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Research article Topical Sections

Assessment of behavioural problems in preschool and school going children with epilepsy

  • Received: 15 March 2022 Revised: 18 May 2022 Accepted: 20 May 2022 Published: 01 June 2022
  • Introduction 

    Children with epilepsy are at greater risk of developing psychiatric and behavioural disorders such as attention deficit/hyperactivity disorder (ADHD), conduct disorder, autism spectrum disorder (ASD), as well as affective and aggressive disorders than normal children which may affect the well- being and quality of life of the child.

    Aim and Objectives 

    This study aims at identifying behavioural problems in children with epilepsy enabling early diagnosis and intervention. The objectives were to assess the presence and type of behavioural problems in children with epilepsy.

    Methods 

    A prospective cross-sectional study was conducted on children who were diagnosed as epilepsy in two age groups of 1.5–5 years and 6–18 years recruited by non-probability convenience sampling. Data regarding seizure semiology, clinical features and treatment were obtained. Children underwent IQ assessment, electroencephalogram and brain neuroimaging. Child Behaviour Check List (CBCL) was administered to parents or primary caregivers after obtaining informed consent. Results were analyzed for presence of behavioural problems using SPSS-23.

    Results 

    In the study, out of 50 study subjects, 72% were between 6–18 years. 60% children had generalised seizures, 58% children had epilepsy for <2 years and abnormal EEG was present in 80% children. 6% children had behavioural problems and 4% had borderline presentations. Co-relation of behavioural problems with age was statistically significant with p value 0.027. Behavioural problems identified were aggressiveness and anxiety.

    Conclusion 

    Childhood epilepsy is associated with behavioural problems along with other co-morbidities warranting a search during follow-up visits.

    Take-home message 

    Early identification and treatment of behavioural problems in children with epilepsy by periodic assessment during follow up visits, careful selection of combination of drugs and appropriate dose can improve the overall outcome in children taking antiepileptic drugs (AEDs) for epilepsy.

    Citation: Harshitha Shanmuganathan, Radha Kumar, D.V. Lal, Chaudhary Devanand Gulab, E. Gayathri, Kesavaraj Pallavi Raja. Assessment of behavioural problems in preschool and school going children with epilepsy[J]. AIMS Neuroscience, 2022, 9(2): 277-287. doi: 10.3934/Neuroscience.2022015

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  • Introduction 

    Children with epilepsy are at greater risk of developing psychiatric and behavioural disorders such as attention deficit/hyperactivity disorder (ADHD), conduct disorder, autism spectrum disorder (ASD), as well as affective and aggressive disorders than normal children which may affect the well- being and quality of life of the child.

    Aim and Objectives 

    This study aims at identifying behavioural problems in children with epilepsy enabling early diagnosis and intervention. The objectives were to assess the presence and type of behavioural problems in children with epilepsy.

    Methods 

    A prospective cross-sectional study was conducted on children who were diagnosed as epilepsy in two age groups of 1.5–5 years and 6–18 years recruited by non-probability convenience sampling. Data regarding seizure semiology, clinical features and treatment were obtained. Children underwent IQ assessment, electroencephalogram and brain neuroimaging. Child Behaviour Check List (CBCL) was administered to parents or primary caregivers after obtaining informed consent. Results were analyzed for presence of behavioural problems using SPSS-23.

    Results 

    In the study, out of 50 study subjects, 72% were between 6–18 years. 60% children had generalised seizures, 58% children had epilepsy for <2 years and abnormal EEG was present in 80% children. 6% children had behavioural problems and 4% had borderline presentations. Co-relation of behavioural problems with age was statistically significant with p value 0.027. Behavioural problems identified were aggressiveness and anxiety.

    Conclusion 

    Childhood epilepsy is associated with behavioural problems along with other co-morbidities warranting a search during follow-up visits.

    Take-home message 

    Early identification and treatment of behavioural problems in children with epilepsy by periodic assessment during follow up visits, careful selection of combination of drugs and appropriate dose can improve the overall outcome in children taking antiepileptic drugs (AEDs) for epilepsy.



    In [4] the authors obtained the following generalization of Montgomery identity for quantum calculus.

    Lemma 1. [4] (Quantum Montgomery identity) Let f:[a,b]R, be an arbitrary function with daqf quantum integrable on [a,b], then the following quantum identity holds:

    f(x)1babaf(t)daqt=(ba)10Kq,x(t)Daqf(tb+(1t)a)d0qt (1.1)

    where Kq,x(t) is defined by

    Kq,x(t)={qt,0txaba,qt1,xaba<t1. (1.2)

    Using this identity, the authors have obtained two Ostrowski type inequalities for quantum integrals and applied it in several special cases.

    Unfortunately, in the proof of this lemma an error is made when calculating the integrals involving the kernel Kq,x(t) on the interval [xaba,1]. Also, in the proofs of Theorem 3 and Theorem 4 a small mistake related to the convexity of |Daqf|r is made.

    In the present paper we prove that the identity (1.1) and, thus, all of the consequent results are incorrect and provide corrections for these results.

    The q-derivative of a function f:[a,b]R for q0,1 (see [5] or [2] for a=0) is given by

    Daqf(x)=f(x)f(a+q(xa))(1q)(xa),forxa,b]Daqf(a)=limxaDaqf(x)

    We say that f:[a,b]R is q-differentiable if limxaDaqf(x) exists. The q-derivative is a discretization of the ordinary derivative and if f is a differentiable function then ([1,3])

    limq1 Daqf(x)=f(x).

    Further, the q-integral of f is defined by

    xaf(t)daqt=(1q)(xa)k=0qkf(a+qk(xa)), x[a,b].

    If the series on the right hand-side is convergent, then the q-integral xaf(t)daqt exists and f:[a,b]R is said to be q-integrable on [a,x]. If f is continuous on [a,b] the series (1q)(xa)k=0qkf(a+qk(xa)) tends to the Riemann integral of f as q1 ([1], [3])

    limq1xaf(t)daqt=xaf(t)dt.

    If ca,x the q-integral is defined by

    xcf(t)daqt=xaf(t)daqtcaf(t)daqt.

    Obviously, the q-integral depends on the values of f at the points outside the interval of integration and an important difference between the definite q-integral and Riemann integral is that even if we are integrating a function over the interval [c,x], a<c<x<b, for q-integral we have to take into account its behavior at t=a as well as its values on [a,x]. This is the main reason for mistakes made in [4] since in the proof of Lemma 1 the following error was made:

    1xabaKq,x(t)Daqf(tb+(1t)a)d0qt=10(qt1)Daqf(tb+(1t)a)d0qtxaba0(qt1)Daqf(tb+(1t)a)d0qt.

    But Kq,x(t)(qt1) for t[0,1] or for t[0,xaba], so the equality does not hold.

    Now, we give a proof that the quantum Montgomery identity (1.1) is not correct, since it does not hold for all x[a,b]. As we shall see, the identity (1.1) is valid only if x=a+qm+1(ba) for some mN{0}. We have

    (ba)10Kq,x(t)Daqf(tb+(1t)a)d0qt=(ba)(1q)k=0qkKq,x(qk)Daqf(a+qk(ba)).

    For q0,1 let mN{0} be such that

    qm+1xaba<qm,

    in other words

    m=logqxaba1.

    Then

    Kq,x(qk)={qk+11,km,qk+1,km+1,

    and

    (ba)(1q)k=0qkKq,x(qk)Daqf(a+qk(ba))=(ba)(1q)(mk=0qk(qk+11)f(a+qk(ba))f(a+qk+1(ba))(1q)qk(ba)+k=m+1qk(qk+1)f(a+qk(ba))f(a+qk+1(ba))(1q)qk(ba))=mk=0(f(a+qk(ba))f(a+qk+1(ba)))+k=0qk+1(f(a+qk(ba))f(a+qk+1(ba)))=f(a+qm+1(ba))f(b)+k=0qk+1(f(a+qk(ba))f(a+qk+1(ba))).

    If we put S=k=0qkf(a+qk(ba))=1(1q)(ba)baf(t)daqt, we have

    k=0(qk+1)(f(a+qk(ba))f(a+qk+1(ba)))=qS(Sf(b))

    and

    1babaf(t)daqt+(ba)10Kq,x(t)Daqf(tb+(1t)a)d0qt=1babaf(t)daqt+(f(a+qm+1(ba))f(b))+qS(Sf(b))=(1q)S+f(a+qm+1(ba))f(b)+qSS+f(b)=f(a+qm+1(ba))

    which is obviously not equal to f(x), unless x=a+qm+1(ba).

    This is no surprise since Jackson integral takes into account only f(a+qk(xa)) for kN{0}. Thus, we have proved the next lemma which is a corrected version of Lemma 1 from [4].

    Lemma 2. (Quantum Montgomery identity) Let f:[a,b]R, be an arbitrary function with Daqf quantum integrable on [a,b], then for all xa,b the following quantum identity holds:

    f(a+qlogqxaba(ba))1babaf(t)daqt=(ba)10Kq,x(t)Daqf(tb+(1t)a)d0qt

    where Kq,x(t) is defined by

    Kq,x(t)={qt,0txaba,qt1,xaba<t1.

    In Theorem 3 and Theorem 4 from [4] the authors have used the identity (1.1) to derive Ostrowski type inequalities for functions f for which Daqf is quantum integrable on [a,b] and |Daqf|r, r1 is a convex function. Since these inequalities depends on the validity of Lemma 1, our discussion invalidates all the results from [4].

    More precisely, in all the inequalities an additional assumption x=a+qm(ba) for some mN{0} should be added. In Theorems 3 and 4 |Daqf(a)|r and |Daqf(b)|r should be swapped, since in the proofs of Theorem 3 and Theorem 4, when applying the convexity of |Daqf|r the following mistake was made

    |Daqf(tb+(1t)a)|rt|Daqf(a)|r+(1t)|Daqf(b)|r.

    Lastly, the integral K4(a,b,x,q) is incorrectly computed and should read:

    K4(a,b,x,q)=1q1+q(bxba)+q1+q(bxba)2.

    The main goal of this paper was to point out that some results in [4] are not correct. We have concentrated on Lemma 3 (Quantum Montgomery identity). The statement of that Lemma is not correct as we have shown. We also found and analyzed the mistake in the proof of Lemma 3.

    However, we went one step further and stated and proved the correct version of Lemma 3 (it is Lemma 2 in our paper). We have also explained how can all inequalities derived from Quantum Montgomery identity be corrected.

    Domagoj Kovačević was supported by the QuantiXLie Centre of Excellence, a project co financed by the Croatian Government and European Union through the European Regional Development Fund-the Competitiveness and Cohesion Operational Programme (Grant KK.01.1.1.01.0004).

    The authors declare that they have no competing interests.

    After our Correction was accepted we were contacted by the first author of [4], Professor Kunt, who suggested an alternate way to correct the results of [4].

    The incorrect version of Montgomery identity from [4]

    f(x)1babaf(t)daqt=(ba)10Kq,x(t)Daqf(tb+(1t)a)d0qt

    can be fixed in two ways: either by changing the left hand side or by changing the right hand side of this equation. In Lemma 2 we showed how to fix the identity by correcting the left hand side. This makes it easier to salvage the rest of results in [4], as all the results remain valid with the added assumption that x=a+qm(ba) for some mN{0}.

    Professor Kunt suggested correcting the right hand side of this equation to obtain the identity:

    f(x)1babaf(t)daqt=(ba)[xaba0qtDaqf(tb+(1t)a)d0qt+1xaba(qt1)Daqf(tb+(1t)a)d0qt].  ()

    By doing so, the proofs of all the remaining results have to be corrected as the bound used

    |1xaba(qt1)Daqf(tb+(1t)a)d0qt|1xaba|(qt1)Daqf(tb+(1t)a)|d0qt

    does not hold for q-integrals in general. This is discussed, for example, on page 12 in [1,Section 1.3.1,Remark (ii)].

    When xaba=qm or equivalently x=a+qm(ba) for some mN{0} the bound above does hold, which is why there is no need to change the rest of the results in [4] if one takes our approach. Nevertheless, we list below the results that can be obtained using identity (3.1). The results below are due to Professor Kunt.

    Theorem 3 in [4] should be as follows:

    Theorem 3. Let f:[a,b]R be an arbitrary function with Daqf is quantum integrable on [a,b]. If |Daqf|r, r1 is a convex function, then the following quantum integral inequality holds:

    |f(x)1babaf(t)daqt|(ba)[(11+q)11r[|Daqf(b)|r1(1+q)(1+q+q2)+|Daqf(a)|rq1+q+q2]1r+(xaba)[|Daqf(b)|r(xaba)11+q+|Daqf(a)|r(1(xaba)11+q)]1r] (3.1)

    for all x[a,b].

    Proof. Using convexity of |Daqf|r, we have that

    |Daqf(tb+(1t)a)|rt|Daqf(b)|r+(1t)|Daqf(a)|r. (3.2)

    By using (), quantum power mean inequality and (3.2), we have that

    |f(x)1babaf(t)daqt| (3.3)
    =(ba)|xaba0qtDaqf(tb+(1t)a)d0qt+1xaba(qt1)Daqf(tb+(1t)a)d0qt|=(ba)|10(qt1)Daqf(tb+(1t)a)d0qt+xaba0Daqf(tb+(1t)a)d0qt|(ba)|10(qt1)Daqf(tb+(1t)a)d0qt|+|xaba0Daqf(tb+(1t)a)d0qt|
    (ba)[10(1qt)|Daqf(tb+(1t)a)|d0qt+xaba0|Daqf(tb+(1t)a)|d0qt]
    (ba)[(101qtd0qt)11r(10(1qt)|Daqf(tb+(1t)a)|rd0qt)1r+(xaba0d0qt)11r(xaba0|Daqf(tb+(1t)a)|rd0qt)1r](ba)[(10(1qt)d0qt)11r×(|Daqf(b)|r10(1qt)td0q+|Daqf(a)|r10(1qt)(1t)d0qt)1r+(xaba0d0qt)11r×(|Daqf(b)|rxaba0td0qt+|Daqf(a)|rxaba0(1t)d0qt)1r]

    On the other hand, calculating the following quantum integrals we have

    10(1qt)d0qt=(1q)n=0qn(1qn+1)=(1q)[11qq1q2]=11+q, (3.4)
    10(1qt)td0qt=(1q)n=0qn[(1qn+1)qn]=(1q)[11q2q1q3]=11+qq1+q+q2=1(1+q)(1+q+q2), (3.5)
    10(1qt)(1t)d0qt=101qtd0qt10(1qt)td0qt=11+q1(1+q)(1+q+q2)=q1+q+q2, (3.6)
    xaba0d0qt=(1q)(xaba)n=0qn=xaba, (3.7)
    xaba0td0qt=(1q)(xaba)n=0qn(qn(xaba))=(xaba)211+q, (3.8)
    xaba0(1t)d0qt=xaba0d0qtxaba0td0qt=xaba(xaba)211+q=(xaba)[1(xaba)11+q]. (3.9)

    Using (3.4)–(3.9) in (3.3), we have (3.1).

    Theorem 4 in [4] should be as follows:

    Theorem 4. Let f:[a,b]R be an arbitrary function with Daqf is quantum integrable on [a,b]. If |Daqf|r, r>1 and 1r+1p=1 is convex function, then the following quantum integral inequality holds:

    |f(x)1babaf(t)daqt| (3.10)
    (ba)[(10(1qt)pd0qt)1p(|Daqf(b)|r11+q+|Daqf(a)|rq1+q)1r+(xaba)[|Daqf(b)|r(xaba)11+q+|Daqf(a)|r(1(xaba)11+q)]1r]

    for all x[a,b].

    Proof. By using () and quantum Hölder inequality, we have

    |f(x)1babaf(t)daqt|(ba)|10(qt1)Daqf(tb+(1t)a)d0qt|+|xaba0Daqf(tb+(1t)a)d0qt|(ba)[10(1qt)|Daqf(tb+(1t)a)|d0qt+xaba0|Daqf(tb+(1t)a)|d0qt](ba)[(10(1qt)pd0qt)1p(10|Daqf(tb+(1t)a)|rd0qt)1r+(xaba0d0qt)1p(xaba0|Daqf(tb+(1t)a)|rd0qt)1r](ba)[(10(1qt)pd0qt)1p(10[t|Daqf(b)|r+(1t)|Daqf(a)|r]d0qt)1r+(xaba0d0qt)1p(xaba0[t|Daqf(b)|r+(1t)|Daqf(a)|r]d0qt)1r](ba)[(10(1qt)pd0qt)1p(|Daqf(b)|r10td0qt+|Daqf(a)|r10(1t)d0qt)1r+(xaba0d0qt)1p(|Daqf(b)|rxaba0td0qt+|Daqf(a)|rxaba0(1t)d0qt)1r]=(ba)[(10(1qt)pd0qt)1p(|Daqf(b)|r11+q+|Daqf(a)|rq1+q)1r+(xaba)[|Daqf(b)|r(xaba)11+q+|Daqf(a)|r(1(xaba)11+q)]1r].

    We conclude this section by noting that the bounds obtained in the original paper [4] which, as we have previously shown, do hold with the added assumption x=a+qm(ba) for some mN{0}, are tighter than the bounds obtained above by Professor Kunt. Professor Kunt's bounds, however, hold for all x[a,b].


    Acknowledgments



    The authors acknowledge the immense help received from the scholar whose article are cited and included in references to this manuscript. The authors are also grateful to authors/publishers/editors of all those articles, journals and books from where the literature for this article has been reviewed and discussed.

    Limitations of the Study



    Major limitations of the present study were small sample size; a larger sample could have brought in the effects. A comparison cohort would have been useful in this study design which was another limitation of the study. Larger study on Indian population on multidrug treatment may give more insight into its effect on behaviour. The generalisability of study findings is limited as the study was from a single centre with limited catchment area. Hence adequate caution needs to be exercised while generalizing the findings to population groups with different demographic structure. It was a onetime assessment of children with epilepsy those with borderline scores were not followed up.

    Source of financial support



    Nil.

    Conflict of interest



    None declared.

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