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Apperly IA, Lee R, van der Kleij SW, Devine RT. A transdiagnostic approach to neurodiversity in a representative population sample: The N+ 4 model. JCPP ADVANCES 2024; 4:e12219. [PMID: 38827989 PMCID: PMC11143952 DOI: 10.1002/jcv2.12219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/21/2023] [Indexed: 06/05/2024] Open
Abstract
Background The concept of neurodiversity draws upon scientific research, and lessons from practice and lived experience to suggest new ways of thinking about neurodevelopmental conditions. Among the formative observations are that characteristics associated with neurodevelopmental conditions are part of a "broader phenotype" of variation across the whole population, and that there appear to be "transdiagnostic" similarities as well as differences in these characteristics. These observations raise important questions that have implications for understanding diversity in neurodevelopmental conditions and in neurocognitive phenotypes across the whole population. Method The present work examines broader phenotypes using seven widely used self-report assessments of traits associated with autism, ADHD, dyslexia, Developmental Coordination Disorder/dyspraxia, tic disorders/Tourette's, cortical hyperexcitability associated with subclinical epilepsy, and sensory sensitivities. A representative sample of 995 adults (aged 17-77) in the UK completed self-report measures of neurodiversity, wellbeing, generalized anxiety, and depression, and cognitive abilities (nonverbal intelligence and executive functioning). Results We used confirmatory factor analysis to test whether variation and covariation was better characterized (1) by traditional diagnostic labels, or (2) transdiagnostically according to similarities in functions, behaviours, or phenomena. Results indicated that neurodiversity characteristics were best explained using a bifactor model with one general "N" factor and four condition-specific factors. Conclusion This was the largest examination to date of the factor structure of broader phenotypes relevant to neurodevelopmental conditions. It provides critical benchmark data, and a framework approach for asking systematic questions about the structure of neurocognitive diversities seen in the whole population and in people with one or more diagnoses.
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Affiliation(s)
- Ian A. Apperly
- Centre for Developmental ScienceSchool of PsychologyUniversity of BirminghamBirminghamUK
| | - Robert Lee
- Centre for Developmental ScienceSchool of PsychologyUniversity of BirminghamBirminghamUK
| | - Sanne W. van der Kleij
- Centre for Developmental ScienceSchool of PsychologyUniversity of BirminghamBirminghamUK
| | - Rory T. Devine
- Centre for Developmental ScienceSchool of PsychologyUniversity of BirminghamBirminghamUK
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2
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Matuska E, Carney A, Sepeta LN, Zelleke T, Pasupuleti A, Berl MM. Clinical Validation of Selected NIH Cognitive Toolbox Tasks in Pediatric Epilepsy. Epilepsy Behav 2024; 153:109684. [PMID: 38401414 DOI: 10.1016/j.yebeh.2024.109684] [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: 11/09/2023] [Revised: 02/01/2024] [Accepted: 02/03/2024] [Indexed: 02/26/2024]
Abstract
The NIH Toolbox Cognition Battery (NIHTB-CB) is designed to assess cognitive functioning across the lifespan. We aimed to evaluate the clinical validity of two NIHTB-CB tasks as cognitive screening tools in pediatric epilepsy by comparing them to standard neuropsychological measures and their association with epilepsy characteristics. Forty-seven patients with epilepsy ages 5-18, including ten repeat evaluations, were assessed. Correlational analyses and agreement statistics were conducted to validate NIHTB-CB tasks (Flanker Inhibitory Control and Attention test (Flanker) and Pattern Comparison Processing Speed test (Pattern Comparison)) with standard clinical measures. We also examined if performance was related to epilepsy characteristics, including polytherapy, age of seizure onset, seizure type, and history of Electrical Status Epilepticus in Sleep (ESES). The NIHTB-CB tests had moderate to strong correlations with neuropsychological measures of executive functioning, processing speed, and intelligence. Agreement statistics indicated better sensitivity than specificity. Polytherapy and later age of seizure onset were associated with lower performance on Pattern Comparison. ESES patients did not significantly differ in performance on the tests compared to non-ESES patients. Pilot data from a subset of repeated measures indicated a good range of change scores. These two NIHTB tasks are feasible as a screening tool in a clinic given their correlation with clinical measures that assess executive function, processing speed, and IQ. This study supports the use of these tasks as brief, easily accessible screener tools to identify cognitive dysfunction in domains commonly impacted in patients with epilepsy and potential use for monitoring over time.
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Affiliation(s)
| | | | - Leigh N Sepeta
- Children's National Hospital, United States; National Institutes of Health, United States.
| | | | | | - Madison M Berl
- Children's National Hospital, United States; George Washington University, United States.
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3
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Roshan JHN, Chamanabad AG, Mashhadi A, Motamedi M. Cathodal HD-tDCS and attention: A study on patients with intractable left lateral frontal lobe epilepsy. Epilepsy Res 2024; 199:107265. [PMID: 38071911 DOI: 10.1016/j.eplepsyres.2023.107265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/20/2023] [Accepted: 11/24/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE Defects in the attentional network in patients with epilepsy are influenced by factors such as the location of epileptic foci. Examining the impact of cathodal high-definition transcranial direct current stimulation (HD-tDCS) on attention components could provide insights into potential attention-related side effects of tDCS. This study aimed to investigate the effect of cathodal HD-tDCS on interictal epileptiform discharges (IEDs), auditory/visual (A/V) attention components, and reaction time (RT) in patients with intractable focal left lateral frontal lobe epilepsy (LFLE). METHODS To control for variations in individual epilepsy syndrome, 12 adult participants diagnosed with drug-resistant left LFLE with focal cortical IEDs on C3 underwent repeated measurements at pretest, posttest, and follow-up steps. 4 × 1 ring electrodes (cathode on C3 and four anodes on F3, P3, T3, and Cz) delivered 2 mA DC for 20 min per session for 10 consecutive days. The integrated visual and auditory continuous performance test (IVA+) assessed the A/V attention components and RT. One-way repeated-measure ANOVA was used. RESULTS The findings suggest a significant effect in reducing IEDs. The IVA+ results showed a significant improvement in auditory divided attention and visual selective and focused attention (p < 0.05). In the follow-up, these changes demonstrated lasting efficacy. A/V speed scales increased (p < 0.05), showing a significant decrease in reaction time. CONCLUSIONS Cathodal HD-tDCS significantly reduced IEDs and improved the components of auditory divided attention, visual focused attention, and visual selective attention, with a reduction in patient reaction time. A significant lasting, side-effect-free positive effect was observed for up to one month after the intervention.
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Affiliation(s)
| | - Ali Ghanaei Chamanabad
- Faculty of Education and Psychology, Ferdowsi University of Mashhad, Mashhad, Iran; Cognitive Science Research Center, Ferdowsi University of Mashhad, Mashhad, Iran.
| | - Ali Mashhadi
- Faculty of Education and Psychology, Ferdowsi University of Mashhad, Mashhad, Iran; Cognitive Science Research Center, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Mahmoud Motamedi
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Sina Hospital, Tehran University of Medical Science, Tehran, Iran
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4
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Sarlo GL, Haughton T, Rizakos E, Merwin S, Havens KA, Pasupuleti A, Gaillard WD, Berl MM. Comparison of psychosocial screeners in an epilepsy clinic. Epilepsy Behav 2023; 148:109452. [PMID: 37797485 PMCID: PMC10842982 DOI: 10.1016/j.yebeh.2023.109452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 09/15/2023] [Accepted: 09/16/2023] [Indexed: 10/07/2023]
Abstract
Screenings are recommended for co-occurring conditions in pediatric epilepsy. However, there is limited research regarding which screener to implement in the clinic. This study aimed to compare different screening measures for attention-deficit/hyperactivity disorder (ADHD) and emotional concerns in a pediatric epilepsy population during a routine neurology clinic visit. Fifty (22%) of 226 contacted parents of children with epilepsy ages 5-17 years old agreed to participate. Screening measures included the Strengths and Difficulties Questionnaire (SDQ; Hyperactivity/Inattention (ADHD), Emotional Problems (E) subscales), the Pediatric Quality of Life Inventory Epilepsy Module (PedsQL-EM; Executive Functioning (EF), Mood/Behavior (M/B) subscales), and the ADHD Rating Scale (ADHD-RS). Analyses comparing measures included Chi Square, Pearson's correlation, and agreement statistics (Cohen's kappa, overall agreement). Consistent with prior literature, positive screening rates ranged from 40% to 72% for ADHD concerns and 38% to 46% for emotional concerns. Agreement between measures ranged from fair to substantial, with the highest agreement (85%; κ = 0.70) between the SDQ-E and PedsQL-EM-M/B. Although all measures rendered positive screens within expected rates, there are differences among the measures that inform screening measure selection.
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Affiliation(s)
- Gabrielle L Sarlo
- Center for Neuroscience, Children's National Research Institute, Washington, DC, United States
| | - Taylor Haughton
- Center for Neuroscience and Behavioral Health CNH, George Washington University, Washington, DC, United States
| | - Eleni Rizakos
- Center for Neuroscience and Behavioral Health CNH, George Washington University, Washington, DC, United States
| | - Stephanie Merwin
- Center for Neuroscience and Behavioral Health CNH, George Washington University, Washington, DC, United States
| | - Kathryn A Havens
- Center for Neuroscience, Children's National Research Institute, Washington, DC, United States; Center for Neuroscience and Behavioral Health CNH, George Washington University, Washington, DC, United States
| | - Archana Pasupuleti
- Center for Neuroscience and Behavioral Health CNH, George Washington University, Washington, DC, United States
| | - William D Gaillard
- Center for Neuroscience, Children's National Research Institute, Washington, DC, United States; Center for Neuroscience and Behavioral Health CNH, George Washington University, Washington, DC, United States
| | - Madison M Berl
- Center for Neuroscience, Children's National Research Institute, Washington, DC, United States; Center for Neuroscience and Behavioral Health CNH, George Washington University, Washington, DC, United States.
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Uliel-Sibony S, Chernuha V, Tokatly Latzer I, Leitner Y. Epilepsy and attention-deficit/hyperactivity disorder in children and adolescents: An overview of etiology, prevalence, and treatment. Front Hum Neurosci 2023; 17:1021605. [PMID: 37113319 PMCID: PMC10126237 DOI: 10.3389/fnhum.2023.1021605] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 03/16/2023] [Indexed: 04/29/2023] Open
Abstract
Epilepsy and attention-deficit/hyperactivity disorder (ADHD) are closely connected and commonly seen in both children and adults. Each of the disorders has major psychosocial and quality of life (QOL) effects, and their co-occurrence makes coping even more challenging for both the patients and their families. Moreover, an adverse effect of some anti-seizure medications can potentially induce or exacerbate symptoms of ADHD on the one hand, while some ADHD medications may increase seizure risk on the other. The combination of proper diagnosis and appropriate treatment may improve or even prevent many of the complications associated with these conditions. The objectives of this review are to present the complex relationship between epilepsy and ADHD, looking into the pathophysiological, anatomical, and functional perspectives along with the psychosocial and QOL influences and the recommended treatment approaches in accordance with the latest literature.
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Affiliation(s)
| | - Veronika Chernuha
- Pediatric Neurology Institute, Dana-Dwek Children’s Hospital, Tel Aviv, Israel
| | - Itay Tokatly Latzer
- Pediatric Neurology Institute, Dana-Dwek Children’s Hospital, Tel Aviv, Israel
| | - Yael Leitner
- The Pediatric ADHD Clinic, Tel Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Fan HC, Chiang KL, Chang KH, Chen CM, Tsai JD. Epilepsy and Attention Deficit Hyperactivity Disorder: Connection, Chance, and Challenges. Int J Mol Sci 2023; 24:ijms24065270. [PMID: 36982345 PMCID: PMC10049646 DOI: 10.3390/ijms24065270] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/20/2023] [Accepted: 03/01/2023] [Indexed: 03/12/2023] Open
Abstract
Comorbidities are common in children with epilepsy, with nearly half of the patients having at least one comorbidity. Attention deficit hyperactivity disorder (ADHD) is a psychiatric disorder characterized by hyperactivity and inattentiveness level disproportional to the child’s developmental stage. The burden of ADHD in children with epilepsy is high and can adversely affect the patients’ clinical outcomes, psychosocial aspects, and quality of life. Several hypotheses were proposed to explain the high burden of ADHD in childhood epilepsy; the well-established bidirectional connection and shared genetic/non-genetic factors between epilepsy and comorbid ADHD largely rule out the possibility of a chance in this association. Stimulants are effective in children with comorbid ADHD, and the current body of evidence supports their safety within the approved dose. Nonetheless, safety data should be further studied in randomized, double-blinded, placebo-controlled trials. Comorbid ADHD is still under-recognized in clinical practice. Early identification and management of comorbid ADHD are crucial to optimize the prognosis and reduce the risk of adverse long-term neurodevelopmental outcomes. The identification of the shared genetic background of epilepsy and ADHD can open the gate for tailoring treatment options for these patients through precision medicine.
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Affiliation(s)
- Hueng-Chuen Fan
- Department of Pediatrics, Tungs’ Taichung Metroharbor Hospital, Wuchi, Taichung 435, Taiwan
- Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli 356, Taiwan
- Department of Life Sciences, Agricultural Biotechnology Center, National Chung Hsing University, Taichung 402, Taiwan
| | - Kuo-Liang Chiang
- Department of Pediatric Neurology, Kuang-Tien General Hospital, Taichung 433, Taiwan
- Department of Nutrition, Hungkuang University, Taichung 433, Taiwan
| | - Kuang-Hsi Chang
- Department of Medical Research, Tungs’ Taichung Metroharbor Hospital, Wuchi, Taichung 435, Taiwan
| | - Chuan-Mu Chen
- Department of Life Sciences, Agricultural Biotechnology Center, National Chung Hsing University, Taichung 402, Taiwan
- The iEGG and Animal Biotechnology Center, and Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung 402, Taiwan
- Correspondence: (C.-M.C.); (J.-D.T.); Tel.: +886-4-22840319-701 (C.-M.C.); +886-4-24730022-21731 (J.-D.T.)
| | - Jeng-Dau Tsai
- School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- Correspondence: (C.-M.C.); (J.-D.T.); Tel.: +886-4-22840319-701 (C.-M.C.); +886-4-24730022-21731 (J.-D.T.)
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7
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Behavioral health screening in pediatric epilepsy: Which measures commonly used in the United States are 'good enough'? Epilepsy Behav 2022; 134:108818. [PMID: 35841809 DOI: 10.1016/j.yebeh.2022.108818] [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: 03/29/2022] [Revised: 06/08/2022] [Accepted: 06/23/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE To improve evidence-based implementation of behavioral health screening measures in pediatric epilepsy care, guidance is needed in the selection and interpretation of evidence-based screening measures. Therefore, the goals of this project were to (1) evaluate the clinical utility and psychometric properties of screening instruments frequently used in the United States (US) for anxiety, depression, and behavior problems in youth with epilepsy (YWE), and (2) provide guidance around selection and interpretation of these behavioral health screening measures. METHOD The critique was conducted in three phases: (1) identification of articles based on search criteria; (2) full review of articles for eligibility assessment; (3) evaluation of screening measures and organization into Tiers. Nine behavioral health measures frequently used to screen for anxiety, depression, and disruptive behaviors in the US were selected for evaluation. PubMed, CINAHL, Medline, and APA databases were searched using the following search terms: [target area] + [screening measure] + epilepsy + children [youth], [adolescents]. Inclusion/exclusion criteria for articles were as follows: (1) focused on YWE, (2) written in English, and (3) conducted in the US. Once articles were selected, Hunsley and Mash's criteria were used to evaluate and categorize the screening measures' psychometric properties, which have clear relevance to clinical practice. Measures were also classified into three tiers by the level of validation according to established evidence-based criteria. RESULTS Forty-one unique papers were identified through the literature search and assessed as eligible. Evaluation of screening measures revealed only two psychometrically sound measures that met criteria for Tier 1, the NDDI-E-Y and the Pediatric NeuroQoL-Depression, both depression screening measures. Several additional depression screening measures met criteria for Tier 2 (CDI-2, BASC-2-Depression Scale, and CBCL Withdrawn/Depressed Scale). Anxiety screening measures have not been validated in pediatric epilepsy and thus only met the criteria for Tier 2 (BASC-2 Anxiety Scale, CBCL DSM-IV Oriented Anxiety Problems Scale, MASC). Similarly for disruptive behaviors, two measures met Tier 2 criteria (BASC-2 Externalizing Problems Index, CBCL Externalizing Problems Index). CONCLUSION Strides have been made in the validation of behavioral health screening measures for YWE; however, continued research in this area is necessary to validate existing psychometrically sound measures and to develop and evaluate epilepsy-specific measures in the pediatric epilepsy population.
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Ahmed GK, Darwish AM, Khalifa H, Haridy NA. Relationship between Attention Deficit Hyperactivity Disorder and epilepsy: a literature review. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-022-00482-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Attention Deficit Hyperactivity Disorder (ADHD) is a prevalent neurological disorder. ADHD has been linked to epilepsy.
Main body
ADHD was found to be present in 30–40% of epileptic children. Researchers have developed numerous theories to explain how and why ADHD and epilepsy coexist. Whether ADHD and epilepsy symptoms are caused by co-occurring psychiatric disorders or by the temporary effects of epileptic discharges or by antiepileptic medicines is critical to consider. Diagnosis and treatment of individuals with ADHD and epilepsy are complicated and challenging from the clinical base.
Conclusions
Comorbidity between ADHD and epilepsy is still challenging to understand. The two diseases have a bidirectional link, so the association may not be coincidental. A disputable point is whether co-occurring ADHD and epilepsy symptoms represent a comorbid psychiatric disorder or are the epileptic discharges’ temporary effects, and are they related to antiepileptic drugs (AEDs). It is recommended to follow up with children with epilepsy or ADHD as they may develop comorbidity after a while.
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9
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Sleep disorders and ADHD symptoms in children and adolescents with typical absence seizures: An observational study. Epilepsy Behav 2022; 128:108513. [PMID: 35085916 DOI: 10.1016/j.yebeh.2021.108513] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/13/2021] [Accepted: 12/13/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the occurrence of sleep disorders (SD) and attention deficit hyperactivity disorder (ADHD) symptoms in children with typical absence seizures (TAS) compared to control children and to evaluate the impact of epilepsy-related factors on sleep and attention in children with TAS. METHODS The Sleep Disturbance Scale for Children (SDSC) and the ADHD rating scale were filled in by parents of a cohort composed by 82 children aged from 5 to 15.6 years, 49% of boys (41 with TAS with a syndromic diagnosis of childhood absence epilepsy and 41 controls). For children with TAS, the Pediatric Epilepsy Side Effects Questionnaire was completed. Statistical analyses were conducted in order to compare sleep and attention scores between groups. In children with TAS, a correlation was computed between these scores. Logistics regression models were conducted to identify predictors of excessive diurnal sleepiness and inattention in children with TAS. RESULTS Compared to controls, children with TAS had higher total scores for subjective sleep (mean 42.9 vs 38.3, p = 0.05) and attention disorders (mean 16.8 vs 11.6, p = 0.01), especially for excessive diurnal sleepiness (mean 3.9 vs 3.2, p = 0.02) and inattention (mean 9.3 vs 5.6, p = 0.003) components. In children with TAS, sleep problems were significantly under-reported by parents. Sleep disorders symptoms as breathing-related sleep disturbance, excessive diurnal sleepiness or naps at or after 7 years of age were reported. Subjective sleep and attention disorders were significantly correlated (r = 0.43, p = 0.01). Subjective excessive diurnal sleepiness may be the result of a polytherapy (p = 0.05) or a side effect of anti-seizure medication (ASM) (p = 0.03) but children without medication side effects also reported subjective SD. In children with TAS, the risk of inattention symptoms was increased in boys (p = 0.02), with a high BMI (p = 0.05), or with ASM side effects (p = 0.03). CONCLUSIONS This study demonstrates that children with TAS are at risk of sleep and attention disorder symptoms. If attention disorders in a context of epilepsy are now widely assessed and identified, sleep disorders are still under-estimated. An accurate identification and management of sleep disorders could improve academic performances, quality of life, and seizure management in children with TAS.
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Gutierrez-Colina AM, Vannest J, Maloney T, Wade SL, Combs A, Horowitz-Kraus T, Modi AC. The neural basis of executive functioning deficits in adolescents with epilepsy: a resting-state fMRI connectivity study of working memory. Brain Imaging Behav 2021; 15:166-176. [PMID: 32043232 DOI: 10.1007/s11682-019-00243-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Working memory deficits are common in youth with epilepsy and consistently associated with long-term negative outcomes. Existing research on the neural basis of working memory disruptions in pediatric epilepsy is limited. The question of whether differences in the functional connectivity of neural networks underlie working memory disruptions in pediatric patients with epilepsy remains unanswered. A total of 49 adolescents between the ages of 13-17 years participated in this study. Twenty-nine adolescents had confirmed epilepsy (n = 17 generalized epilepsy, n = 6 localization-related, n = 6 unclassified). The control group included 20 healthy adolescents. A total of 10-min resting state functional magnetic resonance imaging was obtained for all participants. NeuroSynth-derived regions of interest were used as nodes that comprise working memory neural networks. Group differences in resting state functional connectivity were examined between adolescents with epilepsy and controls. Functional connectivity was computed as the temporal correlation of functional magnetic resonance imaging signal fluctuations between any two regions of interest. Compared to controls, adolescents in the epilepsy group demonstrated both hypoconnectivity and hyperconnectivity in cortical areas that map onto fronto-parietal and cingulo-opercular networks, as well as cerebellar regions. Functional connectivity between pairs of regions of interest was also significantly associated with behavioral measures of working memory across epilepsy and control groups. This study demonstrates that the presence of abnormal patterns in resting state neural network connectivity may underlie the working memory disruptions that frequently characterize the neurocognitive profile of youth with epilepsy.
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Affiliation(s)
- Ana M Gutierrez-Colina
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Jennifer Vannest
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.,University of Cincinnati College of Medicine, 3230 Eden Ave., Cincinnati, OH, 45267, USA
| | - Thomas Maloney
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Shari L Wade
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.,University of Cincinnati College of Medicine, 3230 Eden Ave., Cincinnati, OH, 45267, USA
| | - Angela Combs
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Tzipi Horowitz-Kraus
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.,University of Cincinnati College of Medicine, 3230 Eden Ave., Cincinnati, OH, 45267, USA
| | - Avani C Modi
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA. .,University of Cincinnati College of Medicine, 3230 Eden Ave., Cincinnati, OH, 45267, USA. .,Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. MLC 7039, Cincinnati, OH, 45229, USA.
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11
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Elhady M, Elattar RS, Elaidy AMA, Abdallah NA, Elmalt HA. Role of inflammation in childhood epilepsy and ADHD comorbidity. APPLIED NEUROPSYCHOLOGY-CHILD 2020; 11:291-296. [PMID: 32841085 DOI: 10.1080/21622965.2020.1807982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Epilepsy is a heterogeneous disorder that is not limited to experiencing seizures but also includes multiple neuropsychiatric squeal (i.e. attention-deficit/hyperactivity disorder (ADHD), depression and anxiety) that adversely impact a child quality of life. However, the underlying mechanism linking both disorders is not yet thoroughly explored. Our objective was to assess pro-inflammatory cytokines levels in children with seizure controlled epilepsy and explore the association between pro-inflammatory cytokines and the co-occurrence of ADHD in such children. A cross-sectional study included 50 children with controlled epilepsy for at least one year, in addition to 30 neurotypical children as controls. All children were assessed by the Conner parent scale for ADHD. Serum interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) levels were measured and correlated to clinical data. In the present study, 23 out of 50 children with epilepsy also had ADHD (46%). Children with ADHD have been found to have a significantly lower age of onset, longer duration of epilepsy, and a higher serum level of IL-6 and TNF-α than those without ADHD. The Conner's parent rating scale overall total score yielded significant negative correlations with the age of onset of epilepsy and a significant positive correlation with the duration of epilepsy and pro-inflammatory cytokine levels. In addition to active seizures, the presence of elevated circulating inflammation markers may be associated with increased frequency of ADHD in children with epilepsy aged 6-14 years.
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Affiliation(s)
- Marwa Elhady
- Pediatric Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Rasha Sobhy Elattar
- Neurology Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | | | | | - Heba A Elmalt
- Medical Biochemistry, National Research Center, Cairo, Egypt
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12
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Abstract
This article reviews common and clinically important neuropsychiatric aspects of epilepsy. Comorbidities are common, underdiagnosed, and powerfully impact clinical outcomes. Biological, psychological, and social factors contribute to the associations between epilepsy and neuropsychiatric disorders. Epidemiologic studies point to a bidirectional relationships between epilepsy and neuropsychiatric disorders. People with epilepsy are more likely to develop certain neuropsychiatric disorders, and those with these disorders are more likely to develop epilepsy. This relationship suggests the possibility of shared underlying pathophysiologies. We review the neuropsychiatric impact of antiseizure medications and therapeutic options for treatment. Diagnosis and treatment involve close collaboration among a multidisciplinary team.
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Affiliation(s)
- Benjamin Tolchin
- Department of Neurology, Comprehensive Epilepsy Center, Yale University School of Medicine, 15 York Street, New Haven, CT 06510, USA; Epilepsy Center of Excellence, VA Connecticut Healthcare System, West Haven, CT, USA.
| | - Lawrence J Hirsch
- Department of Neurology, Comprehensive Epilepsy Center, Yale University School of Medicine, 15 York Street, New Haven, CT 06510, USA
| | - William Curt LaFrance
- Brown University, Rhode Island Hospital, Potter 3, 593 Eddy Street, Providence, RI 02903, USA
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13
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Boutzoukas EM, Crutcher J, Somoza E, Sepeta LN, You X, Gaillard WD, Wallace GL, Berl MM. Cortical thickness in childhood left focal epilepsy: Thinning beyond the seizure focus. Epilepsy Behav 2020; 102:106825. [PMID: 31816479 PMCID: PMC6962541 DOI: 10.1016/j.yebeh.2019.106825] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/20/2019] [Accepted: 11/24/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Structural brain differences are found in adults and children with epilepsy, yet pediatric samples have been heterogeneous regarding seizure type, magnetic resonance imaging (MRI) findings, and hemisphere of seizure focus. This study examines whether cortical thickness and surface area differ between children with left-hemisphere focal epilepsy (LHE) and age-matched typically developing (TD) peers. We examined whether age differentially moderated cortical thickness between groups and if cortical thickness was associated with duration of epilepsy, seizure frequency, or neuropsychological functioning. METHODS Thirty-five children with LHE and 35 TD children completed neuropsychological testing and 3T MR imaging. Neuropsychological measures included general intelligence and executive functioning. All MRIs were normal. Surface-based morphometric processing and analyses were conducted using FreeSurfer 6.0. Regression analyses compared age by cortical thickness differences between groups. Correlational analyses examined associations between cortical thickness in these areas with neuropsychological functioning or epilepsy characteristics. RESULTS Left-hemisphere focal epilepsy displayed decreased cortical thickness bilaterally compared to TD controls across 6 brain regions but no differences in surface area. Moderation analyses revealed quadratic relationships between age and cortical thickness for left frontoparietal-cingulate and right superior frontal regions. Higher performance intelligence quotient (IQ) (PIQ) and verbal IQ (VIQ) and fewer parent reported executive function problems were associated with greater cortical thickness in TD children. SIGNIFICANCE Children with LHE displayed thinner cortex extending beyond the hemisphere of seizure focus. The nonlinear pattern of cortical thickness across age occurring in TD children is not evident in the same manner in children with LHE. These differences in cortical thickness patterns were greatest in children 8-12 years old. Greater cortical thickness was associated with higher IQ and fewer executive control problems in daily activities in TD children. Thus, differences in cortical thickness in the absence of differences in surface area, suggest cortical thickness may be a sensitive proxy of subtle neuroanatomical changes that are related to neuropsychological functioning.
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Affiliation(s)
- Emanuel M Boutzoukas
- Comprehensive Pediatric Epilepsy Program, Children's National Medical Center, Washington, DC, USA
| | - Jason Crutcher
- Laboratory of Brain and Cognition, National Institute of Mental Health, Bethesda, MD, USA
| | - Eduardo Somoza
- Comprehensive Pediatric Epilepsy Program, Children's National Medical Center, Washington, DC, USA
| | - Leigh N Sepeta
- Comprehensive Pediatric Epilepsy Program, Children's National Medical Center, Washington, DC, USA; Department of Psychiatry and Behavioral Sciences, The George Washington University, Washington, DC, USA
| | - Xiaozhen You
- Comprehensive Pediatric Epilepsy Program, Children's National Medical Center, Washington, DC, USA; Department of Pediatrics and Neurology, The George Washington University, Washington, DC, USA
| | - William D Gaillard
- Comprehensive Pediatric Epilepsy Program, Children's National Medical Center, Washington, DC, USA; Department of Pediatrics and Neurology, The George Washington University, Washington, DC, USA
| | - Gregory L Wallace
- Laboratory of Brain and Cognition, National Institute of Mental Health, Bethesda, MD, USA; Department of Speech, Language, and Hearing Sciences, The George Washington University, Washington, DC, USA
| | - Madison M Berl
- Comprehensive Pediatric Epilepsy Program, Children's National Medical Center, Washington, DC, USA; Department of Psychiatry and Behavioral Sciences, The George Washington University, Washington, DC, USA.
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14
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BLAST paradigm: A new test to assess brief attentional fluctuations in children with epilepsy, ADHD, and normally developing children. Epilepsy Behav 2019; 99:106470. [PMID: 31430660 DOI: 10.1016/j.yebeh.2019.106470] [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: 06/18/2019] [Revised: 07/18/2019] [Accepted: 07/26/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Pure attentional deficits are still underdiagnosed in children with epilepsy. While attention-deficit hyperactivity disorder (ADHD) is historically the most studied cause of attentional disorders, an important number of children with epilepsy and attentional complaints do not fully meet the DSM-V (Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition) criteria for ADHD and may be excluded from specific care. Clinical tools currently available are insufficient to detect more subtle but clinically relevant attentional fluctuations. OBJECTIVE/METHODS The recently developed Bron-Lyon Attention Stability Test (BLAST) was used to evaluate brief attentional fluctuations with a high temporal precision. Drawing on two new attentional indices, we evaluated spontaneous fluctuations of response accuracy and timing, underlying attentional stability. The main objective was to assess attentional stability in children with i) epilepsy with comorbid ADHD, ii) epilepsy without comorbid ADHD, iii) ADHD not medicated and without epilepsy, and iv) normal development. Further objectives were to assess the main determinants of attentional stability in those groups, including the effect of factors related to the epileptic condition. RESULTS In 122 children with epilepsy (67 with comorbid ADHD), 52 children with ADHD, and 53 healthy controls, we demonstrated lower attentional stability in both the groups with epilepsy and ADHD compared with healthy children. In children with epilepsy, BLAST scores were negatively associated with earlier seizure onset and AED (antiepileptic drug) polytherapy, while the seizure frequency, epilepsy duration, or type did not influence BLAST scores. CONCLUSIONS This study demonstrates that attentional stability is impaired in children with epilepsy and/or ADHD. Bron-Lyon Attention Stability Test seems to be a sensitive test to detect attentional stability deficit in children with epilepsy and with attentional complaints who did not meet all criteria of ADHD. We propose that BLAST could be a useful clinical neuropsychological tool to assess attentional disorders in children.
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15
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van den Berg L, de Weerd A, Reuvekamp M, Hagebeuk E, van der Meere J. Working memory in pediatric frontal lobe epilepsy. APPLIED NEUROPSYCHOLOGY-CHILD 2019; 10:101-110. [PMID: 31092008 DOI: 10.1080/21622965.2019.1611431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Thirty-two children with frontal lobe epilepsy (FLE) were assessed using different working memory measures. In addition, parents and teachers completed the working memory scale of the Behavioral Rating Inventory of Executive Functioning (BRIEF) to assess the children's "daily life behavior." Results suggested minimal working memory deficits as assessed with performance-based measures. However, the BRIEF showed more working memory deficits suggesting that, on a daily life level, working memory problems seem to be associated with FLE. We discuss why the results of the performance-based measures are not consistent with results of the BRIEF.HighlightsParents as well as teachers report working memory dysfunction in daily life to the same extent.Performance based measures show minimal deficits of working memory.Correlation between working memory tasks and proxy measures are low.
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Affiliation(s)
- Lydia van den Berg
- Stichting Epilepsie Instellingen Nederland, Zwolle, Netherlands.,Faculteit Clinical and developmental neuropsychology, Faculty behavioral science, University of Groningen, Netherlands
| | - Al de Weerd
- Stichting Epilepsie Instellingen Nederland, Zwolle, Netherlands
| | | | | | - Jaap van der Meere
- Faculteit Clinical and developmental neuropsychology, Faculty behavioral science, University of Groningen, Netherlands
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16
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Ponzoni L, Sala C, Verpelli C, Sala M, Braida D. Different attentional dysfunctions in
eEF2K
−/−
, IL1RAPL1
−/−
and
SHANK3Δ11
−/−
mice. GENES BRAIN AND BEHAVIOR 2019; 18:e12563. [DOI: 10.1111/gbb.12563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 02/22/2019] [Accepted: 03/04/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Luisa Ponzoni
- CNR, Neuroscience Institute Milan Italy
- Department of Medical Biotechnology and Translational MedicineUniversità degli Studi di Milano Milan Italy
| | | | | | | | - Daniela Braida
- Department of Medical Biotechnology and Translational MedicineUniversità degli Studi di Milano Milan Italy
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17
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Yin Y, Sun K, He S. Multiscale permutation Rényi entropy and its application for EEG signals. PLoS One 2018; 13:e0202558. [PMID: 30180194 PMCID: PMC6122795 DOI: 10.1371/journal.pone.0202558] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 08/06/2018] [Indexed: 11/18/2022] Open
Abstract
There is considerable interest in analyzing the complexity of electroencephalography (EEG) signals. However, some traditional complexity measure algorithms only quantify the complexities of signals, but cannot discriminate different signals very well. To analyze the complexity of epileptic EEG signals better, a new multiscale permutation Rényi entropy (MPEr) algorithm is proposed. In this algorithm, the coarse-grained procedure is introduced by using weighting-averaging method, and the weighted factors are determined by analyzing nonlinear signals. We apply the new algorithm to analyze epileptic EEG signals. The experimental results show that MPEr algorithm has good performance for discriminating different EEG signals. Compared with permutation Rényi entropy (PEr) and multiscale permutation entropy (MPE), MPEr distinguishes different EEG signals successfully. The proposed MPEr algorithm is effective and has good applications prospects in EEG signals analysis.
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Affiliation(s)
- Yinghuang Yin
- School of Physics and Electronics, Central South University, Changsha, P.R.China
| | - Kehui Sun
- School of Physics and Electronics, Central South University, Changsha, P.R.China
- * E-mail:
| | - Shaobo He
- School of Computer Science and Technology, Hunan University of Arts and Science, Changde, P.R.China
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18
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Auvin S, Wirrell E, Donald KA, Berl M, Hartmann H, Valente KD, Van Bogaert P, Cross JH, Osawa M, Kanemura H, Aihara M, Guerreiro MM, Samia P, Vinayan KP, Smith ML, Carmant L, Kerr M, Hermann B, Dunn D, Wilmshurst JM. Systematic review of the screening, diagnosis, and management of ADHD in children with epilepsy. Consensus paper of the Task Force on Comorbidities of the ILAE Pediatric Commission. Epilepsia 2018; 59:1867-1880. [DOI: 10.1111/epi.14549] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/28/2018] [Accepted: 07/31/2018] [Indexed: 01/01/2023]
Affiliation(s)
- Stéphane Auvin
- Department of Pediatric Neurology; Robert-Debré University Hospital; APHP; Paris France
| | - Elaine Wirrell
- Divisions of Child and Adolescent Neurology and Epilepsy; Mayo Clinic; Rochester Minnesota
| | - Kirsten A. Donald
- Division of Developmental Paediatrics; Department of Paediatrics and Child Health; Neurosciences Institute; Red Cross War Memorial Children’s Hospital; University of Cape Town; Cape Town South Africa
| | - Madison Berl
- Division of Pediatric Neuropsychology; Children’s National Medical Center; Washington District of Columbia
| | - Hans Hartmann
- Clinic for Pediatric Kidney, Liver and Metabolic Disorders; Hannover Medical School; Hannover Germany
| | - Kette D. Valente
- Division of Clinical Neurophysiology, Institute and Department of Psychiatry; Clinics Hospital (HCFMUSP); Faculty of Medicine; University of São Paulo; São Paulo Brazil
| | - Patrick Van Bogaert
- Department of Pediatric Neurology and Neurosurgery; University Hospital of Angers; Angers France
| | - J. Helen Cross
- Developmental Neurosciences Programme; UCl Great Ormond Street Institute of Child Health, London & Young Epilepsy; Lingfield UK
| | - Makiko Osawa
- Department of Pediatrics; Tokyo Women’s Medical University; Tokyo Japan
| | - Hideaki Kanemura
- Department of Pediatrics; Faculty of Medicine; University of Yamanashi; Yamanashi Japan
| | - Masao Aihara
- Graduate Faculty of Interdisciplinary Research; Graduate School; University of Amanashi; Yamanashi Japan
| | | | - Pauline Samia
- Department of Paediatrics and Child Health; Aga Khan University; Nairobi Kenya
| | | | - Mary Lou Smith
- Department of Psychology; The Hospital for Sick Children; University of Toronto Mississauga; Toronto Canada
| | - Lionel Carmant
- Department of Neurosciences and Pediatrics; CHU Sainte-Justine; University of Montreal; Montreal Canada
| | - Michael Kerr
- Division of Psychological Medicine and Clinical Neuroscience; Cardiff University; Cardiff Wales UK
| | - Bruce Hermann
- Department of Neurology; School of Medicine and Public Health; University of Wisconsin; Madison Wisconsin
| | - David Dunn
- Section of Child and Adolescent Psychiatry; Departments of Psychiatry and Neurology; Indiana University School of Medicine; Indianapolis Indiana
| | - Jo M. Wilmshurst
- Division of Paediatric Neurology; Neuroscience Institute; Department of Paediatrics and Child Health; Red Cross War Memorial Children’s Hospital; University of Cape Town; Cape Town South Africa
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19
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Almane DN, Zhao Q, Rathouz PJ, Hanson M, Jackson DC, Hsu DA, Stafstrom CE, Jones JE, Seidenberg M, Koehn M, Hermann BP. Contribution of Family Relatedness to Neurobehavioral Comorbidities in Idiopathic Childhood Epilepsies. J Int Neuropsychol Soc 2018; 24:653-661. [PMID: 29745359 PMCID: PMC6988642 DOI: 10.1017/s1355617718000243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Rates of cognitive, academic and behavioral comorbidities are elevated in children with epilepsy. The contribution of environmental and genetic influences to comorbidity risk is not fully understood. This study investigated children with epilepsy, their unaffected siblings, and controls to determine the presence and extent of risk associated with family relatedness across a range of epilepsy comorbidities. METHODS Participants were 346 children (8-18 years), n=180 with recent-onset epilepsy, their unaffected siblings (n=67), and healthy first-degree cousin controls (n=99). Assessments included: (1) Child Behavior Checklist/6-18 (CBCL), (2) Behavior Rating Inventory of Executive Function (BRIEF), (3) history of education and academic services, and (4) lifetime attention deficit hyperactivity disorder (ADHD) diagnosis. Analyses consisted of linear mixed effect models for continuous variables, and logistic mixed models for binary variables. RESULTS Differences were detected between the three groups of children across all measures (p<.001). For ADHD, academic problems, and executive dysfunction, children with epilepsy exhibited significantly more problems than unaffected siblings and controls; siblings and controls did not differ statistically significantly from each other. For social competence, children with epilepsy and their unaffected siblings displayed more abnormality compared with controls, with no statistically significant difference between children with epilepsy and unaffected siblings. For behavioral problems, children with epilepsy had more abnormality than siblings and controls, but unaffected siblings also exhibited more abnormalities than controls. CONCLUSIONS The contribution of epilepsy and family relatedness varies across specific neurobehavioral comorbidities. Family relatedness was not significantly associated with rates of ADHD, academic problems and executive dysfunction, but was associated with competence and behavioral problems. (JINS, 2018, 24, 653-661).
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Affiliation(s)
- Dace N Almane
- 1Department of Neurology,University of Wisconsin School of Medicine and Public Health,Madison,Wisconsin
| | - Qianqian Zhao
- 2Department of Biostatistics and Medical Informatics,University of Wisconsin School of Medicine and Public Health,Madison,Wisconsin
| | - Paul J Rathouz
- 2Department of Biostatistics and Medical Informatics,University of Wisconsin School of Medicine and Public Health,Madison,Wisconsin
| | - Melissa Hanson
- 1Department of Neurology,University of Wisconsin School of Medicine and Public Health,Madison,Wisconsin
| | - Daren C Jackson
- 1Department of Neurology,University of Wisconsin School of Medicine and Public Health,Madison,Wisconsin
| | - David A Hsu
- 1Department of Neurology,University of Wisconsin School of Medicine and Public Health,Madison,Wisconsin
| | - Carl E Stafstrom
- 3Department of Neurology,Johns Hopkins University School of Medicine,Baltimore,Maryland
| | - Jana E Jones
- 1Department of Neurology,University of Wisconsin School of Medicine and Public Health,Madison,Wisconsin
| | - Michael Seidenberg
- 4Department of Psychology,Rosalind Franklin University of Medicine and Science,North Chicago,Illinois
| | - Monica Koehn
- 5Marshfield Clinic Neurosciences,Marshfield Clinic,Marshfield,Wisconsin
| | - Bruce P Hermann
- 1Department of Neurology,University of Wisconsin School of Medicine and Public Health,Madison,Wisconsin
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20
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Kasirian N, Mirzaie H, Pishyareh E, Farahbod M. Investigating the Patterns of Attention Performance in Children With Mathematical Learning Disorder, With Using “Test of Everyday Attention for Children”. JOURNAL OF REHABILITATION 2018. [DOI: 10.21859/jrehab.19.1.76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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21
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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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22
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Lee SY, Park JH, Park SJ, Kim Y, Lee KY. Cognitive Function and Neuropsychological Comorbidities in Children with Newly Diagnosed Idiopathic Epilepsy. J Korean Med Sci 2018; 33:e17. [PMID: 29215804 PMCID: PMC5729645 DOI: 10.3346/jkms.2018.33.e17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 10/15/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In this study, we aimed to identify cognitive function and neuropsychological comorbidities in children with newly diagnosed idiopathic epilepsy. METHODS We retrospectively reviewed the records of 97 antiepileptic drug-naïve children (9.7 ± 2.9 years; 54 males and 43 females) with newly diagnosed idiopathic epilepsy, all of whom underwent a neuropsychological battery. The battery consisted of the Korean Wechsler Intelligence Scale, Attention Deficit Hyperactivity Disorder (ADHD) Rating Scale, ADHD Diagnostic System, Children's Depression Inventory, and State-Trait Anxiety Inventory for Children. We investigated association between scores of the neuropsychological battery and epilepsy classification, lateralization of interictal epileptiform discharges (IEDs) on electroencephalography (EEG), and variables related to seizures. RESULTS Thirteen patients (14.3%) had ADHD symptoms. Three patients (4.1%) had depressive symptoms, and 9 (12.3%) had anxiety symptoms. Patients with idiopathic generalized epilepsy (IGE) had significantly lower full-scale intelligence and performance intelligence quotient scores than patients with idiopathic localization-related epilepsy (ILRE) (89.0 ± 17.6 vs. 96.3 ± 14.8; P = 0.030 and 88.9 ± 16.3 vs. 97.0 ± 16.4; P = 0.016, respectively). Patients with ILRE having unilateral IEDs had significantly higher full-scale intelligence quotient scores than patients with ILRE having bilateral IEDs and patients with IGE (99.9 ± 12.2 vs. 93.7 ± 16.1 vs. 89.0 ± 17.6; P = 0.039, respectively). CONCLUSION Our results suggest that idiopathic epilepsy may be accompanied by various neuropsychological comorbidities even at initial diagnosis. Patients with IGE and ILRE having bilateral IEDs on EEG appear more likely to be at high risk of decreased cognitive function.
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Affiliation(s)
- Seung Yun Lee
- Department of Pediatrics, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jang Ho Park
- Department of Psychiatry, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sin Jae Park
- Department of Psychiatry, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Yangho Kim
- Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Kyung Yeon Lee
- Department of Pediatrics, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
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23
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Ha SH, Choi HY, Lee HW, Kim EJ. A Study on the Factors Affecting Self-Concept of Children and Adolescents with Epilepsy. Soa Chongsonyon Chongsin Uihak 2017. [DOI: 10.5765/jkacap.2017.28.4.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Su Hee Ha
- Department of Psychiatry, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Hee-Yeon Choi
- Department of Psychiatry, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Hyang Woon Lee
- Department of Neurology, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Eui-Jung Kim
- Department of Psychiatry, College of Medicine, Ewha Womans University, Seoul, Korea
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Sleep problems in pediatric epilepsy and ADHD: The impact of comorbidity. Epilepsy Behav 2017; 71:7-12. [PMID: 28437682 DOI: 10.1016/j.yebeh.2017.03.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 03/03/2017] [Accepted: 03/18/2017] [Indexed: 01/01/2023]
Abstract
AIMS Attention-deficit hyperactivity disorder (ADHD) is a frequent comorbidity in pediatric epilepsy. Although sleep problems are commonly reported in both children with primary ADHD and epilepsy, those with epilepsy-ADHD comorbidity have not been well studied. This study aimed to compare sleep problems among three groups of children: 1) children with epilepsy, 2) children with epilepsy and ADHD (epilepsy-ADHD), and 3) children with primary ADHD. METHODS 53 children with epilepsy, 35 children with epilepsy-ADHD, and 52 children with primary ADHD completed the Children's Sleep Habits Questionnaire (CSHQ). Neurology clinic charts were reviewed for the epilepsy-related variables. ADHD subtypes were diagnosed according to the DSM-IV. RESULTS Children with epilepsy-ADHD had the highest CSHQ total scores, while children with primary ADHD had higher scores than those with epilepsy. Besides the total score, epilepsy-ADHD group differed from the primary ADHD and epilepsy groups with higher CSHQ subscores on sleep onset delay and sleep anxiety. The frequency of moderate-severe sleep problems (CSHQ>56) was 62.9% in children with epilepsy-ADHD, while it was 40.4% and 26.4% in children with primary ADHD and epilepsy, respectively. CSHQ total scores were not different between ADHD subtypes in both children with epilepsy-ADHD and those with primary ADHD. None of the epilepsy-related variables were found to be associated with CSHQ scores. DISCUSSION Epilepsy-ADHD is associated with a significantly poor sleep quality which is beyond that of primary ADHD and epilepsy.
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25
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ADHD in Pediatric Epilepsy: Fact or Fiction? Epilepsy Curr 2017; 17:93-95. [DOI: 10.5698/1535-7511.17.2.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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26
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Gascoigne MB, Smith ML, Barton B, Webster R, Gill D, Lah S. Attention deficits in children with epilepsy: Preliminary findings. Epilepsy Behav 2017; 67:7-12. [PMID: 28086190 DOI: 10.1016/j.yebeh.2016.11.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 09/13/2016] [Accepted: 11/07/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Attention difficulties are a common clinical complaint among children with epilepsy. We aimed to compare a range of attentional abilities between groups of children with two common epilepsy syndromes, Temporal Lobe Epilepsy (TLE) and Idiopathic Generalized Epilepsy (IGE), and to healthy controls. We also investigated whether epilepsy factors (laterality of seizure focus, epilepsy onset, duration, and severity) were related to attentional abilities. METHODS Multiple dimensions of attention (selective, sustained, and divided attention and attentional control) were assessed directly with standardized neuropsychological measures in 101 children aged 6-16years (23 children with TLE, 20 with IGE and 58 healthy controls). Attention was also assessed indirectly, via a parent-report measure. RESULTS Children with TLE performed worse than children with IGE (p=0.013) and healthy controls (p<0.001) on a test of attentional control, but no between-group differences were apparent on tests of other attentional abilities. Compared to healthy controls, greater attention problems were reported by parents of children with TLE (p=0.006) and IGE (p=0.012). Left-hemisphere seizure focus and greater epilepsy severity were associated with poorer attentional control and sustained-divided attention, respectively, but no other epilepsy factors were associated with attentional abilities. SIGNIFICANCE These findings suggest that children with localization-related epilepsy, but not generalized epilepsy, may be at risk of deficits in attentional control. Interventions aimed at improving attentional control may be targeted at children with localization-related epilepsy, particularly those with a left-hemisphere seizure focus, who appear to be particularly susceptible to this type of attentional deficit.
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Affiliation(s)
- Michael B Gascoigne
- School of Psychological Sciences, Australian College of Applied Psychology, Sydney, Australia; ARC Centre of Excellence in Cognition and its Disorders Sydney, New South Wales, Australia; School of Psychology, The University of Sydney, Australia.
| | - Mary Lou Smith
- The University of Toronto, Toronto, Canada; ARC Centre of Excellence in Cognition and its Disorders Sydney, New South Wales, Australia; The Hospital for Sick Children, Toronto, Canada
| | - Belinda Barton
- Children's Hospital Education Research Institute, The Children's Hospital at Westmead and Discipline of Paediatrics and Child Health, Faculty of Medicine, University of Sydney, Australia
| | - Richard Webster
- T.Y. Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Sydney, Australia
| | - Deepak Gill
- T.Y. Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Sydney, Australia
| | - Suncica Lah
- ARC Centre of Excellence in Cognition and its Disorders Sydney, New South Wales, Australia; School of Psychology, The University of Sydney, Australia
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Sepeta LN, Casaletto KB, Terwilliger V, Facella-Ervolini J, Sady M, Mayo J, Gaillard WD, Berl MM. The role of executive functioning in memory performance in pediatric focal epilepsy. Epilepsia 2017; 58:300-310. [PMID: 28111742 DOI: 10.1111/epi.13637] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Learning and memory are essential for academic success and everyday functioning, but the pattern of memory skills and its relationship to executive functioning in children with focal epilepsy is not fully delineated. We address a gap in the literature by examining the relationship between memory and executive functioning in a pediatric focal epilepsy population. METHODS Seventy children with focal epilepsy and 70 typically developing children matched on age, intellectual functioning, and gender underwent neuropsychological assessment, including measures of intelligence (Wechsler Abbreviated Scale of Intelligence [WASI]/Differential Ability Scales [DAS]), as well as visual Children's Memory Scale (CMS Dot Locations) and verbal episodic memory (Wide Range Assessment of Memory and Learning [WRAML] Story Memory and California Verbal Learning Test for Children [CVLT-C]). Executive functioning was measured directly (WISC-IV Digit Span Backward; Clinical Evaluation of Language Fundamentals, Fourth Edition (CELF-IV) Recalling Sentences) and by parent report (Behavior Rating Inventory of Executive Function [BRIEF]). RESULTS Children with focal epilepsy had lower delayed free-recall scores than controls across visual and verbal memory tasks (p = 0.02; partial η2 = 0.12). In contrast, recognition memory performance was similar for patients and controls (p = 0.36; partial η2 = 0.03). Children with focal epilepsy demonstrated difficulties in working memory (p = 0.02; partial η2 = 0.08) and planning/organization (p = 0.02) compared to controls. Working memory predicted 9-19% of the variance in delayed free recall for verbal and visual memory; organization predicted 9-10% of the variance in verbal memory. Patients with both left and right focal epilepsy demonstrated more difficulty on verbal versus visual tasks (p = 0.002). Memory performance did not differ by location of seizure foci (temporal vs. extratemporal, frontal vs. extrafrontal). SIGNIFICANCE Children with focal epilepsy demonstrated memory ability within age-level expectations, but delayed free recall was inefficient compared to typically developing controls. Memory difficulties were not related to general cognitive impairment or seizure localization. Executive functioning accounted for significant variance in memory performance, suggesting that poor executive control negatively influences memory retrieval.
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Affiliation(s)
- Leigh N Sepeta
- Department of Neurosciences, Children's National Health System, Washington, District of Columbia, U.S.A.,NINDS Clinical Epilepsy Section, NIH, Bethesda, Maryland, U.S.A
| | | | | | - Joy Facella-Ervolini
- Department of Neurosciences, Children's National Health System, Washington, District of Columbia, U.S.A
| | - Maegan Sady
- Department of Neurosciences, Children's National Health System, Washington, District of Columbia, U.S.A
| | - Jessica Mayo
- Yale School of Medicine, Yale University, New Haven, Connecticut, U.S.A
| | - William D Gaillard
- Department of Neurosciences, Children's National Health System, Washington, District of Columbia, U.S.A.,NINDS Clinical Epilepsy Section, NIH, Bethesda, Maryland, U.S.A
| | - Madison M Berl
- Department of Neurosciences, Children's National Health System, Washington, District of Columbia, U.S.A.,NINDS Clinical Epilepsy Section, NIH, Bethesda, Maryland, U.S.A
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Ekinci O, Isik U, Gunes S, Yildirim C, Killi Y, Guler G. Self-concept in children and adolescents with epilepsy: The role of family functioning, mothers' emotional symptoms and ADHD. Brain Dev 2016; 38:714-22. [PMID: 26992474 DOI: 10.1016/j.braindev.2016.02.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 02/25/2016] [Accepted: 02/29/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE This study aimed to identify the associated factors of poor self-concept in children and adolescents with epilepsy. METHODS Fifty-three patients with uncomplicated epilepsy (aged 7-18years) and 28 healthy controls were included. Study measures included the Piers-Harris 2 Self-Concept Scale, Family Assessment Device (FAD), Turgay DSM-IV based ADHD rating Scale (T-DSM-IV-S), Conners' Teacher Rating Scale (CTRS-R), Beck Depression Inventory and State-Trait Anxiety Inventory (STAI). Neurology clinic charts were reviewed for the epilepsy-related variables. RESULTS While the Piers-Harris 2 total score was not significantly different between the groups, patients with epilepsy had lower (poorer) scores on freedom from anxiety and popularity subscales. Linear regression analysis revealed that the problem solving, affective responsiveness, general functioning and communication scores of FAD; total and inattentiveness scores of T-DSM-IV-S and mothers' Beck scores were associated with the total score of Piers-Harris 2. Epilepsy-related factors were not found to be associated with self-concept scores. CONCLUSION Poor self-concept in children with epilepsy is associated with negative family functioning, mothers' emotional symptoms and ADHD, especially the symptoms of inattentiveness.
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Affiliation(s)
- Ozalp Ekinci
- Child and Adolescent Psychiatry Department, Mersin University School of Medicine, Turkey.
| | - Uğur Isik
- Department of Pediatrics, Division of Pediatric Neurology, Acıbadem University School of Medicine, Turkey
| | - Serkan Gunes
- Child and Adolescent Psychiatry Department, Mersin University School of Medicine, Turkey
| | - Canan Yildirim
- Pediatric Neurology Department, Istanbul Erdem Hospital, Turkey
| | - Yunus Killi
- Child and Adolescent Psychiatry Department, Mersin University School of Medicine, Turkey
| | - Gülen Guler
- Child and Adolescent Psychiatry Department, Mersin University School of Medicine, Turkey
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Ekinci O, Isik U, Gunes S, Ekinci N. Understanding sleep problems in children with epilepsy: Associations with quality of life, Attention-Deficit Hyperactivity Disorder and maternal emotional symptoms. Seizure 2016; 40:108-13. [DOI: 10.1016/j.seizure.2016.06.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/08/2016] [Accepted: 06/13/2016] [Indexed: 11/26/2022] Open
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Nickels KC, Zaccariello MJ, Hamiwka LD, Wirrell EC. Cognitive and neurodevelopmental comorbidities in paediatric epilepsy. Nat Rev Neurol 2016; 12:465-76. [PMID: 27448186 DOI: 10.1038/nrneurol.2016.98] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cognitive and behavioural comorbidities are often seen in children with epilepsy, and are more common and severe in refractory epilepsy. These comorbidities are associated with worse quality of life, increased behavioural and language problems and worse social skills, all of which adversely affect long-term psychosocial functioning. To enable early intervention and therapy, children and teens with epilepsy should be periodically screened for cognitive comorbidities. The location of the epileptic focus can, to a certain degree, predict the type(s) of comorbidity; however, the spectrum of disability is often broad, presumably because focal perturbations can cause network dysfunction. Comorbidities often result from underlying structural or functional pathology that has led to seizures. In selected cases, therapy targeting the underlying cause, such as the ketogenic diet for GLUT1 deficiency syndromes, may be remarkably effective in ameliorating both seizures and cognitive concerns. In many cases, however, cognitive impairment persists despite seizure control. In epileptic encephalopathies, frequent seizures and/or interictal epileptiform abnormalities exacerbate neurocognitive dysfunction, owing to synaptic reorganization or impaired neurogenesis, or to other effects on developing neural circuits, and prompt initiation of effective antiepileptic therapy is essential to limit cognitive comorbidities.
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Affiliation(s)
- Katherine C Nickels
- Child and Adolescent Neurology and Epilepsy, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - Michael J Zaccariello
- Child and Adolescent Neurology and Epilepsy, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - Lorie D Hamiwka
- Seattle Children's Hospital, MB.7.420 - Neurology, 4800 Sand Point Way NE, Seattle, Washington 98105, USA
| | - Elaine C Wirrell
- Child and Adolescent Neurology and Epilepsy, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
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Williams AE, Giust JM, Kronenberger WG, Dunn DW. Epilepsy and attention-deficit hyperactivity disorder: links, risks, and challenges. Neuropsychiatr Dis Treat 2016; 12:287-96. [PMID: 26929624 PMCID: PMC4755462 DOI: 10.2147/ndt.s81549] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Attention-deficit hyperactivity disorder (ADHD) has a prevalence rate of 7%-9% in the general population of children. However, in children with epilepsy, ADHD has been found to be present in 20%-50% of patients. This paper provides a review of ADHD prevalence in pediatric epilepsy populations and reviews data on specific symptom presentation and attention deficits in patients with epilepsy. This paper also reviews evidence-based treatments for ADHD and specifically the treatment of ADHD as a comorbid condition in children with epilepsy.
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Affiliation(s)
- Amy E Williams
- Department of Psychiatry, Riley Child and Adolescent Psychiatry Clinic, Indiana University School of Medicine, Indiana University Health Physicians, Indianapolis, IN, USA
| | - Julianne M Giust
- Department of Psychiatry, Riley Child and Adolescent Psychiatry Clinic, Indiana University School of Medicine, Indiana University Health Physicians, Indianapolis, IN, USA
| | - William G Kronenberger
- Department of Psychiatry, Riley Child and Adolescent Psychiatry Clinic, Indiana University School of Medicine, Indiana University Health Physicians, Indianapolis, IN, USA
| | - David W Dunn
- Department of Psychiatry, Riley Child and Adolescent Psychiatry Clinic, Indiana University School of Medicine, Indiana University Health Physicians, Indianapolis, IN, USA
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