Childhood Epilepsy with Centrotemporal Spikes: Clinical and Neuropsychological Outcomes 5 Years after Remission

Abstract

Although specific neuropsychological deficits have been recognized during the active phase of epilepsy with centrotemporal spikes (ECTS), the natural cognitive and neuropsychological history after remission has not been elucidated so far. We evaluated the natural cognitive and neuropsychological outcomes five years after disease remission and investigated possible predictors of long-term outcome among socio-demographic and electro-clinical variables. We performed an observational cross-sectional study. Electro-clinical characteristics during the active phase of epilepsy, as well as antiepileptic treatment and premorbid neurodevelopmental concerns were reviewed for 70 patients. At least five years after epilepsy remission, all patients were contacted, and 46 completed a structured questionnaire about patients’ current education and academic skills, general health, and parents’ socio-economic status. Among them, 23 patients underwent an ad hoc cognitive and neuropsychological protocol and emotional-behavioral assessment. Chi-square tests and t-tests were carried out to define the role of putative predictors of neuropsychological outcomes. Mean cognitive and neuropsychological performances appeared to be overall adequate, except for the dictation. Positive family history for epilepsy (p = 0.01769) and familial socioeconomic status (mother’s schooling (p = 0.04169), father’s schooling (p = 0.01939), mother’s income (p = 0.0262), father’s income (p = 0.01331)) were identified as predictors of outcomes. Our data suggest that ECTS with typical electro-clinical features depicts an overall preserved cognitive and neuropsychological long-term outcome. We suggest particular attention should be paid to patients with socio-economic disadvantage and familial history of epilepsy, as they may experience worse neurocognitive post-morbid performances.

Impact of sociodemographic disadvantage on neurobehavioral outcomes in children with newly diagnosed seizures and their unaffected siblings over 36 months

“…Our findings presented here extend our understanding of the impact and role of disadvantage in the epilepsy literature, which is consistent with health care outcome findings in multiple other disorders including asthma, autism, COVID-19, diabetes, and sleep health. [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] Examining the influence of disadvantage at the time of diagnosis as well as at 18 and 36 months later, we find that behavior problems, as rated by parents, the child's teacher, and the child with seizures him-/herself, all indicate that behavioral risk increases with greater social disadvantage. This unanimity of effect, across all informants, with the consistency of relationship over time, points to the robustness and reliability of the effect of disadvantage.…”

“…Based on past literature, each SD variable chosen is a relevant social determinant of health. [29][30][31][32][33][34][35][36][42][43][44][45][46][47][48] For caregiver education level and household income, those families below the mean for the sample were assigned a score of 1, whereas those families at or above the mean were assigned a score of 0. The distribution of income for this sample was nearly identical to national income statistics at the time of recruitment.…”

“…behavior, emotional behavior, epilepsy disadvantage index, neurobehavioral outcomes, pediatric, seizures A growing general health status literature has demonstrated the significant role of several demographic factors, including race, caregiver (usually mother's) education level, marital status of the caregiver, neighborhood characteristics, and household income. [29][30][31][32][33] Within the field of pediatrics, the role of SD in health care outcomes has been well established among disorders such as asthma, diabetes, COVID-19, sleep health, and autism. [34][35][36][37][38][39][40][41] In the field of epilepsy, there has been growing awareness of the impact of socioeconomic and neighborhood disadvantage on health and health-related factors in epilepsy.…”

“…A growing general health status literature has demonstrated the significant role of several demographic factors, including race, caregiver (usually mother's) education level, marital status of the caregiver, neighborhood characteristics, and household income 29–33 . Within the field of pediatrics, the role of SD in health care outcomes has been well established among disorders such as asthma, diabetes, COVID‐19, sleep health, and autism 34–41 .…”

Altered Sleep-Related Consolidation and Neurocognitive Comorbidity in CECTS

“…However, evidence of subtle functional and structural abnormalities in CECTS has been mounting ( Pardoe et al, 2013 ; Dryźałowski et al, 2018 ). Despite a growing consensus that neurocognitive impairment in CECTS subsides beyond the active phase ( Deonna et al, 2000 ; Varesio et al, 2020 ), there is also evidence about verbal deficits in the remission period associated with persistent EEG abnormalities ( Massa et al, 2001 ; Filippini et al, 2013 ). The onset of CECTS is between early childhood and middle adolescence.…”