Children with new-onset epilepsy: neuropsychological status and brain structure

Abstract

Abnormalities in cognition, academic performance and brain volumetrics have been reported in children with chronic epilepsy. The nature and degree to which these problems may be present at epilepsy onset or may instead become more evident over time remains to be determined. This study characterizes neuropsychological status, brain structure and their interrelationship in children with recent-onset epilepsy compared with healthy controls. Children (age: 8-18 years) with recent-onset idiopathic epilepsy (n = 53) and healthy controls (n = 50) underwent comprehensive neuropsychological assessment and quantitative volumetric measurement of segmented (grey and white matter) volumes of total cerebrum and lobar regions. Compared with controls, children with recent-onset epilepsy exhibit a pattern of mild diffuse cognitive impairment, regardless of epilepsy syndrome, as well as academic underachievement that in a subset of children antedates the first recognized seizure. There are no overall differences in MR morphometric analyses of total cerebral or lobar tissue volumes. Controls show a strong association between cognitive development and increasing cerebral tissue volume (especially white matter volume), an association that is absent in children with epilepsy. Children with a history of academic achievement problems exhibit the most abnormal cognitive function and have significant volumetric reductions in left occipital and parietal lobe grey matter. Patients with idiopathic epilepsy exhibit cognitive dysfunction and academic underachievement at the onset of the disorder, irrespective of epilepsy syndrome, and indications of antecedent neurocognitive impairment are present in a subset of children. Volumetric abnormalities are not yet apparent in the epilepsy group as a whole, but there are indications of an altered structure-function relationship in epilepsy, and the subset of children with prior history of academic problems have abnormal volume of posterior left hemisphere grey matter. These early abnormalities need to be integrated into lifespan models of the neuropsychology of epilepsy.

Determinants of Social Outcomes in Adults With Childhood-onset Epilepsy

“…Learning problems are common in school-aged children; however, they occur more often in children with uncomplicated epilepsy than in healthy peer controls. 9,[11][12][13] In fact, before diagnosis of epilepsy 11,28 or shortly thereafter, 9 children with uncomplicated epilepsy are already more likely to be receiving special education services compared with similar-aged controls. Before initiation of ASMs, adults with newly diagnosed seizures display evidence of relatively poorer memory function and processing speed compared with healthy controls.…”

“…In children with uncomplicated epilepsy, there is also ample evidence demonstrating an increased level of subtle cognitive as well as psychiatric and behavioral problems relative to healthy controls, which could also influence adult outcomes. [8][9][10][11][12][13] The respective impacts of seizure course versus learning and psychiatric problems on adult outcomes have not been distinguished. Understanding what places a child with epilepsy at risk for poorer outcomes in adulthood might contribute to management of childhood epilepsy, determining the need for early educational and psychiatric/psychological services, and planning pediatric to adult transition and transfer of care.…”

Reduced Cortical Thickness in Children with New-Onset Seizures: Fig 1.

“…A previous study in children with new-onset epilepsy found impairment in several cognitive domains, including intelligence, executive function, psychomotor speed, and language. 24 The reduction in cortical thickness in the frontal lobe could be related to impairment in executive function and psychomotor speed, and the reduced cortical thickness in the cingulate may reflect impairment in executive function.…”

“…Children with new-onset seizures or new-onset epilepsy are known to have neuropsychological deficits and academic underachievement, [23][24][25][26] even when they are intellectually healthy. It is possible that there is an antecedent neurobiologic alteration that predisposes to both seizures and neuropsychological deficits.…”

“…Volumetric imaging of the brain has been used to quantify total and lobar gray and white matter volumes in children with new-onset epilepsy but did not identify overall differences in total cerebral or lobar gray and white matter volumes. 24 It is possible that voxel-based morphometry of total and lobar volumes is not sufficiently sensitive to assess subtle changes in brain structures. Alternatively, other structures such as the hippocampi or thalami could be more susceptible to the neurobiologic alterations and are, therefore, more likely to manifest structural changes.…”