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Enkhtuya B, Bayarsaikhan A, Lkhagvasuren B, Sainbat U, Bayanmunkh B, Avirmed T, Tsend B. Emotional intelligence in children with epilepsy. IBRO Neurosci Rep 2024; 16:260-266. [PMID: 39007084 PMCID: PMC11240295 DOI: 10.1016/j.ibneur.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/17/2023] [Accepted: 01/27/2024] [Indexed: 07/16/2024] Open
Abstract
Objective Epilepsy is a prevalent neurological disorder in the pediatric population, often accompanied by comorbidities, drug-related burdens, and psychosocial issues. Emotional intelligence (EI) is a crucial aspect of neurocognitive functioning that may be impaired in various clinical conditions. This study aimed to assess EI and its associated risk factors in children with epilepsy. Methods In a case-control design, we recruited 47 children with epilepsy (37 males, mean age 10.5 ± 3.1 years) and age- and gender-matched controls. Participants were evaluated using the Emotional Quotient Inventory: Youth Version (EQ-I:YV). We included risk factors, including comorbidities, perinatal complications, epilepsy characteristics, and magnetic resonance imaging results to predict EI. Results Results indicate that children with epilepsy demonstrated significantly lower EI scores compared to controls (Total EQ score: p = 0.031, intrapersonal: p < 0.001, adaptability: p = 0.03, and general mood: p < 0.001). Multiple linear regression analysis indicated that lower total EQ scores were associated with the number of anti-epileptic drugs, age, seizure frequency, MRI abnormalities, aura, and early onset of seizures. Conclusions The study provides evidence that children with epilepsy exhibit lower EQ scores than control group, with notable differences in intrapersonal skills, adaptability, and general mood. Additionally, age, and some seizure-related factors predicted decreased total EQ scores. These findings emphasize the need to consider EI in the context of pediatric epilepsy, as impaired EI may contribute to further psychosocial challenges faced by affected children.
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Affiliation(s)
- Battamir Enkhtuya
- Department of Pediatrics, School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Amgalan Bayarsaikhan
- Department of Pediatrics, School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Battuvshin Lkhagvasuren
- Brain and Mind Research Institute, Mongolian Academy of Sciences, Ulaanbaatar, Mongolia
- Department of Psychosomatic Medicine, International University of Health and Welfare Narita Hospital, Narita, Chiba, Japan
| | - Uranbileg Sainbat
- Mongolian Psychology Diagnostic and Training Methodology Center, Ulaanbaatar, Mongolia
| | - Binderiya Bayanmunkh
- Brain and Mind Research Institute, Mongolian Academy of Sciences, Ulaanbaatar, Mongolia
| | - Tovuudorj Avirmed
- Department of Neurology, School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Bayarmaa Tsend
- Department of Psychology, Mongolian National University of Education, Ulaanbaatar, Mongolia
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Oldrati V, Minghetti S, Zanotta N, Bardoni A, Zucca C. Etiology and duration of the disease in the assessment of intellectual functioning of pediatric patients with epilepsy: An observational study. Heliyon 2023; 9:e14085. [PMID: 36915569 PMCID: PMC10006677 DOI: 10.1016/j.heliyon.2023.e14085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/10/2023] [Accepted: 02/21/2023] [Indexed: 03/05/2023] Open
Abstract
Childhood epilepsy can be frequently associated with impaired cognitive functioning. Previous research has suggested an increased risk of cognitive impairment that may be related to the etiology, the electro-clinical pattern and the load of anti-seizure medications (ASMs). The aim of this study was to evaluate the impact of different clinical features on the global intellectual functioning in a cohort of children and adolescents with epilepsy. We studied eighty patients diagnosed and followed in a tertiary care center. These factors were examined: 1. Etiology of epileptic syndrome; 2. Type of seizure; 3. Number of ASMs; 4. Seizure frequency; 5. Age at seizure onset; 6. Total duration of epilepsy; and 7. Active duration of epilepsy. Multiple regression analysis showed that the etiology and the total duration of epilepsy were the best indicators of intellectual functioning. The present data indicate that children with symptomatic epilepsy (SE) have lower IQ scores (M = 63.5), while children with self-limited focal epilepsy and generalized idiopathic epilepsy, i.e. age-related epileptic syndromes (ARES), have a higher IQ (M = 100.0; p < 0.01). Children with epilepsy of unknown etiology (UEE) (M = 75.1; p < 0.05) are positioned at an intermediate level between the SE and the ARES group (p < 0.01). Increased duration of epilepsy was associated with decreased intellectual functioning. In conclusion, knowledge about the risks associated with etiologic factors and the duration of the disease may guide the definition of optimal neuropsychological rehabilitation strategies.
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Affiliation(s)
- Viola Oldrati
- Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Lecco, Italy
| | - Sara Minghetti
- Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Lecco, Italy
| | - Nicoletta Zanotta
- Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Lecco, Italy
| | - Alessandra Bardoni
- Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Lecco, Italy
| | - Claudio Zucca
- Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Lecco, Italy
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Rogač Ž, Stevanović D, Bečanović S, Božić L, Dimitrijević A, Bogićević D, Bosiočić I, Jovanović K, Nikolić D. Cognitive profile, psychopathological symptoms, and quality of life in newly diagnosed pediatric epilepsy: A six-month, naturalistic follow-up study. Epilepsy Res 2022; 179:106844. [PMID: 34942452 DOI: 10.1016/j.eplepsyres.2021.106844] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 11/29/2022]
Abstract
Long-term studies indicated changes in aspects of cognition, psychopathology, and quality of life (QOL) in children and adolescents followed up after the diagnosis of epilepsy. However, evidence is limited regarding what happens during the first few months after epilepsy is diagnosed because at this phase is possible to adjust and/or change an AED regimen or add other treatment interventions, if needed. This is a naturalistic, six months follow-up study that evaluated changes in overall cognitive profiles, levels of psychopathological symptoms, and quality of life (QOL) in newly diagnosed, uncomplicated pediatric epilepsy. In total, 61 (35 [57.4%] males) children and adolescents aged 7-18 years were assessed at the time of diagnosis and the initiation of antiepileptic drug (AED) treatment and six months afterward. The Revised Wechsler Intelligence Scale for Children, the Revised Child Anxiety and Depression Scale (RCADS), Nisonger Child Behavior Rating Form for typically developing children and adolescents (NCBRF), KIDSCREEN-10 Quality of Life Measure, and Adverse Event Profile (AEP) were used. The RCADS and NCBRF scores significantly increased over time, while the KIDSCREEN-10 scores significantly decreased. The most significant increases were observed in scores measuring social phobia and depressive symptoms and inattentiveness. Verbal cognitive abilities and full-scale intelligence scores changed slightly, while more changes were found in aspects of non-verbal cognitive abilities. This study showed that six months after epilepsy diagnosis and AED initiation, there were marked increases in anxiety levels, depressive symptoms, and behavioral problems, with deteriorations in QOL, while cognitive changes were relatively minimal. Therefore, monitoring levels of psychopathological symptoms and QOL in newly diagnosed epilepsy is highly recommended.
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Affiliation(s)
- Željka Rogač
- Institute for Children's Diseases, Clinical Centre of Montenegro, Podgorica 81000, Montenegro.
| | - Dejan Stevanović
- Clinic for Neurology and Psychiatry for Children and Youth, Belgrade 11000, Serbia.
| | | | - Ljubica Božić
- University Children's Hospital, Belgrade 11000, Serbia.
| | - Aleksandar Dimitrijević
- University Children's Hospital, Belgrade 11000, Serbia; University of Belgrade - School of Medicine, Belgrade 11000, Serbia.
| | - Dragana Bogićević
- University Children's Hospital, Belgrade 11000, Serbia; University of Belgrade - School of Medicine, Belgrade 11000, Serbia.
| | | | | | - Dimitrije Nikolić
- University Children's Hospital, Belgrade 11000, Serbia; University of Belgrade - School of Medicine, Belgrade 11000, Serbia.
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Bugarski Ignjatović V, Pavić S, Gebauer Bukurov K, Nikolašević Ž, Krstić T, Stojadinović A. Behavioral aspects of executive functions in young adults with well-controlled epilepsy. PSYCHOL HEALTH MED 2021; 26:1258-1265. [PMID: 32816533 DOI: 10.1080/13548506.2020.1810719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Executive function (EF) skills involve higher-level cognitive functions, such as planning, goal formation, goal-directed behavior, and effective performance. Previous research has shown that these aspects of EF are essential for successful functioning in everyday life. This study aimed to examine differences in the behavioral aspects of EF between young adults with epilepsy and healthy controls. The study involved 62 young adults, aged 18 to 30 years, divided into two groups: a study group of young adults with well-controlled epilepsy and a control group of healthy young adults. The groups were matched according to basic sociodemographic characteristics. The Behavior Rating Inventory of Executive Function - Adult version was used to assess the behavioral aspects of executive functions. A significant difference between groups was only observed on the Organization of Materials scale, where the group with epilepsy achieved better performance. Our findings suggest that self-assessed behavioral control of EF is almost the same in healthy young adults and young adults with epilepsy who have no comorbidities and have good control of the disease as well as preserved intellectual ability and functionality in everyday activities.
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Affiliation(s)
| | - Sara Pavić
- Faculty of Medicine, Department of Special Education and Rehabilitation, University of Novi Sad, Novi Sad, Serbia
| | | | - Željka Nikolašević
- Faculty of Medicine, Department of Psychology, University of Novi Sad, Novi Sad, Serbia
| | - Tatjana Krstić
- Faculty of Medicine, Department of Psychology, University of Novi Sad, Novi Sad, Serbia
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McMillan TM, Mason CA, Seidenberg M, Jones J, Hermann B. The impact of processing speed on cognition in temporal lobe epilepsy. Epilepsy Behav 2021; 122:108203. [PMID: 34274747 PMCID: PMC8565181 DOI: 10.1016/j.yebeh.2021.108203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/27/2021] [Accepted: 06/29/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To characterize the impact of slowed processing speed on the efficiency of broader cognitive function in temporal lobe epilepsy (TLE). METHODS Participants included 100 patients with TLE and 89 healthy controls (mean ages 36.8 and 33.6, respectively) administered a neuropsychological battery consisting of 15 cognitive metrics. Confirmatory factor analysis using structural equation modeling (SEM) latent variable modeling demonstrated a cognitive structure representing the domains of verbal intelligence, immediate memory, delayed memory, executive function, working memory, and processing speed. Furthermore, the latent variable measurement model determined the direct and indirect relationships of verbal intelligence and processing speed with immediate memory, delayed memory, executive function, and working memory. RESULTS Following SEM of hypothesized structural models, the results demonstrated that, among controls, intelligence had a direct and unmediated (by processing speed) relationship with all identified cognitive domains. In contrast, among participants with TLE, processing speed mediated the relationship between verbal intelligence and performance across all cognitive domains. CONCLUSION Slowing of cognitive/psychomotor processing speed appears to play a critical mediating role in the broader cognitive status of participants with TLE and may serve as a target through which to attempt to exert a broad positive impact on neuropsychological status.
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Affiliation(s)
- Taylor M. McMillan
- Department of Psychology, University of Maine, 301 Little Hall, Orono, ME 04469, USA,Corresponding author at: Department of Psychology, University of Maine-Orono, 301 Little Hall, Orono, ME 04469, USA., (T.M. McMillan)
| | - Craig A. Mason
- School of Learning and Teaching, University of Maine, 5766 Shibles Hall, Orono, ME 04469, USA
| | - Michael Seidenberg
- Department of Psychology, Rosalind Franklin University of Science and Medicine, 3333 N. Green Bay Road, North Chicago, IL 60064, USA
| | - Jana Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI 53705, USA
| | - Bruce Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI 53705, USA
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Dravet Syndrome-The Polish Family's Perspective Study. J Clin Med 2021; 10:jcm10091903. [PMID: 33924914 PMCID: PMC8125154 DOI: 10.3390/jcm10091903] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/09/2021] [Accepted: 04/15/2021] [Indexed: 12/27/2022] Open
Abstract
Aim: The aim of the paper is to study the prevalence of Dravet Syndrome (DS) in the Polish population and indicate different factors other than seizures reducing the quality of life in such patients. Method: A survey was conducted among caregivers of patients with DS by the members of the Polish support group of the Association for People with Severe Refractory Epilepsy DRAVET.PL. It included their experience of the diagnosis, seizures, and treatment-related adverse effects. The caregivers also completed the PedsQL survey, which showed the most important problems. The survey received 55 responses from caregivers of patients with DS (aged 2–25 years). Results: Prior to the diagnosis of DS, 85% of patients presented with status epilepticus lasting more than 30 min, and the frequency of seizures (mostly tonic-clonic or hemiconvulsions) ranged from 2 per week to hundreds per day. After the diagnosis of DS, patients remained on polytherapy (drugs recommended in DS). Before diagnosis, some of them had been on sodium channel blockers. Most patients experienced many adverse effects, including aggression and loss of appetite. The frequency of adverse effects was related to the number of drugs used in this therapy, which had an impact on the results of the PedsQL form, particularly in terms of the physical and social spheres. Intensive care unit stays due to severe status epilepticus also had an influence on the results of the PedsQL form. Conclusions: Families must be counseled on non-pharmacologic strategies to reduce seizure risk, including avoidance of triggers that commonly induce seizures (including hyperthermia, flashing lights and patterns, sleep abnormalities). In addition to addressing seizures, holistic care for a patient with Dravet syndrome must involve a multidisciplinary team that includes specialists in physical, occupational and speech therapy, neuropsychology, social work.
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van den Berg L, de Weerd AW, Reuvekamp MHF, van der Meere JJ. Associating executive dysfunction with behavioral and socioemotional problems in children with epilepsy. A systematic review. Child Neuropsychol 2021; 27:661-708. [PMID: 33726631 DOI: 10.1080/09297049.2021.1888906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
As children with epilepsy may have a number of learning and behavioral problems, it is important that insight into the underlying neurocognitive differences in these children, which may underlie these areas of challenge is gained. Executive function (EF) problems particularly are associated with specific learning abilities as well as behavioral problems. We aim to review systematically the current status of empirical studies on the association between EF problems and behavior and socioemotional problems in children with epilepsy. After search, 26 empirical studies were identified, most of them of moderate quality. Overall, attention problems were the most reported cognitive deficit in test assessment and the most reported problem by parents. In 54% of the studies, children with epilepsy scored below average compared to controls/normative samples on different aspects of EF. Most studies reported behavior problems, which ranged from mild to severe. Forty-two percent of the studies specifically reported relationships between EF deficits and behavioral problems. In the remaining studies, below average neuropsychological functioning seemed to be accompanied by above average reported behavioral problems. The association was most pronounced for cognitive control and attention in relation to externalizing behavior problems. This cognitive control is also associated with social functioning. Relevant epilepsy variables in this relationship were early age at onset and high seizure frequency.Future research should distinguish specific aspects of EF and take age into account, as this provides more insight on the association between EF and behavior in pediatric epilepsy, which makes it possible to develop appropriate and early intervention.
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Affiliation(s)
- Lydia van den Berg
- Psychology Department, Stichting Epilepsie Instellingen Nederland, Zwolle, Netherlands.,RijksUniversiteitGroningen, Faculteit Gedrags- & Maatschappijwetenschappen, Klinische & Ontwikkelingsneuropsychologie, Groningen, Netherlands
| | - Al W de Weerd
- Psychology Department, Stichting Epilepsie Instellingen Nederland, Zwolle, Netherlands
| | - Marieke H F Reuvekamp
- Psychology Department, Stichting Epilepsie Instellingen Nederland, Zwolle, Netherlands
| | - Jaap J van der Meere
- RijksUniversiteitGroningen, Faculteit Gedrags- & Maatschappijwetenschappen, Klinische & Ontwikkelingsneuropsychologie, Groningen, Netherlands
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Mohamed IN, Osman AH, Mohamed S, Hamid EK, Hamed AA, Alsir A, Gerais YA, Bakhiet AM, Elsadig SM, Elseed MA. Intelligence quotient (IQ) among children with epilepsy: National epidemiological study - Sudan. Epilepsy Behav 2020; 103:106813. [PMID: 31937511 DOI: 10.1016/j.yebeh.2019.106813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 11/18/2019] [Accepted: 11/19/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Many studies of selected groups of children with epilepsy have demonstrated an association between epilepsy and cognitive deficits. The aim of this study was to assess the intellectual skills of children with epilepsy and to investigate the influence of gender, age at seizure onset, type of epilepsy, antiepileptic drug used, and control of epilepsy on their intellectual function. METHODS This is a descriptive prospective study in which one hundred and eighty-seven patients at school age (6-14 years) were recruited. Epilepsy was classified using the International League Against Epilepsy (ILAE) Commission on Classification and Terminology 2005-2009 report. An intelligence quotient (IQ) test was conducted to all patients using Stanford-Binet Fifth Edition (SB5)/Arabic version. RESULTS Eighty-eight (47.1%) patients had an average score on Full Scale IQ (FSIQ), 44 (23.5%) had low average, whereas 18 (9.6%) had borderline impaired or delayed score. In the nonverbal IQ (NVIQ) score, the majority 84 (44.9%) had average score. The performance of the patients in the nonverbal score is better than in the verbal score, which was found to be statistically significant (P-value = 0.01). The FSIQ score was negatively affected by younger age at onset of epilepsy, polytherapy, and uncontrolled seizures. CONCLUSIONS Most of children with epilepsy had an average FSIQ; uncontrolled seizure had worse effect on overall FSIQ and memory. Interventions to support children with epilepsy should focus on epilepsy management and school psychosocial domains.
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Affiliation(s)
- Inaam N Mohamed
- Department of Paediatrics and Child Health, Faculty of Medicine, University of Khartoum, Khartoum, Sudan; Neurology Unit, Gafer Ibn Auf Specialized hospital for Children, Sudan.
| | - Abdelgadir H Osman
- Department of Psychiatry, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Somia Mohamed
- Neurology Unit, Gafer Ibn Auf Specialized hospital for Children, Sudan
| | - Emtinan K Hamid
- Department of Community Medicine- Biostatistics Division, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Ahlam A Hamed
- Department of Paediatrics and Child Health, Faculty of Medicine, University of Khartoum, Khartoum, Sudan; Neurology Unit, Soba University Hospital, Sudan
| | - Ali Alsir
- Neurology Unit, Soba University Hospital, Sudan
| | - Yasmin A Gerais
- Department of Paediatrics and Child Health, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Aisha M Bakhiet
- Department of Psychiatry, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Sarah M Elsadig
- Department of Medicine, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Maha A Elseed
- Department of Paediatrics and Child Health, Faculty of Medicine, University of Khartoum, Khartoum, Sudan; Neurology Unit, Gafer Ibn Auf Specialized hospital for Children, Sudan
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Sanlidag B, Dirik MA. Comorbidities and childhood epilepsy. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2019. [DOI: 10.23736/s0393-3660.18.03907-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Reilly C, Atkinson P, Memon A, Jones C, Dabydeen L, Das KB, Gillberg C, Neville BGR, Mahoney JM, Scott RC. Global development and adaptive behaviour in children with early-onset epilepsy: a population-based case-control study. Dev Med Child Neurol 2019; 61:145-151. [PMID: 29862505 DOI: 10.1111/dmcn.13926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2018] [Indexed: 12/30/2022]
Abstract
AIM There are limited population-based data on global development and adaptive behaviour in children with early-onset epilepsy. The aims of this study were: (1) to identify the prevalence of deficits in global development and adaptive behaviour experienced by children with early-onset epilepsy; (2) to identify factors associated with such deficits; and (3) to compare the relationship between measures of neurodevelopment in the group with epilepsy to a group without epilepsy who had other neurological or neurodevelopmental difficulties. METHOD The Sussex Early Epilepsy and Neurobehaviour study is a prospective, community-based study involving children (1-7y) with epilepsy. We undertook comprehensive psychological assessment with participants, including measures of global development and adaptive behaviour. We compared the children with epilepsy with a sex, age, and developmentally-matched group of children without epilepsy who had neurodevelopmental or neurological difficulties using correlation matrices. RESULTS Forty-eight children (91% of the eligible population) with epilepsy underwent assessment. Seventy-one per cent of children displayed delayed global development (<2SD) and 56% showed significant deficits (<2SD) in adaptive behaviour. Our analysis revealed that non-white ethnicity and use of polytherapy were independently associated with decreased scores on measures of global development and adaptive behaviour. The correlations between measures of developmental functioning were higher in children with epilepsy than in those without. INTERPRETATION Children with early-onset epilepsy frequently have difficulties with global development and adaptive behaviour. The higher correlations between neurodevelopmental measures in children with epilepsy suggest that the profile in children with epilepsy is different. This may have significant implications for both neuropathology and interventions. WHAT THIS PAPER ADDS Children with early-onset epilepsy are at significant risk of intellectual disability. Developmental impairment is associated with use of polytherapy but not with any seizure parameters. Developmental profiles in young children with epilepsy differ from other conditions.
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Affiliation(s)
- Colin Reilly
- Research Department, Young Epilepsy, Lingfield, Surrey, UK.,UCL Great Ormond Street Institute of Child Health (ICH), London, UK
| | - Patricia Atkinson
- Child Development Centre, Crawley Hospital, Crawley, West Sussex, UK
| | - Ayesha Memon
- Child Development Centre, Crawley Hospital, Crawley, West Sussex, UK
| | - Chloe Jones
- Research Department, Young Epilepsy, Lingfield, Surrey, UK
| | - Lyvia Dabydeen
- Research Department, Young Epilepsy, Lingfield, Surrey, UK
| | - Krishna B Das
- UCL Great Ormond Street Institute of Child Health (ICH), London, UK.,Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Christopher Gillberg
- Research Department, Young Epilepsy, Lingfield, Surrey, UK.,UCL Great Ormond Street Institute of Child Health (ICH), London, UK.,Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden
| | - Brian G R Neville
- Research Department, Young Epilepsy, Lingfield, Surrey, UK.,UCL Great Ormond Street Institute of Child Health (ICH), London, UK
| | - J Matthew Mahoney
- Department of Neurological Sciences, University of Vermont College of Medicine, Burlington, VT, USA
| | - Rod C Scott
- UCL Great Ormond Street Institute of Child Health (ICH), London, UK.,Great Ormond Street Hospital for Children NHS Trust, London, UK.,Department of Neurological Sciences, University of Vermont College of Medicine, Burlington, VT, USA
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11
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Modi AC, Gutierrez-Colina AM, Wagner JL, Smith G, Junger K, Huszti H, Mara CA. Executive functioning phenotypes in youth with epilepsy. Epilepsy Behav 2019; 90:112-118. [PMID: 30530131 DOI: 10.1016/j.yebeh.2018.11.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 10/23/2018] [Accepted: 11/21/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objectives of this study were to identify executive functioning (EF) phenotypes in youth with epilepsy and to examine whether phenotypes differ on psychosocial and medical outcomes (i.e., absence/presence of seizures in the past three months), health-related quality of life (HRQOL), and emotional and behavioral functioning. METHODS Youth 5-18 years with diagnosed epilepsy and caregivers completed a battery of questionnaires as part of a larger national validation of the Pediatric Quality of Life (PedsQL) Epilepsy Module. The primary measure of interest was the Behavior Rating Inventory of Executive Function-Parent Form. Medical chart reviews and demographic data were also collected. Latent class analysis was used to identify EF phenotypes. Chi-square and analyses of covariance (ANCOVA) were conducted to examine EF phenotype group differences on seizure outcomes, HRQOL, and behavioral and emotional functioning. RESULTS Two-hundred and thirty-seven children with epilepsy (Mage = 11.2 years; 56% female; 60% White: Non-Hispanic; 55% experienced seizures in the past three months) and their caregivers participated. Four EF phenotypes were identified: Group 1 - No EF deficits (45% of sample), Group 2 - Global EF deficits (29% of sample), Group 3 - Behavioral Regulation + Working Memory deficits (8% of sample), and Group 4 - Metacognitive deficits (17% of sample). No significant EF phenotype group differences were found for seizure characteristics. The ANCOVAs indicated significant EF phenotype group differences on HRQOL (parent-reported Impact, Cognitive, Sleep, EF, and Mood/Behavior and child-reported Cognitive, Sleep, EF, and Mood/Behavior subscales; ps < .001) and emotional and behavioral functioning (Externalizing, Internalizing, and Behavioral Symptom Index; ps < .001), with the Global EF deficits (Group 2) and Behavioral Regulation + Working Memory deficits groups (Group 3) demonstrating the greatest level of impairment. CONCLUSION Phenotypic variability in EF is significantly related to patient-reported outcomes. Interventions addressing EF deficits need to be individualized to a child's particular EF phenotype to achieve optimal outcomes.
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Affiliation(s)
- Avani C Modi
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039, United States of America; University of Cincinnati, College of Medicine, United States of America.
| | - Ana M Gutierrez-Colina
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039, United States of America
| | - Janelle L Wagner
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas St. MSC 160, Charleston, SC 29425-1600, United States of America
| | - Gigi Smith
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas St. MSC 160, Charleston, SC 29425-1600, United States of America
| | - Katherine Junger
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039, United States of America; University of Cincinnati, College of Medicine, United States of America
| | - Heather Huszti
- Division of Pediatric Psychology, Children's Hospital of Orange County, 1120 W La Veta Ave 470, Orange, CA 92868, United States of America
| | - Constance A Mara
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039, United States of America; University of Cincinnati, College of Medicine, United States of America
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12
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Development of the transition-age program (TAP): Review of a pilot psychosocial multidisciplinary transition program in a Level 4 epilepsy center. Epilepsy Behav 2018; 89:153-158. [PMID: 30415138 DOI: 10.1016/j.yebeh.2018.10.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/17/2018] [Accepted: 10/17/2018] [Indexed: 12/13/2022]
Abstract
Approximately 50% of patients diagnosed with epilepsy in childhood will need treatment in adulthood. Transition from pediatric to adult epilepsy care is challenging, and an unsuccessful transition can have detrimental effects. Researchers emphasize the importance of addressing possible barriers to transition in a multidisciplinary setting. In this paper, we describe a transition program implemented in a Level 4 epilepsy center in the Midwest. This program involves a psychosocial multidisciplinary team including a pediatric neuropsychologist, pediatric psychologist, and social worker who meet jointly with patient and his/her caregiver(s) before and after the transition. The pretransition visit involves assessment of transition readiness, screening for neurobehavioral comorbidities, provision of education regarding epilepsy care during the transition period, goal-setting, and development of a portable summary. The posttransition visit revisits goals and provides additional individualized recommendations and/or referrals for intervention as clinically indicated. The goal of this program is to facilitate a smooth transition from pediatric to adult providers to ensure optimal epilepsy care and quality of life.
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13
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Almane DN, Zhao Q, Rathouz PJ, Hanson M, Jackson DC, Hsu DA, Stafstrom CE, Jones JE, Seidenberg M, Koehn M, Hermann BP. Contribution of Family Relatedness to Neurobehavioral Comorbidities in Idiopathic Childhood Epilepsies. J Int Neuropsychol Soc 2018; 24:653-661. [PMID: 29745359 PMCID: PMC6988642 DOI: 10.1017/s1355617718000243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Rates of cognitive, academic and behavioral comorbidities are elevated in children with epilepsy. The contribution of environmental and genetic influences to comorbidity risk is not fully understood. This study investigated children with epilepsy, their unaffected siblings, and controls to determine the presence and extent of risk associated with family relatedness across a range of epilepsy comorbidities. METHODS Participants were 346 children (8-18 years), n=180 with recent-onset epilepsy, their unaffected siblings (n=67), and healthy first-degree cousin controls (n=99). Assessments included: (1) Child Behavior Checklist/6-18 (CBCL), (2) Behavior Rating Inventory of Executive Function (BRIEF), (3) history of education and academic services, and (4) lifetime attention deficit hyperactivity disorder (ADHD) diagnosis. Analyses consisted of linear mixed effect models for continuous variables, and logistic mixed models for binary variables. RESULTS Differences were detected between the three groups of children across all measures (p<.001). For ADHD, academic problems, and executive dysfunction, children with epilepsy exhibited significantly more problems than unaffected siblings and controls; siblings and controls did not differ statistically significantly from each other. For social competence, children with epilepsy and their unaffected siblings displayed more abnormality compared with controls, with no statistically significant difference between children with epilepsy and unaffected siblings. For behavioral problems, children with epilepsy had more abnormality than siblings and controls, but unaffected siblings also exhibited more abnormalities than controls. CONCLUSIONS The contribution of epilepsy and family relatedness varies across specific neurobehavioral comorbidities. Family relatedness was not significantly associated with rates of ADHD, academic problems and executive dysfunction, but was associated with competence and behavioral problems. (JINS, 2018, 24, 653-661).
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Affiliation(s)
- Dace N Almane
- 1Department of Neurology,University of Wisconsin School of Medicine and Public Health,Madison,Wisconsin
| | - Qianqian Zhao
- 2Department of Biostatistics and Medical Informatics,University of Wisconsin School of Medicine and Public Health,Madison,Wisconsin
| | - Paul J Rathouz
- 2Department of Biostatistics and Medical Informatics,University of Wisconsin School of Medicine and Public Health,Madison,Wisconsin
| | - Melissa Hanson
- 1Department of Neurology,University of Wisconsin School of Medicine and Public Health,Madison,Wisconsin
| | - Daren C Jackson
- 1Department of Neurology,University of Wisconsin School of Medicine and Public Health,Madison,Wisconsin
| | - David A Hsu
- 1Department of Neurology,University of Wisconsin School of Medicine and Public Health,Madison,Wisconsin
| | - Carl E Stafstrom
- 3Department of Neurology,Johns Hopkins University School of Medicine,Baltimore,Maryland
| | - Jana E Jones
- 1Department of Neurology,University of Wisconsin School of Medicine and Public Health,Madison,Wisconsin
| | - Michael Seidenberg
- 4Department of Psychology,Rosalind Franklin University of Medicine and Science,North Chicago,Illinois
| | - Monica Koehn
- 5Marshfield Clinic Neurosciences,Marshfield Clinic,Marshfield,Wisconsin
| | - Bruce P Hermann
- 1Department of Neurology,University of Wisconsin School of Medicine and Public Health,Madison,Wisconsin
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14
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Hessen E, Alfstad KÅ, Torgersen H, Lossius MI. Tested and reported executive problems in children and youth epilepsy. Brain Behav 2018; 8:e00971. [PMID: 29761020 PMCID: PMC5943753 DOI: 10.1002/brb3.971] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 03/11/2018] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Executive problems in children and youth with epilepsy influence their ability to handle important aspects of daily life activities. The present study sought to explore factors associated with executive problems for patients with epilepsy in this age group. METHODS The cohort consisted of 97 consecutive patients at the National Centre for Epilepsy in Norway, aged 10-19 years, with focal or genetic generalized epilepsy. All underwent tests of executive functions (D-KEFS), the Behavior Rating Inventory for Executive Function (BRIEF), and screening for psychiatric symptoms, using the Strengths and Difficulties Questionnaire (SDQ). RESULTS Parent-reported cognitive executive dysfunction (BRIEF, Metacognitive Index) was the strongest independent predictor for tested executive dysfunction and vice versa. Furthermore, male gender correlated strongest with parent-reported behavioral regulation problems (BRIEF, Behavioral Regulation Index) along with borderline/pathological score on the SDQ and parent-reported cognitive executive dysfunction. CONCLUSIONS A strong association between parent-reported cognitive executive dysfunction and tested executive dysfunction was found. Male gender correlated strongest with parent-reported behavioral regulation problems. The latter was probably related to a higher frequency of symptoms associated with psychopathology among the boys than the girls. The frequency of executive deficits according to the different modes of measurement varied from 16% to 43%, suggesting that they capture different aspects of behavior under the executive umbrella.
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Affiliation(s)
- Erik Hessen
- Division of Clinical Neuroscience National Centre for Epilepsy Oslo University Hospital Oslo Norway.,Department of Neurology Akershus University Hospital Lørenskog Norway.,Department of Psychology University of Oslo Oslo Norway
| | - Kristin Å Alfstad
- Division of Clinical Neuroscience National Centre for Epilepsy Oslo University Hospital Oslo Norway
| | - Halvor Torgersen
- Division of Clinical Neuroscience National Centre for Epilepsy Oslo University Hospital Oslo Norway
| | - Morten I Lossius
- Division of Clinical Neuroscience National Centre for Epilepsy Oslo University Hospital Oslo Norway.,University of Oslo Oslo Norway
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15
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Modi AC, Vannest J, Combs A, Turnier L, Wade SL. Pattern of executive functioning in adolescents with epilepsy: A multimethod measurement approach. Epilepsy Behav 2018; 80:5-10. [PMID: 29396361 DOI: 10.1016/j.yebeh.2017.12.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/19/2017] [Accepted: 12/22/2017] [Indexed: 11/25/2022]
Abstract
Youth with epilepsy demonstrate deficits in executive functioning (EF), the skills necessary for goal-directed behavior (e.g., problem-solving, initiating, monitoring, organization, planning, and working memory). Despite 30-50% of youth with epilepsy demonstrating EF deficits, no extant studies have utilized both performance and questionnaire-based measures to examine the pattern of EF deficits in adolescents with epilepsy. Study aims were to 1) identify the pattern of EF deficits in adolescents with epilepsy and 2) identify which assessment tools are most sensitive to EF deficits in this population (adolescents, ages 13-17, with epilepsy). An exploratory aim was to examine group differences on measures of EF by epilepsy type. Standard performance-based neuropsychological measures (Wechsler Intelligence Scale for Children - Version V or Wechsler Adult Intelligence Scale Working Memory Index-Version IV, Delis Kaplan Executive Functioning System, NIH Toolbox, Test of Everyday Attention for Children) and the Behavior Rating Inventory of Executive Functioning (BRIEF) comprised the multimethod assessment battery. Depending on the measure, 30% of adolescents with epilepsy had deficits in working memory, 17% in cognitive flexibility/problem solving, 6% in inhibition, and 18% in planning/organization. Attention was a significant problem for 15% of adolescents with epilepsy. Correlations among the various EF measures were quite poor. Across various EF domains, results indicated that adolescents with localization-related epilepsy demonstrated better EF skills compared to adolescents with unclassified epilepsy. Overall, our findings suggest that executive functioning deficits are selective and different from those observed in other neurological populations (e.g., attention deficit hyperactivity disorder (ADHD), traumatic brain injury) where problems with self-regulation (i.e., inhibition, planning/organization) are more pronounced. These findings support utilizing multiple measures, including both performance-based neuropsychological tests and parent- and self-reports, to assess executive functioning difficulties in adolescents with epilepsy as they are uniquely sensitive to executive functioning domains. Adolescents with unclassified epilepsy also appear to be at higher risk for EF deficits and thus represent an important group to target for intervention.
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Affiliation(s)
- Avani C Modi
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
| | - Jennifer Vannest
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Angela Combs
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Luke Turnier
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Shari L Wade
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
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16
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Choudhary S, Niranjan N, Khichar S, Berwal PK, Barath AS. Behavioral Problems and Intelligence Quotient Changes in Pediatric Epilepsy: A Case-Control Study. J Neurosci Rural Pract 2017; 8:617-621. [PMID: 29204024 PMCID: PMC5709887 DOI: 10.4103/jnrp.jnrp_57_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Epilepsy is the most common chronic neurological disease and has neurological impairment as an important comorbidity. Objective To find behavioral problems and intelligence quotient (IQ) changes associated with epilepsy and to know the association of variables such as frequency, type of seizures, and duration of disease with cognitive impairment. Materials and Methods A descriptive cross sectional study, consisting of 50 cases (patients of epilepsy) and 50 controls (other patients of same socioeconomic status) was conducted at S.P. Medical College, Bikaner. The patients were subjected to detailed clinical history, thorough examination, Pediatric Symptom Checklist, and Bhatia's Battery of Performance intelligence Test. Data analysis was carried out with the help of SPSS 22 software. Results The prevalence of behavioral problems in generalized and partial seizure group was high (42% and 53.8%) as compared to control group (9%). Low IQ was present more in the patients (44%) of generalized and partial seizure group as compared with the control group, and results were statistically significant. Furthermore, behavioral problems were more in patients who were having more number of seizures (≥3 per year) with significant P values (χ2 = 5.067, P = 0.024). Conclusion We conclusively found that behavioral problems and cognitive factors, apart from control of seizures, must be kept in mind to determine how well a child with epilepsy progresses toward independence.
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Affiliation(s)
- Shyama Choudhary
- Department of Pediatrics, Dr. S. N. Medical College, New Delhi, India
| | - N Niranjan
- Department of Pediatrics, Dr. R.M.L. Institute of Medical Sciences, New Delhi, India
| | | | - Pramod K Berwal
- Department of Pediatrics, S. P. Medical College, Bikaner, Rajasthan, India
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Development of a web-based executive functioning intervention for adolescents with epilepsy: The Epilepsy Journey. Epilepsy Behav 2017; 72:114-121. [PMID: 28575759 PMCID: PMC5534186 DOI: 10.1016/j.yebeh.2017.04.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 03/28/2017] [Accepted: 04/03/2017] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Youth with epilepsy exhibit significant deficits in executive functioning (EF), yet there are few interventions to improve EF for adolescents. The aims of the current study were to develop an individually-tailored intervention, called Epilepsy Journey, to improve aspects of EF through an iterative, patient-centered process including focus groups and usability testing. METHODS Five adolescents and caregivers participated in focus groups. This input was used to develop ten learning modules based on subscales of the Behavioral Rating Inventory of Executive Functions and key issues that may impact EF in adolescents. Six adolescents participated in usability testing and a usability expert conducted a heuristic evaluation. Demographic information, chart reviews and measures of EF were also completed. RESULTS Focus group participants and their parents reported difficulties with memory, attention, organization, monitoring, initiation, impulsivity, emotional control, sleep, awareness in schools and managing stress. They also identified successful strategies to address memory and organizational difficulties. Usability testing of the resultant Epilepsy Journey modules revealed problems with navigation and identified features that promoted usability, including progress bars and interactive modules. Program modifications were made after each usability trial resulting in a relatively brief, interactive and readily navigable program. Perceived utility was high with all but one participant. Participants rated the content as helpful and indicated they would recommend Epilepsy Journey to others. CONCLUSIONS Feedback from the focus group and usability testing yielded a feasible, acceptable, relevant and user-friendly web-based intervention for adolescents with epilepsy. The Epilepsy Journey program will be further tested in an open pilot with adolescents with epilepsy and associated EF deficits.
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18
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Menlove L, Reilly C. Memory in children with epilepsy: a systematic review. Seizure 2014; 25:126-35. [PMID: 25457449 DOI: 10.1016/j.seizure.2014.10.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 09/28/2014] [Accepted: 10/04/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Research suggests an increased risk for cognitive impairment in childhood epilepsy with memory being one area of cognition most likely to be affected. Understanding the prevalence and predictors of memory difficulties may help improve awareness of the difficulties and allow efficacious supports to be put in place. METHOD A systematic review was carried out using the search terms 'memory', 'children' and 'epilepsy' in the database PUBMED. Eighty-eight studies met inclusion criteria. The review focuses on comparisons of memory scores of children with epilepsy and controls, and comparison of memory scores of children with epilepsy to normative scores. Predictors of memory impairment and the effect of surgery on memory functioning are also reviewed. RESULTS The majority (78%) of studies reviewed revealed that children with epilepsy scored lower than controls and normative scores on measures of memory. Post-surgery, memory scores were reported to improve in 50% of studies. Predictors of memory impairment included a greater number of AEDs used, younger age of onset, increased seizure frequency and longer duration of epilepsy. CONCLUSION Children with epilepsy have a high frequency of memory impairments. However, the exact prevalence of difficulties is not clear due to the lack of population-based data. Most studies have not controlled for IQ and thus it is unclear if difficulties are always related to global cognitive difficulties. There is need for future population-based studies and studies focussing on the neurobiology of memory problems in children with epilepsy.
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Affiliation(s)
- Leanne Menlove
- Research Department, Young Epilepsy, St. Piers Lane, Lingfield, Surrey RH7 6PW, United Kingdom.
| | - Colin Reilly
- Research Department, Young Epilepsy, St. Piers Lane, Lingfield, Surrey RH7 6PW, United Kingdom.
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19
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Developmental stage affects cognition in children with recently-diagnosed symptomatic focal epilepsy. Epilepsy Behav 2014; 39:97-104. [PMID: 25240120 DOI: 10.1016/j.yebeh.2014.08.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 08/03/2014] [Accepted: 08/06/2014] [Indexed: 12/19/2022]
Abstract
This study explored the impact of developmental stage on cognitive function in children with recently-diagnosed epilepsy. In keeping with a neurodevelopmental framework, skills in a critical developmental period were expected to be more vulnerable than those stable at the time of seizure onset. We studied children with early-onset (EO) symptomatic focal epilepsy (onset: 3-5 years; n=18) and compared their performance with that of the group with late-onset (LO) epilepsy (onset: 6-8 years performance of; n=8) on a range of cognitive tasks. Performance of both groups was compared with normative standards. 'Critical' and 'stable' classifications were based on developmental research. Nonparametric analyses revealed that skills in a critical developmental period for the group with EO epilepsy fell below normative standards (Phonological Processing: p=.007, Design Copying: p=.01, Visuomotor Precision:, p=.02) and fell below the performance of the group with LO epilepsy (Design Copying: p=.03, Visuomotor Precision: p=.03). There were no differences between the group with EO epilepsy and the group with LO epilepsy on measures of receptive vocabulary and memory, which were proposed to be in a stable developmental period across both groups. Auditory span, as measured by Word Order, was reduced for both the group with EO epilepsy (p=.02) and the group with LO epilepsy (p=.02) relative to normative standards, but the groups did not differ from each other. These results are consistent with a prolonged period of critical development for this skill. These findings support the notion that skills in a critical phase of development are particularly vulnerable following the onset of symptomatic focal epilepsy in childhood.
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20
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Gulati S, Yoganathan S, Chakrabarty B. Epilepsy, cognition and behavior. Indian J Pediatr 2014; 81:1056-62. [PMID: 25073691 DOI: 10.1007/s12098-014-1530-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 06/27/2014] [Indexed: 02/08/2023]
Abstract
Epilepsy is defined as two or more unprovoked seizures. Epileptic patients have intellectual disability and behavioral co-morbidities to the tune of up to 25 and 75% respectively. Various factors like underlying etiology, socioeconomic environment at home, age at onset, seizure semiology, seizure descriptors like duration, severity and frequency, therapy related adverse effects secondary to antiepileptic drugs and epilepsy surgery have been implicated for the causation of cognitive and behavioral impairment in epilepsy. Cognitive epilepsy has emerged as a specific entity. This may manifest as a transient behavioral or cognitive change, insidous onset subacute to chronic encephalopathy or more catastrophic in the form of nonconvulsive status epilepticus. Cognitive impairment seen in epileptic children include difficulties in learning, memory, problem solving as well as concept formation. Anxiety, depression and attention deficit hyperkinetic disorders are the most common psychiatric co-morbidities seen. Investigating a child with epilepsy for cognitive and behavioral impairment is difficult as these tests would require cooperation from the patient's side to a significant extent. A rational approach towards treatment would be judicious selection of antiepileptic drugs, treatment of underlying cause, appropriate management of behavioral co-morbidities including psychopharmacotherapy and a trial of immunotherapy (particularly in cognitive epilepsies), wherever appropriate.
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Affiliation(s)
- Sheffali Gulati
- Division of Pediatric Neurology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India,
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21
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Eom S, Eun SH, Kang HC, Eun BL, Nam SO, Kim SJ, Chung HJ, Kwon SH, Lee YM, Lee JS, Kim DW, Oh KJ, Kim HD. Epilepsy-related clinical factors and psychosocial functions in pediatric epilepsy. Epilepsy Behav 2014; 37:43-8. [PMID: 24972158 DOI: 10.1016/j.yebeh.2014.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 05/19/2014] [Accepted: 05/23/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to identify the different influencing patterns of demographic and epilepsy-related variables on various aspects of psychosocial function in pediatric epilepsy. METHOD Five hundred ninety-eight patients with pediatric epilepsy between the ages of 4 and 18 years (boys=360, 60% and girls=238, 40%) and their parents participated in the study. Parents completed the Social Maturity Scale (SMS), the Korean version of the Child Behavior Checklist (K-CBCL), and the Korean version of the Quality of Life in Childhood Epilepsy Questionnaire (K-QOLCE) to assess daily living function, behavior, and quality of life. The Children's Global Assessment Scale (CGAS) was completed by clinicians to assess general adaptive function. Demographic variables, such as age and sex of child, and epilepsy-related clinical variables, including seizure type, seizure frequency, duration of epilepsy, and number of medications, were obtained from medical records. RESULTS Demographic and epilepsy-related clinical variables had a strong influence (22-32%) on the cognition-related domain such as general adaptive function, school/total competence, and quality of life for cognitive function while a comparatively smaller effect (2-16%) on the more psychological domain including behavioral, emotional, and social variables. Younger age, shorter duration of illness, and smaller number of medications showed a strong positive impact on psychosocial function in pediatric epilepsy, particularly for adaptive function, competence, and quality-of-life aspects. CONCLUSION Given the wide range of impact of demographic and clinical variables on various facets of psychosocial functions, more specific understanding of the various aspects of factors and their particular pattern of influence may enable more effective therapeutic approaches that address both the medical and psychological needs in pediatric epilepsy.
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Affiliation(s)
- Soyong Eom
- Epilepsy Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - So-Hee Eun
- Department of Pediatrics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hoon-Chul Kang
- Division of Pediatric Neurology, Pediatric Epilepsy Clinic, Severance Children's Hospital, Epilepsy Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Baik-Lin Eun
- Department of Pediatrics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sang Ook Nam
- Department of Pediatrics, Pusan National University Children's Hospital School of Medicine, Yangsan, Republic of Korea
| | - Sun Jun Kim
- Department of Pediatrics, Chonbuk National University, Medical School, Jeonju, Republic of Korea
| | - Hee Jung Chung
- Department of Pediatrics, National Health Insurance Corporation, Ilsan Hospital, Goyang, Republic of Korea
| | - Soon Hak Kwon
- Department of Pediatrics, Kyungpook National University College of Medicine, Daegu, Republic of Korea
| | - Young-Mock Lee
- Department of Pediatrics, Gangnam Severance Hospital, Younsei University College of Medicine, Seoul, Republic of Korea
| | - Joon Soo Lee
- Division of Pediatric Neurology, Pediatric Epilepsy Clinic, Severance Children's Hospital, Epilepsy Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Wook Kim
- Department of Pediatrics, Inje University College of Medicine, Goyang, Republic of Korea
| | - Kyung Ja Oh
- Department of Psychology, Yonsei University, Seoul, Republic of Korea
| | - Heung Dong Kim
- Division of Pediatric Neurology, Pediatric Epilepsy Clinic, Severance Children's Hospital, Epilepsy Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Reilly C, Atkinson P, Das KB, Chin RF, Aylett SE, Burch V, Gillberg C, Scott RC, Neville BG. Neurobehavioral comorbidities in children with active epilepsy: a population-based study. Pediatrics 2014; 133:e1586-93. [PMID: 24864167 DOI: 10.1542/peds.2013-3787] [Citation(s) in RCA: 244] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In addition to recurrent epileptic seizures, children with epilepsy can have coexisting cognitive and behavioral difficulties but the spectrum and prevalence of such difficulties are uncertain. METHODS The Children with Epilepsy in Sussex Schools study is a prospective, community-based study involving school-aged children (5–15 years) with active epilepsy in a defined geographical area in the United Kingdom. Participants underwent comprehensive psychological assessment, including measures of cognition, behavior, and motor functioning. Consensus neurobehavioral diagnoses were made with respect to Diagnostic and Statistical Manual, Fourth Edition-Text Revision (DSM-IV-TR) criteria. RESULTS A total of 85 children (74% of eligible population) were enrolled; 80% of children with active epilepsy had a DSM-IV-TR behavioral disorder and/or cognitive impairment (IQ ,85). Intellectual disability (ID) (IQ ,70) (40%), attention-deficit/hyperactivity disorder (ADHD) (33%), and autism spectrum disorder (ASD) (21%) were the most common neurobehavioral diagnoses. Of those who met criteria for a DSM-IV-TR behavioral disorder, only one-third had previously been diagnosed. Logistic regression revealed that seizures in the first 24 months compared with first seizures at 24 to 60 or 61+ months (odds ratio [OR] 13, 95% confidence interval 2.2–76.9; OR 21.3, 3.2–148.9) and polytherapy (OR 7.7, 1.6–36.3) were independently associated with ID and the presence of ID was associated with a diagnosis of ASD (OR 14.1, 2.3–87.1) after Bonferroni adjustment. Epilepsy-related factors did not independently predict the presence of behavioral disorders. CONCLUSIONS Screening for neurobehavioral comorbidities should be an integral part of management in children with “active” epilepsy. There is a need for research to identify neurobiological mechanisms underpinning neurobehavioral impairments and studies to evaluate possible treatments.
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Affiliation(s)
- Colin Reilly
- Research Department, Young Epilepsy, Lingfield, Surrey, United Kingdom
| | - Patricia Atkinson
- Child Development Centre, Crawley Hospital, Crawley, West Sussex, United Kingdom
| | - Krishna B. Das
- Research Department, Young Epilepsy, Lingfield, Surrey, United Kingdom
- Neurosciences Unit, Institute of Child Health, University College London, London, United Kingdom
- Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - Richard F.M.C. Chin
- Muir Maxwell Epilepsy Centre, Edinburgh Neurosciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Sarah E. Aylett
- Neurosciences Unit, Institute of Child Health, University College London, London, United Kingdom
- Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - Victoria Burch
- Research Department, Young Epilepsy, Lingfield, Surrey, United Kingdom
| | - Christopher Gillberg
- Neurosciences Unit, Institute of Child Health, University College London, London, United Kingdom
- Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden; and
| | - Rod C. Scott
- Neurosciences Unit, Institute of Child Health, University College London, London, United Kingdom
- Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
- College of Medicine, University of Vermont, Burlington, Vermont
| | - Brian G.R. Neville
- Research Department, Young Epilepsy, Lingfield, Surrey, United Kingdom
- Neurosciences Unit, Institute of Child Health, University College London, London, United Kingdom
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23
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Jackson DC, Lin JJ, Chambers KL, Kessler-Jones A, Jones JE, Hsu DA, Stafstrom CE, Seidenberg M, Hermann BP. Birth weight and cognition in children with epilepsy. Epilepsia 2014; 55:901-8. [PMID: 24735169 PMCID: PMC4057970 DOI: 10.1111/epi.12622] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Birth weight is an important indicator of prenatal environment, and subtle variations of birth weight within the normal range have been associated with differential risk for cognitive and behavioral problems. Therefore, we aimed to determine if there are differences in birth weight between full-term children with uncomplicated new/recent-onset epilepsies and typically developing healthy controls. We further examined the relationships between birth weight and childhood/adolescent cognition, behavior, and academic achievement. METHODS One hundred eight children with new-onset/recent-onset epilepsy and 70 healthy controls underwent neuropsychological assessment. All participants were born full-term (>37 weeks) without birth complications. Parents were interviewed regarding their child's gestation, birth, and neurodevelopmental history. RESULTS Birth weight of children with epilepsy was significantly lower than healthy controls (p = 0.023). Whereas birth weight (covaried with age, sex, handedness, and mother's education) was significantly associated with cognition in controls in multiple domains (intelligence, language, aspects of academic achievement), this relationship was absent in children with epilepsy. Birth weight was not associated with clinical epilepsy variables (age of onset, epilepsy syndrome) and was not predictive of a variety of other academic or psychiatric comorbidities of epilepsy. SIGNIFICANCE Although the origin of lower birth weight in children with epilepsy is unknown, these findings raise the possibility that abnormal prenatal environment may affect childhood-onset epilepsy. Furthermore, the positive relationship between birth weight and cognition evident in healthy controls was disrupted in children with epilepsy. However, birth weight was not related to academic and psychiatric comorbidities of childhood epilepsy. A PowerPoint slide summarizing this article is available for download in the Supporting Information section here.
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Affiliation(s)
- Daren C. Jackson
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - Jack J. Lin
- Department of Neurology, University of California at Irvine, Irvine CA
| | - Karlee L. Chambers
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - Alanna Kessler-Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - Jana E. Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - David A. Hsu
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - Carl E. Stafstrom
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - Michael Seidenberg
- Department of Psychology, Rosalind Franklin School of Medicine and Science, North Chicago IL
| | - Bruce P. Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
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Melbourne Chambers R, Morrison-Levy N, Chang S, Tapper J, Walker S, Tulloch-Reid M. Cognition, academic achievement, and epilepsy in school-age children: a case-control study in a developing country. Epilepsy Behav 2014; 33:39-44. [PMID: 24632351 DOI: 10.1016/j.yebeh.2014.02.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 02/02/2014] [Accepted: 02/04/2014] [Indexed: 10/25/2022]
Abstract
We conducted a case-control study of 33 Jamaican children 7 to 12years old with uncomplicated epilepsy and 33 of their classroom peers matched for age and gender to determine whether epilepsy resulted in differences in cognitive ability and school achievement and if socioeconomic status or the environment had a moderating effect on any differences. Intelligence, language, memory, attention, executive function, and mathematics ability were assessed using selected tests from NEPSY, WISCR, TeaCh, WRAT3 - expanded, and Raven's Coloured Progressive Matrices. The child's environment at home was measured using the Middle Childhood HOME inventory. Socioeconomic status was determined from a combination of household, crowding, possessions, and sanitation. We compared the characteristics of the cases and controls and used random effects regression models (using the matched pair as the cluster) to examine the relationship between cognition and epilepsy. We found that there was no significant difference in IQ, but children with epilepsy had lower scores on tests of memory (p<0.05), language (p<0.05), and attention (p<0.01) compared with their controls. In random effects models, epilepsy status had a significant effect on memory (coefficient=-0.14, CI: -0.23, -0.05), language (coefficient=-0.13, CI: -0.23, -0.04), and mathematics ability (coefficient=-0.01, CI: -0.02, -0.00). Adjustment for the home environment and socioeconomic status and inclusion of interaction terms for these variables did not alter these effects. In conclusion, we found that epilepsy status in Jamaican children has a significant effect on performance on tests of memory, language, and mathematics and that this effect is not modified or explained by socioeconomic status or the child's home environment.
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Affiliation(s)
- R Melbourne Chambers
- Department of Child and Adolescent Health, University of the West Indies (UWI), Mona, Jamaica.
| | - N Morrison-Levy
- Bustamante Hospital for Children, Arthur Wint Drive, Kingston, Jamaica.
| | - S Chang
- Epidemiology Research Unit, Tropical Medicine Research Institute, UWI, Mona, Jamaica.
| | - J Tapper
- Bustamante Hospital for Children, Arthur Wint Drive, Kingston, Jamaica.
| | - S Walker
- Epidemiology Research Unit, Tropical Medicine Research Institute, UWI, Mona, Jamaica.
| | - M Tulloch-Reid
- Epidemiology Research Unit, Tropical Medicine Research Institute, UWI, Mona, Jamaica.
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Lopes AF, Simões MR, Monteiro JP, Fonseca MJ, Martins C, Ventosa L, Lourenço L, Robalo C. Intellectual functioning in children with epilepsy: frontal lobe epilepsy, childhood absence epilepsy and benign epilepsy with centro-temporal spikes. Seizure 2013; 22:886-92. [PMID: 23992789 DOI: 10.1016/j.seizure.2013.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 07/26/2013] [Accepted: 08/04/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE The purpose of our study is to describe intellectual functioning in three common childhood epilepsy syndromes - frontal lobe epilepsy (FLE), childhood absence epilepsy (CAE) and benign epilepsy with centro-temporal spikes (BECTS). And also to determine the influence of epilepsy related variables, type of epilepsy, age at epilepsy onset, duration and frequency of epilepsy, and treatment on the scores. METHODS Intellectual functioning was examined in a group of 90 children with epilepsy (30 FLE, 30 CAE, 30 BECTS), aged 6-15 years, and compared with a control group (30). All subjects obtained a Full Scale IQ ≥ 70 and they were receiving no more than two antiepileptic medications. Participants completed the Wechsler Intelligence Scale for Children - Third Edition. The impact of epilepsy related variables (type of epilepsy, age at epilepsy onset, duration of epilepsy, seizure frequency and anti-epileptic drugs) on intellectual functioning was examined. RESULTS Children with FLE scored significantly worse than controls on WISC-III Verbal IQ, Full Scale IQ and Processing Speed Index. There was a trend for children with FLE to have lower intelligence scores than CAE and BECTS groups. Linear regression analysis showed no effect for age at onset, frequency of seizures and treatment. Type of epilepsy and duration of epilepsy were the best indicators of intellectual functioning. CONCLUSION It is crucial that children with FLE and those with a longer active duration of epilepsy are closely monitored to allow the early identification and evaluation of cognitive problems, in order to establish adequate and timely school intervention plans.
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Affiliation(s)
- Ana Filipa Lopes
- Faculty of Psychology, University of Coimbra, Coimbra, Portugal; Neuropaediatric Unit - Garcia de Orta Hospital, Almada, Portugal.
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Jackson DC, Dabbs K, Walker NM, Jones JE, Hsu DA, Stafstrom CE, Seidenberg M, Hermann BP. The neuropsychological and academic substrate of new/recent-onset epilepsies. J Pediatr 2013; 162:1047-53.e1. [PMID: 23219245 PMCID: PMC3615134 DOI: 10.1016/j.jpeds.2012.10.046] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Revised: 09/26/2012] [Accepted: 10/18/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To characterize neuropsychological and academic status in children, ages 8-18 years, with new-/recent-onset idiopathic generalized epilepsy (IGE) and idiopathic localization-related epilepsy (ILRE) compared with healthy controls. STUDY DESIGN Participants underwent neuropsychological assessment, and parents were interviewed regarding their child's academic history. Cognitive scores for children with epilepsy were age- and sex-adjusted and compared with controls across both broad-band (IGE n = 41 and ILRE n = 53) and narrow-band (childhood/juvenile absence, juvenile myoclonic, benign epilepsy with centro-temporal spikes, and focal [temporal/frontal/not otherwise specified]) syndromes. Academic histories were examined, including problems antecedent to epilepsy onset and diagnosis. RESULTS Children with new/recent-onset epilepsies exhibit considerable cognitive abnormality at baseline, including patterns of shared abnormalities across syndromes (eg, psychomotor slowing) as well as unique syndrome-specific cognitive effects (eg, executive function in IGE and language/verbal memory in ILRE) that are observed and sometimes exacerbated in specific IGE and ILRE syndromes. Academic difficulties are evident in approximately 50% of the children with epilepsy, affecting all syndrome groups to an equal degree. DISCUSSION Patterns of shared and syndrome-specific cognitive abnormalities and academic problems are present early in the course of virtually all epilepsy syndromes examined here, including syndromes classically viewed as benign. This is the base upon which the effects of recurrent seizures, treatment, and psychosocial effects will be added over time.
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Affiliation(s)
- DC Jackson
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - K Dabbs
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - NM Walker
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - JE Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - DA Hsu
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - CE Stafstrom
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - M Seidenberg
- Department of Psychology, Rosalind Franklin School of Medicine and Science, North Chicago IL
| | - BP Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
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Kernan CL, Asarnow R, Siddarth P, Gurbani S, Lanphier EK, Sankar R, Caplan R. Neurocognitive profiles in children with epilepsy. Epilepsia 2012; 53:2156-63. [PMID: 23126490 DOI: 10.1111/j.1528-1167.2012.03706.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE The presence of specific neurocognitive deficits may help explain why school achievement and psychosocial functioning are often worse in children with epilepsy than would be predicted by their global intellectual functioning. This study compared children with two forms of epilepsy: localization-related epilepsy with complex partial seizures (CPS) and childhood absence epilepsy (CAE), to determine whether they display distinct neurocognitive profiles. METHODS Fifty-one children with CPS, 31 children with CAE, and 51 controls underwent neuropsychological testing assessing verbal memory, visual memory, and executive functioning. Groups were compared in these cognitive domains. Within-group analyses were also conducted to examine seizure-related factors that may be related to neuropsychological test performance. KEY FINDINGS When compared to controls, children with CPS showed a mild generalized cognitive deficit, whereas children with CAE did not. When we controlled for intelligent quotient (IQ), both epilepsy groups showed poorer performance relative to controls in the domain of verbal memory. When the epilepsy groups were compared to one another, the CPS group performed significantly poorer than the CAE group on a test of generalized cognitive functioning. However, in the specific domains of executive functioning, verbal memory, and visual memory the epilepsy groups did not differ when compared to one another. SIGNIFICANCE Neurocognitive deficits present in the context of grossly intact global intellectual functioning highlight the importance of neuropsychological screening in both children with CPS and children with CAE.
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Affiliation(s)
- Claudia L Kernan
- Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, California 90024, USA.
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Abstract
Epilepsy is a common neurological disorder that is complicated by psychiatric, cognitive, and social comorbidities that have become a major target of concern and investigation in view of their adverse effect on the course and quality of life. In this report we define the specific psychiatric, cognitive, and social comorbidities of paediatric and adult epilepsy, their epidemiology, and real life effects; examine the relation between epilepsy syndromes and the risk of neurobehavioural comorbidities; address the lifespan effect of epilepsy on brain neurodevelopment and brain ageing and the risk of neurobehavioural comorbidities; consider the overarching effect of broader brain disorders on both epilepsy and neurobehavioural comorbidities; examine directions of causality and the contribution of selected epilepsy-related characteristics; and outline clinic-friendly screening approaches for these problems and recommended pharmacological, behavioural, and educational interventions.
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Affiliation(s)
- Jack J. Lin
- Department of Neurology, University of California at Irvine, Irvine, California, USA
| | - Marco Mula
- Amedeo Avogadro University, Novara, Italy
| | - Bruce P. Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Starting at the beginning: the neuropsychological status of children with new-onset epilepsies. Epileptic Disord 2012; 14:12-21. [PMID: 22421240 DOI: 10.1684/epd.2012.0483] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
This review examines the neurodevelopmental contribution to the cognitive and behavioural complications of epilepsy. Following a brief review of the lifespan complications of childhood epilepsies, attention turns to cognitive, psychiatric and social correlates of childhood epilepsies reported in population-based and tertiary care studies. The focus then becomes the neurobehavioural status of children with new-onset epilepsy; a point in time not confounded by the effects of years of recurrent seizures, medications, and social reactions to epilepsy. Recent research shows that abnormalities in cognition, brain structure and behaviour are present at or near the time of diagnosis. Further, careful history taking indicates that neurobehavioural problems may be present in advance of the first seizure suggesting the potential influence of epileptogenesis, antecedent neurodevelopmental abnormalities, genetic and environmental susceptibilities, and other risk factors. This becomes the substrate upon which to characterise the effects of epilepsy and its treatment on subsequent neurodevelopment. The review concludes with suggestions for future clinical care and research.
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Burton K, Rogathe J, Hunter E, Burton M, Swai M, Todd J, Neville B, Walker R, Newton C. Behavioural comorbidity in Tanzanian children with epilepsy: a community-based case-control study. Dev Med Child Neurol 2011; 53:1135-42. [PMID: 22092080 PMCID: PMC3592385 DOI: 10.1111/j.1469-8749.2011.04109.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to define the prevalence of and risk factors for behavioural disorders in children with epilepsy from a rural district of Tanzania by conducting a community-based case-control study. METHOD One hundred and twelve children aged 6 to 14 years (55 males, 57 females; median age 12 y) with active epilepsy (at least two unprovoked seizures in the last 5 y) were identified in a cross-sectional survey and included in this study. Children who were younger than 6 years were excluded in order to eliminate febrile seizures. Behaviour was assessed using the Rutter scale; children who scored 13 or more were considered to have disordered behaviour. A comparison group was made up of age- and sex-matched children without epilepsy (n = 113; 57 males, 56 females; median age 12 y). RESULTS Behavioural disorders were diagnosed in 68 of 103 (66%) children with epilepsy and in 19 of 99 (19%) controls. Disordered behaviour was significantly more common in children with epilepsy than in the comparison group (univariate odds ratio 8.2; 95% confidence interval [CI] 4.3-15.6; p < 0.001) and frequent seizures and poor scholastic attainment were associated in children with epilepsy. Behavioural disorders were not associated with antiepileptic drug usage. Attention problems were present in 48 of 91 (53%) children with epilepsy and 16 of 97 (17%) controls (univariate odds ratio 5.7; 95% CI 2.9-11.1; p < 0.001). In children with epilepsy, attention problems were significantly more common in males and were associated with frequent seizures. INTERPRETATION Children with epilepsy in a rural area of sub-Saharan Africa have a high prevalence of behavioural disorders and attention problems, both of which are associated with frequent seizures. Providing behaviour assessment and appropriate intervention programmes for children with epilepsy may reduce the burden of behaviour disorders in this setting.
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Affiliation(s)
- K.J Burton
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
,Neurosciences Unit, Institute of Child Health, University College London, United Kingdom
| | - J Rogathe
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - E Hunter
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | - M.J Burton
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
,Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Tropical Medicine, United Kingdom
| | - M. Swai
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - J. Todd
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Tropical Medicine, United Kingdom
,National Institute for Medical Research, PO Box 1462, Mwanza, Tanzania
| | - B.G Neville
- Neurosciences Unit, Institute of Child Health, University College London, United Kingdom
| | - R. Walker
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | - C.R.J.C Newton
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
,National Institute for Medical Research, PO Box 1462, Mwanza, Tanzania
,Department of Paediatrics, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
,University of Oxford, Oxford, United Kingdom
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McDonald CR, Taylor J, Hamberger M, Helmstaedter C, Hermann BP, Schefft B. Future directions in the neuropsychology of epilepsy. Epilepsy Behav 2011; 22:69-76. [PMID: 21795122 DOI: 10.1016/j.yebeh.2011.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 06/05/2011] [Indexed: 11/17/2022]
Abstract
Two important themes for future clinical research in the neuropsychology of epilepsy are proposed: (1) the neurobiological abnormalities that underlie neuropsychological impairment in people with epilepsy, and (2) neuropsychological status of persons with new-onset epilepsy.
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Affiliation(s)
- Carrie R McDonald
- Multimodal Imaging Laboratory, Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
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Abstract
This paper first summarizes the main findings of clinical studies conducted over the past two and a half decades on psychopathology (i.e., psychiatric diagnoses, behavior and emotional problems) in children with new onset and chronic epilepsy both with and without intellectual disability who are treated medically and surgically. Although impaired social relationships are core features of the psychiatric disorders found in pediatric epilepsy, few studies have examined social competence (i.e., social behavior, social adjustment, and social cognition) in these children. There also is a dearth of treatment studies on the frequent psychiatric comorbidities of pediatric epilepsy, attention deficit hyperactivity disorder, anxiety disorders, and depression. Drs. Hamiwka and Jones then describe their current and planned studies on social competence and cognitive behavioral treatment of anxiety disorders, respectively, in these children and how they might mitigate the poor long-term psychiatric and social outcome of pediatric epilepsy.
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Affiliation(s)
- Lorie Hamiwka
- Division of Child Neurology, Ohio State University College of Medicine, Columbus, OH, USA
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Rantanen K, Eriksson K, Nieminen P. Cognitive impairment in preschool children with epilepsy. Epilepsia 2011; 52:1499-505. [DOI: 10.1111/j.1528-1167.2011.03092.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ebrahimi A, Houshmand M, Tonekaboni SH, Fallah Mahboob Passand MS, Zainali S, Moghadasi M. Two novel mutations in SCN1A gene in Iranian patients with epilepsy. Arch Med Res 2010; 41:207-14. [PMID: 20682179 DOI: 10.1016/j.arcmed.2010.04.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Accepted: 01/26/2010] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS Epilepsy as a common chronic neurological disorder is characterized by recurrent unprovoked seizures. Febrile seizures are the most common type of epilepsy in infants and children. Our aim was the molecular analysis of SCN1A gene in affected Iranian patients with GEFS+ and Dravet syndrome diagnosed clinically to explain genotype-phenotype correlation and exact classification. METHODS The 34 unrelated Iranian families with epilepsy were selected and screened for SCN1A mutations by MLPA, ARMS, and PCR-RFLP confirmed by direct sequencing. RESULTS MLPA analysis showed normal patterns, but direct sequencing revealed that generally 20/34 (0.588) probands have common reported single nucleotide polymorphisms (SNPs) (p.A1067G; rs2298771) with allelic frequency as 0.706/0.294 in patients and 0.515/0.485 in control group, respectively, for A/G. No significant differences between groups were observed. Moreover, four novel allelic variants as missense substitutions included two new sequence variation (p.F412 I, p.Y1274N) and two previously reported mutations (p.R101G, p.S103G) that were detected in 4/34 probands but not in control groups and other healthy normal family members. CONCLUSIONS Clinical diagnosis could nearly establish the classification, but mutation screening helps clinicians to confirm their data. We found mutation in four probands and confirmed the net diagnosis. Our data suggest that the clinical symptom variations could be also explained, considering the role of modifier genes such as mitochondrial mutations or other genes responsible for drug metabolism pathways including multiple drug resistance family genes (ABCB1) or MTHFR.
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Affiliation(s)
- Ahmad Ebrahimi
- National Institute of Genetic Engineering and Biotechnology (NIGEB), Tehran, Iran
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Hermann BP, Lin JJ, Jones JE, Seidenberg M. The emerging architecture of neuropsychological impairment in epilepsy. Neurol Clin 2009; 27:881-907. [PMID: 19853214 PMCID: PMC2811050 DOI: 10.1016/j.ncl.2009.08.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A new literature is now under way, one linking cognitive abnormalities directly to indices of structural, functional, metabolic, and other neurobiologic markers of cerebral integrity, independent of their association with clinical epilepsy characteristics. These trends are reviewed in this article. The focus is on temporal lobe epilepsy (TLE) as a model with which to address the core points because this form of localization-related epilepsy has been very carefully studied from both a cognitive and imaging standpoint. Some pertinent historical issues are touched on first, followed by more detailed reviews of the cognitive and neuroimaging abnormalities that have been found in TLE, followed by an overview of studies examining direct structure-function relationships in TLE and other epilepsies.
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Affiliation(s)
- Bruce P Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, 600 North Highland Avenue, Madison, WI 53792, USA.
| | - Jack J Lin
- Department of Neurology, University of California-Irvine, Irvine, CA 92697, USA
| | - Jana E Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, 600 North Highland Avenue, Madison, WI 53792, USA
| | - Michael Seidenberg
- Department of Psychology, Rosalind Franklin School of Medicine and Science, 3333 N. Green Bay Road, North Chicago, IL 60064, USA
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Rytter E, Landmark CJ, Johannessen SI. Antiepileptic drug treatment of children at a referral centre for epilepsy--does admission make a difference? Seizure 2009; 18:573-9. [PMID: 19576793 DOI: 10.1016/j.seizure.2009.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Accepted: 05/29/2009] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To study the antiepileptic drug treatment of children at a referral centre for epilepsy, including a follow-up study three months after discharge. MATERIAL AND METHODS The study includes children admitted to The National Centre for Epilepsy in Norway. Data were collected from the medical records of 261 children, and a questionnaire regarding the pharmacological treatment was sent to their parents three months after discharge. RESULTS The most common reasons for admission to the referral centre were medical and diagnostic evaluation. New antiepileptic drugs were used more frequently than old, in 251 and 158 cases, respectively. 53 and 54% were using polytherapy at admission and discharge, respectively. Levetiracetam, valproate and lamotrigine were the most frequently used antiepileptic drugs before, during, and after the stay at the centre. Levetiracetam was the only drug being more frequently used at discharge/three months after discharge than at admission. Dosage adjustments were made in 83% of the patients following measurement of serum concentrations and clinical evaluation. According to the parents the number of adverse effects had been reduced by 20% three months after discharge. Likewise 40% stated that their children experienced better seizure control, and 47% that their family experienced a better everyday life after the stay. CONCLUSION Close comprehensive follow-up of children admitted to the referral centre, with main focus on optimalization of the pharmacological treatment, is of importance regarding quality of life aspects both to the children and their families.
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Affiliation(s)
- Elisif Rytter
- National Centre for Epilepsy, Sandvika, Division of Clinical Neuroscience, Rikshospitalet University Hospital, Oslo, Norway.
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Abstract
INTRODUCTION Cognitive disorders are common in patients with epilepsy. Their aetiology is multifactorial, being affected by the type and location of the epileptogenic lesion, epileptic syndrome, type of seizures, age of onset, frequency and severity. Timely diagnosis and treatment can help to reduce their impact on the patient's quality of life. RESULTS The most significant cognitive deficits are associated with focal epilepsy, although some, usually mild, neuropsychological disorders can be found in idiopathic generalized epilepsy. The use of antiepileptic drugs (AEDs) can cause additional neuropsychological disorders that are of particular concern in learning-age children and elderly patients with cognitive disorders before the start of treatment. Recent studies have raised the concern that the use of some AEDs during pregnancy may cause cognitive disorders in the child exposed to them in utero. Cognitive disorders can also present as a complication of surgery for refractory epilepsy. Some risk factors for significant memory loss after surgery for temporal lobe epilepsy have been described. They include intervention in the dominant hemisphere, good preoperative function and poor functional reserve in the contralateral hippocampus. CONCLUSIONS The heterogeneity of different types of epilepsy makes case-control studies difficult; however, thanks to the growing interest in the neuropsychological deficits associated with epilepsy, we now know some factors that could lead to the appearance of these disorders and their prognosis. Special care must be taken to detect cognitive side effects associated with AEDs, which seem to be more common with classic than with new AEDs, and in those patients receiving polytherapy. Neuropsychological assessment should be routinely performed before epilepsy surgery to predict possible postsurgical cognitive deficits.
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Høie B, Sommerfelt K, Waaler PE, Alsaker FD, Skeidsvoll H, Mykletun A. The combined burden of cognitive, executive function, and psychosocial problems in children with epilepsy: a population-based study. Dev Med Child Neurol 2008; 50:530-6. [PMID: 18611204 DOI: 10.1111/j.1469-8749.2008.03015.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The combined burden of psychosocial (Achenbach scales), cognitive (Raven matrices), and executive function (EF) problems was studied in a population-based sample of 6- to 12-year-old children with epilepsy (n=162; 99 males, 63 females) and in an age- and sex-matched control group (n=107; 62 males, 45 females). Approximately 35% of the children with epilepsy had severe non-verbal cognitive problems. In those that did not, mild cognitive problems (26% vs 11%, p=0.005), EF problems (31% vs 11%, p<0.001), and psychosocial problems (45% vs 10%, p<0.001) were each much more common than among controls. Having problems in two or all three of these areas simultaneously was more frequent among the children with epilepsy (14% vs. 3%, p<0.001 and 4% vs 0%, p<0.001 respectively). Excluding those having remote symptomatic epilepsy aetiology did not change the problem load significantly for the children with epilepsy with the important exception that having severe non-verbal problems was approximately halved from 35 to 18%. In 30 children with benign epilepsy of childhood with centrotemporal spikes, mild cognitive problems were somewhat more common, but psychosocial and EF problems were similar compared with control children.
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Affiliation(s)
- B Høie
- Department of Paediatrics, Haukeland University Hospital, Bergen, Norway
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van Mil SGM, Reijs RP, van Hall MHJA, Aldenkamp AP. Neuropsychological Profile of Children with Cryptogenic Localization Related Epilepsy. Child Neuropsychol 2008; 14:291-302. [DOI: 10.1080/09297040701503319] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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40
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van Mil SG, Reijs RP, van Hall MH, Aldenkamp AP. The effect of duration of epilepsy on IQ in children with CLRE; a comparison to SLRE and IGE. Seizure 2008; 17:308-13. [DOI: 10.1016/j.seizure.2007.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Revised: 08/08/2007] [Accepted: 10/05/2007] [Indexed: 10/22/2022] Open
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Abstract
OBJECTIVE To critically review literature published from 1996 to 2007 on psychopathology in children with epilepsy (CWE). METHOD Using Ovid, we searched Medline and PsychInfo databases for original studies on epidemiology, risk factors, clinical characteristics, treatment, and outcome of psychopathology in CWE, ages 0 to 18 years, using the terms "psychopathology," "emotional and behavioral problems," and "mental health problems." We selectively present the findings of studies that are clinically relevant to mental health professionals. RESULTS Psychopathology occurs in 37% to 77% of CWE, and attention, internalizing, and thought problems may be specific to epilepsy. Cognitive and linguistic deficits, as well as family factors, have moderating effects on psychopathology in CWE. The association of epilepsy-related variables, including antiepileptic drugs, with psychopathology is inconsistent in cognitively normal CWE. Children with symptomatic epilepsy and devastating epilepsy syndromes have high rates of global developmental delay, hyperactivity, and autistic symptoms. The treatment of psychopathology in CWE integrates standard psychiatric practices. CONCLUSIONS Epilepsy is a neuropsychiatric disorder characterized by seizures, psychopathology, cognitive, and linguistic problems. Improved early identification of CWE at risk for psychopathology, evidence-based psychiatric treatment, and multidisciplinary management strategies would advance clinical practice in this highly complex field of pediatric neuropsychiatry.
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Austin JK, Caplan R. Behavioral and Psychiatric Comorbidities in Pediatric Epilepsy: Toward an Integrative Model. Epilepsia 2007; 48:1639-1651. [PMID: 17565593 DOI: 10.1111/j.1528-1167.2007.01154.x] [Citation(s) in RCA: 144] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
It is well recognized that children with epilepsy are at heightened risk for developing behavior problems and psychiatric disorders. Studies identifying factors associated with child behavior were reviewed and findings were placed into two broad categories for review and critique: illness-related variables and psychosocial variables. Illness-related variables were seizure frequency and seizure control, type of epilepsy, age of onset, duration of illness, and antiepileptic drugs. Psychosocial variables were reviewed using a family stress framework: stressors, perceptions, adaptive resources, coping, and family adjustment. After the literature on each category is reviewed, an integrated heuristic model that includes key illness-related and psychosocial variables is presented.
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Affiliation(s)
- Joan K Austin
- Indiana University School of Nursing, Indianapolis, IndianaSemel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, California, U.S.A
| | - Rochelle Caplan
- Indiana University School of Nursing, Indianapolis, IndianaSemel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, California, U.S.A
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Wu Y, Chan KFY, Eubanks JH, Guin Ting Wong C, Cortez MA, Shen L, Che Liu C, Perez Velazquez J, Tian Wang Y, Jia Z, Carter Snead O. Transgenic mice over-expressing GABA(B)R1a receptors acquire an atypical absence epilepsy-like phenotype. Neurobiol Dis 2007; 26:439-51. [PMID: 17363260 DOI: 10.1016/j.nbd.2007.01.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2006] [Revised: 12/19/2006] [Accepted: 01/28/2007] [Indexed: 11/21/2022] Open
Abstract
In this study, we tested whether over-expressing the GABA(B) receptor R1a subtype in transgenic mouse forebrain neurons would be sufficient to induce spontaneous absence seizures. As hypothesized, these transgenic mice develop spontaneous, recurrent, bilaterally synchronous, 3-6 Hz slow spike and wave discharges between 2 and 4 months of age. These discharges are blocked by ethosuximide and exacerbated by baclofen confirming their absence nature. The discharges occur coincident with absence-like behaviors such as staring, facial myoclonus, and whisker twitching. However, in contrast to typical absence epilepsy models, these mice move during the ictal event, display spike and wave discharges in both thalamocortical and limbic circuitry, exhibit impaired hippocampal synaptic plasticity, and display significantly impaired learning ability. Collectively, these features are more characteristic of the less common but more debilitating atypical form of absence epilepsy. Thus, these data support a role for the GABA(B)R1a receptor subtype in the etiology of atypical absence epilepsy.
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Affiliation(s)
- Ying Wu
- Program in Brain and Behavior, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Velazquez JLP, Huo JZ, Dominguez LG, Leshchenko Y, Snead OC. Typical versus atypical absence seizures: network mechanisms of the spread of paroxysms. Epilepsia 2007; 48:1585-93. [PMID: 17484751 DOI: 10.1111/j.1528-1167.2007.01120.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE Typical absence seizures differ from atypical absence seizures in terms of semiology, EEG morphology, network circuitry, and cognitive outcome, yet have the same pharmacological profile. We have compared typical to atypical absence seizures, in terms of the recruitment of different brain areas. Our initial question was whether brain areas that do not display apparent paroxysmal discharges during typical absence seizures, are affected during the ictal event in terms of synchronized activity, by other, distant areas where seizure activity is evident. Because the spike-and-wave paroxysms in atypical absence seizures invade limbic areas, we then asked whether an alteration in inhibitory processes in hippocampi may be related to the spread seizure activity beyond thalamocortical networks, in atypical seizures. METHODS We used two models of absence seizures in rats: one of typical and the other of atypical absence seizures. We estimated phase synchronization, and evaluated inhibitory transmission using a paired-pulse paradigm. RESULTS In typical absence seizures, we observed an increase in synchronization between hippocampal recordings when spike-and-wave discharges occurred in the cortex and thalamus. This indicates that seizure activity in the thalamocortical circuitry enhances the propensity of limbic areas to synchronize, but is not sufficient to drive hippocampal circuitry into a full paroxysmal discharge. Lower paired-pulse depression was then found in hippocampus of rats that displayed atypical absence seizures. CONCLUSIONS These observations suggest that circuitries in brain areas that do not display apparent seizure activity become synchronized as seizures occur within thalamocortical circuitry, and that a weakened hippocampal inhibition may predispose to develop synchronization into full paroxysms during atypical absence seizures.
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Affiliation(s)
- Jose L Perez Velazquez
- Programme for Neuroscience and Mental Health and Division of Neurology, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada.
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45
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Marsh ED, Brooks-Kayal AR, Porter BE. Seizures and Antiepileptic Drugs: Does Exposure Alter Normal Brain Development? Epilepsia 2006; 47:1999-2010. [PMID: 17201696 DOI: 10.1111/j.1528-1167.2006.00894.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Seizures and antiepileptic drugs (AEDs) affect brain development and have long-term neurological consequences. The specific molecular and cellular changes, the precise timing of their influence during brain development, and the full extent of the long-term consequences of seizures and AEDs exposure have not been established. This review critically assesses both the basic and clinical science literature on the effects of seizures and AEDs on the developing brain and finds that evidence exists to support the hypothesis that both seizures and antiepileptic drugs influence a variety of biological process, at specific times during development, which alter long-term cognition and epilepsy susceptibility. More research, both clinical and experimental, is needed before changes in current clinical practice, based on the scientific data, can be recommended.
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Affiliation(s)
- Eric D Marsh
- Division of Child Neurology and Pediatric Regional Epilepsy Program, Children's Hospital of Philadelphia, and Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
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46
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Abstract
PURPOSE The aim of the study was to define sleep disturbances in pentylenetetrazole (PTZ)-kindled rats and to explore the effects of the nootropic drug piracetam (Pir; 100 mg/kg) and the noncompetitive N-methyl-D-aspartate (NMDA)-antagonist MK-801 (0.3 mg/kg), which normalized learning performance in PTZ-kindled rats, on altered sleep parameters. METHODS This is the first report showing a significant reduction in paradoxical sleep (PS) as a consequence of PTZ kindling. A correlation analysis revealed a significant correlation between seizure severity and PS deficit. RESULTS Pir did not interfere with seizure severity, and the substance did not ameliorate the PS deficit. However, the substance disconnected the correlation between seizure severity and PS deficit. MK-801, which reduced the severity of kindled seizures, counteracted the PS deficit efficaciously. CONCLUSIONS The results suggest that seizure severity and alterations in sleep architecture are two factors in the comprehensive network underlying learning impairments associated with epilepsy. Considering the results obtained in the experiments with Pir, reduction of seizure severity does not guarantee the reduction of impairments in the domain of learning.
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Affiliation(s)
- Markus Schilling
- O.-v.-Guericke University Magdeburg, Faculty of Medicine, Institute of Pharmacology and Toxicology, Magdeburg, Germany
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47
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Reijs RP, van Mil SGM, van Hall MHJA, Arends JBAM, Weber JW, Renier WO, Aldenkamp AP. Cryptogenic localization-related epilepsy with childhood onset: The problem of definition and prognosis. Epilepsy Behav 2006; 8:693-702. [PMID: 16678492 DOI: 10.1016/j.yebeh.2006.03.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2006] [Revised: 03/01/2006] [Accepted: 03/04/2006] [Indexed: 11/27/2022]
Abstract
BACKGROUND Up to one-third of children with epilepsy are diagnosed with cryptogenic localization-related epilepsy (CLRE). CLRE is a large nonspecific category within the ILAE classification. For this population no unequivocal prognosis exists. METHODS Twenty-five articles describing aspects of CLRE were included in this review. RESULTS As a result of the progress in epilepsy research, as well as more advanced investigation in individual cases, the population with CLRE constantly changes. Also, disagreement on interpretation of the classification has resulted in striking differences between the populations described. High remission rates are reported, but relapse occurs frequently, leaving the long-term prognosis unforeseeable. This is reflected in academic and psychosocial prognosis, which is described to be problematic in CLRE specifically. Possible prognostic factors of CLRE in children have been identified: age at onset, seizure semiology, seizure frequency, intractability, interictal epileptiform activity on EEG, and premorbid IQ. These factors are explored to define subgroups within the CLRE population. DISCUSSION Prospective studies on well-defined CLRE cohorts are needed to identify factors that distinguish various prognostic subgroups. Specific attention should be focused on course of the epilepsy, scholastic achievement, and psychosocial outcome.
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Affiliation(s)
- Rianne P Reijs
- Department of Research and Development, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands.
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48
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Abstract
We aimed to review recent prospective and cross-sectional studies regarding the gradual and chronic effects of (cumulative) seizures on cognition. In contrast with the increasing evidence of structural changes in the brain associated with repeated seizures, its functional repercussions remain unclear. Methodological difficulties of cross-sectional and prospective studies are addressed. It appears that all but one of the prospective studies available on children are limited to measures of intelligence. Most studies revealed no significant adverse effects, although there appears to be a subgroup of about 10-25% of children that shows a clinically significant intellectual decline. Children with generalized symptomatic epilepsies, frequent seizures, high antiepileptic drug use, and early onset of epilepsy appear at risk, although psychosocial factors may also play an important role. Five of the six prospective studies on adults report evidence of a mild decline in cognition in patients with a (longstanding) history of pharmacoresistant epilepsy. The adverse effect on cognitive abilities, memory in particular, seems somewhat more robust than that on measures of intelligence. A significant association between cognitive decline and seizure related variables is rarely substantiated in prospective research and cross-sectional studies show contradicting results. Taken together, the data suggest a mild but measurable decline of intellectual performance in children and adults. Decline of specific cognitive abilities in children is impossible to evaluate given the very little data available. In adults, memory appears to be the most vulnerable cognitive function. Due to many confounding variables, the effect of seizures per se is difficult to estimate, but appears limited.
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Affiliation(s)
- Guy Vingerhoets
- Laboratory for Neuropsychology, Department of Internal Medicine-Section Neurology, Ghent University, De Pintelaan 185-4K3, B-9000 Ghent, Belgium.
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Høie B, Sommerfelt K, Waaler PE, Alsaker FD, Skeidsvoll H, Mykletun A. Psychosocial problems and seizure-related factors in children with epilepsy. Dev Med Child Neurol 2006; 48:213-9. [PMID: 16483398 DOI: 10.1017/s0012162206000454] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2005] [Indexed: 11/05/2022]
Abstract
In this study we describe psychosocial functions and seizure-related factors in a population-based sample of children with epilepsy. Psychosocial problems (Achenbach scales), cognitive function, and socioeconomic status were studied in 117 children with epilepsy aged between 6 and 13 years (mean age 11y [SD 2y 1mo] and 10y 8mo [SD 2y]; 71 males, 46 females) and in randomly selected controls matched with 117 children for sex and age (mean age 11y 2mo [SD 2y 1mo] and 10y 5mo [SD 2y 4mo]; 69 males, 48 females). The children had partial (n=67), generalized (n=43), or undetermined (n=7) epilepsy syndromes, and partial (n=68), generalized (n=47), or other (n=2) main seizure types. Psychosocial problems were more common among children with epilepsy than controls (odds ratio 5-9) and significantly related to epilepsy syndrome, main seizure type, age at onset, and seizure frequency. Mothers and teachers reported males with epilepsy as having more problems than females. Females self-reported psychosocial problems, males did not. Psychosocial problems were common in childhood epilepsy. Females appreciated the problems more realistically than males. Psychosocial problems should be considered an integral part of epilepsy management.
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Affiliation(s)
- B Høie
- Section for Paediatrics, Department of Clinical Medicine, University of Bergen, Norway.
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50
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Seizure: One year after a change of Editorship. Seizure 2005. [DOI: 10.1016/j.seizure.2005.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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