Baseline cognition, behavior, and motor skills in children with new‐onset, idiopathic epilepsy

Abstract

AIM Epilepsy is associated with difficulties in cognition and behavior in children. These problems have been attributed to genetics, ongoing seizures, psychosocial issues, underlying abnormality of the brain, and ⁄ or antiepileptic drugs. In a previous study, we found baseline cognitive differences between children with partial versus generalized and convulsive versus non-convulsive seizures. Measures in that study focused primarily on IQ scores. In the present study, we assessed baseline function with respect to new learning, attention, and memory, thus providing a more comprehensive profile than our previous study. METHODWe examined 57 children (42 females, 15 males), aged 6 to 17 years (mean 10y 1mo, SD 2y 9mo), with new-onset, idiopathic epilepsy, using tests of cognitive function reflective of new learning, memory, and attention. Seizures were classified as generalized convulsive (n=5), generalized non-convulsive (n=18), or focal (n=34). Focal seizures were divided into unilateral versus bilateral independent foci, and presence versus absence of secondary generalization.RESULTS Attention was a particular area of weakness across all groups. The Vocabulary score of an intelligence screen was higher for the focal seizure groups (p=0.012), primarily because of a difference between the unilateral focal and the primary generalized groups (p<0.047). Children with generalized, non-convulsive seizures performed significantly worse than the focal group on a measure of short-term auditory memory (p=0.019). All groups performed poorly on a test of visualmotor speed.INTERPRETATION These findings suggest intrinsic abnormalities in children with new-onset, idiopathic epilepsy at baseline.Epilepsy has been associated with difficulties in cognitive and behavioral performance in children. These problems have been attributed to an interplay of genetics, ongoing seizures, subclinical epileptiform discharges, postictal states, psychosocial issues, underlying abnormality of the brain, and the use of antiepileptic drugs. 1-9Studies attempting to identify the cause of impairment of learning and behavioral function in children with epilepsy are limited by methodological shortcomings, including variability of seizure type and etiology, absence of baseline data, polypharmacy, and attributing disturbances to antiepileptic drugs by default.10,11 Overall, there have been few prospective studies that have investigated baseline performance in children to characterize better the problems intrinsic to the epileptic condition.A study by Seidenberg et al. 12 pointed to impaired academic performance in children with epilepsy, with correlations to the number of lifetime seizure episodes, earlier onset of seizures, and multiple types of seizure. Increased rates of psychiatric problems, such as psychosis and depression, and diminished quality of life have been observed in children with epilepsy compared with typically developing children.13,14 Inattention, poor concentration, hyperactivity, and anxiety are also seen with increased frequency.15 ...

Behavioural comorbidity in Tanzanian children with epilepsy: a community-based case-control study

“…4,5 A detailed study of baseline cognitive function in children with new-onset idiopathic epilepsy demonstrated that attention was affected across all seizure types, which is consistent with our study. 42 …”

Funcionamento intelectual em pacientes pediátricos com epilepsia: comparação de crianças controladas com medicação, não controladas com medicação e controladas com cirurgia

“…Considering the number of antiepileptic drugs, the medically controlled group had a higher statistically significant number of patients using monotherapy than the surgically controlled and medically uncontrolled groups In this study, idiopathic epilepsy was only found in the medically controlled group and the number of patients with probably symptomatic and symptomatic focal epilepsy was significantly higher in the surgically controlled and the medically uncontrolled groups when compared to the medically controlled group. Bhise et al 17 reported cognitive impairments, mainly in attention tasks, in a group of children with idiopathic epilepsy, regardless of seizure type. Berg et al 18 showed that impaired cognitive performance in children with symptomatic focal seizures is more specific and closely related to the most affected brain region.…”

Intellectual functioning in pediatric patients with epilepsy: a comparison of medically controlled, medically uncontrolled and surgically controlled children

“…Bhise et al 17 relataram prejuízos cognitivos, principalmente em tarefas de atenção, em um grupo de crianças com epilepsia idiopática, independentemente do tipo de crise. Berg et al 18 mostraram que o prejuízo do desempenho cognitivo em crianças com epilepsia focal sintomática é mais específico e intimamente relacionado à região do cérebro mais afetada.…”