Absence epilepsy: Characteristics, pathophysiology, attention impairments, and the related risk of accidents. A narrative review

Abstract

In this narrative review, we critically discuss the pathophysiology of AE and the impairment of attention in children and adolescents with AE. In particular, we contextualize the attentive dysfunctions of AE with the associated risks, such as accidental injuries. Data source: An extensive literature search on attention deficits and the rate of accidental injuries in AE was run. The search was conducted on Scopus, Pubmed, and the online libraries of the University of Twente and Maastricht University. Relevant references of the included articles were added. Retrospective and prospective studies, case reports, meta-analysis, and narrative reviews were included. Only studies written in English were considered. Date of last search is February 2020. The keywords used were "absence epilepsy" AND "attention"/ "awareness", "absence epilepsy" AND "accidental injuries"/"accident*"/"injuries". Results: Ten retrospective and two prospective studies on cognition and AE were fully screened. Seventeen papers explicitly referring to attention in AE were reviewed. Just one paper was found to specifically focus on accidental injuries and AE, while twelve studies generally referring to epilepsy syndromesamong which AEand related accidents were included. Conclusion: Absence epilepsy and attention deficits show some patterns of pathophysiological association. This relation may account for dysfunctions in everyday activities in the pediatric population. Particular metrics, such as the risk related to biking in children with AE, should be used in future studies to address the problem in a novel way and to impact clinical indications.

Neurodevelopmental disorders and anti-epileptic treatment in a patient with a SATB1 mutation: A case report

“…Children, especially newborns, infants, and young children, with developmental epilepsies have an increased risk of cognitive, neurobehavioral, and psychiatric disorders (8)(9)(10). This has important implications for treatment, especially in children with epileptic encephalopathy, in whom early and successful treatment of seizures and interictal epileptiform activity may be crucial for positive neurodevelopmental outcomes (11,12). In children with SCN1A seizure disorders, who are at a high risk of sudden unexplained death in epilepsy, seizure control is critical.…”

Prefrontal PV interneurons facilitate attention and are linked to attentional dysfunction in a mouse model of absence epilepsy

“…Absence epilepsy patients experience attention impairments during interictal periods and while on successful treatment with anti-epileptic drugs (Barone et al 2020), suggesting that attention dysfunction is not purely due to the periodic losses of consciousness associated with SWDs.…”

“…Additionally, absence seizure prevalence is highest in periods of quiet waking (Barone et al 2020), thus we hypothesized that seizure burden would be low while animals were actively performing the task, and would not influence task performance. To examine this, we implanted Scn8a +/− mice with screws for cortical surface (ECoG) recordings over the somatosensory cortex (S1) and recorded ECoG signals while animals were engaged in the task (Fig.…”

The impact of early-life environment on absence epilepsy and neuropsychiatric comorbidities

“…For a long time, CAE was considered to be a benign form of epilepsy given the high (60–70%) complete remission rate ( Berg et al, 2014 , Bouma et al, 1996 ) and the absence of comorbid pathologies. However, subsequent studies have shown that CAE is associated with cognitive impairments, among other things, attention disturbances, and psychiatric comorbidities, such as attention-deficit/hyperactivity disorder (ADHD), anxiety, and depression ( Barone et al, 2020 , Cheng et al, 2017 , Gruenbaum et al, 2021 , Masur et al, 2013 , Tenney et al, 2013 , Tenney and Glauser, 2013 , Vega et al, 2011 ). Cognitive impairments, including recognition memory and attention disturbances, were also found in the WAG/Rij model of CAE ( Fedosova et al, 2022 , Fedosova et al, 2021 , Leo et al, 2019 ).…”