Three to four years after diagnosis: cognition and behaviour in children with ‘epilepsy only’. A prospective, controlled study

Abstract

A 3.5-year follow-up study of cognition and behaviour in 42 children with newly diagnosed idiopathic or cryptogenic epilepsy ('epilepsy only') attending mainstream education and 30 healthy gender-matched classmate controls was carried out to identify differences between groups, to detect factors that contribute to the difference and its change over time, and to establish the proportion of poorly performing children. The neuropsychological battery covered the major domains of cognition, mental and motor speed and academic language skills. Children were tested at the time of diagnosis (before any anti-epileptic drug treatment started) and 3, 12 and approximately 42 months later. Parents and teachers completed behaviour checklists, for which the scoring was adapted to prevent any influence of epilepsy-related ambiguity. Based on parental interviews at the time of diagnosis, children with epilepsy were categorized as having longstanding behavioural and/or learning problems, as belonging to a troubled family, as being exposed to 'off-balance' parenting starting at the time of epilepsy onset and/or as reacting maladaptively to the changes in relation to the onset of epilepsy. Throughout follow-up, the group of children with epilepsy only performed less well than healthy classmates on measures of learning, memory span for words, attention and behaviour. After controlling for school delay, proactive interference (number of responses to the same images as in the learning trials, but now presented in reordered locations) was the only remaining variable that distinguished the group of children with epilepsy only. Group-wise, no changes in cognitive and behavioural differences over time were found, but instability in individual performances appeared to characterize children with epilepsy only. Rather than intrinsically epilepsy-related variables, such as idiopathic versus cryptogenic aetiology, seizure control or anti-epileptic drug treatment, the child's prediagnostic learning and behavioural histories and the parents' ability to continue their habitual parenting in the face of the diagnosis of epilepsy only were shown by both group-wise and case-by-case analyses to be important for understanding the cognitive and behavioural functioning of the children with epilepsy only.

Temperament, family environment, and behavior problems in children with new-onset seizures

“…The results of our study further elaborate this theoretical framework by showing support for modified models (Figure 1-B) that include the interaction of specific family and early child characteristics with later behavior problems. Early behavior problems in children with epilepsy are one of the best predictors of behavior problems later in childhood [9]. Therefore, it is important that we identify children with behavior problems at the onset of seizures to try to prevent future behavioral maladjustment.…”

“…Children with epilepsy have been shown to be at increased risk for psychopathology [2,3] as well as for problems with adjustment, including behavior, and cognition [4][5][6][7][8][9]. Children with seizures are up to 4.7 times more likely to have behavior problems than control children [4,8,10,11].…”

Cognitive Impairment in Epilepsy: A Clinical Study

“…Moreover individuals with epilepsy tend to discontinue education early due to disability, or show poor scholastic performance due to cognitive decline. 39,47,50 Earlier studies have not included occupation and Socio-Economic class as variables. This study shows that subjects belonging to the lower Socio-Economic group and having unskilled labour have cognitive impairment when compared to subjects in the middle and upper economic class.This study included marital status, domicile and type of family as socio-demographic variables, these variables did not have any statistical significance.…”

“…5 Patients with idiopathic generalized epilepsy performed significantly poorer in non-verbal and verbal attention, verbal learning and memory, word fluency, and controlled sequential fine motor responses excluding non-verbal memory. 47,50,51 Patients with idiopathic generalized epilepsy, early seizure onset prior to 18 years was a powerful predictor of neuropsychological impairment. 7,8,52 There are several reports about the cognitive impairment and cognitive deterioration in patients with epilepsy.The research data indicate that the cognitive impairment and deterioration are due to associated brain damage and not attributable to Epilepsy.…”

Academic performance in children with new-onset seizures and asthma: A prospective study

“…They did not obtain specific measures of each child's academic performance. The final study by Oostrom and colleagues (27,29) compared children enrolled in regular school classrooms who had experienced two or more unprovoked idiopathic or cryptogenic seizures within the past year with gender-matched classmate normal controls. They found that children with epilepsy scored significantly worse on academic skills (reading, writing, and math) than controls and, over the year following entry into the study, a decline in these skills was found.…”