Children with epilepsy who also have mental handicap (a term preferred over the older term, “mental retardation”) or cerebral palsy often have unique challenges compared to children without these difficulties. Children with mental handicaps have below-average intellectual ability and are often impaired in their ability to understand, communicate, solve problems, and function in social settings. Children with cerebral palsy have muscle spasms, difficulty standing or walking, or postural problems. Their intelligence may range from average to below average. Mental handicap and cerebral palsy can also be associated with vision, hearing, and speech problems and possibly some physical deformity or emotional disturbance. Management of children with epilepsy and mental handicap or cerebral palsy requires the combined effort of doctors, therapists, and parents.
Mental handicap is a term loaded with fear for parents. In the past, “mental retardation” usually implied mental incompetence and the child was often placed in an institution. Mental handicap means slowed or delayed mental development. Children with mental handicap are not incapable of learning; they just do not learn as rapidly as other children. However, children with mental handicap often will not attain completely normal intellectual development, even as adults.
Approximately 2% of children in the general population are affected by mental handicap, whereas up to 25% of children with cerebral palsy are affected. Among children with epilepsy, mental handicap occurs in 9%. Until recently, about two thirds of children with cerebral palsy also had mental handicap. But now, thanks to early medical intervention and advanced technology, the incidence of mental handicap among children with cerebral palsy has fallen markedly. For those children who have epilepsy, mental handicap is more common with the following factors: early age when seizures begin (especially before age 2 years), prolonged duration of epilepsy, multiple seizure types, and use of several antiepileptic drugs in high dosages.
Cerebral palsy is not a specific medical diagnosis but rather a descriptive name given to a group of disorders that affect control of movement, and result from an abnormality of the central nervous system (the brain and spinal cord). The disorder is referred to as “stable” or “static” because the condition does not worsen over time. The abnormality may occur while the fetus is in the womb, during or shortly after birth, or during the first year of life. Even when an injury occurs in the womb or at birth, not all children born with cerebral palsy show any clear signs of the disorder immediately after birth, and the symptoms vary in severity depending on the type and degree of abnormality involved.
Mental handicap occurs in approximately one third of children with cerebral palsy, and some children with cerebral palsy and epilepsy are also mentally handicapped. The major problems for children with cerebral palsy are poor muscle control, such as difficulty in sucking or holding up the head, delay in rolling over, delay in walking or inability to walk, incoordination, muscle tightness, and muscle spasms.
About 25% to 35% of all children with cerebral palsy have epilepsy. A much smaller proportion of those with epilepsy have cerebral palsy. Epilepsy and cerebral palsy are separate disorders, but both can result from the same abnormality of the brain. Epilepsy does not cause cerebral palsy. Cerebral palsy does not cause epilepsy. The two conditions simply coexist.