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Mastrangelo M, Manti F, Ricciardi G, Bove R, Greco C, Tolve M, Pisani F. The burden of epilepsy on long-term outcome of genetic developmental and epileptic encephalopathies: A single tertiary center longitudinal retrospective cohort study. Epilepsy Behav 2024; 152:109670. [PMID: 38335860 DOI: 10.1016/j.yebeh.2024.109670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/11/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND This retrospective cohort analysis highlighted neurodevelopmental outcome predictors of genetic developmental and epileptic encephalopathies (DEE). PATIENTS AND METHODS Patients' demographic, clinical and molecular genetics data were collected. All patients underwent clinical, developmental, and neuropsychological assessments. RESULTS We recruited 100 participants (53 males, 47 females) with a mean follow-up lasting 10.46 ± 8.37 years. Age at epilepsy-onset was predictive of poor adaptive and cognitive functions (VABS-II score, r = 0.350, p = 0.001; BRIEF control subscale, r = -0.253; p = 0.031). Duration of epilepsy correlated negatively with IQ (r = -0.234, p = 0.019) and VABS-II score (r = -0.367, p = 0.001). Correlations were found between delayed/lacking EEG maturation/organization and IQ (r = 0.587, p = 0.001), VABS-II score (r = 0.658, p = 0.001), BRIEF-MI and BRIEF-GEC scores (r = -0.375, p = 0.001; r = -0.236, p = 0.033), ASEBA anxiety (r = -0.220, p = 0.047) and ADHD (r = -0.233, p = 0.035) scores. The number of antiseizure medications (ASMs) correlated with IQ (r = -0.414, p = 0.001), VABS-II (r = -0.496, p = 0.001), and BRIEF-MI (r = 0.294, p = 0.012) scores; while age at the beginning of therapy with ASEBA anxiety score (r = 0.272, p = 0.013). The occurrence of status epilepticus was associated with worse adaptive performances. The linear regression analysis model showed that delayed/lacking EEG maturation/organization had a significant influence on the IQ (R2 = 0.252, p < 0.001) and the BRIEF-GEC variability (R2 = 0.042, p = 0.036). The delayed/lacking EEG maturation/organization and the duration of epilepsy also had a significant influence on the VABS-II score (R2 = 0.455, p = 0.005). CONCLUSIONS Age at seizure-onset, EEG maturation/organization, duration of epilepsy, occurrence of status epilepticus, age at the introduction and number of ASMs used are reliable predictors of long-term outcomes in patients with genetic DEE.
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Affiliation(s)
- Mario Mastrangelo
- Department of Women/Child Health and Urological Science, Sapienza University of Rome, Rome, Italy; Unit of Child Neurology and Psychiatry, Azienda Ospedaliero Universitaria Policlinico Umberto, Rome, Italy.
| | - Filippo Manti
- Unit of Child Neurology and Psychiatry, Azienda Ospedaliero Universitaria Policlinico Umberto, Rome, Italy; Unit of Child Neurology and Psychiatry, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Giacomina Ricciardi
- Unit of Child Neurology and Psychiatry, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Rossella Bove
- Unit of Child Neurology and Psychiatry, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Carlo Greco
- Unit of Child Neurology and Psychiatry, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Manuela Tolve
- Unit of Child Neurology and Psychiatry, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy; Department of Experimental Medicine, Sapienza University of Rome, Italy
| | - Francesco Pisani
- Unit of Child Neurology and Psychiatry, Azienda Ospedaliero Universitaria Policlinico Umberto, Rome, Italy; Unit of Child Neurology and Psychiatry, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
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Domańska M, Zawadzka M, Konieczna S, Mazurkiewicz-Bełdzińska M. Impairment of cognitive functions in children and adolescents with focal epilepsy. Heliyon 2023; 9:e17210. [PMID: 37360098 PMCID: PMC10285258 DOI: 10.1016/j.heliyon.2023.e17210] [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: 08/01/2022] [Revised: 05/30/2023] [Accepted: 06/09/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction Frontal Lobe Epilepsy (FLE) and Temporal Lobe Epilepsy (TLE) are the two most frequent types of focal epilepsies and they are connected with difficulties in cognitive functioning. Despite multiple trials to systematize profile of cognitive functioning among children with epilepsy by researchers, the available data are ambiguous. The aim of our study was to compare the cognitive function of children upon diagnosis of TLE and FLE and during follow-up and to compare with a control group of healthy children. Material and methods Study included 39 patients with newly diagnosed TLE, 24 patients with FLE whose first epileptic seizure occurred between their 6th and 12th year of life and 24 healthy children matched by age, sex and IQ level. Neuropsychological examination was performed the moment of diagnosis and 2-3 years later using diagnostic tools validated and standardized to the patient's age. Intergroup comparison was conducted in both stages of study. Also, correlation between localization of epileptic focus and cognitive difficulties was analysed. Results Children with FLE and TLE accomplished worse results in most of the cognitive tasks compared to the control group already in the initial examination. Patients with FLE presented difficulties in memorizing verbal and visual material, attention and in learning new information. Patients with TLE had difficulties in tasks engaging verbal and non-verbal memory and attention. In the follow-up, patients with FLE presented more severe cognitive impairment compared with the other groups. Despite similar tendencies among children with TLE significantly worse results in tasks engaging verbal memory and attention were observed among patients with FLE. It is noteworthy that patients suffering from FLE and TLE present deficits in many aspects of cognitive functioning already at the time of diagnosis. Conclusion Children and adolescents suffering from epilepsy are at risk of psychosocial difficulties, emotional disorders and mental illnesses. Thus, full assessment of cognitive function is essential in this patient group not only at the moment of diagnosis but also during follow-up in order to quickly introduce an individual support system.
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Cano-Villagrasa A, Moya-Faz FJ, López-Zamora M. Relationship of epilepsy on the linguistic-cognitive profile of children with ASD: A systematic review of the literature. Front Psychol 2023; 14:1101535. [PMID: 37063523 PMCID: PMC10092355 DOI: 10.3389/fpsyg.2023.1101535] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/17/2023] [Indexed: 03/31/2023] Open
Abstract
IntroductionThe prevalence of comorbidity between epilepsy and Autism Spectrum Disorder (ASD) in the pediatric age increased significantly in recent years. The onset of epilepsy negatively influences the abilities of the user with ASD. Thus, epilepsy will be a disabling factor that will reduce the cognitive-linguistic skills of users with ASD. The main objective of this work is to review the current scientific literature and to compare the relationship of epilepsy on the development of cognitive and linguistic skills of children with ASD.MethodsIn this regard, a systematic search was carried out in the main sources (Medline, PubMed, WOS, ResearchGate and Google Scholar). 481 articles were identified, from which, after meeting the different inclusion and exclusion criteria, a total of 18 studies of relevance to the objectives of this work were selected.ResultsThe results reflect that, at a global level, epilepsy significantly influences the performance of cognitive- linguistic skills in people with ASD.DiscussionIn conclusion, epilepsy in the ASD population leads to a reduction in cognitive and linguistic abilities, which respond to the different types of epilepsy and their location, significantly impacting the quality of life and basic activities of daily living of the user with ASD.
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Affiliation(s)
- Alejandro Cano-Villagrasa
- Health Sciences PhD Program, Universidad Católica de Murcia UCAM, Campus de los Jerónimos, Murcia, Spain
- Facultad de Ciencias de la Salud, Valencian International University, Valencia, Spain
- *Correspondence: Alejandro Cano-Villagrasa
| | - Francisco José Moya-Faz
- Facultad de Ciencias de la Salud, Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain
- Francisco José Moya-Faz
| | - Miguel López-Zamora
- Departamento de Psicología Evolutiva y de la Educación, Facultad de Psicología y Logopedia, Universidad de Málaga, Málaga, Spain
- Miguel López-Zamora
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Executive Functioning and Social Skills in Children with Epileptic Seizures and Non-Epileptic Seizures. Epilepsy Res 2022; 188:107051. [DOI: 10.1016/j.eplepsyres.2022.107051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 10/13/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022]
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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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Executive Functions and Attention in Childhood Epilepsies: A Neuropsychological Hallmark of Dysfunction? J Int Neuropsychol Soc 2021; 27:673-685. [PMID: 33183389 DOI: 10.1017/s1355617720001125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Patients with epilepsy are at risk for several lifetime problems, in which neuropsychological impairments may represent an impacting factor. We evaluated the neuropsychological functions in children suffering from three main epilepsy categories. Further, we analyzed the longitudinal evolution of the neuropsychological profile over time. METHODS Patients undergoing neuropsychological evaluation at our Department from 2012 to 2018 were identified retrospectively. We selected patients aged 6-16 years and with at least two evaluations. Three epilepsy categories were considered: focal/structural, focal self-limited, and idiopathic generalized. Each evaluation included the same structured assessment of main neuropsychological domains. The effect of the epilepsy category, illness duration, seizure status, and medication was computed in multilevel models. RESULTS We identified 103 patients (focal self-limited = 27; focal/structural = 51; and idiopathic generalized = 25), for 233 evaluations. The majority of deficits were reported in attention and executive functions (>30% of patients); the results were dichotomized to obtain global indexes. Multilevel models showed a trend toward statistical significance of category of epilepsy on the global executive index and of illness duration on global attention index. Illness duration predicted the scores of executive and attention tasks, while category and medication predicted executive task performance. Focal/structural epilepsies mostly affected the executive domain, with deficits persisting over time. By contrast, an ameliorative effect of illness duration for attention was documented in all epilepsies. CONCLUSIONS This study offers lacking information about the evolution of deficits in time, the role of epilepsy category, and possible psychological implications for high-order cognitive skills, central in several social and academic problems.
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Panjatharakul P, Phuphaibul R, Wongvatunyu S, Visudtibhan A. Selected factors related to behavior control by executive function in Thai preschool children with epilepsy. JOURNAL OF HEALTH RESEARCH 2021. [DOI: 10.1108/jhr-12-2020-0602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose
This descriptive correlational study describes behavior control by executive function (EF) and explores the relationship among age at seizure onset, duration of epilepsy, seizure frequency, number of antiepileptic drugs (AEDs), family income, the caregiver's education, home environment and behavior control by EF in preschool children with epilepsy.
Design/methodology/approach
The purposive sample was 69 caregivers of preschool children with epilepsy. Data were collected in two medical centers in Bangkok from June 2019 to February 2020. The research instruments constituted: (1) a sociodemographic and medical information form for children with epilepsy and the caregiver; (2) early childhood-home observation for the measurement of the environment (EC-HOME) inventory and (3) the behavior rating inventory of executive function-preschool version® (BRIEF-P). The data were analyzed using Pearson's product-moment correlation and Spearman's Rho correlation.
Findings
Most of the participants had quite high scores on home environment (mean = 44.35) and mildly elevated levels of EF deficit (mean = 61.04). The duration of epilepsy and the number of AEDs were positively correlated with behavior control by EF. Family income was negatively associated with behavior control by EF. However, age at seizure onset, seizure frequency, the caregiver's education and home environment had no association with behavior control by EF.
Originality/value
Preschool children with epilepsy have poor behavioral control by EF. Consequently, healthcare providers should promote interventions in children to control seizures and to decrease the factors that impact the development of EF.
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Esteso Orduña B, Fournier Del Castillo MDLC, Cámara Barrio S, García Fernández M, Andrés Esteban EM, Álvarez-Linera Prado J, Budke M, Maldonado Belmonte MJ, González Marqués J, Pérez Jiménez MÁ. Cognitive and behavioral profiles of pediatric surgical candidates with frontal and temporal lobe epilepsy. Epilepsy Behav 2021; 117:107808. [PMID: 33640566 DOI: 10.1016/j.yebeh.2021.107808] [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] [Received: 09/28/2020] [Revised: 01/17/2021] [Accepted: 01/19/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND We aimed to prospectively analyze memory and executive and social cognitive functioning in patients with drug-resistant frontal lobe epilepsy (FLE) and temporal lobe epilepsy (TLE) with focal lesions and isolate the impact of intellectual ability on specific deficits. METHODS A neuropsychological evaluation was performed in 23 children with FLE, 22 children with TLE, and 36 healthy pediatric controls (HCs). Patients in the epilepsy groups had a range of lesions, including low-grade epilepsy-associated tumors (LEAT), focal cortical dysplasia (FCD) type II, and mesial temporal sclerosis (MS). RESULTS There were no significant differences between children with FLE and TLE regarding memory, executive, or social cognitive functioning. General Ability Index (GAI) was a predictor of memory, executive function, and social cognition scores and was influenced by age at onset, duration of epilepsy, and number of antiepileptic drugs (AEDs) prescribed at the time of assessment. Working Memory Index scores of patients with TLE, which measure verbal mnesic processing, were significantly lower than those of HCs and patients with TLE. The greatest differences in both clinical groups compared to HCs were recorded in cognitive executive functions, and patients with FLE had lower scores in this domain. Regarding behavioral executive functions, patients with TLE presented impaired emotional control and impulse inhibition and patients with FLE exhibited decreased flexibility. CONCLUSION Consistent with previous research, our findings provide further detailed evidence of small differences in cognitive performance among children with FLE and TLE. These differences emerge on analysis of the factors with which deficits are associated.
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Affiliation(s)
- Borja Esteso Orduña
- Clinical Neuropsychology Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
| | | | - Silvia Cámara Barrio
- Clinical Neuropsychology Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Marta García Fernández
- Epilepsy Monitoring Unit, Clinical Neurophysiology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | | | - Marcelo Budke
- Neurosurgery Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - Javier González Marqués
- Cognitive Processes Department, Faculty of Psychology, Universidad Complutense de Madrid, Madrid, Spain
| | - María Ángeles Pérez Jiménez
- Epilepsy Monitoring Unit, Clinical Neurophysiology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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Beaussart-Corbat ML, Barbarot S, Farges D, Martin L, Roy A. Executive functions in preschool-aged children with neurofibromatosis type 1: Value for early assessment. J Clin Exp Neuropsychol 2021; 43:163-175. [PMID: 33685350 DOI: 10.1080/13803395.2021.1893277] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Executive functions (EFs) impairment is common in children with neurofibromatosis type 1 (NF1), and could be a significant vulnerability associated with this medical disorder. However, we still know little about EFs in preschool NF1. Our study assessed EFs in NF1 children using performance-based tests and daily life questionnaires, which combined the views of parents and teachers.Method: Seven classic experimental tasks were used to evaluate EFs in 33 NF1 children aged 3 to 5 years old, and BRIEF-P questionnaires were completed by their parents and teachers. These children's performance was compared with a control group of 52 healthy children matched in age, gender and socio-cultural status.Results: NF1 children have significantly lower scores for 5 out of 7 executive tasks than control children and significantly higher levels of EF concerns in the parent and teacher BRIEF-P ratings. The correlations between performance-based tests and questionnaires are weak.Conclusions: Our results support an early executive dysfunction in NF1 children and call for early and systematic assessment of EFs. Both performance-based tests and questionnaires are complementary tools to investigate early EFs dysfunction in children with NF1.
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Affiliation(s)
| | - Sébastien Barbarot
- Department of Dermatology, Nantes University, CHU Nantes, Nantes, France.,Neurofibromatosis Clinic, Nantes University Hospital, Nantes, France
| | - Denis Farges
- Pediatrics Department, Angers University Hospital, France
| | - Ludovic Martin
- Department of Dermatology, Angers University Hospital, France.,Reference Center for Inherited Skin Disorders (MAGEC Nord), Angers University Hospital, France
| | - Arnaud Roy
- Laboratory of Psychology, LPPL EA4638, University of Angers, Angers, France.,Neurofibromatosis Clinic, Nantes University Hospital, Nantes, France.,Reference Center for Learning Disabilities, Nantes University Hospital, Nantes, France
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Roche J, Câmara-Costa H, Roulin JL, Chevignard M, Frappaz D, Guichardet K, Benkhaled O, Kerrouche B, Prodhomme J, Kieffer-Renaux V, Le Gall D, Fournet N, Roy A. Assessment of everyday executive functioning using the BRIEF in children and adolescents treated for brain tumor. Brain Inj 2020; 34:583-590. [DOI: 10.1080/02699052.2020.1725982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Jeanne Roche
- Laboratory of Psychology Pays de la Loire, EA4638, UBL, Angers University, Angers, France
- SMAEC, Resource Centre for Children, Adolescents, Young Adults with Acquired Neurological Injury, Miribel, France
| | - Hugo Câmara-Costa
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
- Laboratoire d’Imagerie Biomédicale, LIB, Sorbonne Université, Paris, France
| | - Jean-Luc Roulin
- University Grenoble Alpes, University Savoie Mont Blanc, CNRS, LPNC, Grenoble, France
| | - Mathilde Chevignard
- Laboratoire d’Imagerie Biomédicale, LIB, Sorbonne Université, Paris, France
- Rehabilitation Department for children with acquired neurological injury, and Outreach team for children and adolescents with acquired brain injury, Saint Maurice Hospitals, Saint Maurice, France
- GRC 24 HaMCRe, Handicap Moteur et Cognitif et Réadaptation, Sorbonne Université, Paris, France
| | - Didier Frappaz
- Institut d’Hématologie et d’Oncologie Pédiatrique, Lyon, France
| | - Karine Guichardet
- Medical Clinic of Paediatrics, HCE, CHU de Grenoble Alpes, Grenoble, France
| | - Ouarda Benkhaled
- Rehabilitation Department for children with acquired neurological injury, and Outreach team for children and adolescents with acquired brain injury, Saint Maurice Hospitals, Saint Maurice, France
| | - Bernadette Kerrouche
- Rehabilitation Department for children with acquired neurological injury, and Outreach team for children and adolescents with acquired brain injury, Saint Maurice Hospitals, Saint Maurice, France
| | - Julie Prodhomme
- Rehabilitation Department for children with acquired neurological injury, and Outreach team for children and adolescents with acquired brain injury, Saint Maurice Hospitals, Saint Maurice, France
| | - Virginie Kieffer-Renaux
- Rehabilitation Department for children with acquired neurological injury, and Outreach team for children and adolescents with acquired brain injury, Saint Maurice Hospitals, Saint Maurice, France
| | - Didier Le Gall
- Laboratory of Psychology Pays de la Loire, EA4638, UBL, Angers University, Angers, France
- Département de neurologie, CHU d’Angers, Université Bretagne Loire, France
| | - Nathalie Fournet
- University Grenoble Alpes, University Savoie Mont Blanc, CNRS, LPNC, Grenoble, France
| | - Arnaud Roy
- Laboratory of Psychology Pays de la Loire, EA4638, UBL, Angers University, Angers, France
- Centre Référent des Troubles d’Apprentissage, Centre de Compétence Nantais de Neurofibromatose, Hôpital Femme-Enfant-Adolescent, CHU de Nantes, Nantes, France
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Rantanen K, Vierikko E, Eriksson K, Nieminen P. Neuropsychological group rehabilitation on neurobehavioral comorbidities in children with epilepsy. Epilepsy Behav 2020; 103:106386. [PMID: 31645316 DOI: 10.1016/j.yebeh.2019.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/14/2019] [Accepted: 06/17/2019] [Indexed: 10/25/2022]
Abstract
Neurobehavioral comorbidities, particularly attention-deficits, are common in children with epilepsy (CWE). Neurobehavioral problems are manifested in school performance, peer relations, and social competence. Although the high prevalence of these comorbid behavioral problems is fully recognized, there remains to be a lack of studies on the interventions targeted for CWE. A manualized neuropsychological group intervention, Rehabilitation of EXecutive Function and ATtention (EXAT) has been developed for school-aged children (aged 6-12 years) with executive function (EF) and attention-deficits. This study aimed to explore the effects of EXAT on parent- and teacher-rated attention and behavior problems in CWE compared with children with the diagnosis of attention-deficit hyperactivity disorder (ADHD) and children with no formal diagnosis but prominent deficits in EF and attention. Forty-two children attending in neuropsychological group rehabilitation EXAT between the years 2006 and 2017 participated in this retrospective registry study. The CWE group consisted of 11 children, the ADHD group with 16 children, and EF/attention group consisted of 15 children with EF attention and/or problems without diagnosis of ADHD. The CWE group did not differ from the other two study groups (ADHD and no formal diagnosis) before the EXAT intervention. This indicates that attention problems in CWE are similar to those with diagnosed ADHD. The results were promising for applying structured multilevel intervention for CWE and neurobehavioral comorbidities. Lack of group differences between the groups participating EXAT suggests similar intervention effects between CWE, ADHD, and those with less severe EF and attention problems. In parent ratings, intervention effects were higher in hyperactivity and oppositional behavior for children with attention problems and without epilepsy. Parents in the CWE group reported no effects except for one subscale related to hyperactivity. However, teachers reported consistently positive intervention effects for both inattention and hyperactivity-impulsivity along with anxiety and emotional lability. The results suggest that neurobehavioral comorbidities in CWE could be targeted in neuropsychological group intervention. In conclusion, CWE seem to benefit from interventions and behavior modification techniques first developed for children with ADHD.
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Affiliation(s)
- Kati Rantanen
- Tampere University Hospital, Department of Pediatrics, Finland; Tampere University, Faculty of Social Sciences, Finland.
| | | | - Kai Eriksson
- Tampere Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Finland; Department of Pediatric Neurology, Tampere University Hospital, Finland
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Breuillard D, Jambaqué I, Laschet J, Nabbout R. Usefulness of preschool and school versions of the Behavioral Rating Inventory of Executive Functions in the evaluation of the daily life executive function in myoclonic-atonic epilepsy. Epilepsy Behav 2019; 99:106482. [PMID: 31461681 DOI: 10.1016/j.yebeh.2019.106482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/02/2019] [Accepted: 08/03/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Executive functions (EF) are high-order cognitive skills that have a major influence on quality of life, social skills, and school achievement. We aimed to screen EF daily life abilities in young patients with myoclonic-atonic epilepsy (MAE) using an ecological questionnaire and to correlate EF to epilepsy characteristics. METHODS Behavioral Rating Inventory of Executive Functions - Preschool (BRIEF-P) and BRIEF - for school-aged patients - parental questionnaires were proposed to patients with MAE and typically developing children (TDC) including Inhibit, Shift, Emotional control, Working memory (WM), Plan/Organize, Initiate, Organization of materials, and Monitor subscales. We included prospectively 12 patients with MAE and 44 TDC aged 3 to 5 years and seven patients with MAE and 21 TDC aged 6-7 years. We performed in addition for all patients an intellectual efficiency evaluation using WPPSI-IV (Wechsler intelligence scale for preschool children version IV) and collected demographics, age at onset of epilepsy, epilepsy duration, response to treatment, number and type of treatments including AEDs (antiepileptic drugs), and ketogenic diet. RESULTS Four out of 12 patients for BRIEF-P and 6/7 patients for BRIEF had pathological scores for at least one domain. Behavioral Rating Inventory of Executive Functions' questionnaires showed higher pathological scores for WM, Plan/Organize, Initiate, Monitor, and Metacognition Index in patients with MAE compared to TDC suggesting higher problems reported by parents. Working memory scores were higher in the group with MAE than TDC for both BRIEF-P and BRIEF. Response to treatment is a predictor of multiple BRIEF-P domains. Epilepsy duration predicts Shift and WM domains while age at onset predicts WM domain on BRIEF in this syndrome. CONCLUSIONS This study is the first to assess prospectively EF in young patients with MAE. We show everyday deficits in EF reported by parents. Metacognition and more specifically WM, appear to be a core deficit. Early evaluation of EF using both questionnaires and standardized tools is necessary for early detection of EF deficit and initiating tailored rehabilitation. Given the normal development before seizure onset and the absence of cerebral lesion in MAE, these results are in favor of the impact of epilepsy on EF.
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Affiliation(s)
- Delphine Breuillard
- Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Necker Enfants Malades Hospital, APHP, Paris Descartes University, Imagine Institute, Paris, France; Memory, Brain and Cognition (MC2Lab, EA 7536), Paris Descartes University, Paris, France; France Institute of Psychology, Paris Descartes University, Boulogne Billancourt, France.
| | - Isabelle Jambaqué
- Memory, Brain and Cognition (MC2Lab, EA 7536), Paris Descartes University, Paris, France; France Institute of Psychology, Paris Descartes University, Boulogne Billancourt, France
| | - Jacques Laschet
- INSERM U1129 "Child Epilepsies & Brain Plasticity", University Paris Descartes, Sorbonne Paris Cité, CEA, Gif sur Yvette, France; University Paris Descartes, Sorbonne Paris Cité, CEA, Gif sur Yvette, France
| | - Rima Nabbout
- Memory, Brain and Cognition (MC2Lab, EA 7536), Paris Descartes University, Paris, France; France Institute of Psychology, Paris Descartes University, Boulogne Billancourt, France; Inserm UMR 1163, Paris, France
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13
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Carron S, Dezsi G, Ozturk E, Nithianantharajah J, Jones NC. Cognitive deficits in a rat model of temporal lobe epilepsy using touchscreen‐based translational tools. Epilepsia 2019; 60:1650-1660. [DOI: 10.1111/epi.16291] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/25/2019] [Accepted: 06/25/2019] [Indexed: 01/15/2023]
Affiliation(s)
- Simone Carron
- Department of Medicine (Royal Melbourne Hospital) Melbourne Brain Centre University of Melbourne Parkville Victoria Australia
| | - Gabi Dezsi
- Department of Neuroscience Central Clinical School The Alfred Hospital Monash University and Department of Neurology Melbourne Victoria Australia
| | - Ezgi Ozturk
- Department of Neuroscience Central Clinical School The Alfred Hospital Monash University and Department of Neurology Melbourne Victoria Australia
| | - Jess Nithianantharajah
- Florey Institute of Neuroscience and Mental Health Melbourne Brain Centre Parkville Victoria Australia
| | - Nigel C. Jones
- Department of Medicine (Royal Melbourne Hospital) Melbourne Brain Centre University of Melbourne Parkville Victoria Australia
- Department of Neuroscience Central Clinical School The Alfred Hospital Monash University and Department of Neurology Melbourne Victoria Australia
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14
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Colliva C, Ferrari M, Benatti C, Guerra A, Tascedda F, Blom JMC. Executive functioning in children with epilepsy: Genes matter. Epilepsy Behav 2019; 95:137-147. [PMID: 31054523 DOI: 10.1016/j.yebeh.2019.02.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 02/18/2019] [Accepted: 02/18/2019] [Indexed: 02/02/2023]
Abstract
Pediatric epilepsy has emerged as a chronic medical disease with a characteristic behavioral and cognitive phenotype, which includes compromised executive functioning (EF) and attention-related deficits. However, considerable interindividual variability exists; children often display very different or even opposite outcomes, and some children are more likely than others to develop neurocognitive problems in the face of similar individual and disease-related problems. The factors responsible for this interindividual variability are still largely unknown, but we do know that some genetic factors render the developing brain more susceptible to damage or traumatic experiences than others. Dopamine availability has a neuromodulatory function in the prefrontal cortex (PFC) and especially affects EF. Dopamine availability relates to polymorphisms in the gene encoding catechol-O-methyltransferase (COMT Val158Met), which in turn is affected by the methylation state of its promoter. Allelic variation of the methylenetetrahydrofolate reductase (MTHFR C677T) gene, alters methylation and may influence the methylation state of the COMT promoter. Given this, we tested the hypothesis that these polymorphisms interact in children with epilepsy, and that variability in allelic expression is associated with variability in cognitive phenotype. Executive function was tested directly and indirectly (parent-rated) in 42 children between 5 and 12 years of age. The MTHFR T allele carriers performed worse than MTHFR homozygous CC carriers on indirect EF, and a significant decline was observed when T allele carriers had at least one met allele of the COMT gene, especially on Working Memory. Direct EF was significantly compromised in COMT Val/Val carriers where reduced dopamine availability seems to confer a higher risk in a test that requests a high degree of executive attention and planning. This finding suggests that in children with epilepsy, genes that influence methylation and dopamine availability affect PFC-related EF. Therefore, we should consider genetic vulnerability as a polygenic risk, which might predispose for a particular phenotype and include specific genetic signatures as part of each patient's behavioral and cognitive profile from the moment that we start to take care of the child.
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Affiliation(s)
- Chiara Colliva
- Dept. of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Cristina Benatti
- Dept. of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy; Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
| | - Azzurra Guerra
- Dept. of Medical and Surgical science, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Tascedda
- Dept. of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy; Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
| | - Joan M C Blom
- Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy; Dept. of Education and Human Sciences, University of Modena and Reggio Emilia, Modena, Italy.
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15
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Chakravarty K, Shukla G, Poornima S, Agarwal P, Gupta A, Mohammed A, Ray S, Pandey RM, Goyal V, Srivastava A, Behari M. Effect of sleep quality on memory, executive function, and language performance in patients with refractory focal epilepsy and controlled epilepsy versus healthy controls - A prospective study. Epilepsy Behav 2019; 92:176-183. [PMID: 30665125 DOI: 10.1016/j.yebeh.2018.12.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 12/30/2018] [Accepted: 12/30/2018] [Indexed: 01/16/2023]
Abstract
We aimed to evaluate the effect of sleep quality on memory, executive function, and language performance in patients with refractory focal epilepsy and controlled epilepsy and compare these with healthy individuals. We prospectively enrolled 37 adolescent and adult patients with refractory focal epilepsy (Group 1) and controlled epilepsy (Group 2) in each group. History pertaining to epilepsy and sleep were recorded, and all patients underwent overnight polysomnography. Language, memory, and executive function assessments were done using Western Aphasia Battery, Post Graduate Institute (PGI) memory scale, and battery of four executive function tests (Trail Making Test A & B, Digit symbol test, Stroop Task, and Verbal Fluency Test), respectively. Forty age- and sex-matched controls were also included in the study. Significant differences were noted in both objective and subjective sleep parameters among all the groups. On polysomnography, parameters like total sleep time, sleep efficiency, sleep latency, and rapid eye movement (REM) latency were found to be significantly worse in Group 1 as compared with Group 2. Cognitive and executive parameters were significantly impaired in Group 1. Shorter total sleep time, poorer sleep efficiency, and prolonged sleep latencies were observed to be associated with poor memory and executive function in patients with refractory epilepsy. Our study strongly suggests that sleep disturbances, mainly shorter total sleep time, poor sleep efficiency, and prolonged sleep latencies, are associated with impaired memory and executive function in patients with refractory focal epilepsy and to a lesser extent, among those with medically controlled epilepsy.
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Affiliation(s)
- Kamalesh Chakravarty
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Shukla
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
| | - Shivani Poornima
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Priya Agarwal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Anupama Gupta
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Afsar Mohammed
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Sucharita Ray
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ravindra M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Vinay Goyal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Achal Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Madhuri Behari
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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16
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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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17
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van den Berg L, de Weerd A, Reuvekamp M, Hagebeuk E, van der Meere J. Executive and behavioral functioning in pediatric frontal lobe epilepsy. Epilepsy Behav 2018; 87:117-122. [PMID: 30115605 DOI: 10.1016/j.yebeh.2018.07.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 07/23/2018] [Accepted: 07/24/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Epilepsy, as a chronic and neurological disease, is generally associated with an increased risk for social and emotional behavior problems in children. These findings are mostly derived from studies on children with different epilepsy types. However, there is limited information about the associations between frontal lobe epilepsy (FLE) and cognitive and behavioral problems. The aim of this study was to examine relationships between FLE and executive and behavioral functioning reported by parents and teachers. MATERIAL AND METHODS Teachers and parents of 32 children (18 boys, 14 girls, mean age 9; 2 years ±1;6) with a confirmed diagnosis of FLE completed the Behavioral Rating Inventory of Executive Function (BRIEF), the Child Behavior Checklist (CBCL), and Teacher Report Form (TRF). RESULTS About 25 to 35% of the parents and teachers rated children in the abnormal range of the main scales of the BRIEF, CBCL, and TRF. Teachers tend to report more metacognition problems, whereas parents tend to report more behavior regulation problems. Children with left-sided FLE showed more problems than children with bilateral or right-sided FLE. The whole range of executive dysfunctioning is linked to behavioral dysfunctioning in FLE, but ratings vary across settings and informants. The epilepsy variables age of onset, lateralization, drug load, and duration of epilepsy had only a small and scattered contribution. CONCLUSION Ratings on the BRIEF, CBCL, and TRF are moderately to highly correlated, suggesting a (strong) link between executive and behavioral functioning. Subtle differences between parents and teachers ratings suggest different executive function demands in various settings.
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Affiliation(s)
- Lydia van den Berg
- Stichting Epilepsie Instellingen Nederland, Postbus 563, 8000, AN, Zwolle, Netherlands; Rijksuniversiteit Groningen, Faculteit Gedrags- & Maatschappijwetenschappen, Klinische & Ontwikkelingsneuropsychologie, Grote Kruisstraat 2/1, 9712, TS, Groningen, Netherlands.
| | - Al de Weerd
- Stichting Epilepsie Instellingen Nederland, Postbus 563, 8000, AN, Zwolle, Netherlands
| | - Marieke Reuvekamp
- Stichting Epilepsie Instellingen Nederland, Postbus 563, 8000, AN, Zwolle, Netherlands
| | - Eveline Hagebeuk
- Stichting Epilepsie Instellingen Nederland, Postbus 563, 8000, AN, Zwolle, Netherlands
| | - Jaap van der Meere
- Rijksuniversiteit Groningen, Faculteit Gedrags- & Maatschappijwetenschappen, Klinische & Ontwikkelingsneuropsychologie, Grote Kruisstraat 2/1, 9712, TS, Groningen, Netherlands
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18
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Sun MK. Executive functioning: perspectives on neurotrophic activity and pharmacology. Behav Pharmacol 2018; 29:592-604. [PMID: 30179884 DOI: 10.1097/fbp.0000000000000427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Executive functioning is a high-level cognitive ability, regulating other abilities and behaviors to achieve desired goals. A typical executive task can be defined as the capacity to maintain one's attention on the current task, that is, responding only to the correct but not to distractive stimuli. Impairments of executive functions, or executive dysfunctions, have a growing impact on everyday life and academic achievement and are usually an early feature, and one of the core features, in brain injury and memory and behavioral disorders. Furthermore, emerging evidence indicates that memory therapeutics cannot achieve their clinical benefits in cognition if executive dysfunction is not effectively and simultaneously treated. Improvement of executive functions might be achieved through targeting some signaling pathways in the brain, including the brain-derived neurotrophic factor signaling pathways. These agents may be useful either as stand-alone interventions for patients with executive dysfunction and/or psychiatric and memory disorders or as essential adjuncts to drugs that target the underlying pathology in various brain injury and memory and behavioral disorders.
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Affiliation(s)
- Miao-Kun Sun
- Blanchette Rockefeller Neurosciences Institute, Morgantown, West Virginia, USA
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19
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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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20
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Law N, Widjaja E, Smith ML. Unique and shared areas of cognitive function in children with intractable frontal or temporal lobe epilepsy. Epilepsy Behav 2018; 80:157-162. [PMID: 29414546 DOI: 10.1016/j.yebeh.2017.12.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/30/2017] [Accepted: 12/31/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Previous findings have been mixed in terms of identifying a distinct pattern of neuropsychological deficits in children with frontal lobe epilepsy (FLE) and in those with temporal lobe epilepsy (TLE). The current study investigated the neuropsychological similarities and differences across these two pediatric medically intractable localization-related epilepsies. METHOD Thirty-eight children with FLE, 20 children with TLE, and 40 healthy children (HC) participated in this study. A comprehensive battery of standardized tests assessed five neuropsychological domains including intelligence, language, memory, executive function, and motor function. A principal component analysis (PCA) was used to distill our neuropsychological measures into latent components to compare between groups. RESULTS Principal component analysis extracted 5 latent components: executive function (F1), verbal semantics (F2), motor (F3), nonverbal cognition/impulsivity (F4), and verbal cognition/attention (F5). The group with FLE differed from the HC group on F1, F2, F4, and F5, and had worse performance than the group with TLE on F1; the group with TLE had lower performance relative to the HC group on F2. CONCLUSION Our findings suggest that, in comparison with neurotypically developing children, children with medically intractable FLE have more widespread neuropsychological impairments than do children with TLE. The differences between the two patient groups were greatest for the factor score most clearly related to executive function. The results provide mixed support for the concept of specificity in neuropsychological dysfunction among different subtypes of localization-related medically intractable childhood epilepsies.
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Affiliation(s)
- Nicole Law
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada; Department of Psychology, Hospital for Sick Children, Toronto, Ontario, Canada; Program in Neurosciences and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elysa Widjaja
- Program in Neurosciences and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada; Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada; Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mary Lou Smith
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada; Department of Psychology, Hospital for Sick Children, Toronto, Ontario, Canada; Program in Neurosciences and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada; Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada.
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21
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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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22
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Black CL, Shih SW, Sepeta LN, Facella-Ervolini JM, Isquith PK, Berl MM. Everyday executive function in focal onset pediatric epilepsy on the parent-report BRIEF2. Child Neuropsychol 2018; 25:22-43. [PMID: 29375005 DOI: 10.1080/09297049.2018.1424326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Executive function (EF) difficulties are a core neuropsychological feature of pediatric epilepsy, and parent-report measures of EF concerns are an important complement to task-based EF measures. The Behavior Rating Inventory of Executive Function (BRIEF) has shown sensitivity to parent-reported EF concerns in epilepsy and other pediatric populations. We compared profiles of parent-reported EF concerns using the BRIEF and its revision, the BRIEF2, in 117 pediatric patients with focal onset epilepsy to examine the clinical utility of the revised scale. We then compared BRIEF2 profiles between patients and age- and gender-matched healthy controls. Among patients, profiles on the BRIEF did not globally differ from the BRIEF2, and agreement was very good across scales. Patients and controls differed significantly on the BRIEF2, with patients showing higher EF difficulties reported by parents across most scales. High rates of clinical elevation among patients emerged on the Task Monitor, Plan/Organize, Working Memory, and Shift scales. Younger age of epilepsy onset, chronic epilepsy, and right hemisphere seizure focus were associated with higher parent-reported EF concerns. Findings suggest that the BRIEF2 demonstrates similar performance to the BRIEF among pediatric patients with focal onset epilepsy who are most at risk in the areas of task monitoring, working memory, planning and organization, and flexibility. These findings are informative when comparing literature across versions and provide additional insight into the nature of parent-reported EF difficulties among children with focal onset epilepsy.
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Affiliation(s)
- Chelsea L Black
- a Division of Pediatric Neuropsychology , Children's National Medical Center , Washington , DC , USA
| | - Sharon W Shih
- a Division of Pediatric Neuropsychology , Children's National Medical Center , Washington , DC , USA.,b Department of Psychology , Georgia State University , Atlanta , GA , USA
| | - Leigh N Sepeta
- a Division of Pediatric Neuropsychology , Children's National Medical Center , Washington , DC , USA
| | - Joy M Facella-Ervolini
- a Division of Pediatric Neuropsychology , Children's National Medical Center , Washington , DC , USA.,c Institute of Health Professions , Massachusetts General Hospital , Charlestown , MA , USA
| | - Peter K Isquith
- d Department of Psychiatry , Boston Children's Hospital, Harvard Medical School , Boston , MA , USA
| | - Madison M Berl
- a Division of Pediatric Neuropsychology , Children's National Medical Center , Washington , DC , USA
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23
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Ecological Assessment of Everyday Executive Functioning at Home and at School Following Childhood Traumatic Brain Injury Using the BRIEF Questionnaire. J Head Trauma Rehabil 2017; 32:E1-E12. [DOI: 10.1097/htr.0000000000000295] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Spitoni GF, Ottaviani C, Petta AM, Zingaretti P, Aragona M, Sarnicola A, Antonucci G. Obesity is associated with lack of inhibitory control and impaired heart rate variability reactivity and recovery in response to food stimuli. Int J Psychophysiol 2017; 116:77-84. [PMID: 28390903 DOI: 10.1016/j.ijpsycho.2017.04.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 04/02/2017] [Accepted: 04/04/2017] [Indexed: 02/09/2023]
Abstract
Recent theories compare obesity with addiction in terms of lack of inhibitory control in both clinical populations. The present study hypothesized impaired inhibition in obese patients reflected both in executive functions and reduced vagal tone (indexed by a decrease in heart rate variability; HRV) in response to food stimuli. Twenty-four inpatients with obesity (19 women) and 37 controls (24 women) underwent ECG monitoring during baseline, food stimuli viewing, and a recovery phase. Tests and questionnaires assessing inhibitory control and psychopathological dispositions were also administered. As hypothesized, patients were characterized by deficits in all the tests measuring inhibitory capacities. Results also show greater HRV reduction and impaired HRV recovery in response to food stimuli in obese patients compared to controls. The drive to eat experienced by obese patients in the absence of caloric need may rely on impairments in inhibitory and vagal functioning. Results are discussed in terms of implications for therapy.
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Affiliation(s)
- Grazia Fernanda Spitoni
- Department of Psychology, Sapienza University of Rome, Rome, Italy; IRCCS Santa Lucia Foundation, Rome, Italy.
| | - Cristina Ottaviani
- Department of Psychology, Sapienza University of Rome, Rome, Italy; IRCCS Santa Lucia Foundation, Rome, Italy
| | - Anna Maria Petta
- IRCCS Santa Lucia Foundation, Rome, Italy; Crossing Dialogues Association, Rome, Italy
| | | | | | - Antonio Sarnicola
- Centre for the Treatment of Eating Disorders and Obesity Hospital, Villa Pia, Guidonia, Italy
| | - Gabriella Antonucci
- Department of Psychology, Sapienza University of Rome, Rome, Italy; IRCCS Santa Lucia Foundation, Rome, Italy
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Remigereau C, Roy A, Costini O, Barbarot S, Bru M, Le Gall D. Praxis skills and executive function in children with neurofibromatosis type 1. APPLIED NEUROPSYCHOLOGY-CHILD 2017; 7:224-234. [DOI: 10.1080/21622965.2017.1295856] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Chrystelle Remigereau
- a Laboratory of Psychology LPPL (EA 4638), UBL , Brittany-Loire University , Angers , France.,b Reference Center for Learning Disabilities , University Hospital of Nantes , Nantes , France
| | - Arnaud Roy
- a Laboratory of Psychology LPPL (EA 4638), UBL , Brittany-Loire University , Angers , France.,c Neurofibromatosis Clinic and Reference Center for Learning Disabilities , University Hospital of Nantes , Nantes , France
| | - Orianne Costini
- a Laboratory of Psychology LPPL (EA 4638), UBL , Brittany-Loire University , Angers , France.,d Pediatric Unit for Learning Disabilities , University Hospital of Nice , Nice , France
| | - Sébastien Barbarot
- e Neurofibromatosis Clinic , University Hospital of Nantes , Nantes , France
| | - Marie Bru
- b Reference Center for Learning Disabilities , University Hospital of Nantes , Nantes , France
| | - Didier Le Gall
- a Laboratory of Psychology LPPL (EA 4638), UBL , Brittany-Loire University , Angers , France
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MacAllister WS, Maiman M, Marsh M, Whitman L, Vasserman M, Cohen RJ, Salinas CM. Sensitivity of the Wisconsin Card Sorting Test (64-Card Version) versus the Tower of London (Drexel Version) for detecting executive dysfunction in children with epilepsy. Child Neuropsychol 2017; 24:354-369. [DOI: 10.1080/09297049.2016.1265101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Moshe Maiman
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | | | | | | | - Robyn J Cohen
- Department of Neuropsychology, Arnold Palmer Hospital for Children, Orlando, FL, USA
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Love CE, Webbe F, Kim G, Lee KH, Westerveld M, Salinas CM. The role of executive functioning in quality of life in pediatric intractable epilepsy. Epilepsy Behav 2016; 64:37-43. [PMID: 27728901 DOI: 10.1016/j.yebeh.2016.08.018] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 08/19/2016] [Accepted: 08/19/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Children with epilepsy are vulnerable to executive dysfunction, but the relationship between executive functioning (EF) and quality of life (QOL) in children with epilepsy is not fully delineated. This exploratory study elucidated the relationship between ecological EF and QOL in pediatric intractable epilepsy. METHOD Fifty-four consecutively referred pediatric epilepsy surgery candidates and their parents were administered IQ measures, the Behavior Rating Inventory of Executive Function (BRIEF), and the Quality of Life in Childhood Epilepsy (QOLCE) as part of a comprehensive neuropsychological evaluation. RESULTS A significant difference was found in QOL between those with and without clinical impairments on the BRIEF [t(52)=3.93; p<.001]. That is, children with executive dysfunction had lower overall QOL. All seizure variables and BRIEF scales were associated with overall QOL [F(12, 40)=6.508; p=.001; R2=.661]. Working memory from the BRIEF was the most frequently elevated scale in our sample (57%). Those with executive dysfunction had 9.7 times the risk of having poor QOL. CONCLUSIONS Poor EF control according to behavior ratings is significantly related to QOL in intractable pediatric epilepsy. Identification of executive dysfunction in home environments is an essential component of presurgical evaluations and target for intervention, which may improve QOL.
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Affiliation(s)
- Christina Eguizabal Love
- Florida Institute of Technology, Department of Psychology, 150 W. University Blvd., Melbourne, FL 32901, USA
| | - Frank Webbe
- Florida Institute of Technology, Department of Psychology, 150 W. University Blvd., Melbourne, FL 32901, USA
| | - Gunha Kim
- Florida Hospital for Children, Comprehensive Epilepsy Center, 615 E. Princeton St., Orlando, FL 32803, USA
| | - Ki Hyeong Lee
- Florida Hospital for Children, Comprehensive Epilepsy Center, 615 E. Princeton St., Orlando, FL 32803, USA
| | - Michael Westerveld
- Florida Hospital for Children, Comprehensive Epilepsy Center, 615 E. Princeton St., Orlando, FL 32803, USA
| | - Christine M Salinas
- Florida Hospital for Children, Comprehensive Epilepsy Center, 615 E. Princeton St., Orlando, FL 32803, USA; Boston Children's Hospital, Department of Neurology, Division of Epilepsy, 300 Longwood Ave., Fegan 9, Boston, MA 02115, USA.
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Save-Pédebos J, Pinabiaux C, Dorfmuller G, Sorbets SF, Delalande O, Jambaqué I, Bulteau C. The development of pragmatic skills in children after hemispherotomy: Contribution from left and right hemispheres. Epilepsy Behav 2016; 55:139-45. [PMID: 26773685 DOI: 10.1016/j.yebeh.2015.12.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 12/07/2015] [Accepted: 12/09/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE Hemispherotomy (H) is the standard treatment used to cure hemispheric epileptic syndromes in childhood. The postoperative linguistic profile involves hemispheric specialization processes and developmental cognitive plasticity. This research concerns pragmatic aspects of language as a tool for communication which involves both linguistic and extralinguistic communication in context. Our aim was to analyze whether any correlation exists with age at surgery and side of surgery on pragmatic skills following H. METHOD Forty children who underwent H (23 females, 16 right H) were evaluated at a mean age of 12.8 years (±2.6) with two receptive tasks (oral comprehension and syntactic judgment), the Children's Communication Checklist (CCC) rating scale, and the Behavioral Rating Inventory of Executive Function (BRIEF) questionnaire in order to evaluate the role of executive functions on pragmatic skills. Children operated on before the age of 18 months were considered the "early" group (5 right H and 9 left H), while those operated on later were called the "late" group (11 right H and 15 left H). KEY FINDINGS The whole group had significant deficits in all three measures. We demonstrated a statistically significant crossed interaction between the side of H and the age at H with pragmatic language impairments (F(1,36)=17.48; p=.0002) and disorders in executive function (F(1,36)=5.80; p=.021) in left early H and in right late H patients. These findings are consistent with the previous studies of pragmatic language impairments concerning adolescents and adults with right hemisphere damage and emphasize the contribution of structural language in the early stage of verbal communication. SIGNIFICANCE These results emphasize for the first time that hemispherotomized children have pragmatic language impairments that are independent of receptive language. Our findings are congruent with the recent theory on pragmatic language development in childhood with evidence of a participation of the left hemisphere at the early age followed by right hemispheric specialization and involvement of executive functions, independently of receptive language.
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Affiliation(s)
- Jessica Save-Pédebos
- INSERM U1129 "Infantile Epilepsies and Brain Plasticity", Paris, France; Université Paris Descartes, Sorbonne Paris Cité, France; CEA, Gif sur Yvette, France; Rothschild Foundation Hospital, Pediatric Neurosurgery Department, Paris, France
| | - Charlotte Pinabiaux
- CHArt-P10 (EA4004) (Human and Artificial Cognition), Department of Psychology, University Paris Ouest Nanterre La Défense, France
| | - Georg Dorfmuller
- Rothschild Foundation Hospital, Pediatric Neurosurgery Department, Paris, France
| | | | - Olivier Delalande
- Rothschild Foundation Hospital, Pediatric Neurosurgery Department, Paris, France
| | - Isabelle Jambaqué
- INSERM U1129 "Infantile Epilepsies and Brain Plasticity", Paris, France; Université Paris Descartes, Sorbonne Paris Cité, France; CEA, Gif sur Yvette, France; Rothschild Foundation Hospital, Pediatric Neurosurgery Department, Paris, France
| | - Christine Bulteau
- INSERM U1129 "Infantile Epilepsies and Brain Plasticity", Paris, France; Université Paris Descartes, Sorbonne Paris Cité, France; CEA, Gif sur Yvette, France; Rothschild Foundation Hospital, Pediatric Neurosurgery Department, Paris, France.
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