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Poole BJ, Phillips NL, Killer BL, Gilmore C, Lah S. Mathematics Skills in Epilepsy: A Systematic Review and Meta-Analysis. Neuropsychol Rev 2024; 34:598-636. [PMID: 37490196 PMCID: PMC11166774 DOI: 10.1007/s11065-023-09600-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 05/25/2023] [Indexed: 07/26/2023]
Abstract
Mathematics incorporates a broad range of skills, which includes basic early numeracy skills, such as subitizing and basic counting to more advanced secondary skills including mathematics calculation and reasoning. The aim of this review was to undertake a detailed investigation of the severity and pattern of early numeracy and secondary mathematics skills in people with epilepsy. Searches were guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Twenty adult studies and 67 child studies were included in this review. Overall, meta-analyses revealed significant moderate impairments across all mathematics outcomes in both adults (g= -0.676), and children (g= -0.593) with epilepsy. Deficits were also observed for specific mathematics outcomes. For adults, impairments were found for mathematics reasoning (g= -0.736). However, two studies found that mathematics calculation was not significantly impaired, and an insufficient number of studies examined early numeracy skills in adults. In children with epilepsy, significant impairments were observed for each mathematics outcome: early numeracy (g= -0.383), calculation (g= -0.762), and reasoning (g= -0.572). The gravity of impairments also differed according to the site of seizure focus for children and adults, suggesting that mathematics outcomes were differentially vulnerable to the location of seizure focus.
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Affiliation(s)
- Belinda J Poole
- School of Psychology, University of Sydney, Sydney, NSW, 2006, Australia
| | - Natalie L Phillips
- School of Psychology, University of Sydney, Sydney, NSW, 2006, Australia
| | - Brittany L Killer
- School of Psychology, University of Sydney, Sydney, NSW, 2006, Australia
| | - Camilla Gilmore
- Centre for Mathematical Cognition, Loughborough University, Loughborough, UK
| | - Suncica Lah
- School of Psychology, University of Sydney, Sydney, NSW, 2006, Australia.
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Neumann H, Daseking M, Thiels C, Köhler C, Lücke T. Cognitive development in children with new-onset Rolandic epilepsy and Rolandic discharges without seizures: Focusing on intelligence, visual perception, working memory and the role of parents' education. Epilepsy Behav 2024; 152:109596. [PMID: 38350362 DOI: 10.1016/j.yebeh.2023.109596] [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: 07/14/2023] [Revised: 12/13/2023] [Accepted: 12/21/2023] [Indexed: 02/15/2024]
Abstract
PURPOSE Our aim was to assess intelligence, visual perception and working memory in children with new-onset Rolandic epilepsy (RE) and children with Rolandic discharges without seizures (RD). METHODS The participants in the study were 12 children with RE and 26 children with RD aged 4 to 10 years (all without medication and shortly after diagnosis) and 31 healthy controls. Their cognitive performance was assessed using the German versions of the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-III), the Wechsler Intelligence Scale for Children (WISC-IV), the Developmental Test of Visual Perception-2 (DTVP-2), the Developmental Test of Visual Perception-Adolescent and Adult (DTVP-A) (each according to age) and the Word Order, Hand Movements and Spatial Memory subtests of the German version of the Kaufman Assessment Battery for Children (K-ABC). RESULTS The comparison of the entire group of children with RE/RD and the control group conducted in the first step of our analysis revealed a weaker performance of the children with RE/RD in all cognitive domains. Significant deficits, however, were found exclusively in the RD group. Compared to the controls, they performed significantly weaker regarding IQ (full scale IQ: p < 0.001; verbal IQ: p < 0.001; performance IQ: p = 0.002; processing speed: p = 0.005), visual perception (general visual perception: p = 0.005; visual-motor integration: p = 0.002) and working memory (WISC working memory: p = 0.002 and K-ABC Word Order (p = 0.010) and Hand Movements (p = 0.001) subtests. Also, the children without seizures scored significantly lower than those with seizures on the WISC Working Memory Index (p = 0.010) and on the K-ABC Word Order (p = 0.021) and Hand Movements (p = 0.027) subtests. Further analysis of our data demonstrated the particular importance of the family context for child development. Significant cognitive deficits were found only in children with RD from parents with lower educational levels. This group consistently scored lower compared to the control group regarding IQ (full scale IQ: p < 0.001; verbal IQ: p < 0.001; performance IQ: p = 0.012; processing speed: p = 0.034), visual perception (general visual perception: p = 0.018; visual-motor integration: p = 0.010) and auditory working memory (WISC working memory: p = 0.014). Furthermore, compared to the children with RE, they performed significantly weaker on verbal IQ (p = 0.020), auditory working memory consistently (WISC working memory: p = 0.027; K-ABC: Word Order: p = 0.046) as well as in one of the K-ABC spatial working memory subtests (Hand Movements: p = 0.029). Although we did not find significant deficits in children with new-onset RE compared to healthy controls, the performance of this group tended to be weaker more often. No statistically significant associations were observed between selected clinical markers (focus types: centrotemporal/other foci/laterality of foci and spread of Rolandic discharges) and cognitive test results. Except for spatial working memory, we also found no evidence that the age of our patients at the time of study participation was of significant importance to their cognitive performance. CONCLUSIONS Our study provides some evidence that children with Rolandic discharges, with and without seizures, may be at higher risk of cognitive impairment. In addition to medical care, we emphasise early differentiated psychosocial diagnostics to provide these children and their families with targeted support if developmental problems are present.
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Affiliation(s)
- Helmut Neumann
- University Children's Hospital, Ruhr University Bochum, Department of Neuropediatrics Bochum, Germany.
| | - Monika Daseking
- Department of Educational Psychology, Helmut Schmidt University/University of the Armed Forces Hamburg, Hamburg, Germany
| | - Charlotte Thiels
- University Children's Hospital, Ruhr University Bochum, Department of Neuropediatrics Bochum, Germany
| | - Cornelia Köhler
- University Children's Hospital, Ruhr University Bochum, Department of Neuropediatrics Bochum, Germany
| | - Thomas Lücke
- University Children's Hospital, Ruhr University Bochum, Department of Neuropediatrics Bochum, Germany
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Hauger LE, Lossius MI, Aaberg KM, Helmstaedter C, Lossius J, Skogan AH. Screening of attention and executive functions in pediatric patients at a tertiary epilepsy center. Eur J Paediatr Neurol 2023; 46:35-41. [PMID: 37418997 DOI: 10.1016/j.ejpn.2023.06.006] [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: 01/16/2023] [Revised: 05/23/2023] [Accepted: 06/19/2023] [Indexed: 07/09/2023]
Abstract
OBJECTIVE Executive dysfunction is prevalent in children with epilepsy, and associated with poor psychosocial outcome. Sensitive and time effective tools are needed, which capture executive dysfunction across a wide range of impairment. The present study evaluates the applicability of EpiTrack Junior® (EpiTrackJr) as a screening tool at a tertiary epilepsy center, and explore how EpiTrackJr in combination with a subjective measure of everyday attention and executive functions (EFs) may provide clinically important information. METHODS Retrospective study including 235 pediatric patients admitted to the Norwegian National Centre for Epilepsy. EpiTrackJr and Behavioral Rating Inventory of Executive Functioning (BRIEF) were used to assess attention and EFs. RESULTS 27,7% obtained a score categorized as "average/unimpaired", 23% as "mildly impaired", and 47.7% as "significantly impaired" on EpiTrackJr. The distribution of age-corrected EpiTrackJr scores was satisfactory. Performance was related to numbers of anti-seizure medication (ASM load), comorbidity and IQ. We found a significant, but weak correlation between EpiTrackJr performance and the BRIEF Metacognitive Index (r = -0.236, n = 108, p=.014), but no significant correlation with the Behavioral Regulation Index (r = -0.178, n = 108, p=.065). SIGNIFICANCE Our results indicate that EpiTrackJr is applicable as a screening tool for attention and EFs in pediatric patients at a tertiary epilepsy center. Impaired test performance was associated with greater ASM load, comorbidity and lower IQ. Performance based measures and behavior ratings likely capture different aspects of EFs. In combination, the two provide important and nonredundant information about the child's EFs in different settings.
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Affiliation(s)
- Lisa E Hauger
- National Centre for Epilepsy, Division for Clinical Neuroscience, Oslo University Hospital, Postbox 4959, Nydalen, Norway.
| | - Morten I Lossius
- National Centre for Epilepsy, Division for Clinical Neuroscience, Oslo University Hospital, Postbox 4959, Nydalen, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Kari M Aaberg
- National Centre for Epilepsy, Division for Clinical Neuroscience, Oslo University Hospital, Postbox 4959, Nydalen, Norway.
| | - Christoph Helmstaedter
- Department of Epileptology, University Hospital Bonn, Building 83, Venusberg - Campus 1, 53127, Bonn, Germany.
| | - Johanne Lossius
- National Centre for Epilepsy, Division for Clinical Neuroscience, Oslo University Hospital, Postbox 4959, Nydalen, Norway.
| | - Annette H Skogan
- National Centre for Epilepsy, Division for Clinical Neuroscience, Oslo University Hospital, Postbox 4959, Nydalen, Norway.
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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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Sherlock C, Madigan C, Linehan C, Keenan L, Downes M. Academic attainment following pediatric epilepsy surgery: A systematic review. Epilepsy Behav 2022; 134:108847. [PMID: 35914437 DOI: 10.1016/j.yebeh.2022.108847] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 07/05/2022] [Accepted: 07/05/2022] [Indexed: 11/03/2022]
Abstract
Academic skills, such as reading, spelling and arithmetic, are central to meaningful engagement with society throughout adolescence and into adulthood. The disruption caused by on-going seizure activity places children with drug-resistant epilepsy at a particularly high risk of poor academic attainment. Though epilepsy surgery during childhood has long-been associated with various cognitive changes, less is known of the extent to which pediatric epilepsy surgery impacts academic attainment. The aim of the present systematic review was to identify the nature of the effect of pediatric epilepsy surgery on the core academic skills of reading, writing, and arithmetic. The electronic databases Embase, Medline, PubMed, PsychInfo, OpenAire, and the ISRCTN registry were searched for studies examining academic attainment following epilepsy surgery in childhood, over the last three decades. Two thousand three-hundred and sixty-eight articles were screened for relevance. Thirteen studies met the inclusion criteria. Study quality and reliability were independently assessed by two reviewers. Results indicate that academic attainment primarily stabilizes in the first year following epilepsy surgery. Though changes to learning ability would not be expected in this early recovery phase, this review indicates that children do not, at least, lose the academic skills they have acquired before surgery. Postoperative declines in performance were most notably recorded in assessments of arithmetic, suggesting an area of potential vulnerability in this cohort. These declines were noted in cohorts with the longest periods between seizure onset and surgery. While older age at onset and seizure freedom correlated with improved academic attainment, further research is necessary to fully understand the specific effect of epilepsy surgery on academic attainment. Still, the present review provides valuable information regarding the likely academic outcomes in the early years following surgical treatment for drug-resistant epilepsy.
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Affiliation(s)
- Clara Sherlock
- University College Dublin, UCD School of Psychology, Dublin, Ireland.
| | - Cathy Madigan
- Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Christine Linehan
- University College Dublin, UCD School of Psychology, Dublin, Ireland; UCD Centre for Disability Studies, University College Dublin, Dublin, Ireland
| | - Lisa Keenan
- University College Dublin, UCD School of Psychology, Dublin, Ireland
| | - Michelle Downes
- University College Dublin, UCD School of Psychology, Dublin, Ireland
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Abstract
PURPOSE OF REVIEW Comorbidities are a common feature in epilepsy, but neither the entire spectrum nor the significance of such comorbidities has been fully explored. We review comorbidities associated with epilepsy and their associated burden, provide an overview of relationships, and discuss a new conceptualization of the comorbidities. RECENT FINDINGS The epidemiology of the comorbidities of epilepsy and effects on health outcomes, healthcare use, and healthcare expenditures have been partly delineated. Distinct mechanisms of the associations have been suggested but not entirely ascertained. Movement from conceptualizing epilepsy as a condition to a symptom-complex has occurred. SUMMARY Comorbidities are common among people with epilepsy and are associated with poorer clinical outcomes and quality of life, greater use of health resources, and increased expenditure. Becoming aware of the associated mechanisms and their uncertainty is central to understanding the relationships between epilepsy and comorbid health conditions, which have implications for diagnosis and screening, medical management, and surgical management. Conceptualizing comorbidities of epilepsy as precipitating factors and epilepsy as the symptom will improve the understanding of epilepsy and catalyze research and improvements in clinical practice.
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Affiliation(s)
- Nathan A Shlobin
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, Queen Square, London WC1N 3BG & Chalfont Centre for Epilepsy, Chalfont St Peter, UK
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede 2103SW, The Netherlands
- Neurology Department, West of China Hospital, Sichuan University, Chengdu, China
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7
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Cheng D, Miao X, Wu H, Chen C, Chen Q, Zhou X. Dyscalculia and dyslexia in Chinese children with idiopathic epilepsy: different patterns of prevalence, comorbidity and gender differences. Epilepsia Open 2022; 7:160-169. [PMID: 35007403 PMCID: PMC8886104 DOI: 10.1002/epi4.12577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 11/22/2022] Open
Abstract
Objective The present study aimed to examine the prevalence of dyscalculia, dyslexia, and their comorbidity rates in a large population‐based sample of children with idiopathic epilepsy (N = 2282) and a comparison sample of typically developing schoolchildren (N = 2371). Methods Both groups of children were screened using an arithmetic fluency test for dyscalculia and a reading fluency test for dyslexia. Their comorbidity rates were assessed. The prevalence rates of dyscalculia, dyslexia, comorbidity, and isolated dyscalculia/dyslexia (ie, participants with comorbid dyslexia and dyscalculia were excluded) were analyzed. Results In both −1.5 SD and −1 SD cutoff criterion, the prevalence rates were about two times higher in children with idiopathic epilepsy than in other schoolchildren; the prevalence rates of isolated dyslexia were higher in children with idiopathic epilepsy than in other schoolchildren (−1 SD: 10.9% vs 8.6%; −1.5 SD: 6.5% vs 4.7%). Meanwhile, comorbidity rates of dyscalculia and dyslexia were higher in children with idiopathic epilepsy than in other schoolchildren (32.7% vs 26.6%; 38.3% vs 23.5%, respectively). Overall, patterns of prevalence rates were different for children with idiopathic epilepsy and schoolchildren, in which children with idiopathic epilepsy had a higher prevalence rate of dyscalculia than dyslexia, while schoolchildren had a higher prevalence of dyslexia than dyscalculia, regardless of cutoff criteria. Interestingly, gender differences in the prevalence rates of all types of learning disabilities were found in schoolchildren, but there were only gender differences in the prevalence rates of dyslexia in children with idiopathic epilepsy. Significance The results highlight the vulnerability of children with idiopathic epilepsy for learning disabilities and a differential pattern of gender differences in dyslexia. Moreover, different patterns of prevalence rates suggest that children with idiopathic epilepsy and schoolchildren are more prone to different types of learning disabilities. The findings suggest needs for special interventions of learning disabilities for children with idiopathic epilepsy.
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Affiliation(s)
- Dazhi Cheng
- Department of Pediatric Neurology, Capital Institute of Pediatrics, 100020, Beijing, China.,State Key Laboratory of Cognitive Neuroscience and Learning, IDG/McGovern Institute for Brain Research, Beijing Normal University, 100875, Beijing, China.,Lab for Educational Neuroscience, Center for Educational Science and Technology, Beijing Normal University, 100875, Beijing, China.,Institute of Basic Medicine, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China
| | - Xinyang Miao
- State Key Laboratory of Cognitive Neuroscience and Learning, IDG/McGovern Institute for Brain Research, Beijing Normal University, 100875, Beijing, China.,Institute of Basic Medicine, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China
| | - Haiyan Wu
- Centre for Cognitive and Brain Sciences and Department of Psychology, University of Macau, Taipa, Macau
| | - Chuansheng Chen
- Department of Psychological Science, University of California, Irvine, 92697-7085 CA, USA
| | - Qian Chen
- Department of Pediatric Neurology, Capital Institute of Pediatrics, 100020, Beijing, China
| | - Xinlin Zhou
- State Key Laboratory of Cognitive Neuroscience and Learning, IDG/McGovern Institute for Brain Research, Beijing Normal University, 100875, Beijing, China.,Institute of Basic Medicine, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China
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Perazzo D, Moore R, Kasparian NA, Rodts M, Horowitz-Kraus T, Crosby L, Turpin B, Beck AF, Hutton J. Chronic pediatric diseases and risk for reading difficulties: a narrative review with recommendations. Pediatr Res 2022; 92:966-978. [PMID: 35121848 PMCID: PMC9586865 DOI: 10.1038/s41390-022-01934-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 11/02/2021] [Accepted: 12/13/2021] [Indexed: 12/03/2022]
Abstract
Literacy is a major social determinant of health, rooted in skills that develop during early childhood. Children arriving at kindergarten unprepared to learn to read are more likely to have low reading proficiency thereafter. General and health literacy are highly correlated, affecting understanding of health conditions, treatment adherence, and transition to self-care and adult healthcare services. The American Academy of Pediatrics (AAP) recommends literacy and school readiness promotion during well-visits and neurodevelopmental surveillance is emphasized across primary and subspecialty care. While genetic and environmental risk factors for reading difficulties are well-established, risks related to complex and chronic medical conditions are less appreciated and under-researched. This review applies an eco-bio-developmental framework to explore literacy across five complex chronic conditions affecting millions of children worldwide: asthma, cancer, congenital heart disease, epilepsy, and sickle cell disease. In each, integration of an efficient reading brain network may be impacted by direct factors, such as ischemia, anesthesia, and/or medications, and also indirect factors, such as altered parent-child routines, hospital stays, and missed school. By integrating literacy into care management plans for affected children, pediatric primary care and specialty providers are poised to identify risks early, target guidance and interventions, and improve academic and health outcomes. IMPACT: While genetic and environmental risk factors for reading difficulties are well-established, risks related to complex and/or chronic medical conditions such as asthma, cancer, congenital heart disease, epilepsy, and sickle cell disease are substantial, less appreciated, and under-researched. General and health literacy are highly correlated, with implications for the understanding one's health condition, treatment adherence, and transitioning to self-care, which is especially important for children with complex and/or chronic illness. Pediatric primary care and specialty providers are poised to integrate reading and literacy into care management plans for children with complex and/or chronic illness, including early screening, guidance, support, and interventions.
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Affiliation(s)
- Donna Perazzo
- grid.24827.3b0000 0001 2179 9593Reading and Literacy Discovery Center, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Ryan Moore
- grid.24827.3b0000 0001 2179 9593The Heart Institute, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Nadine A. Kasparian
- grid.24827.3b0000 0001 2179 9593The Heart Institute, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA ,grid.24827.3b0000 0001 2179 9593Center for Heart Disease and Mental Health, Heart Institute and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Megan Rodts
- grid.24827.3b0000 0001 2179 9593The Heart Institute, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Tzipi Horowitz-Kraus
- grid.24827.3b0000 0001 2179 9593Reading and Literacy Discovery Center, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA ,grid.24827.3b0000 0001 2179 9593Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA ,grid.6451.60000000121102151Educational Neuroimaging Center, Faculty of Education in Science and Technology and Faculty of Biomedical Engineering, Technion, Haifa, Israel
| | - Lori Crosby
- grid.24827.3b0000 0001 2179 9593Center for Clinical and Translational Science and Training and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Brian Turpin
- grid.24827.3b0000 0001 2179 9593Division of Oncology, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Andrew F. Beck
- grid.24827.3b0000 0001 2179 9593Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA ,grid.24827.3b0000 0001 2179 9593Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - John Hutton
- Reading and Literacy Discovery Center, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA. .,Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Zanaboni MP, Varesio C, Pasca L, Foti A, Totaro M, Celario M, Provenzi L, De Giorgis V. Systematic review of executive functions in children with self-limited epilepsy with centrotemporal spikes. Epilepsy Behav 2021; 123:108254. [PMID: 34428616 DOI: 10.1016/j.yebeh.2021.108254] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/28/2021] [Accepted: 07/28/2021] [Indexed: 12/01/2022]
Abstract
Self-limited Epilepsy with Centrotemporal Spikes (ECTS) is a self-limiting childhood epilepsy with an overall good prognosis. The neurocognitive profile of ECTS shows various degrees of neuropsychological impairment, with speech impairment and executive dysfunction being the most prominent. This review aimed to clarify the executive function (EF) profile of children with ECTS and the clinical variables' impact on these abilities. We conducted a systematic review of the relevant literature for articles published up to January 2021. Demographic and clinical characteristics were abstracted from the original records. EF tasks used in the studies were classified according to Diamond's model, which identified four components: working memory, inhibitory control, cognitive flexibility, and higher order EFs. Twenty-three studies were included. Among the included records, 14 studies examined working memory, 15 inhibitory control, 15 flexibility, 4 higher order EFs, and 2 general EFs. Results confirmed the presence of a specific impairment in two abilities: inhibitory control and cognitive flexibility. This review confirms the need to assess each EF both in verbal and visual-spatial tasks. The early detection of children with ECTS at risk of developing neuropsychological impairment could activate interventions and prevent worse school achievement, social functioning, and a poor quality of life. Systematic review registration: PROSPERO: CRD42021245959.
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Affiliation(s)
| | - Costanza Varesio
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
| | - Ludovica Pasca
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Annalisa Foti
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
| | - Martina Totaro
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Massimiliano Celario
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Livio Provenzi
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
| | - Valentina De Giorgis
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
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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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11
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Modi AC, Mara CA, Schmidt M, Smith AW, Turnier L, Wade SL. Pilot Executive Functioning Intervention in Epilepsy: Behavioral and Quality of Life Outcomes. J Pediatr Psychol 2021; 46:363-374. [PMID: 33434271 DOI: 10.1093/jpepsy/jsaa119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 11/04/2020] [Accepted: 11/13/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine changes in emotional and behavioral functioning and health-related quality of life (HRQOL) following a web-based executive functioning (EF) intervention open pilot trial (e.g., Epilepsy Journey) for adolescents with epilepsy. METHODS Adolescents with an established diagnosis of epilepsy, EF deficits, and without developmental disorders participated in a single-arm trial of Epilepsy Journey. Epilepsy Journey is a gamified, online learning environment comprised of 10 learning modules targeting EF deficits (e.g., working memory, organization) and tailored to epilepsy with accompanying telehealth problem-solving sessions. Adolescents completed questionnaires assessing emotional and behavioral functioning and HRQOL at baseline, posttreatment, and 2 follow-ups . Longitudinal mixed models and logistic regression analyses were used for these secondary analyses. RESULTS 39 adolescents were recruited for Epilepsy Journey (Mage=15.3 years; 67% female; 87% White: Non-Hispanic; 39% experienced seizures in the past 3 months). Preliminary data indicate significant improvements in caregiver-reported Externalizing symptoms, Behavioral Symptom Index scores and Adaptive Skills from baseline to 5-month follow-up. Significant improvements were observed for caregiver-reported Mood/Behavior and self-reported Impact, Cognitive Functioning, Executive Functioning, and Sleep subscales of the PedsQL Epilepsy Module. Clinically significant improvements (e.g., clinical/at-risk to normative levels) in behavioral and quality of life domains were also noted. CONCLUSION Epilepsy Journey appears to contribute to changes in emotional and behavioral functioning and HRQOL in adolescents with epilepsy. Given the proof of concept trial format of this study, an important future direction is to conduct a randomized controlled trial with a larger, generalizable cohort of adolescents with epilepsy.
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Affiliation(s)
- Avani C Modi
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center.,College of Medicine, University of Cincinnati
| | - Constance A Mara
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center.,College of Medicine, University of Cincinnati
| | - Matthew Schmidt
- Instructional Design and Technology, College of Education, Criminal Justice, and Human Services, University of Cincinnati
| | - Aimee W Smith
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center
| | - Luke Turnier
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center
| | - Shari L Wade
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center.,College of Medicine, University of Cincinnati
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12
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Neurocognitive Effects of Antiseizure Medications in Children and Adolescents with Epilepsy. Paediatr Drugs 2021; 23:253-286. [PMID: 33956338 DOI: 10.1007/s40272-021-00448-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 11/08/2022]
Abstract
Impairments in cognition are common in epilepsy and may be caused or exacerbated by antiseizure medications (ASMs). Positive effects on cognition may also be seen with some ASMs. Cognitive outcomes are of particular concern in children who may be at an increased risk of cognitive adverse effects of treatment. A comprehensive literature search was conducted in PubMed in order to evaluate the evidence for cognitive changes associated with treatment with ASMs in paediatric epilepsy patients. The ASMs considered were those in the current edition of the British National Formulary (BNF). For most ASMs, remarkably few studies providing robust data on cognitive effects in paediatric patients were identified. The available evidence suggests cognitive impairments may be associated with treatment with phenobarbital. Topiramate and phenytoin are also associated with negative effects on cognition, in particular word-finding difficulties and other language deficits with topiramate, but there are few data available specifically on children. Lamotrigine, levetiracetam and fenfluramine are associated with improvements in some cognitive domains, although it is unclear whether these effects are directly attributable to the medications or are a result of improvements in seizures. Neutral effects on cognition (no substantial evidence of worsening) were suggested for carbamazepine, everolimus, lacosamide, oxcarbazepine, perampanel and valproate. There is limited data for cannabidiol, clobazam, eslicarbazepine acetate, ethosuximide, rufinamide, vigabatrin and zonisamide, although the available evidence suggests these drugs are not associated with severe cognitive impairment. There was too little information to reach conclusions about the effects of brivaracetam, felbamate, gabapentin, pregabalin, retigabine, stiripentol or tiagabine.
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13
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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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14
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Winning AM, Holmbeck GN. JPP Student Journal Club Commentary: Executive Functioning Intervention in Epilepsy: Implications for Other Pediatric Chronic Health Conditions. J Pediatr Psychol 2021; 46:375-377. [PMID: 33792690 PMCID: PMC8056208 DOI: 10.1093/jpepsy/jsab036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 03/17/2021] [Accepted: 03/17/2021] [Indexed: 11/13/2022] Open
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15
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Poole BJ, Phillips NL, Stewart E, Harris IM, Lah S. Working Memory in Pediatric Epilepsy: A Systematic Review and Meta-Analysis. Neuropsychol Rev 2021; 31:569-609. [PMID: 33818735 DOI: 10.1007/s11065-021-09491-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 02/21/2021] [Indexed: 10/21/2022]
Abstract
Working memory is a multicomponent system that is supported by overlapping specialized networks in the brain. Baddeley's working memory model includes four components: the phonological loop, visuo-spatial sketchpad, the central executive, and episodic buffer. The aim of this review was to establish the gravity and pattern of working memory deficits in pediatric epilepsy. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guided electronic searches. Sixty-five studies were included in the review. Meta-analyses revealed significant impairments across each working memory component: phonological loop (g = 0.739), visuo-spatial sketchpad (g = 0.521), and central executive (g = 0.560) in children with epilepsy compared to controls. The episodic buffer was not examined. The pattern of impairments, however, differed according to the site and side of seizure focus. This suggests that working memory components are differentially vulnerable to the location of seizure focus in the developing brain.
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Affiliation(s)
- Belinda J Poole
- School of Psychology, University of Sydney, Sydney, NSW, 2006, Australia.,ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, NSW, 2109, Australia
| | - Natalie L Phillips
- School of Psychology, University of Sydney, Sydney, NSW, 2006, Australia.,ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, NSW, 2109, Australia
| | - Elizabeth Stewart
- School of Psychology, University of Sydney, Sydney, NSW, 2006, Australia.,ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, NSW, 2109, Australia
| | - Irina M Harris
- School of Psychology, University of Sydney, Sydney, NSW, 2006, Australia
| | - Suncica Lah
- School of Psychology, University of Sydney, Sydney, NSW, 2006, Australia. .,ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, NSW, 2109, Australia.
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16
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Lenck-Santini PP, Sakkaki S. Alterations of Neuronal Dynamics as a Mechanism for Cognitive Impairment in Epilepsy. Curr Top Behav Neurosci 2021; 55:65-106. [PMID: 33454922 DOI: 10.1007/7854_2020_193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Epilepsy is commonly associated with cognitive and behavioral deficits that dramatically affect the quality of life of patients. In order to identify novel therapeutic strategies aimed at reducing these deficits, it is critical first to understand the mechanisms leading to cognitive impairments in epilepsy. Traditionally, seizures and epileptiform activity in addition to neuronal injury have been considered to be the most significant contributors to cognitive dysfunction. In this review we however highlight the role of a new mechanism: alterations of neuronal dynamics, i.e. the timing at which neurons and networks receive and process neural information. These alterations, caused by the underlying etiologies of epilepsy syndromes, are observed in both animal models and patients in the form of abnormal oscillation patterns in unit firing, local field potentials, and electroencephalogram (EEG). Evidence suggests that such mechanisms significantly contribute to cognitive impairment in epilepsy, independently of seizures and interictal epileptiform activity. Therefore, therapeutic strategies directly targeting neuronal dynamics rather than seizure reduction may significantly benefit the quality of life of patients.
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Affiliation(s)
- Pierre-Pascal Lenck-Santini
- Aix-Marseille Université, INSERM, INMED, Marseille, France. .,Department of Neurological sciences, University of Vermont, Burlington, VT, USA.
| | - Sophie Sakkaki
- Department of Neurological sciences, University of Vermont, Burlington, VT, USA.,Université de. Montpellier, CNRS, INSERM, IGF, Montpellier, France
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17
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Arski ON, Young JM, Smith ML, Ibrahim GM. The Oscillatory Basis of Working Memory Function and Dysfunction in Epilepsy. Front Hum Neurosci 2021; 14:612024. [PMID: 33584224 PMCID: PMC7874181 DOI: 10.3389/fnhum.2020.612024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/10/2020] [Indexed: 11/16/2022] Open
Abstract
Working memory (WM) deficits are pervasive co-morbidities of epilepsy. Although the pathophysiological mechanisms underpinning these impairments remain elusive, it is thought that WM depends on oscillatory interactions within and between nodes of large-scale functional networks. These include the hippocampus and default mode network as well as the prefrontal cortex and frontoparietal central executive network. Here, we review the functional roles of neural oscillations in subserving WM and the putative mechanisms by which epilepsy disrupts normative activity, leading to aberrant oscillatory signatures. We highlight the particular role of interictal epileptic activity, including interictal epileptiform discharges and high frequency oscillations (HFOs) in WM deficits. We also discuss the translational opportunities presented by greater understanding of the oscillatory basis of WM function and dysfunction in epilepsy, including potential targets for neuromodulation.
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Affiliation(s)
- Olivia N. Arski
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Program in Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | - Julia M. Young
- Program in Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Department of Psychology, Hospital for Sick Children, Toronto, ON, Canada
| | - Mary-Lou Smith
- Program in Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Department of Psychology, Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, Canada
| | - George M. Ibrahim
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Program in Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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18
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Kanner AM, Helmstaedter C, Sadat-Hossieny Z, Meador K. Cognitive disorders in epilepsy I: Clinical experience, real-world evidence and recommendations. Seizure 2020; 83:216-222. [DOI: 10.1016/j.seizure.2020.10.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/02/2020] [Accepted: 10/04/2020] [Indexed: 01/14/2023] Open
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19
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Stern A, Winning A, Ohanian D, Driscoll CFB, Starnes M, Glownia K, Holmbeck GN. Longitudinal associations between neuropsychological functioning and medical responsibility in youth with spina bifida: The moderational role of parenting behaviors. Child Neuropsychol 2020; 26:1026-1046. [PMID: 32308112 PMCID: PMC7544676 DOI: 10.1080/09297049.2020.1751098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/28/2020] [Indexed: 10/24/2022]
Abstract
For youth with spina bifida (SB), the transfer of medical responsibilities from parent- to self-management is an important component of autonomy development. Youth with SB are at risk for neurocognitive impairments with inattention and executive dysfunction, which may impact their ability to take responsibility for medical tasks. However, adaptive parenting may buffer against the negative impact of executive/attentional dysfunction on levels of medical responsibility. Thus, this study examined the moderating roles of parenting behaviors and child age on the longitudinal associations between neuropsychological functioning and medical responsibility in youth with SB. Participants were recruited as part of a larger, longitudinal study. Youth with SB (N = 89, Mage = 11.10 years) completed a neuropsychological battery of executive functioning and attention measures at Time 1 (T1). Parents reported on youth's executive functioning/attention skills at T1, and child medical responsibility two years later at Time 2 (T2). Observational methods were used to assess parenting behaviors (warmth, behavioral and psychological control) at T1. Attention and cognitive shifting skills at T1 were positively related to child medical responsibility at T2. Two-way interactions between planning/organizing skills and paternal acceptance, and planning/organizing skills and paternal psychological control, were found. A three-way interaction between cognitive shifting skills, maternal acceptance, and child age was found. When conceptualizing risk factors for low medical responsibility in youth with SB, it is important to consider the family context beyond individual, cognitive factors. The results are discussed within the wider context of social-ecological models of medical responsibility.
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Affiliation(s)
- Alexa Stern
- Psychology Department, Loyola University Chicago , Chicago, IL, USA
| | - Adrien Winning
- Psychology Department, Loyola University Chicago , Chicago, IL, USA
| | - Diana Ohanian
- Psychology Department, Loyola University Chicago , Chicago, IL, USA
| | | | - Meredith Starnes
- Psychology Department, Loyola University Chicago , Chicago, IL, USA
| | - Karen Glownia
- Psychology Department, Loyola University Chicago , Chicago, IL, USA
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20
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Memory outcomes following hemispherectomy in children. Epilepsy Behav 2020; 112:107360. [PMID: 32882625 DOI: 10.1016/j.yebeh.2020.107360] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/02/2020] [Accepted: 07/15/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE A vast proportion of children with epilepsy exhibit memory impairments. Although numerous studies have examined memory performance following pediatric resective epilepsy surgery, little is known about the memory outcomes following hemispherectomy. The few studies that report on memory performance typically include restricted measures, consist of case reports, or do not report on preoperative performance. Given the current limitations, the aim of this study was to delineate pre- and postoperative memory functioning in youth who underwent a hemispherectomy. METHOD Participants included patients who had undergone a hemispherectomy at the Hospital for Sick Children, between 1999 and 2016. Standardized neuropsychological assessments of verbal (digit span, word list recall, word pair recall, stories) and visual (faces, dot locations) memory abilities prior to and after surgery were reviewed. A Wilcoxon signed rank test and effect sizes was completed to compare patients' memory performance to population norms and to assess pre- to postoperative difference scores. RESULTS Thirteen participants were included in the study: five patients completed preoperative assessments only and eight patients completed pre- and postoperative assessments. Preoperatively, patients performed substantially worse relative to population norms as indicated by large effect sizes (r: 0.5-0.9). Postoperatively, effect sizes were large for the majority of the memory tests, demonstrating considerable differences in patients' memory scores over time. When clinically meaningful changes were examined, stable performance was evident on 63% of the memory tasks. CONCLUSION Overall, the results highlight that youth who are eligible for hemispherectomy demonstrate profound memory deficits prior to surgery. In addition, undergoing hemispherectomy was not necessarily associated with declined memory performance, with the majority of patients showing stable scores.
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21
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Abstract
Since the seminal work on the patient HM, who in his adulthood presented an acquired amnesic syndrome following the resection of the bilateral temporal lobe, other research has described several cases of isolated memory dysfunction in children. This chapter presents developmental and long-lasting memory disorders emerging from an organic or neurologic cause at birth or in infancy. More notably, we focus on developmental amnesic syndrome caused by neonatal bihippocampal damage and memory dysfunction caused by medial temporal developmental epilepsy. We describe these two pediatric populations and present the consequences of hippocampal/medial temporal lobe damage in the development of memory systems. We review episodic memory deficits in children with developmental amnesia and temporal lobe epilepsy and highlight their impact on new learning, personal memories, and independent life. Finally, we provide a brief overview of some of the insights and debates emerging from classic work and recent advances in the context of episodic memory dysfunction displayed by children with hippocampal/medial temporal lobe amnesia and propose new perspectives in child neuropsychology of memory, suggesting new avenues for more ecologic memory assessment and rehabilitation.
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22
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Hermann BP, Struck AF, Stafstrom CE, Hsu DA, Dabbs K, Gundlach C, Almane D, Seidenberg M, Jones JE. Behavioral phenotypes of childhood idiopathic epilepsies. Epilepsia 2020; 61:1427-1437. [PMID: 32557544 DOI: 10.1111/epi.16569] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/11/2020] [Accepted: 05/11/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To characterize the presence and nature of discrete behavioral phenotypes and their correlates in a cohort of youth with new and recent onset focal and generalized epilepsies. METHODS The parents of 290 youth (age = 8-18 years) with epilepsy (n = 183) and typically developing participants (n = 107) completed the Child Behavior Checklist for children aged 6-18 from the Achenbach System of Empirically Based Assessment. The eight behavior problem scales were subjected to hierarchical clustering analytics to identify behavioral subgroups. To characterize the external validity and co-occurring comorbidities of the identified subgroups, we examined demographic features (age, gender, handedness), cognition (language, perception, attention, executive function, speed), academic problems (present/absent), clinical epilepsy characteristics (epilepsy syndrome, medications), familial factors (parental intelligence quotient, education, employment), neuroimaging features (cortical thickness), parent-observed day-to-day executive function, and number of lifetime-to-date Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) diagnoses. RESULTS Hierarchical clustering identified three behavioral phenotypes, which included no behavioral complications (Cluster 1, 67% of epilepsy cohort [n = 122]), nonexternalizing problems (Cluster 2, 11% of cohort [n = 21]), and combined internalizing and externalizing problems (Cluster 3, 22% of cohort [n = 40]). These behavioral phenotypes were characterized by orderly differences in personal characteristics, neuropsychological status, history of academic problems, parental status, cortical thickness, daily executive function, and number of lifetime-to-date DSM-IV diagnoses. Cluster 1 was most similar to controls across most metrics, whereas Cluster 3 was the most abnormal compared to controls. Epilepsy syndrome was not a predictor of cluster membership. SIGNIFICANCE Youth with new and recent onset epilepsy fall into three distinct behavioral phenotypes associated with a variety of co-occurring features and comorbidities. This approach identifies important phenotypes of behavior problem presentations and their accompanying factors that serve to advance clinical and theoretical understanding of the behavioral complications of children with epilepsy and the complex conditions with which they co-occur.
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Affiliation(s)
- Bruce P Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Aaron F Struck
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Carl E Stafstrom
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - David A Hsu
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Kevin Dabbs
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Carson Gundlach
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Dace Almane
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Michael Seidenberg
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Jana E Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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23
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Harden C, Rea H, Buchanan-Perry I, Gee B, Johnson A. A Multidisciplinary Educational Approach for Children With Chronic Illness: An Intervention Case Study. CONTINUITY IN EDUCATION 2020; 1:8-21. [PMID: 38774530 PMCID: PMC11104317 DOI: 10.5334/cie.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 10/14/2019] [Indexed: 05/24/2024]
Abstract
Chronic illness requires frequent medical treatments and lifestyle restrictions that increase academic and socioemotional stressors for families. This paper presents academic intervention recommendations based on a hospital's approach to improving educational outcomes for children with chronic illness. A case study on an intervention for a girl with sickle cell disease (SCD) and a history of stroke. SCD is a relatively common chronic illness that has physical and psychosocial side effects that are central to other chronic illnesses (Platt, Eckman, & Hsu, 2016). A quality improvement approach resulted in five cycles of interventions that were assessed with both qualitative and quantitative measures. The initial strategy of improving academics through collaboration among the school, hospital, and family resulted in psychosocial, but not academic, improvements. Frequent tutoring, which was most achievable using online platforms, resulted in the greatest gains. The girl passed previously failed classes and advanced to the next grade. Recommendations for how to improve academic outcomes for children with chronic illness using the presented intervention strategies are discussed.
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Affiliation(s)
| | | | | | - Beatrice Gee
- Children’s Healthcare of Atlanta, US
- Morehouse School of Medicine, US
| | - Alcuin Johnson
- Children’s Healthcare of Atlanta, US
- Emory School of Medicine, US
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24
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Oyegbile TO. The role of task-based neural activation research in understanding cognitive deficits in pediatric epilepsy. Epilepsy Behav 2019; 99:106332. [PMID: 31399340 DOI: 10.1016/j.yebeh.2019.05.028] [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: 03/20/2019] [Revised: 05/15/2019] [Accepted: 05/19/2019] [Indexed: 11/29/2022]
Abstract
Children with epilepsy can experience significant cognitive dysfunction that can lead to academic underachievement. Traditionally believed to be primarily due to the effects of factors such as the chronicity of epilepsy, medication effects, or the location of the primary epileptogenic lesion;, recent evidence has indicated that disruption of cognition-specific distributed neural networks may play a significant role as well. Specifically, over the last decade, researchers have begun to characterize the mechanisms underlying disrupted cognitive substrates by evaluating neural network abnormalities observed during specific cognitive tasks, using task-based functional magnetic resonance imaging (fMRI). This targeted review assesses the current literature investigating the relationship between neural network abnormalities and cognitive deficits in pediatric epilepsy. The findings indicate that there are indeed neural network abnormalities associated with deficits in executive function, language, processing speed, and memory. Overall, cognitive dysfunction in pediatric epilepsy is associated with a decrease in neural network activation/deactivation as well as increased recruitment of brain regions not typically related to the specific cognitive task under investigation. The research to date has focused primarily on children with focal epilepsy syndromes with small sample sizes and differing research protocols. More extensive research in children with a wider representation of epilepsy syndromes (including generalized epilepsy syndromes) is necessary to fully understand these relationships and begin to identify underlying cognitive phenotypes that may account for the variability observed across children with epilepsy. Furthermore, more uniformity in fMRI protocols and neuropsychological tasks would be ideal to advance this literature.
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Affiliation(s)
- Temitayo O Oyegbile
- Georgetown University Medical Center, Washington, D.C., United States of America.
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25
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Modi AC, Mara CA, Schmidt M, Smith AW, Turnier L, Glaser N, Wade SL. Epilepsy Journey: A proof of concept trial of a Web-based executive functioning intervention for adolescents with epilepsy. Epilepsia 2019; 60:1895-1907. [PMID: 31423591 DOI: 10.1111/epi.16317] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 07/27/2019] [Accepted: 07/29/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine the preliminary feasibility and acceptability of a Web-based program, Epilepsy Journey, to improve executive function behaviors in adolescents with epilepsy. METHODS We conducted a proof of concept single-arm pilot trial of Epilepsy Journey with 31 adolescents (average age = 15.3 ± 1.3 years) who had an epilepsy diagnosis and executive function (EF) deficits on the caregiver-report version of the Behavior Rating Inventory of Executive Function (BRIEF). Epilepsy Journey coupled a gamified problem-solving website comprised of 10 learning modules targeting EF deficits (eg, working memory, organization, problem-solving) with Skype sessions with a trained therapist. Outcomes included feasibility (attrition, sessions completed) and acceptability (satisfaction ratings). Exploratory analyses examined changes in caregiver-, self-, and teacher-reported BRIEF scores from baseline to posttreatment and at 2- and 5-month follow-ups. RESULTS Seventy-nine percent of participants completed the program. Satisfaction was high, with 97% of caregivers and adolescents rating the program as helpful and indicating they would recommend it to others. Caregivers and adolescents reported global improvements on the BRIEF, with caregivers reporting significant improvements on all BRIEF subscales. EF symptoms rebounded slightly between the 2- and 5-month follow-ups for some of the self- and caregiver-reported BRIEF scales. Notably, clinically meaningful improvements (eg, clinical/subclinical to normative levels) were reported for several caregiver-reported BRIEF subscales, including the Global Executive Composite (62% to 33-34%) and Metacognitive Index (74% to 41-42%) from baseline to 2- and 5-month follow-up. SIGNIFICANCE Findings suggest that a Web-based problem-solving intervention tailored to EF deficits for adolescents with epilepsy is both feasible and acceptable and may contribute to improvements in EF behaviors across domains.
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Affiliation(s)
- Avani C Modi
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,University of Cincinnati, Cincinnati, Ohio
| | - Constance A Mara
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,University of Cincinnati, Cincinnati, Ohio
| | | | - Aimee W Smith
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Luke Turnier
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Shari L Wade
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,University of Cincinnati, Cincinnati, Ohio
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Yıldız-Çoksan S, Aslan A, Çoksan S, Okuyaz Ç. Cognitive profile and academic achievement of children with absence epilepsy. Epilepsy Behav 2019; 95:95-99. [PMID: 31030079 DOI: 10.1016/j.yebeh.2019.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/19/2019] [Accepted: 04/02/2019] [Indexed: 11/16/2022]
Abstract
The main aim of this study was to examine the cognitive profile and academic achievement of children with absence epilepsy. It is investigated whether all scale intelligence score, intelligence subscale scores, and academic achievement of the children with absence epilepsy differed from healthy peers and Turkish norm values. Nineteen children with absence epilepsy and 19 healthy children participate in the study. The Wechsler Intelligence Scale for Children-IV (WISC-IV) is used to measure their intelligence scores. A teacher assessment form (Teacher's Report Form (TRF)) is obtained from the participants' teachers for the measurement of academic achievement, and the students' report cards are collected as an additional measure of it. Participants with absence epilepsy have significantly lower scores of total intelligence score (Mean (M) = 76.68, Standard Deviation (SD) = 25.18), verbal comprehension score (M = 81.68, SD = 25.29), perceptual reasoning score (M = 85.47, SD = 20.61), processing speed score (M = 77.95, SD = 18.61), and working memory (M = 83.74, SD = 19.04), which are measured by WISC-IV, than healthy peers (respectively M = 105.84, SD = 16.20; M = 105.47, SD = 18.12; M = 103.63, SD = 12.88; M = 104.05, SD = 12.98; M = 104.74, SD = 18.97) and norm values (M = 100, SD = 10). No difference is observed between the subscale scores of WISC-IV for within group with absence epilepsy. Moreover, they have lower Turkish language (M = 73.65, SD = 19.19) and mathematics (M = 76.26, SD = 22.29) grade report scores than healthy peers (respectively M = 90.76, SD = 12.01; M = 88.64, SD = 15.93). There is no difference between the two groups in terms of the academic achievement obtained from the TRF. It is necessary to support children with absence epilepsy academically. We analyzed whether the current pattern has changed by comparing the intelligent scores and academic achievement of children with absence epilepsy who have recovered after treatment with their healthy peers. In fact, there is no difference between the children with absence epilepsy who have recovered after treatment and their healthy peers in terms of total intelligence score and its subscale scores. Similarly, there is no difference between them in terms of mathematics score on their report. Only the difference in the score of Turkish language continues in the same direction.
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Affiliation(s)
- Serpil Yıldız-Çoksan
- Ankara University, Faculty of Health Sciences, Department of Child Development, Ankara, Turkey.
| | - Aslı Aslan
- Mersin University, Faculty of Arts and Sciences, Department of Psychology, Mersin, Turkey
| | - Sami Çoksan
- Middle East Technical University, Faculty of Arts and Sciences, Department of Psychology, Ankara, Turkey
| | - Çetin Okuyaz
- Mersin University, School of Medicine, Department of Pediatric Neurology, Mersin, Turkey
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Modi AC, Gutierrez-Colina AM, Wagner JL, Smith G, Junger K, Huszti H, Mara CA. Executive functioning phenotypes in youth with epilepsy. Epilepsy Behav 2019; 90:112-118. [PMID: 30530131 DOI: 10.1016/j.yebeh.2018.11.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 10/23/2018] [Accepted: 11/21/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objectives of this study were to identify executive functioning (EF) phenotypes in youth with epilepsy and to examine whether phenotypes differ on psychosocial and medical outcomes (i.e., absence/presence of seizures in the past three months), health-related quality of life (HRQOL), and emotional and behavioral functioning. METHODS Youth 5-18 years with diagnosed epilepsy and caregivers completed a battery of questionnaires as part of a larger national validation of the Pediatric Quality of Life (PedsQL) Epilepsy Module. The primary measure of interest was the Behavior Rating Inventory of Executive Function-Parent Form. Medical chart reviews and demographic data were also collected. Latent class analysis was used to identify EF phenotypes. Chi-square and analyses of covariance (ANCOVA) were conducted to examine EF phenotype group differences on seizure outcomes, HRQOL, and behavioral and emotional functioning. RESULTS Two-hundred and thirty-seven children with epilepsy (Mage = 11.2 years; 56% female; 60% White: Non-Hispanic; 55% experienced seizures in the past three months) and their caregivers participated. Four EF phenotypes were identified: Group 1 - No EF deficits (45% of sample), Group 2 - Global EF deficits (29% of sample), Group 3 - Behavioral Regulation + Working Memory deficits (8% of sample), and Group 4 - Metacognitive deficits (17% of sample). No significant EF phenotype group differences were found for seizure characteristics. The ANCOVAs indicated significant EF phenotype group differences on HRQOL (parent-reported Impact, Cognitive, Sleep, EF, and Mood/Behavior and child-reported Cognitive, Sleep, EF, and Mood/Behavior subscales; ps < .001) and emotional and behavioral functioning (Externalizing, Internalizing, and Behavioral Symptom Index; ps < .001), with the Global EF deficits (Group 2) and Behavioral Regulation + Working Memory deficits groups (Group 3) demonstrating the greatest level of impairment. CONCLUSION Phenotypic variability in EF is significantly related to patient-reported outcomes. Interventions addressing EF deficits need to be individualized to a child's particular EF phenotype to achieve optimal outcomes.
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Affiliation(s)
- Avani C Modi
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039, United States of America; University of Cincinnati, College of Medicine, United States of America.
| | - Ana M Gutierrez-Colina
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039, United States of America
| | - Janelle L Wagner
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas St. MSC 160, Charleston, SC 29425-1600, United States of America
| | - Gigi Smith
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas St. MSC 160, Charleston, SC 29425-1600, United States of America
| | - Katherine Junger
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039, United States of America; University of Cincinnati, College of Medicine, United States of America
| | - Heather Huszti
- Division of Pediatric Psychology, Children's Hospital of Orange County, 1120 W La Veta Ave 470, Orange, CA 92868, United States of America
| | - Constance A Mara
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039, United States of America; University of Cincinnati, College of Medicine, United States of America
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Abstract
Assessment of naming in children has been hampered by the use of tests that were developed, either to assess naming in adults or to assess related verbal functions in children. We developed comparable visual naming test (VNT) and auditory description naming (ANT) specifically for children. We collected normative data, not only for accuracy, typically the sole performance measure, but also for response time (RT) and reliance on phonemic cuing. The normative sample consisted of 200 typically developing children, ages 6-15, with 40 children per 2-year age group (6-7, 8-9, 10-11, 12-13, and 14-15). Children were tested individually by a trained examiner. Based on item analysis, naming tests were finalized at 36 items for ages 8-15 and 28 items for ages 6-7. Age-stratified normative data are provided for accuracy, mean RT, tip-of-the-tongues (i.e., delayed but accurate responses plus items named following phonemic cueing), and a summary score, which incorporates all performance measures. Internal and test-retest reliability coefficients for both tests were reasonable. Accuracy scores were high across age groups, indicating that item names were within the mental lexicon of most typically developing children. By contrast, time and cue-based scores improved with age, reflecting greater efficiency in word retrieval with development. These complementary auditory naming and visual naming tests for children address a longstanding clinical need, improving upon the current standard with respect to the sensitivity of performance measures and the addition of an auditory verbal component to the assessment of naming in children.
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Affiliation(s)
| | - William T. Seidel
- Ironshore Pharmaceuticals Inc., 1550 Liberty Ridge Dr.Chesterbrook, PA 19087, , Phone: 914-591-8188
| | - William S. MacAllister
- Department of Neurology, New York University, 225 East 34th Street, New York, NY 10016, , Phone: 646-558-0809
| | - Mary Lou Smith
- Department of Psychology, University of Toronto, 3359 Mississauga Road N., Mississauga, Ontario L5L 1C6, , Phone: 905-828-3960
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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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Modi AC, Vannest J, Combs A, Turnier L, Wade SL. Pattern of executive functioning in adolescents with epilepsy: A multimethod measurement approach. Epilepsy Behav 2018; 80:5-10. [PMID: 29396361 DOI: 10.1016/j.yebeh.2017.12.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/19/2017] [Accepted: 12/22/2017] [Indexed: 11/25/2022]
Abstract
Youth with epilepsy demonstrate deficits in executive functioning (EF), the skills necessary for goal-directed behavior (e.g., problem-solving, initiating, monitoring, organization, planning, and working memory). Despite 30-50% of youth with epilepsy demonstrating EF deficits, no extant studies have utilized both performance and questionnaire-based measures to examine the pattern of EF deficits in adolescents with epilepsy. Study aims were to 1) identify the pattern of EF deficits in adolescents with epilepsy and 2) identify which assessment tools are most sensitive to EF deficits in this population (adolescents, ages 13-17, with epilepsy). An exploratory aim was to examine group differences on measures of EF by epilepsy type. Standard performance-based neuropsychological measures (Wechsler Intelligence Scale for Children - Version V or Wechsler Adult Intelligence Scale Working Memory Index-Version IV, Delis Kaplan Executive Functioning System, NIH Toolbox, Test of Everyday Attention for Children) and the Behavior Rating Inventory of Executive Functioning (BRIEF) comprised the multimethod assessment battery. Depending on the measure, 30% of adolescents with epilepsy had deficits in working memory, 17% in cognitive flexibility/problem solving, 6% in inhibition, and 18% in planning/organization. Attention was a significant problem for 15% of adolescents with epilepsy. Correlations among the various EF measures were quite poor. Across various EF domains, results indicated that adolescents with localization-related epilepsy demonstrated better EF skills compared to adolescents with unclassified epilepsy. Overall, our findings suggest that executive functioning deficits are selective and different from those observed in other neurological populations (e.g., attention deficit hyperactivity disorder (ADHD), traumatic brain injury) where problems with self-regulation (i.e., inhibition, planning/organization) are more pronounced. These findings support utilizing multiple measures, including both performance-based neuropsychological tests and parent- and self-reports, to assess executive functioning difficulties in adolescents with epilepsy as they are uniquely sensitive to executive functioning domains. Adolescents with unclassified epilepsy also appear to be at higher risk for EF deficits and thus represent an important group to target for intervention.
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Affiliation(s)
- Avani C Modi
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
| | - Jennifer Vannest
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Angela Combs
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Luke Turnier
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Shari L Wade
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
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Pre-surgical mapping of eloquent cortex for paediatric epilepsy surgery candidates: Evidence from a review of advanced functional neuroimaging. Seizure 2017; 52:136-146. [DOI: 10.1016/j.seizure.2017.09.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 06/16/2017] [Accepted: 09/29/2017] [Indexed: 11/19/2022] Open
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32
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Cognitive predictors of adaptive functioning in children with symptomatic epilepsy. Epilepsy Res 2017; 136:67-76. [DOI: 10.1016/j.eplepsyres.2017.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 07/24/2017] [Accepted: 07/25/2017] [Indexed: 12/18/2022]
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Mendes TP, Crespo CA, Austin JK. The psychological costs of comparisons: Parents' social comparison moderates the links between family management of epilepsy and children's outcomes. Epilepsy Behav 2017; 75:42-49. [PMID: 28826008 DOI: 10.1016/j.yebeh.2017.07.017] [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: 05/16/2017] [Revised: 07/12/2017] [Accepted: 07/14/2017] [Indexed: 10/19/2022]
Abstract
Parents play a key role in how children deal with epilepsy. When diagnosed with health conditions, people seek comparison information from fellow patients and families, and this information has consequences for how they evaluate their situation. This study examined the moderating role of parents' social comparison orientation in the associations between family management (parental perceptions of family life difficulties and child's daily life) and adaptation outcomes of children with epilepsy (HRQoL and perceived stigma). Participants included 201 dyads of children with epilepsy and either their mother or father. The results showed that when parents perceived higher difficulties managing their child's epilepsy and/or reported that their child was more affected by this condition, children reported higher perceived stigma and worse HRQoL only when parents had a higher social comparison orientation. Our results are innovative in showing that when parents have a higher social comparison orientation, their children may be at increased risk of poorer outcomes.
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Affiliation(s)
- Teresa P Mendes
- Faculdade de Psicologia e de Ciências da Educação, Universidade de Coimbra, Portugal.
| | - Carla A Crespo
- Faculdade de Psicologia, Universidade de Lisboa, Portugal
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Academic Outcomes in Individuals With Childhood-Onset Epilepsy: Mediating Effects of Working Memory. J Int Neuropsychol Soc 2017; 23:594-604. [PMID: 28343465 DOI: 10.1017/s135561771700008x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Academic difficulties are common in children with epilepsy, although little is known about the effect of various seizure-related and cognitive variables. Given that persistent seizures may negatively impact academics, and that working memory is predictive of academic abilities, we examined the effects of recent seizures and working memory on word reading, spelling, and arithmetic in pediatric epilepsy. We hypothesized that persistent seizures would be associated with lower working memory ability, which would in turn result in poorer academic performance. METHODS Our sample consisted of 91 children with epilepsy being treated at the Hospital for Sick Children in Toronto, Canada, who underwent neuropsychological testing between 2002 and 2009 to help determine surgical candidacy. Four to 11 years later, follow-up testing was conducted on both surgical (n=61) and non-surgical (n=30) patients. Seizure status was defined by the presence or absence of seizures within the preceding 12 months. RESULTS 5000 bias-corrected bootstrap resamples with replacement were used to calculate the 95% confidence intervals (CIs) for the indirect effect of seizure status on academics through working memory, controlling for baseline academic functioning. Persistent seizures were associated with reduced working memory, which was in turn associated with lower reading (B=-4.64, 95% CI [-10.21, -1.30]), spelling (B=-7.09, 95% CI [-13.97, -2.56], and arithmetic scores (B=-8.04, 95% CI [-13.66, -3.58] at follow-up. CONCLUSIONS For children with intractable epilepsy, working memory deficits present a significant barrier to the development of academic skills. Working memory interventions may be a helpful adjunct to academic remediation in this population to facilitate academic progress. (JINS, 2017, 23, 594-604).
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Seizure-related variables are predictive of attention and memory in children with epilepsy. Epilepsy Behav 2017; 73:36-41. [PMID: 28605632 DOI: 10.1016/j.yebeh.2017.05.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/21/2017] [Accepted: 05/13/2017] [Indexed: 11/23/2022]
Abstract
Children with epilepsy (CWE) are at greater risk for cognitive deficits and behavioral difficulties than are typically developing healthy children, and particular epileptic symptoms and treatments may contribute to this risk. The current study examined the relationships between four seizure-related variables and attention and memory functioning in a sample of 207 CWE (ages 6-16) using both neurocognitive and parent/teacher-report measures. Sociodemographic, medical, and neuropsychological data were collected from patients' medical charts in a retrospective fashion. Hierarchical multiple regressions were performed with sociodemographic variables (age, gender, race) entered as step one and seizure-related variables (number of anti-epileptic drugs [AEDs], EEG laterality, EEG lobe of focus, lifetime seizure duration) entered as step two. Results indicated that seizure-related variables were consistently predictive of poor cognitive performances above and beyond sociodemographic variables, although only minimally predictive of parent/teacher-reports. A longer duration of seizure burden and greater number of AEDs were robust predictors of performances on most cognitive measures. These findings indicate that CWE with long lifetime seizure durations and multiple AEDs are at risk for inefficiencies in attention and memory. Knowledge of this risk will allow treating providers greater accuracy and precision when planning medical treatment and making recommendations to families.
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A Complex Case of Tri-lingual, Tri-cultural, Bi-racial, and Multiple Medical Comorbidities. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2017. [DOI: 10.1007/s40817-017-0043-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Fuentes A, Kerr EN. Maintenance effects of working memory intervention (Cogmed) in children with symptomatic epilepsy. Epilepsy Behav 2017; 67:51-59. [PMID: 28088681 DOI: 10.1016/j.yebeh.2016.12.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 12/01/2016] [Accepted: 12/12/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE To extend previous research documenting the benefits of working memory (WM) intervention (Cogmed) immediately post-intervention in children with epilepsy by assessing the 3-month maintenance effects. METHODS Participants involved in a previous randomized clinical trial (RCT) were invited to participate if they completed Cogmed within the last 3months (n=15) and additional participants (n=13) were prospectively recruited. Standardized assessments of near-transfer effects (i.e., visual and auditory attention and WM) were completed prior to and immediately after intervention and at 3-month follow-up. An additional measure assessing the far-transfer effect of fluid reasoning was administered prior to intervention and at 3-month follow-up. RESULTS Participants exhibited gains in auditory and visual attention and WM immediately following intervention and gains were generally sustained at 3-month follow-up. Intervention did not improve visual-verbal WM or fluid reasoning. The clinical variables studied (i.e., age of seizure onset, seizure frequency, epilepsy duration, and overall intellectual functioning) did not elucidate reliable relationships with intervention. CONCLUSIONS Working memory training is possibly efficacious in improving related skills which are maintained for 3months in children with active epilepsy. No transfer to fluid reasoning was documented. Further investigation by means of a large-scale RCT which includes a placebo and both objective and subjective measures of the impact of training on daily functioning is warranted.
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Affiliation(s)
- Amanda Fuentes
- Department of Psychology, Hospital for Sick Children, 555 University Ave., Toronto, Ontario M5G 1X8, Canada
| | - Elizabeth N Kerr
- Department of Psychology, Hospital for Sick Children, 555 University Ave., Toronto, Ontario M5G 1X8, Canada.
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Chew J, Haase AM, Carpenter J. Individual and family factors associated with self-esteem in young people with epilepsy: A multiple mediation analysis. Epilepsy Behav 2017; 66:19-26. [PMID: 27987477 DOI: 10.1016/j.yebeh.2016.09.039] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 09/22/2016] [Accepted: 09/23/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE As young people experience added demands from living with epilepsy, which may lead to poor psychosocial adjustment, it is essential to examine mechanisms of change to provide practitioners with knowledge to develop effective interventions. The aim of this study was to examine individual and family-level factors - stress and illness perceptions, coping behaviors and family resilience - that promote or maintain young people's self-esteem. METHODS From November 2013 to August 2014, young people attending a neurology clinic in KK Women's and Children's Hospital, Singapore, participated in a cross-sectional survey (n=152; 13-16years old). Multiple mediation analyses were conducted to evaluate whether these variables mediated the relationship between illness severity (i.e., low, moderate, high) and self-esteem. RESULTS Multiple mediation analyses demonstrated that illness severity had a direct effect on young people's self-esteem. Compared to those with moderate illness severity (reference group), young people with low severity had significantly higher self-esteem (c=3.42, p<0.05); while those with high severity had a more negative view of themselves (c=-3.93, p<0.001). Illness severity also had an indirect influence on self-esteem through its effects on mediators, such as perceived stress, illness perceptions and family resilience (D1: Total ab=3.46, 95% CI 1.13, 5.71; D2: Total ab=-2.80, 95% CI -4.35, -1.30). However, young people's coping levels did not predict their self-esteem, when accounting for the effects of other variables. SIGNIFICANCE The continued presence of seizure occurrences is likely to place greater demands on young people and their families: in turn, increased stress and negative illness perceptions negatively affected family processes that promote resilience. As the mediating effect of these modifiable factors were above and beyond the contributions of illness characteristics and young people's levels of coping, this has implications for developing individual and family interventions aimed to support young people living with epilepsy.
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Affiliation(s)
- Judith Chew
- School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, United Kingdom.
| | - Anne M Haase
- School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, United Kingdom
| | - John Carpenter
- School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, United Kingdom
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Lagunju IOA, Adeniyi YC, Olukolade G. Cognitive function in Nigerian children with newly diagnosed epilepsy: a preliminary report. Pan Afr Med J 2016; 24:113. [PMID: 27703598 PMCID: PMC5031373 DOI: 10.11604/pamj.2016.24.113.8995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 03/21/2016] [Indexed: 11/29/2022] Open
Abstract
Introduction Epilepsy has long been associated with cognitive dysfunction and educational underachievement. The purpose of the study was to describe the baseline findings from a larger prospective study. Methods New cases of epilepsy aged 6-16 years seen at a paediatric neurology clinic in Ibadan, Nigeria were evaluated for any evidence of cognitive impairment. Intelligence quotient (IQ) of the participants was measured using the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV). Scores on cognitive subtests and Full Scale IQ (FSIQ) were computed and association between the subsets scores and seizure variables were calculated. Results 40 children, 24 males and 16 females were studied and their ages ranged from 6 to 16 years with a mean of 10.8 (SD=3.0) years. Global intellectual functioning as measured by the WISC-IV was in the normal range (FSIQ scores <85) for 52.5% (n = 21) of the participants and the remaining participants (47.5%) scored between the borderline and severe category for intellectual disability. The strongest correlation was between ‘caregiver's assessment of school performance’ and FSIQ, (r = 0.70; p< 0.001). Age at onset of epilepsy and seizure type had no significant association with scores on the WISC-IV composite scores. Conclusion There is a high prevalence of significant cognitive dysfunction in Nigerian children with epilepsy, even in the absence of any known brain insult. All children with epilepsy should have routine IQ assessment following diagnosis, in order to allow for early intervention when indicated, and thus, improved outcomes.
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Affiliation(s)
- Ike Oluwa Abiola Lagunju
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria & Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Yetunde Celia Adeniyi
- Department of Child and Adolescent Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Gbemi Olukolade
- Department of Child and Adolescent Psychiatry, University College Hospital, Ibadan, Nigeria
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Puka K, Smith ML. Academic skills in the long term after epilepsy surgery in childhood. Epilepsy Behav 2016; 62:97-103. [PMID: 27450313 DOI: 10.1016/j.yebeh.2016.06.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 06/03/2016] [Accepted: 06/04/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We evaluated the progression of academic skills in a cohort of patients who underwent, or were considered for, epilepsy surgery in childhood, four to eleven years before. The few existing studies that have evaluated cognitive function in the long term after surgery have examined intelligence and memory. METHOD Participants were 97 patients with childhood-onset intractable epilepsy; 61 had undergone resective epilepsy surgery. Participants completed standardized tests of reading, spelling, arithmetic, and intelligence at baseline and, on average, 7years after. Surgical patients were additionally assessed one year postsurgery. RESULTS At baseline and long-term follow-up, 61% and 69% of patients, respectively, scored at least one standard deviation below normative data in at least one academic domain. Evaluation of change over time while controlling for IQ showed that arithmetic scores were lower at long-term follow-up in comparison with those at baseline among all patient groups, whereas reading and spelling scores remained unchanged. Few advantages were associated with seizure control. Multiple regression analyses found that older age at surgery, cessation of antiepileptic medications, improved IQ, and low baseline scores were independently associated with improvement in some academic domains among all patient groups. CONCLUSION We found that arithmetic scores were lower at long-term follow-up, suggesting a lack of ongoing development or deterioration in skills. Reading and spelling scores remained stable suggesting that patients made gains in abilities at a rate expected for their increase in age; this finding contrasts with recent short-term outcome studies identifying significantly lower scores over time in these areas.
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Affiliation(s)
- Klajdi Puka
- Department of Psychology, The Hospital for Sick Children, Toronto, Canada
| | - Mary Lou Smith
- Department of Psychology, The Hospital for Sick Children, Toronto, Canada; Department of Psychology, University of Toronto Mississauga, Mississauga, Canada; Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, Canada.
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Martin R, Cirino P, Hiscock M, Schultz R, Collins R, Chapieski L. Risks and benefits of epilepsy surgery in a pediatric population: Consequences for memory and academic skills. Epilepsy Behav 2016; 62:189-96. [PMID: 27494354 DOI: 10.1016/j.yebeh.2016.06.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 06/13/2016] [Accepted: 06/23/2016] [Indexed: 10/21/2022]
Abstract
We examined benefits and risks for memory and academic functioning associated with epilepsy surgery in a pediatric population. A total of 46 patients with intractable seizures and a single seizure focus were divided into four groups according to focus localization: right temporal, left temporal, frontal, and parietal/occipital region. Pre- and postsurgery performance measures were compared across groups and with a fifth group of patients that had intractable seizures but did not undergo surgery. Both groups with temporal lobe epilepsy showed significant declines in memory test scores, while performance of the group with frontal lobe epilepsy improved. These changes were mirrored in parental reports of everyday memory. Consistent with other pediatric studies, no lateralized material-specific declines in the groups with temporal lobe epilepsy were found. When memory improved, the improvement was associated with decreases in seizure frequency and the number of anticonvulsant medications. Presurgical performance was the best predictor of declines in memory test performance. Deterioration of academic test scores in the group that did not have surgery exemplified a potential risk of living with seizures and antiepilepsy medication.
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Affiliation(s)
- Rebecca Martin
- Department of Psychology, University of Houston, Houston, TX, USA.
| | - Paul Cirino
- Department of Psychology, University of Houston, Houston, TX, USA.
| | - Merrill Hiscock
- Department of Psychology, University of Houston, Houston, TX, USA; Center for Neuro-Engineering and Cognitive Science, University of Houston, Houston, TX, USA.
| | - Rebecca Schultz
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
| | - Robert Collins
- Neurology Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA; Department of Neurology, Baylor College of Medicine, Houston, TX, USA.
| | - Lynn Chapieski
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
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Chew J, Haase AM. Psychometric properties of the Family Resilience Assessment Scale: A Singaporean perspective. Epilepsy Behav 2016; 61:112-119. [PMID: 27337164 DOI: 10.1016/j.yebeh.2016.05.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 04/26/2016] [Accepted: 05/13/2016] [Indexed: 11/28/2022]
Abstract
Families of young people with chronic illnesses are more likely to experience higher levels of stress. In turn, their ability to cope with multiple demands is likely to affect young people's adaptation. The purpose of this study was to examine psychometric properties of the Family Resilience Assessment Scale (FRAS), an assessment tool that measures the construct of family resilience. A total of 152 young people with epilepsy, aged 13 to 16years old, from KK Women's and Children's Hospital, Singapore, completed the FRAS along with the Rosenberg Self-Esteem Scale. Factor structure of the FRAS was examined. Exploratory factor analysis resulted in a 7-factor solution - meaning-making and positive outlook, transcendence and spirituality, flexibility and connectedness, social and economic resources (community), social and economic resources (neighbors), clarity and open emotional expression, and collaborative problem-solving - accounting for 83.0% of the variance. Internal consistency of the scale was high (α=0.92). Family resilience was significantly correlated with higher levels of self-esteem. Our study provides preliminary findings that suggest that FRAS is a reliable and valid scale for assessing the construct of family resilience among young people with epilepsy in Singapore.
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Affiliation(s)
- Judith Chew
- School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, United Kingdom; Medical Social Work Department, KK Women's and Children's Hospital, 100 Bukit Timah Road, S 229899, Singapore.
| | - Anne M Haase
- School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, United Kingdom
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Reuner G, Kadish NE, Doering JH, Balke D, Schubert-Bast S. Attention and executive functions in the early course of pediatric epilepsy. Epilepsy Behav 2016; 60:42-49. [PMID: 27179191 DOI: 10.1016/j.yebeh.2016.04.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/20/2016] [Accepted: 04/02/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Our prospective study aimed at exploring attention and executive functions in children with new-onset epilepsy prior to and during the early course of antiepileptic treatment. Sociodemographic and epilepsy-related factors were analyzed as potential predictors both of impaired cognitive functions as well as for changes in cognitive functioning in the early course of illness. METHODS From a total group of 115 children aged six to 17years without major disabilities, 76 children were assessed longitudinally with a screening tool for attention and executive functions (EpiTrack Junior®). Sociodemographic variables (gender, age at epilepsy onset, need of special education) and epilepsy-related variables (etiology of epilepsy, semiology of seizures, number of seizures) were considered as potential predictors for impaired functions prior to treatment and for deterioration/amelioration in cognitive functions in the early course. RESULTS Attention and executive functions of children with new-onset epilepsy were significantly more often impaired when compared with a healthy population, but less often when compared with children with chronic epilepsy. The majority of children showed stable cognitive functioning in the early course of treatment. The risk of impaired cognitive functions was significantly heightened when etiology of epilepsy was unknown or not classifiable. The chance for improvement of functioning was lowered by having a genetic epilepsy, or an unknown semiology of seizures. CONCLUSIONS Children with new-onset epilepsy are at high risk for impaired attention and executive functions even prior to antiepileptic treatment, especially when etiology of their epilepsy remains unclear. The high stability of cognitive functioning in the early course can be used in counseling of families who worry about negative side effects of drug treatment. Finally, a systematic assessment of cognitive functions in children with new-onset epilepsy is necessary to detect subtle deficits in the early course and adjust treatment accordingly.
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Affiliation(s)
- Gitta Reuner
- University Children's Hospital Heidelberg, Section Neuropediatrics and Inborn Errors of Metabolism, Heidelberg, Germany.
| | - Navah Esther Kadish
- University Children's Hospital Heidelberg, Section Neuropediatrics and Inborn Errors of Metabolism, Heidelberg, Germany; Department of Neuropediatrics, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany; Department of Medical Psychology and Medical Sociology, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Jan Henje Doering
- University Children's Hospital Heidelberg, Section Neuropediatrics and Inborn Errors of Metabolism, Heidelberg, Germany
| | - Doreen Balke
- University Children's Hospital Heidelberg, Section Neuropediatrics and Inborn Errors of Metabolism, Heidelberg, Germany
| | - Susanne Schubert-Bast
- University Children's Hospital Heidelberg, Section Neuropediatrics and Inborn Errors of Metabolism, Heidelberg, Germany; Department of Pediatric Neurology, Goethe University Hospital, Frankfurt, Germany
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Kavanaugh BC, Scarborough VR, Salorio CF. Use of a Cumulative Risk Scale to Predict Poor Intellectual and Academic Outcomes in Childhood Epilepsy. J Child Neurol 2016; 31:831-6. [PMID: 26747083 DOI: 10.1177/0883073815623633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 11/15/2015] [Indexed: 11/16/2022]
Abstract
Discrete risk factors for poor outcomes in childhood epilepsy have been identified, but it is unclear whether the combined effect of several risk factors better predicts outcome. The Epilepsy Cumulative Risk Scale was developed to quantify cumulative risk for poor outcomes in childhood epilepsy. Participants included 156 clinic-referred children with epilepsy. The Epilepsy Cumulative Risk Scale was developed using variables previously associated with functional outcomes. Scale utility was examined through its association with intellectual and academic functioning. All Epilepsy Cumulative Risk Scale variables were significantly associated with functioning. The Total Score (ie, cumulative effect) was most strongly correlated with cognition and academic skills. A Total Score ≥ 5 had the best sensitivity and specificity for differentiating those at high risk for poor outcomes. The Epilepsy Cumulative Risk Scale shows promise as a practical, data-driven tool for quantification of cumulative risk for poor outcomes in childhood epilepsy and may be helpful in detecting those needing referral for additional services.
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Affiliation(s)
- Brian C Kavanaugh
- Emma Pendleton Bradley Hospital, Riverside, RI, USA Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Cynthia F Salorio
- Kennedy Krieger Institute, Baltimore, MD, USA Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Comorbidities of epilepsy: current concepts and future perspectives. Lancet Neurol 2016; 15:106-15. [DOI: 10.1016/s1474-4422(15)00225-2] [Citation(s) in RCA: 317] [Impact Index Per Article: 39.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 08/18/2015] [Accepted: 08/24/2015] [Indexed: 12/23/2022]
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Developing from child to adult: Risk factors for poor psychosocial outcome in adolescents and young adults with epilepsy. Epilepsy Behav 2015; 51:182-90. [PMID: 26291772 DOI: 10.1016/j.yebeh.2015.07.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/16/2015] [Accepted: 07/28/2015] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Childhood-onset epilepsy during the years of transition to adulthood may affect normal social, physical, and mental development, frequently leading to psychosocial and health-related problems in the long term. OBJECTIVE This study aimed to describe the main characteristics of patients in transition and to identify risk factors for poor psychosocial outcome in adolescents and young adults with epilepsy. METHODS Patients with epilepsy, 15-25years of age, who visited the Kempenhaeghe Epilepsy Transition Clinic from March 2012 to December 2014 were included (n=138). Predefined risk scores for medical, educational/occupational status, and independence/separation/identity were obtained, along with individual risk profile scores for poor psychosocial outcome. Multivariate linear regression analysis and discriminant analysis were used to identify variables associated with an increased risk of poor long-term psychosocial outcome. RESULTS Demographic, epilepsy-related, and psychosocial variables associated with a high risk of poor long-term outcome were lower intelligence, higher seizure frequency, ongoing seizures, and an unsupportive and unstable family environment. Using the aforementioned factors in combination, we were able to correctly classify the majority (55.1%) of the patients regarding their risk of poor psychosocial outcome. CONCLUSION Our analysis may allow early identification of patients at high risk of prevention, preferably at pretransition age. The combination of a chronic refractory epilepsy and an unstable family environment constitutes a higher risk of transition problems and poor outcome in adulthood. As a consequence, early interventions should be put into place to protect youth at risk of poor transition outcome.
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Kerr EN, Blackwell MC. Near-transfer effects following working memory intervention (Cogmed) in children with symptomatic epilepsy: An open randomized clinical trial. Epilepsia 2015; 56:1784-92. [PMID: 26391621 DOI: 10.1111/epi.13195] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Limited research exists regarding the effectiveness of educational and psychological interventions for improving commonly presenting cognitive impairments experienced by children with epilepsy. We evaluated the efficacy of a commercially available, computerized, working memory (WM) program (Cogmed) using a well-defined population of children with epilepsy. METHODS In this controlled trial, 77 children with symptomatic epilepsy (ages 6.5-15.5 years; 100% taking medication) with estimated intellectual ability greater than the 2nd percentile were randomly assigned to an intervention (n = 42) or waitlist-control (n = 35) group. Standardized assessments of attention and WM were administered pre- and posttraining or waitlist interval, 7 weeks apart. RESULTS Without intervention, participants displayed significant weaknesses in intelligence, attention, and WM compared to normative samples. After controlling for preintervention scores and intelligence, we found that significant treatment effects for the intervention group were evident for visual attention span, auditory WM, and visual-verbal WM. Intention-to-treat analyses (all participants) and sensitivity analyses (n = 37 and n = 21 for the intervention and waitlist-control groups, respectively) were highly similar, providing confidence to the results. Effect sizes for significant outcomes were large (greater than or equal to two thirds of the standard deviation of the normative-data). The clinical/demographic and functional factors studied did not elucidate who most benefits from training. SIGNIFICANCE This is the first study to evaluate the effectiveness of intervention to ameliorate WM deficits commonly experienced by children with symptomatic epilepsy. Results support group improvement on some untrained tasks immediately postintervention, demonstrating preliminary usefulness of Cogmed as a treatment option.
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Affiliation(s)
- Elizabeth N Kerr
- The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
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Austin JK. A career in nursing research: A personal journey. Epilepsy Behav 2015; 46:2-6. [PMID: 25873439 DOI: 10.1016/j.yebeh.2015.01.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 01/21/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Joan K Austin
- Indiana University School of Nursing, Indianapolis, IN 46202, USA.
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Triplett RL, Asato MR. Brief cognitive and behavioral screening in children with new-onset epilepsy: a pilot feasibility trial. Pediatr Neurol 2015; 52:49-55. [PMID: 25433909 PMCID: PMC4276487 DOI: 10.1016/j.pediatrneurol.2014.09.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 09/24/2014] [Accepted: 09/25/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Minimal work has used psychometrically robust measures in a systematic fashion to identify and monitor children at risk for cognitive and behavioral comorbidities in current epilepsy care. We piloted a computerized cognitive battery and behavioral questionnaire for children with newly diagnosed epilepsy to determine clinical feasibility and acceptability to parents and patients. METHODS We recruited medication-naïve children (ages 8-17 years) with recent-onset seizures and typical developmental history from an outpatient child neurology clinic. Children completed the CNS Vital Signs computerized battery, whereas parents completed the Strengths and Difficulties Questionnaire. Post-test interviews with parents and patients were completed regarding the acceptability of the assessment procedures. RESULTS Forty-four families were eligible, and 39 agreed to participate (89%). All assessments were completed in less than 45 minutes. Parents rated testing in clinic as convenient and important, expressing strong interest in the cognitive and behavioral impact of epilepsy and medication. Children also rated the testing procedure as acceptable and agreed that they would recommend it to peers. CONCLUSIONS Our brief battery was tolerated and well received by children and their parents. Computerized testing of children along with a parent questionnaire is a psychometrically viable approach that is acceptable to families. Our protocol is time efficient for clinical use with the potential to detect early cognitive and behavioral difficulties related to epilepsy. Ongoing longitudinal study will provide further information regarding the success of our screening methods in monitoring for disease- or treatment-related changes.
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Affiliation(s)
| | - Miya R. Asato
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh PA,Department of Pediatrics, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh PA
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