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Oyegbile-Chidi T, Harvey D, Eisner J, Dunn D, Jones J, Byars A, Hermann B, Austin J. The Relationship Between Sleep, Cognition and Behavior in Children With Newly-Diagnosed Epilepsy Over 36 Months. Front Neurol 2022; 13:903137. [PMID: 35959398 PMCID: PMC9360804 DOI: 10.3389/fneur.2022.903137] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction There is substantial evidence that children with epilepsy experience more sleep, behavior and cognitive challenges than children without epilepsy. However, the literature is limited in describing the relationship between sleep, epilepsy, cognition and behavioral challenges and the interactions amongst these factors over time. This study aims to understand the nature and strength of the relationship between sleep, cognition, mood and behavior in children with new-onset epilepsy as assessed by multiple informants at multiple time periods using multiple different dependent measures. Methods 332 participants (6-16years) were recruited within 6 weeks of their first recognized seizure. The comparison group was comprised of 266 healthy siblings. Participants underwent sleep evaluation by a parent using the Sleep Behavioral Questionnaire (SBQ), cognitive evaluation using a comprehensive neuropsychological test battery, a behavioral evaluation using the Child Behavior Checklist (CBCL from parents and TRF from teachers) and the Children's Depression Inventory (CDI). These evaluations were completed at baseline (B), at 18 months, and at 36 months. Results Compared to siblings, children with new-onset epilepsy had more sleep disturbance (SBQ), higher rates of behavioral problems (CBCL and TRF), lower cognitive testing scores, and higher rates of depression; which persisted over the 36-month study. Sleep significantly correlated with behavioral problems, cognitive scores and depression. When divided into categories based of sleep disturbance scores, 39.7% of children with epilepsy experienced "Persistently Abnormal Sleep", while 14.8% experienced "Persistently Normal Sleep". Children with persistently abnormal sleep experienced the highest rates of behavioral problems, depression and cognitive impairment compared to those with persistently normal sleep, regardless of epilepsy syndrome. Younger age of seizure onset, younger age at testing, and lower grade level at baseline were associated with persistently abnormal sleep. Conclusions To our knowledge, this is the first demonstration of the nature, strength, reliability, stability and persistence of the relationship between sleep, cognition, and behavioral problems over time in a large cohort of children with newly diagnosed epilepsy, as assessed by multiple informants at different timepoints. The results of this study indicate that children with epilepsy are at a high risk of significant persisting neurobehavioral multimorbidity. Therefore, early screening for these challenges may be essential for optimizing quality of life long-term.
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Affiliation(s)
- Temitayo Oyegbile-Chidi
- Department of Neurology, School of Medicine, University of California, Davis, Sacramento, CA, United States
| | - Danielle Harvey
- Department of Public Health Sciences, School of Medicine, University of California, Davis, Sacramento, CA, United States
| | - Jordan Eisner
- Department of Neurology, School of Medicine, University of California, Davis, Sacramento, CA, United States
| | - David Dunn
- Department of Psychiatry, School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Jana Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Anna Byars
- Department of Pediatrics, Cincinnati Children's Hospital at the University of Cincinnati, University of Cincinnati, Cincinnati, OH, United States
| | - Bruce Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Joan Austin
- School of Nursing, Indiana University, Indianapolis, IN, United States
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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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Saard M, Bachmann M, Sepp K, Pertens L, Kornet K, Reinart L, Kööp C, Kolk A. Positive outcome of visuospatial deficit rehabilitation in children with epilepsy using computer-based FORAMENRehab program. Epilepsy Behav 2019; 100:106521. [PMID: 31577988 DOI: 10.1016/j.yebeh.2019.106521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 08/24/2019] [Accepted: 08/24/2019] [Indexed: 12/17/2022]
Abstract
Children with epilepsy often show deficits in attention and visuospatial functions. Still, very few systematically controlled evidence-based pediatric neurorehabilitation methods exist. The aim was to assess the effectiveness of a computer-based rehabilitation program for visuospatial deficit remediation in children with epilepsy. Fifty-eight children aged 8-12 years participated: 17 children with epilepsy diagnosis in intervention group, 22 patients in waiting-list control group, and 19 healthy age equivalent controls. The intervention group received guided visuospatial functions rehabilitation with FORAMENRehab software twice a week for a 5-week period. Baseline assessments were carried out before and immediately after the intervention period, and as follow-up 1.31 years later. Intervention group showed positive immediate rehabilitation effect in 3 out of 4 visuospatial components: visual organization, visual attention, and visuospatial perception. A long-term rehabilitation effect in the study group was observed in all 4 of the trained components. Also, a positive generalized effect was confirmed by the parents' and children's qualitative feedback with some of the improved skills transferring to children's everyday life. One hundred percent compliance further confirmed the children's motivation to participate and the effectiveness of FORAMENRehab for pediatric neurorehabilitation.
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Affiliation(s)
- Marianne Saard
- University of Tartu, Faculty of Medicine, Tartu, Estonia.
| | | | - Kirsi Sepp
- University of Tartu, Faculty of Social Sciences, Institute of Education, Tartu, Estonia
| | - Lisanna Pertens
- Tartu University Hospital Children's Clinic, Department of Pediatrics and Neurology, Tartu, Estonia
| | - Kai Kornet
- University of Tartu, Faculty of Medicine, Tartu, Estonia
| | - Liina Reinart
- Tartu University Hospital Children's Clinic, Department of Pediatrics and Neurology, Tartu, Estonia; University of Tartu, Faculty of Social Sciences, Institute of Psychology, Tartu, Estonia
| | - Christen Kööp
- University of Tartu, Faculty of Medicine, Tartu, Estonia
| | - Anneli Kolk
- University of Tartu, Faculty of Medicine, Tartu, Estonia; Tartu University Hospital Children's Clinic, Department of Pediatrics and Neurology, Tartu, Estonia
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Kibby MY, Cohen MJ, Stanford L, Park YD. Are frontal and temporal lobe epilepsy dissociable in their memory functioning? Epilepsy Behav 2019; 99:106487. [PMID: 31476730 DOI: 10.1016/j.yebeh.2019.106487] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/06/2019] [Accepted: 08/06/2019] [Indexed: 11/19/2022]
Abstract
There is controversy in the literature as to how dissociable frontal lobe epilepsy (FLE) and temporal lobe epilepsy (TLE) are in terms of memory deficits. Some researchers have demonstrated that FLE is associated with greater executive dysfunction including working memory, whereas TLE is associated with greater memory impairment. Others have found the two groups to be comparable in memory functioning. Hence, we examined this question in children with FLE and TLE versus typically developing controls. We found most of the expected effects when the groups with focal onset epilepsy were compared to controls. Specifically, children with left TLE performed worse on verbal short-term memory/learning and long-term memory measures. In contrast, children with right TLE exhibited a more global pattern of difficulty on short-term memory/learning measures but performed worse than controls on long-term memory for faces. Children with FLE performed worse than controls on verbal working memory. Nevertheless, laterality effects were mild, as children with right and left TLE did not differ significantly from each other. Further, children with FLE did not differ from those with TLE on most measures except delayed facial recognition, where children with right TLE performed worse. In addition, attention problems and poor behavioral regulation were related to encoding problems in both the total epilepsy sample and in children with TLE specifically. Hence, our findings overall are consistent with prior studies indicating that children with TLE and FLE are commensurate in most aspects of memory impairment when compared to each other, likely related to rapid propagation between the frontal and temporal lobes, as would be expected with an excitatory lesion.
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Affiliation(s)
- Michelle Y Kibby
- Southern Illinois University, Department of Psychology, LSII, Room 281, Carbondale, IL 62901-6502, USA.
| | - Morris J Cohen
- Pediatric Neuropsychology International, 2963 Foxhall Circle, Augusta, GA 30907, USA.
| | - Lisa Stanford
- NeuroDevelopmental Science Center, Akron Children's Hospital, Considine Professional Building, 215 W. Bowery St., Suite 4400, Akron, OH 44308, United States of America.
| | - Yong D Park
- Department of Neurology, Medical College of Georgia at Augusta University Children's Medical Center, 1446 Harper Street, Augusta, GA 30912, USA.
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Law N, Smith ML, Widjaja E. Thalamocortical Connections and Executive Function in Pediatric Temporal and Frontal Lobe Epilepsy. AJNR Am J Neuroradiol 2018; 39:1523-1529. [PMID: 29880477 DOI: 10.3174/ajnr.a5691] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 04/11/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Largely accepted in the literature is the role the interconnections between the thalamus and cortex play in generalized epilepsy. However, thalamocortical involvement is less understood in focal epilepsy in terms of the effect of seizures on thalamocortical circuitry in the developing brain and subsequent cognitive outcome. We investigated thalamocortical pathway microstructure in pediatric frontal lobe epilepsy and temporal lobe epilepsy and examined the associations between pathway microstructure and measures of executive function. MATERIALS AND METHODS We examined thalamocortical connections in 24 children with frontal lobe epilepsy, 17 patients with temporal lobe epilepsy, and 25 healthy children using DTI. We investigated several executive function measures in patients and controls, which were distilled into latent executive function components to compare among groups, and the associations between measures of thalamocortical microstructure and executive function. RESULTS We found no differences in thalamocortical pathway microstructure between the groups, but aspects of executive function (mental flexibility/inhibition/shifting) were impaired in the frontal lobe epilepsy group compared with controls. In patients with frontal lobe epilepsy, younger age at seizure onset and a greater number of antiepileptic drugs were associated with DTI indices indicative of damaged/less developed thalamocortical pathways. In patients with temporal lobe epilepsy, poorer performance on all measures of executive function was associated with DTI indices reflective of damaged/less developed pathways. CONCLUSIONS Our results give insight into vulnerable neural networks in pediatric focal epilepsy and suggest thalamocortical pathway damage as a potential mechanism of executive function impairment in temporal lobe epilepsy but not frontal lobe epilepsy. Identifying structure-function relations can help inform how we measure functional and cognitive/behavioral outcomes in these populations.
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Affiliation(s)
- N Law
- From the Department of Psychology (N.L., M.L.S.), University of Toronto, Toronto, Ontario, Canada.,Department of Psychology (N.L., M.L.S.).,Program in Neurosciences and Mental Health (N.L., M.L.S.)
| | - M L Smith
- From the Department of Psychology (N.L., M.L.S.), University of Toronto, Toronto, Ontario, Canada.,Department of Psychology (N.L., M.L.S.).,Program in Neurosciences and Mental Health (N.L., M.L.S.)
| | - E Widjaja
- Diagnostic Imaging (E.W.) .,Division of Neurology (E.W.), Hospital for Sick Children, Toronto, Ontario, Canada
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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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Zhang T, Chen L, Wang Y, Zhang M, Wang L, Xu X, Xiao G, Chen J, Shen Y, Zhou N. Impaired theory of mind in Chinese children and adolescents with idiopathic generalized epilepsy: Association with behavioral manifestations of executive dysfunction. Epilepsy Behav 2018; 79:205-212. [PMID: 29309954 DOI: 10.1016/j.yebeh.2017.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 12/02/2017] [Accepted: 12/08/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Epilepsy is a common neurological disorder with a core feature of cognitive impairments. Previous studies showed that patients with focal epilepsy have deficits in both theory of mind (ToM) and executive function (EF). However, there are few studies of ToM in patients with idiopathic generalized epilepsy (IGE), especially in populations with pediatric epilepsy. The aim of this study was to examine the characteristics of ToM and EF, including some of their subcomponents, and explore the relationship between them in Chinese children with IGE. MATERIALS AND METHODS We recruited 54 children and adolescents with IGE as the experimental subjects and 37 typically developing children and adolescents as control subjects. Both groups completed ToM tests, namely, second-order false belief tasks (FBTs) and faux pas tasks (FPTs). Their caregivers completed the Behavior Rating Inventory of Executive Function (BRIEF) at the same time. RESULTS Children and adolescents with IGE displayed worse performance on some of the FBTs and FPTs than healthy controls (p<0.01). They also exhibited widespread EF deficits, comprising eight subcomponents (p<0.05). Pearson's correlation analysis revealed that several subcomponents of EF (inhibition, emotional control, initiation, working memory, and monitoring) were unequally correlated with FBT and FPT. Regression analysis showed that ToM had associations with inhibition, working memory, and duration of seizures. Analysis of variance (ANOVA) indicated that children with newly diagnosed epilepsy displayed significant deficits in FBT, FPT, and distinct subscales of EF. CONCLUSIONS Our results revealed significant impairments in ToM and EF in children and adolescents with IGE compared with healthy controls. We found significant correlations between ToM and two subcomponents of EF (inhibition and working memory) in children with IGE. Additionally, the duration of seizures affected ToM in patients but was a less powerful predictor than the two subcomponents of EF. Even for children with new-onset seizures and without medication, the deficits in ToM and some distinct subscales of EF were apparent. This result has clinical implications for both nonpharmaceutical therapies and cognitive rehabilitation.
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Affiliation(s)
- Ting Zhang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, PR China
| | - Lingyan Chen
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, PR China
| | - Yu Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, PR China
| | - Mengmeng Zhang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, PR China
| | - Lanlan Wang
- Anhui Provincial Stereotactic Neurosurgical Institute, Anhui Provincial Hospital, Hefei, Anhui Province, PR China
| | - Xiangjun Xu
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui Province, PR China
| | - Gairong Xiao
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, PR China
| | - Jing Chen
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, PR China
| | - Yeru Shen
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, PR China
| | - Nong Zhou
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, PR China.
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Agah E, Asgari-Rad N, Ahmadi M, Tafakhori A, Aghamollaii V. Evaluating executive function in patients with temporal lobe epilepsy using the frontal assessment battery. Epilepsy Res 2017; 133:22-27. [DOI: 10.1016/j.eplepsyres.2017.03.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 03/06/2017] [Accepted: 03/21/2017] [Indexed: 11/27/2022]
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