Developmental outcomes of childhood‐onset temporal lobe epilepsy: A community‐based study

Abstract

Summary Purpose: To assess the impact of childhood‐onset temporal lobe epilepsy (TLE) on the attainment of normative developmental tasks and identify predictors of long‐term developmental outcomes. Methods: In 1992–1993, a prospective longitudinal cohort study of childhood‐onset TLE was commenced in the State of Victoria, Australia. At review in 2004–2006, we assessed developmental tasks, which are age‐specific individual psychosocial achievements tied to particular phases of the lifespan. The cohort comprised 54 individuals (33 female) with a mean age of 20 years (range 12–29), and mean age at TLE onset of 6 years (range 0.2–15). Key Findings: Individuals were clustered into three groups representing distinct developmental trajectories: (1) a Normal group (52%) who achieved most of their developmental tasks, (2) an Altered group (37%) who achieved some, and (3) a Delayed group (11%) who achieved few. The groups showed significant cognitive differences, with the Normal group outperforming the Altered and Delayed groups on a range of measures (p < 0.05). Multiple discriminant function analysis indicated that membership of the groups was independently predicted by the chronicity of seizures, cognitive functioning, having surgically remediable epilepsy, and gender (p < 0.001). Seizure chronicity and cognition discriminated between all three trajectories, while surgical intervention and gender primarily discriminated between the Altered and Delayed trajectories. Significance: Childhood‐onset TLE can disrupt achievement of normative developmental tasks that is independently predicted by medical, biologic, and cognitive factors. Assessment of developmental tasks across the lifespan provides a practical framework for guiding prognostic counseling of patients and families.

Transition in lesional focal epilepsy, and following epilepsy surgery

“…The best model for this is temporal lobe epilepsy (TLE); the Oxford study of children with TLE followed over a 40‐year period demonstrated one‐ third to be independent off medication, but one third remained independent on medication and a further third remained fully dependent . A more recent community‐based study confirmed two thirds of individuals presenting with TLE in childhood to have altered or delayed long‐term neurodevelopmental trajectories . Ongoing epileptic seizures into adulthood are associated with progressive cognitive impairment, and a high risk of psychiatric disorder, particularly when transitioning from adolescence to adulthood .…”

“…1 A more recent communitybased study confirmed two thirds of individuals presenting with TLE in childhood to have altered or delayed long-term neurodevelopmental trajectories. 2 Ongoing epileptic seizures into adulthood are associated with progressive cognitive impairment, 3 and a high risk of psychiatric disorder, particularly when transitioning from adolescence to adulthood. 4 The longer the duration of TLE the more likely there will be frontocentral and parietal atrophy.…”

Epileptic encephalopathies: Optimizing seizure control and developmental outcome

“…Several population cohort studies have documented improved cognitive outcomes with better seizure control either through dissecting the harmful cognitive implications of earlier age at seizure onset in children with drug‐resistant epilepsy, or through documenting direct correlations between longer epilepsy durations and higher rates of altered or delayed developmental trajectories . Similarly, studies focusing on some individual EE syndromes, showed concordant results supporting a direct link between seizure control and developmental outcomes: a longer duration of EE as reflected by a longer delay to treatment in infantile spasms was associated with poorer developmental outcomes in the UKISS (United Kingdom Infantile Spasms Study).…”

Identifying the trajectory of social milestones 15‐20 years after epilepsy surgery: Realistic timelines for postsurgical expectations

“…5,6 Alongside freedom from seizures and reduced antiepileptic drugs (AEDs), patients commonly expect improvements in their social functioning in the form of increased opportunities for driving, employment, interpersonal relationships, and social activities. 10 Following successful surgery, achievement of these milestones can provide a benchmark by which patients measure the success of the operation. Indeed, a study of adolescents and young adults with temporal lobe epilepsy (TLE) found reduced achievement of key social milestones compared to age-expected levels.…”