Executive Functions and Attention in Childhood Epilepsies: A Neuropsychological Hallmark of Dysfunction?

Abstract

Objective: Patients with epilepsy are at risk for several lifetime problems, in which neuropsychological impairments may represent an impacting factor. We evaluated the neuropsychological functions in children suffering from three main epilepsy categories. Further, we analyzed the longitudinal evolution of the neuropsychological profile over time. Methods: Patients undergoing neuropsychological evaluation at our Department from 2012 to 2018 were identified retrospectively. We selected patients aged 6–16 years and with at least two evaluations. Three epilepsy categories were considered: focal/structural, focal self-limited, and idiopathic generalized. Each evaluation included the same structured assessment of main neuropsychological domains. The effect of the epilepsy category, illness duration, seizure status, and medication was computed in multilevel models. Results: We identified 103 patients (focal self-limited = 27; focal/structural = 51; and idiopathic generalized = 25), for 233 evaluations. The majority of deficits were reported in attention and executive functions (>30% of patients); the results were dichotomized to obtain global indexes. Multilevel models showed a trend toward statistical significance of category of epilepsy on the global executive index and of illness duration on global attention index. Illness duration predicted the scores of executive and attention tasks, while category and medication predicted executive task performance. Focal/structural epilepsies mostly affected the executive domain, with deficits persisting over time. By contrast, an ameliorative effect of illness duration for attention was documented in all epilepsies. Conclusions: This study offers lacking information about the evolution of deficits in time, the role of epilepsy category, and possible psychological implications for high-order cognitive skills, central in several social and academic problems.

The Relationship Between Sleep, Cognition and Behavior in Children With Newly-Diagnosed Epilepsy Over 36 Months

“…This indicates that there is evidence of sleep, behavior and cognitive problems independent of anti-seizure medications, which is consistent with prior literature that cognition and behavior may be abnormal prior to the diagnosis of epilepsy ( 3 , 15 ). The findings from our large cohort data showed no significant differences amongst epilepsy syndromes, which is consistent with some prior literature ( 3 , 8 , 22 , 58 ) but varies from other prior literature ( 16 , 62 , 63 ). In spite of this, the existence of cognitive, behavior and sleep problems is indeed a consistent finding in the literature amongst all epilepsy syndromes, which corroborates our findings.…”

“…At this point, causality cannot be inferred, however, it is clear that these multi-morbidity patterns are substantial. Most studies tend to investigate these comorbidities individually (15)(16)(17)(18)(59)(60)(61)(62)(63)(64), however, we show here that investigating these factors simultaneously can provide insight into the overall burden as well as the interrelationships that persist over time in a large cohort of children with seizures.…”

“…Critically, while these multiple co-morbidities in children with epilepsy have been well documented, the direct associations between them have yet to be established as they are most often evaluated individually (12)(13)(14)(15)(16)(17)(18). In addition, daytime behavioral problems are often provided primarily from parental reports and whether similar relationships would be observed in the reports from the children themselves or from their teachers remain to be determined (19)(20)(21).…”

Mentation Tracks Severity but not Oxygenation in Obstructive Sleep Apnea

“…Maybe the cognitive tests which we take to be the most “frontal” or “executive” are merely the most “sensitive” to diffuse or variegated cerebral dysfunction because they tap into broadly distributed networks [cf. Cainelli et al (2021) regarding childhood epilepsy and St. John et al (2022) regarding adult autism].…”

Embrace the Complexity: Agnostic Evaluation of Children’s Neuropsychological Performances Reveals Hidden Neurodevelopment Patterns

“…Despite heterogeneous etiopathogenesis, the most common adverse conditions in early life (prematurity, HIE, and CHD) can determine a wide range of neuropsychological impairments and learning difficulties without a defined characterization between medical conditions or specific phenotypes. Most frequently, complex high-order abilities, such as attention and executive function, are the first affected [ 7 , 15 , 16 , 17 ], as shown in studies on pediatric neurological conditions [ 18 , 19 , 20 , 21 ].…”