Towards a Better Understanding of Cognitive Deficits in Absence Epilepsy: a Systematic Review and Meta-Analysis

Abstract

Cognition in absence epilepsy (AE) is generally considered undisturbed. However, reports on cognitive deficits in AE in recent years have suggested otherwise. This review systematically assesses current literature on cognitive performance in children with AE. A systematic literature search was performed in Pubmed, Embase, Cochrane and Web of Science. All studies reporting on cognitive performance in children with AE were considered. In total 33 studies were eligible for inclusion. Neuropsychological tests were classified into the following domains: intelligence; executive function; attention; language; motor & sensory-perceptual examinations; visuoperceptual/visuospatial/visuoconstructional function; memory and learning; achievement. Random-effect meta-analyses were conducted by estimating the pooled mean and/or pooling the mean difference in case-control studies. Full-scale IQ in children with AE was estimated at 96.78 (95%CI:94.46–99.10) across all available studies and in case-control studies IQ was on average 8.03 (95%CI:-10.45- -5.61) lower. Verbal IQ was estimated at 97.98 (95%CI:95.80–100.16) for all studies and 9.01 (95%CI:12.11- -5.90) points lower in case-control studies. Performance IQ was estimated at 97.23 (93.24–101.22) for all available studies and 5.32 (95%CI:-8.27–2.36) points lower in case-control studies. Lower performance was most often reported in executive function (cognitive flexibility, planning, and verbal fluency) and attention (sustained, selective and divided attention). Reports on school difficulties, neurodevelopmental problems, and attentional problems were high. In conclusion, in contrast to common beliefs, lower than average neurocognitive performance was noted in multiple cognitive domains, which may influence academic and psychosocial development.Electronic supplementary materialThe online version of this article (10.1007/s11065-019-09419-2) contains supplementary material, which is available to authorized users.

Network, clinical and sociodemographic features of cognitive phenotypes in temporal lobe epilepsy

“…These empirical findings, summarized in narrative, systematic and meta-analytic reviews ( Fonseca Wald et al, 2019 , Loughman et al, 2014 , Nickels et al, 2016 , Smith, 2016 , Wickens et al, 2017 , Wilson and Baxendale, 2014 ), appear complementary to modern neuroimaging studies detecting more extended than anticipated abnormalities in brain structure and connectivity within several epilepsy syndromes ( Keller et al, 2015 , Lin et al, 2007 , McDonald et al, 2008 , Nuyts et al, 2017 , Otte et al, 2012 , Slinger et al, 2016 , van Diessen et al, 2014 , Whelan et al, 2018 ), contributing to the contemporary perspective that neuropsychological abnormalities result from disruption in widely distributed cognition-dependent neuronal circuitry ( Rayner and Tailby, 2017 , Rayner et al, 2019 , Wilson and Baxendale, 2014 ).…”

Absence epilepsy: Characteristics, pathophysiology, attention impairments, and the related risk of accidents. A narrative review

“…Epilepsy in general, and AE in particular, can be described as one of the factors that unconventionally modify attention [61]. It is not clear whether this impairment is just confined to the level of signal processing, or it derives from higher-order processing such as decision-making, motor impairment, memory degrading, or any combination of these aspects [33].…”

Prevalence of leukoencephalopathy and its potential cognitive sequelae in cancer patients

“…Such neurological complications (e.g. stroke, epilepsy) are associated with white matter damage 14 and in turn increase the risk for cognitive decline [15][16][17][18][19] .…”

“…This suggests the presence of leukoencephalopathy, or concomitant neurological events, to be indicative for risk of long-term cognitive functioning. In non-cancer populations, neurological insults (and their resulting brain damage) are known to impact cognition; epilepsy (inducing abnormal electrophysiological brain activity), loss of blood supply (inducing ischemic damage), stroke (with vascular damage, microbleeds and possible necrosis) [16][17][18][19] . In older individuals, this interplay of cardiovascular diseases, CNS pathology and cognitive impairment becomes even more apparent 62 .…”

“…As expected, patients with a history of seizures scored lower on several cognitive tests. Still, future studies are required to unravel the role of CNS events in a patients' susceptibility for cognitive decline, since patients with different neurological profiles (history of stroke, small vessel disease or epilepsy) are also expected to have different cognitive profiles [16][17][18][19]62 .…”