The epileptic encephalopathies are devastating conditions characterized by frequent seizures, severely abnormal EEGs and cognitive slowing or regression. The cognitive impairment in the epileptic encephalopathies may be more concerning to the patient and parents than the epilepsy itself. There is increasing recognition that the cognitive co-morbidity can be both chronic, primarily due to the underlying etiology of the epilepsy and dynamic or evolving because of recurrent seizures, interictal spikes and antiepileptic drugs. Much of our understanding of the neurophysiological underpinnings of cognitive dysfunction in the epileptic encephalopathies comes from rodent studies. Frequent seizures and interictal EEG discharges in rats lead to considerable spatial and social-cognitive deficits. Paralleling these cognitive deficits are dyscoordination of dynamic neural activity within and between the neural networks that subserve normal cognitive processes.
Keywordsoscillations; theta rhythm; phase; coherence; voltage correlations; active avoidance; water maze; interictal spikes While the majority of children with epilepsy maintain stable IQ scores, there is now strong evidence that some children with epilepsy slow, or even regress, in their mental development [1][2][3] . While etiology of the epilepsy is the most important factor in cognitive development, there are indications that early-life seizures independent of etiology can lead to cognitive impairment 4;5 .Cognition is of particular concern in children with epileptic encephalopathies [6][7][8] , defined by the International League Against Epilepsy (ILAE) as a condition where the "epileptic activity itself may contribute to severe cognitive and behavioral impairments above and beyond what might be expected from the underlying pathology alone (e.g., cortical malformation), and that these can worsen over time" 8 . The epileptic encephalopathies are characterized by slowing or regression of development due to seizures, abnormal interictal cortical and subcortical EEG activity, or both, rather than the underlying etiology of the epilepsy 6 . While all of the epilepsy syndromes have an underlying etiology that could lead
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Author ManuscriptAuthor Manuscript to the cognitive impairment, the observation that individuals with epileptic encephalopathies who are successfully treated with medications or surgery can improve cognitive function is a demonstration that seizures and an abnormal EEG play an important role in cognitive impairment [9][10][11][12][13] .Understanding the neurophysiological underpinnings of the epileptic encephalopathies is essential to developing targeted therapies to prevent or improve cognitive function in this vulnerable group of children. Trying to determine those factors that lead to cognitive decline is difficult in children because of the variability in etiology, age of seizure onset, seizure frequency, duration and intensity, interictal EEG abnormalities and antiepileptic drug therapy....