Headache in Children with Epilepsy

Headache is a common comorbidity in pediatric epileptic patients. The relationship between headache and epilepsy is considered complex and though there is evidence of association, its mechanisms are not yet completely clear. Numerous studies of comorbidity focus on primary headaches, such as migraine and tension-type headache, describing them as the most prevalent in patients with epilepsy. Some authors, though, report similar prevalence of headache and specifically migraine in epilepsy patients as compared to that of the general population. When describing this comorbidity, it should be noted that secondary headaches can also be frequent in patients with structural epilepsy, e.g. in brain tumors or other space-occupying lesions.In this paper we summarize literature data on the problem of epilepsy and headache comorbidity, and also present two clinical cases of patients with tension-type and with secondary headache, respectively

Quality of Life and Comorbidity in Children with Epilepsy // Качество на живот и коморбидност при деца с епилепсия

Epilepsy is a chronic disease of the central nervous system, combining various conditions and syndromes, with particular importance in childhood. Some of the affected patients have comorbidities. The concept of "health-related quality of life" concerns the impact of the disease and its influence on the general quality of life. It is defined as an important end goal in modern clinical practice. The thesis aims to conduct a study of comorbidity in paediatric patients with epilepsy and to assess the impact of accompanying diseases on health-related quality of life. The study results indicate that a significant part of the subjects have accompanying diseases. Examining the quality of life through a specially selected questionnaire (KINDLR) demonstrates a range of values below average for the population. A particularly pronounced deterioration of the quality of life is reported in the presence of comorbidity. Psychiatric and neurological comorbidities are highlighted in this regard, and the need for increased attention towards the patient, targeted testing, neuropsychological follow-up, and psychiatric consultations is emphasised without underestimating the importance of any other known comorbidities. The nature of the paediatric population suggests that educational problems should be considered as well, as they, in addition to medical issues, emphasise the social dimensions of the problem.Епилепсията е хронично заболяване на централната нервна система, обединяващо различни състояния и синдроми, с особено значение в детската възраст. При някои от засегнатите пациенти са налице и придружаващи заболявания. Понятието „качество на живот, свързано със здравето“ касае влиянието на болестта и нейното лечение върху общото качество на живота и се определя като важна крайна цел в съвременната клинична практика. Цел на настоящата работа е да се проведе проучване на коморбидността при пациенти в детска възраст с епилепсия и да се оцени влиянието ѝ върху качеството им на живот. Резултатите сочат, че при значителна част от изследвания контингент са налице придружаващи заболявания. Изследването на качеството на живот чрез специално подбрания за целта въпросник KINDLR показва поредица стойности под нормалните за популацията. Особено изразено влошаване на качество на живот се отчита при наличие на коморбидност. Извеждат се на преден план психичните и неврологичните придружаващи заболявания и се подчертава необходимостта от засилено внимание към пациентите, насочено изследване, невропсихологично проследяване и психиатрични консултации, без да се омаловажава значението на всяко от другите известни съпътстващи заболявания. Характерът на детската популация предполага разглеждане и на проблемите с обучението, които, добавени към медицинските, подчертават и социалните измерения на проблема

KINDLR questionnaire for quality of life in children: translation and adaptation in Bulgarian

Health-related quality of life can be assessed using specially developed instruments. One of these questionnaires, specific to pediatric practice, is KINDLR. It is a short, methodologically suitable, psychometrically sound and flexible tool, available in three versions which cover the different age groups and stages of development of children and adolescents between 3 and 17 years. This paper describes the translation and adaptation of the questionnaire in Bulgarian. The process was conducted according to an approved procedure developed by the authors of the original version and followed when the instrument was translated into other languages. The generic questionnaires KiddyKINDL, KidKINDL, and KiddoKINDL, the additional scales for long-term illness and hospitalization, as well as the module for epilepsy have been requested and approved for translation and adaptation in Bulgarian. In its final form in Bulgarian, the KINDLR questionnaire is approved for use in research and in practice. It is relatively short, easy to use, but also convenient in terms of processing the results. Tables for data entry in a format directly compatible with popular statistical software are publicly accessible. The availability of many other language versions, norms, and published results in the literature provides opportunities for conducting comparative studies of health-related quality of life in children on a national and international level