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Idowu J, Meades C, Cross JH, Muggeridge A, Lakhanpaul M, Robinson K, Sherar LB, Pearson N, Reilly C. "One size does not fit all" - Barriers to and facilitators of physical activity in adolescents with epilepsy. Epilepsy Behav 2024; 156:109772. [PMID: 38788654 DOI: 10.1016/j.yebeh.2024.109772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/31/2024] [Accepted: 04/01/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVE To explore the barriers to physical activity and to identify the support needed to facilitate physical activity in adolescents with epilepsy (AWE). METHODS AWE (aged 11-16 years) and their caregivers completed survey-based open questions regarding perceived barriers to, and facilitators of physical activity in young people with epilepsy. The responses were analysed using Thematic Analysis. RESULTS Themes concerning barriers to physical activity included concerns about seizure safety, general anxiety and anxiety related to seizures, stigma/negative attitudes associated with having epilepsy, tiredness, and perceived lack of physical competence. Themes regarding the support needed to facilitate physical activity included better education amongst staff/coaches about epilepsy (e.g., seizure management/prevention, associated fatigue/tiredness), improvements in societal attitudes towards epilepsy, flexibility/tailoring of activities to the child's needs (e.g., need for breaks), and peer support for young people with epilepsy to encourage engagement in physical activity. CONCLUSIONS There is a perception among AWE and caregivers, that significant barriers exist with regard to engaging in physical activity for young people with epilepsy. Barriers are related to concerns about seizure management but also wider safety and social issues. A number of facilitators were identified to promote physical activity engagement in AWE, including education for staff and caregivers, peer support, and tailoring activities to the adolescent's needs. There is a need to develop interventions to reduce barriers to physical activity in young people with epilepsy.
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Affiliation(s)
- J Idowu
- Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, UK
| | - C Meades
- Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, UK
| | - J H Cross
- Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, UK; UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street London WC1N 1EH UK; Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH, UK
| | - A Muggeridge
- Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, UK
| | - M Lakhanpaul
- UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street London WC1N 1EH UK
| | - K Robinson
- Whittington Health NHS Trust, Magdala Avenue, London N19 5NF, UK
| | - L B Sherar
- School of Sport, Exercise, and Health Sciences, Loughborough University, LE11 3TU UK
| | - N Pearson
- School of Sport, Exercise, and Health Sciences, Loughborough University, LE11 3TU UK
| | - C Reilly
- Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, UK; UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street London WC1N 1EH UK.
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Laguitton V, Boutin M, Brissart H, Breuillard D, Bilger M, Forthoffer N, Guinet V, Hennion S, Kleitz C, Mirabel H, Mosca C, Pradier S, Samson S, Voltzenlogel V, Planton M, Denos M, Bulteau C. Neuropsychological assessment in pediatric epilepsy surgery: A French procedure consensus. Rev Neurol (Paris) 2024; 180:494-506. [PMID: 37949750 DOI: 10.1016/j.neurol.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 07/11/2023] [Accepted: 08/08/2023] [Indexed: 11/12/2023]
Abstract
Neuropsychological assessment is a mandatory part of the pre- and post-operative evaluation in pediatric epilepsy surgery. The neuropsychology task force of the ILAE - French Chapter aims to define a neuropsychological procedure consensus based on literature review and adapted for French practice. They performed a systematic review of the literature published between 1950 and 2023 on cognitive evaluation of individuals undergoing presurgical work-up and post-surgery follow-up and focused on the pediatric population aged 6-16. They classified publications listed in the PubMed database according to their level of scientific evidence. The systematic literature review revealed no study with high statistical power and only four studies using neuropsychological scales in their French version. Afterwards, the experts defined a neuropsychological consensus strategy in pediatric epilepsy surgery according to the psychometric determinants of cognitive tests, specificity of epilepsy, surgery context, French culture and literature reports. A common French neuropsychological procedure dedicated to pediatric epilepsy surgery is now available. This procedure could serve as a guide for the pre- and post-surgical work-up in French centers with pediatric epilepsy surgery programs. The main goal is to anticipate the functional risks of surgery, to support the postoperative outcome beyond the seizure-related one, while taking into consideration the plasticity and vulnerability of the immature brain and allowing the possibility of collaborative studies.
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Affiliation(s)
- V Laguitton
- Clinical Neurophysiology AP-HM, Timone Hospital, Marseille, France; Department of Pediatric Neurology, APHM, Timone Hospital, Marseille, France.
| | - M Boutin
- GHU-Paris Pôle Neuro-Sainte-Anne - Neurosurgery Unity, 1, rue Cabanis, Paris, France
| | - H Brissart
- Université de Lorraine, CNRS, CRAN, 54000 Nancy, France; Université de Lorraine, CHRU-Nancy, Service de Neurologie, 54000 Nancy, France
| | - D Breuillard
- Reference Center Rare Epilepsies, Hôpital Necker Enfants-Malades, Paris, France
| | - M Bilger
- Neurology Department, Hôpital Hautepierre, CHRU Strasbourg, Strasbourg, France
| | - N Forthoffer
- Université de Lorraine, CNRS, CRAN, 54000 Nancy, France
| | - V Guinet
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Lyon, France
| | - S Hennion
- Reference Center Rare Epilepsies, Epilepsy Unit, University Lille, INSERM, CHU Lille, U1171 Degenerative and vascular cognitive disorders, Lille, France
| | - C Kleitz
- Neurology Department, Hôpital Hautepierre, CHRU Strasbourg, Strasbourg, France
| | - H Mirabel
- Neurology Department, Hôpital Pierre-Paul Riquet, CHU de Toulouse, Toulouse, France
| | - C Mosca
- Epilepsy Unit, CHU Grenoble-Alpes, Grenoble-Alpes, France
| | - S Pradier
- Functional Explorations of the Nervous System, Clinical Neurosciences Center, University Hospital Center Pellegrin, Bordeaux, France
| | - S Samson
- Neurology Department, Rehabilitation Unit, GH Pitié-Salpêtrière, APHP, Paris, France; Équipe Neuropsychologie: Audition, Cognition et Action (EA 4072), UFR de psychologie, Université Lille-Nord de France, Villeneuve d'Ascq, France
| | - V Voltzenlogel
- Centre d'études et de recherches en psychopathologie et psychologie de la santé, université de Toulouse, UT2J, Toulouse, France
| | - M Planton
- Neurology Department, Hôpital Pierre-Paul Riquet, CHU de Toulouse, Toulouse, France; Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - M Denos
- Neurology Department, Rehabilitation Unit, GH Pitié-Salpêtrière, APHP, Paris, France
| | - C Bulteau
- Pediatric Neurosurgery Department, Rothschild Foundation Hospital, EpiCare Member, Paris, France; University of Paris Cité, MC(2)Lab, Institute of Psychology, 92000 Boulogne-Billancourt, France
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Fu Y, Zhang J, Cao Y, Ye L, Zheng R, Li Q, Shen B, Shi Y, Cao J, Fang J. Recognition memory deficits detected through eye-tracking in well-controlled children with self-limited epilepsy with centrotemporal spikes. Epilepsia 2024; 65:1128-1140. [PMID: 38299621 DOI: 10.1111/epi.17902] [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: 10/04/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 02/02/2024]
Abstract
OBJECTIVE Children with self-limited epilepsy characterized by centrotemporal spikes (SeLECTS) exhibit cognitive deficits in memory during the active phase, but there is currently a lack of studies and techniques to assess their memory development after well-controlled seizures. In this study, we employed eye-tracking techniques to investigate visual memory and its association with clinical factors and global intellectual ability, aiming to identify potential risk factors by examining encoding and recognition processes. METHODS A total of 26 recruited patients diagnosed with SeLECTS who had been seizure-free for at least 2 years, along with 24 control subjects, underwent Wechsler cognitive assessment and an eye-movement-based memory task while video-electroencephalographic (EEG) data were recorded. Fixation and pupil data related to eye movements were utilized to detect distinct memory processes and subsequently to compare the cognitive performance of patients exhibiting different regression patterns on EEG. RESULTS The findings revealed persistent impairments in visual memory among children with SeLECTS after being well controlled, primarily observed in the recognition stage rather than the encoding phase. Furthermore, the age at onset, frequency of seizures, and interictal epileptiform discharges exhibited significant correlations with eye movement data. SIGNIFICANCE Children with SeLECTS exhibit persistent recognition memory impairment after being well controlled for the disease. Controlling the frequency of seizures and reducing prolonged epileptiform activity may improve memory cognitive development. The application of the eye-tracking technique may provide novel insights into exploring memory cognition as well as underlying mechanisms associated with pediatric epilepsy.
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Affiliation(s)
- Yanlu Fu
- Department of Neurology, Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Jingxin Zhang
- Department of Neurology, Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Yina Cao
- Department of Neurology, Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Linmei Ye
- Department of Neurology, Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Runze Zheng
- Artificial Intelligence Institute, Hangzhou Dianzi University School of Automation, Hangzhou, Zhejiang, China
| | - Qiwei Li
- Department of Neurology, Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Beibei Shen
- Department of Neurology, Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Yi Shi
- Department of Neurology, Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Jiuwen Cao
- Artificial Intelligence Institute, Hangzhou Dianzi University School of Automation, Hangzhou, Zhejiang, China
| | - Jiajia Fang
- Department of Neurology, Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, Zhejiang, China
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Zhang Q, Sun W, Huang K, Qin L, Wen S, Long X, Wang Q, Feng L. Frontal lobe epilepsy: an eye tracking study of memory and attention. Front Neurosci 2023; 17:1298468. [PMID: 38116071 PMCID: PMC10728291 DOI: 10.3389/fnins.2023.1298468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/17/2023] [Indexed: 12/21/2023] Open
Abstract
Objective To explore the characteristics and mechanisms of working memory impairment in patients with frontal lobe epilepsy (FLE) through a memory game paradigm combined with eye tracking technology. Method We included 44 patients with FLE and 50 healthy controls (HC). All participants completed a series of neuropsychological scale assessments and a short-term memory game on an automated computer-based memory evaluation platform with an eye tracker. Results Memory scale scores of FLE patients including digit span (U = 747.50, p = 0.007), visual recognition (U = 766.50, p = 0.010), and logical memory (U = 544.00, p < 0.001) were significantly lower than HC. The patients with FLE took longer to complete the four levels of difficulty of the short-term memory game than healthy controls (level 1: U = 2974.50, p = 0.000; level 2: U = 3060.50, p = 0.000; level 3: U = 2465.00, p = 0.000; level 4: U = 2199.00, p = 0.000). During the memory decoding period, first fixation on the targets took significantly longer for FLE patients for all difficulty levels compared to controls (level 1: U = 3407.00, p = 0.008; level 2: U = 3618.00, p = 0.036; level 3: U = 3345.00, p = 0.006; level 4: U = 2781.00, p = 0.000). The average fixation duration per target among patients with FLE was found to be significantly longer compared to HC (level 1: U = 2994.50, p = 0.000; level 2: U = 3101.00, p = 0.000; level 3: U = 2559.50, p = 0.000; level 4: U = 2184.50, p = 0.000). The total fixation duration on AOI/total completion time of FLE patients was significantly lower than those of HC for levels 1 to 3 (level 1: U = 1557.00, p = 0.000; level 2: U = 2333.00, p = 0.000; level 3: U = 2757.00, p = 0.000). Furthermore, the eye tracking data during the memory decoding phase were correlated with neuropsychological scale scores (p < 0.05). Conclusion Patients with FLE exhibited short-term memory impairment probably due to deficits in attentional maintenance, especially during the memory decoding phase. Eye tracking technology provided the possibility to help separate and quantify visual attention from memory processing, contributing to exploring underlying mechanisms of memory impairment in FLE.
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Affiliation(s)
- Qiong Zhang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Weifeng Sun
- Key Laboratory of Biomedical Spectroscopy of Xi’an, Xi’an Institute of Optics and Precision Mechanics of the Chinese Academy of Sciences, Xi’an, China
- Key Laboratory of Spectral Imaging Technology, Xi’an Institute of Optics and Precision Mechanics, Chinese Academy of Sciences, Xi’an, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Kailing Huang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Li Qin
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shirui Wen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiaoyan Long
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Quan Wang
- Key Laboratory of Biomedical Spectroscopy of Xi’an, Xi’an Institute of Optics and Precision Mechanics of the Chinese Academy of Sciences, Xi’an, China
- Key Laboratory of Spectral Imaging Technology, Xi’an Institute of Optics and Precision Mechanics, Chinese Academy of Sciences, Xi’an, China
| | - Li Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
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5
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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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Johnson EC, Atkinson P, Muggeridge A, Cross JH, Reilly C. Knowledge about, and attitudes towards epilepsy among school staff: A UK-based survey. Epilepsy Res 2023; 192:107116. [PMID: 36921479 DOI: 10.1016/j.eplepsyres.2023.107116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/27/2023] [Accepted: 03/02/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVE To survey attitudes towards, and knowledge about, epilepsy among school staff in a defined geographical region in the United Kingdom. METHODS School staff (n = 160) from 18 schools (56% of eligible schools) where children with epilepsy were currently attending were surveyed. Surveys were developed in collaboration with educational professionals. Questions focussed on attitudes towards, and knowledge about, epilepsy. Factors associated with attitudes and knowledge were analyzed using multivariable logistic regression. RESULTS The majority of staff expressed positive attitudes towards the inclusion of children with epilepsy in school, although for most questions there was a significant minority who expressed less positive views. Only 30% of staff agreed that they would feel confident managing a child having a seizure whilst 42% of all staff would be concerned if they had to administer emergency medication. Regarding knowledge, half (50%) of respondents correctly indicated that a child who has a seizure should not always leave the classroom, whilst 54% knew that an ambulance should not always be called every time a child has a seizure. Regarding seizure semiology, almost all respondents (96%) answered 'yes' when asked if seizures could involve convulsions/limb jerking or whole-body convulsions. The vast majority (94%) also identified that seizures could involve 'staring blankly into space'. From a list of eight medical/neurodevelopmental conditions, epilepsy was the condition staff ranked of most concern. Factors independently associated with more positive attitudes and better knowledge included working in a special school as opposed to a mainstream school, having previously witnessed a seizure, and having been in receipt of training on epilepsy (all p < 0.05). Most respondents expressed a desire for more training on seizure management and on the learning and behavioral aspects of epilepsy. CONCLUSION Whilst attitudes toward children with epilepsy are largely positive, epilepsy was the condition staff were most concerned about. Additionally, attitudes towards seizure management and administration of emergency medication in school are less positive, and knowledge of correct actions in the event of seizures in the classroom is deficient in nearly half of respondents. More positive attitudes and better knowledge were associated with previous experience of witnessing seizures, working in special schools, and having received epilepsy training. School staff in UK schools are likely to benefit from access to training on epilepsy in order to improve attitudes and increase knowledge and confidence towards supporting a child with epilepsy in their classroom.
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Affiliation(s)
- Emma C Johnson
- Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, UK
| | - Patricia Atkinson
- Child Development Centre, Crawley Hospital, West Green Drive, Crawley, RH11 7DH West Sussex, UK
| | - Amy Muggeridge
- Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, UK
| | - J Helen Cross
- Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, UK; Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH, UK; UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, London WC1N 1EH, UK
| | - Colin Reilly
- Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, UK; UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, London WC1N 1EH, UK.
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Moorhouse FJ, Cornell S, Gerstl L, Wagner J, Tacke M, Roser T, Heinen F, von Stülpnagel C, Vollmar C, Kunz M, Ramantani G, Borggraefe I. Cognitive profiles in pediatric unilobar vs. multilobar epilepsy. Eur J Paediatr Neurol 2022; 41:48-54. [PMID: 36265333 DOI: 10.1016/j.ejpn.2022.09.006] [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: 09/27/2021] [Revised: 09/12/2022] [Accepted: 09/24/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We aimed to determine how cognitive impairment relates to the extent of the presumed epileptogenic zone in pediatric focal epilepsies. We analyzed the cognitive functions in unilobar compared to multilobar focal epilepsy patients that underwent neuropsychological testing at a tertiary epilepsy center. METHODS We assessed cognitive functions of pediatric focal epilepsy patients with the German version of the Wechsler Intelligence Scales that measures full-scale IQ and subcategories. We assessed differences in IQ and epilepsy-related variables between unilobar and multilobar epilepsy patients. RESULTS We included 62 patients (37 unilobar, 25 multilobar), aged 10.6 ± 3.7 years. Full-scale IQ values were significantly higher in unilobar (93.6 ± 17.7, 95% CI 87.7-99.6) than in multilobar epilepsy patients (77.3 ± 17.2, 95% CI 69.3-85.0; p = 0.001). In all but one IQ subcategory (working memory), significantly higher values were measured in unilobar than in multilobar epilepsy patients. The proportion of unilobar epilepsy patients with severe cognitive impairment (8.3%) and below-average intelligence (30.5%) was lower compared to multilobar epilepsy patients (47.6% and 61.9%; p = 0.002 and p = 0.021, respectively). Epilepsy onset occurred earlier in multilobar (4.0 years, 95% CI 2.6-5.5, SD ± 3.4 years) than in unilobar epilepsy patients (7.0 years, 95% CI 5.5-8.5, SD ± 4.4 years, p = 0.008). CONCLUSIONS Pediatric multilobar epilepsy patients face more cognitive issues than unilobar epilepsy patients on average. Our findings should help to identify children and adolescents who are most at risk for impaired cognitive development. A limitation of our study is the simple division into unilobar and multilobar epilepsies, with no specific account being taken of etiology/epilepsy syndrome, which can have a profound effect on cognition.
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Affiliation(s)
- Frederik Jan Moorhouse
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Sonia Cornell
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Lucia Gerstl
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Johanna Wagner
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Moritz Tacke
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Timo Roser
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Florian Heinen
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Celina von Stülpnagel
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Paracelsus Medical University, Salzburg, Austria
| | - Christian Vollmar
- Department of Neurology, Ludwig-Maximilians-University, Munich, Germany; Comprehensive Epilepsy Center, Ludwig-Maximilians-University, Munich, Germany
| | - Mathias Kunz
- Comprehensive Epilepsy Center, Ludwig-Maximilians-University, Munich, Germany; Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany
| | - Georgia Ramantani
- Department of Neuropediatrics, University Children's Hospital, Zurich, Switzerland; University of Zurich, Zurich, Switzerland
| | - Ingo Borggraefe
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Comprehensive Epilepsy Center, Ludwig-Maximilians-University, Munich, Germany.
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Higashijima T, Akimoto T, Sakata K. Effect of Mahjong on children's intelligence quotient. Front Psychol 2022; 13:934453. [PMID: 36225701 PMCID: PMC9549265 DOI: 10.3389/fpsyg.2022.934453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
This study investigated the effect of Mahjong, which is a table game played by three or four players and involves intellectual activity, on the intelligence quotient (IQ) of children. The participants were children between the age of 6 and 15 years, and their IQ was assessed immediately after enrolling in children's Mahjong classes and 1 year after the enrollment using the Wechsler Intelligence Scale for Children Fourth Edition (WISC-IV). Twenty children were included in the analysis. Their mean age at the time of the initial evaluation was 9 years and 6 months. In addition, we conducted a 1-year post-examination. The change in the IQ of this group was compared to that of a historical control group with a similar age range and test–retest interval. The mean overall full-scale IQ of the 20 children during the initial and post-1-year examinations was 106.05 and 113.75, respectively, and showed a statistically significant increase (p < 0.01). Based on the subscale index, the verbal comprehension index (VCI) and processing speed index (PSI) scores both showed a statistically significant increase from 100.6 to 106.75 and from 108.05 to 119.05 (p < 0.01), respectively. The PSI of the children included in the analysis showed a statistically significant increase compared to the historical control group. This study suggests that children who participate in Mahjong classes during their childhood have increased PSI scores of WISC-IV.
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Johnson E, Atkinson P, Muggeridge A, Cross JH, Reilly C. Impact of epilepsy on learning and behaviour and needed supports: Views of children, parents and school staff. Eur J Paediatr Neurol 2022; 40:61-68. [PMID: 36031701 DOI: 10.1016/j.ejpn.2022.08.001] [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: 01/18/2022] [Revised: 07/01/2022] [Accepted: 08/08/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND There is limited data on the views of young people with epilepsy, their parents and school staff regarding the impact of epilepsy on learning and behaviour in school. The purpose of the study was to gain an understanding of the impact of epilepsy on learning and behaviour and needed supports according to children with epilepsy, their parents and supporting school staff. METHODS School-aged children (n = 20) with 'active epilepsy' (taking anti-seizure Medications (ASMs) for epilepsy), their parents (n = 68) and school staff (n = 56) were interviewed or completed surveys. The quantitative data was analysed using descriptive statistics and responses were compared for children attending mainstream and special schools using chi-square analyses. The answers to open questions were answered using thematic analyses. RESULTS The majority (53%) of children with epilepsy felt that epilepsy affected their learning including aspects such as memory, attention and concentration but also physical and emotional wellbeing including increased tiredness and lowered self-confidence. In addition, children brought up possible negative aspects of taking ASMs including increased irritability and emotional reactivity. The children also mentioned that epilepsy in school was associated with stigma and restrictions. The majority (85%) of parents agreed that epilepsy affects the child's learning/behaviour while more staff agreed that epilepsy affects learning (61%) than behaviour (45%). Most parents agreed that that their child's school provided the appropriate resources to support their child's learning (79%) and 72% agreed that they were satisfied overall with the support their child received at school. However, parents of children attending special schools were more likely to agree that the child's school provided appropriate resources to support their child's learning (p = 0.034) and be satisfied with the support their child received in school (p = 0.02), than parents of children attending mainstream schools. With respect to current or desired supports, analysis of the children's responses indicated that they want access to supportive environments outside the classroom, accommodations in tests/exams and increased support from trusted adults. Parent responses included approaches that promote child wellbeing, environmental accommodations, a high ratio of adult support and a consideration of the child's communication needs. Staff views regarding optimal strategies included a high level of adult support for the child, environmental accommodations, use of multimodal learning, adapting communication and approaches that promote psychological wellbeing. CONCLUSIONS The majority of children perceived that epilepsy affected their learning and behaviour in school including leading to specific learning difficulties, but also negative impacts on emotional and physical wellbeing. Levels of parental satisfaction with supports were significantly higher in special schools compared with mainstream schools. Children, parents and staff highlighted a number of supports which they felt can support the child with epilepsy's learning but also emotional wellbeing.
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Affiliation(s)
- Emma Johnson
- Research Department, Young Epilepsy, Lingfield, Surrey, RH7 6PW, UK; Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Patricia Atkinson
- Child Development Centre, Crawley Hospital, West Green Drive, Crawley, RH11 7DH, West Sussex, UK
| | - Amy Muggeridge
- Research Department, Young Epilepsy, Lingfield, Surrey, RH7 6PW, UK
| | - J Helen Cross
- Research Department, Young Epilepsy, Lingfield, Surrey, RH7 6PW, UK; Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK; UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, London, WC1N 1EH UK
| | - Colin Reilly
- Research Department, Young Epilepsy, Lingfield, Surrey, RH7 6PW, UK; UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, London, WC1N 1EH UK.
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10
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Chisolm PF, Warner JD, Hale AT, Estevez-Ordonez D, Murdaugh D, Rozzelle CJ, Blount JP. Quantifying and Reporting Outcomes in Pediatric Epilepsy Surgery: A Systematic Review. Epilepsia 2022; 63:2754-2781. [PMID: 35847999 DOI: 10.1111/epi.17369] [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: 04/08/2022] [Revised: 07/15/2022] [Accepted: 07/15/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Several instruments and outcomes measures have been reported in pediatric patients undergoing epilepsy surgery. The objective of this systematic review is to summarize, evaluate, and quantify outcome metrics for the surgical treatment of pediatric epilepsy that address seizure frequency, neuropsychological, and health-related quality of life (HRQL). METHODS We performed a systematic review according to PRISMA guidelines to identify publications between 2010 and June 2021 from PubMed, Embase, and the Cochrane Database of Systematic Reviews that report clinical outcomes in pediatric epilepsy surgery. RESULTS Eighty-one papers were included for review. Overall, rates of post-operative seizure frequency were the most common metric reported (n= 78 studies, 96%). Among the seizure frequency metrics, the Engel Epilepsy Surgery Outcome Scale (n= 48 studies, 59%) was most commonly reported. Neuropsychological outcomes, performed in 32 studies (40%) were assessed using 36 different named metrics. Health-Related Quality of Life (HRQL) outcomes were performed in 16 studies (20%) using 13 different metrics. Forty-six studies (57%) reported postoperative changes in anti-epileptic drug (AED) regimen and time-to-event analysis was performed in 15 (19%) studies. Only 13 outcomes metrics (1/5 seizure frequency, 6/13 HRQL, 6/36 neuropsychological) have been validated for use in pediatric patients with epilepsy and only 13 have been assessed through reliability studies (4/5 seizure frequency, 6/13 HRQL, and 3/36 neuropsychological). Of the 81 included studies, 17 (21%) used at least one validated metric. SIGNIFICANCE Outcome variable metrics in pediatric epilepsy surgery are highly variable. While nearly all studies report seizure frequency, there is considerable variation in reporting. HRQL and neuropsychological outcomes are less frequently and much more heterogeneously reported. Reliable and validated outcomes metrics should be used to increase standardization and accuracy of reporting outcomes in pediatric patients undergoing epilepsy surgery.
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Affiliation(s)
- Paul F Chisolm
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeffrey D Warner
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andrew T Hale
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Donna Murdaugh
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Curtis J Rozzelle
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA.,Division of Pediatric Neurosurgery, Children's of Alabama, Birmingham, AL, USA
| | - Jeffrey P Blount
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA.,Division of Pediatric Neurosurgery, Children's of Alabama, Birmingham, AL, USA
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11
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Paramita ADP, Adnyana IGANS, Subanada IB, Suwarba IGNM, Gunawijaya E, Wati DK. Association of Hair Zinc Level with Cognitive and Language Delays in Children Aged 9–24 Months Old. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: The delay in cognitive and language development can be caused by multifactor, including chronic deficiency of micronutrient, zinc. Level of zinc serum is influenced by food intake which can cause bias. There are inconsistencies in previous studies between zinc levels and the development caused by differences of sample or subjects. This study using hair as sample in analyzing the association between zinc level on cognitive and language delays in children aged 9-24 months old.
AIM: To find out that low hair zinc level is associated with delayed of cognitive and language development in children 9-24 months old.
Method: This analytical observational study with case-control design. Case group consisted of 69 children with cognitive and language development delays, based on CAT/CLAMS scores < 85 subjects aged 9-24 months meanwhile the control group consist of 69 children with normal cognitive and language development. Chi-square test was used to assess the association between zinc levels and the incidence of cognitive and language delays. Multivariate analysis was performed by logistic regression.
Results: Univariate analysis showed no association between low zinc level and delayed of cognitive and language development in children aged 9-24 months (OR 1.263; 95% CI 0.64-2.46; p=0.495). Logistic regression was performed for other variables and screen time > 2 hours and lack of stimulation were risk factors for cognitive and language development delays (adjusted OR 2.78; 95% CI 1,284-6.058; p=0.010 and adjusted OR 3.96; 95% CI 1.833-8.581; p<0.001).
Conclusion: There is no relationship between low hair zinc level and delays in cognitive and language development in children age 9-24 months, but there is an association between screen time more than two hours per day and lack of stimulation with delays in cognitive and language development in children 9-24 months 24 months.
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12
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Rogač Ž, Stevanović D, Bečanović S, Božić L, Dimitrijević A, Bogićević D, Bosiočić I, Jovanović K, Nikolić D. Cognitive profile, psychopathological symptoms, and quality of life in newly diagnosed pediatric epilepsy: A six-month, naturalistic follow-up study. Epilepsy Res 2022; 179:106844. [PMID: 34942452 DOI: 10.1016/j.eplepsyres.2021.106844] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 11/29/2022]
Abstract
Long-term studies indicated changes in aspects of cognition, psychopathology, and quality of life (QOL) in children and adolescents followed up after the diagnosis of epilepsy. However, evidence is limited regarding what happens during the first few months after epilepsy is diagnosed because at this phase is possible to adjust and/or change an AED regimen or add other treatment interventions, if needed. This is a naturalistic, six months follow-up study that evaluated changes in overall cognitive profiles, levels of psychopathological symptoms, and quality of life (QOL) in newly diagnosed, uncomplicated pediatric epilepsy. In total, 61 (35 [57.4%] males) children and adolescents aged 7-18 years were assessed at the time of diagnosis and the initiation of antiepileptic drug (AED) treatment and six months afterward. The Revised Wechsler Intelligence Scale for Children, the Revised Child Anxiety and Depression Scale (RCADS), Nisonger Child Behavior Rating Form for typically developing children and adolescents (NCBRF), KIDSCREEN-10 Quality of Life Measure, and Adverse Event Profile (AEP) were used. The RCADS and NCBRF scores significantly increased over time, while the KIDSCREEN-10 scores significantly decreased. The most significant increases were observed in scores measuring social phobia and depressive symptoms and inattentiveness. Verbal cognitive abilities and full-scale intelligence scores changed slightly, while more changes were found in aspects of non-verbal cognitive abilities. This study showed that six months after epilepsy diagnosis and AED initiation, there were marked increases in anxiety levels, depressive symptoms, and behavioral problems, with deteriorations in QOL, while cognitive changes were relatively minimal. Therefore, monitoring levels of psychopathological symptoms and QOL in newly diagnosed epilepsy is highly recommended.
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Affiliation(s)
- Željka Rogač
- Institute for Children's Diseases, Clinical Centre of Montenegro, Podgorica 81000, Montenegro.
| | - Dejan Stevanović
- Clinic for Neurology and Psychiatry for Children and Youth, Belgrade 11000, Serbia.
| | | | - Ljubica Božić
- University Children's Hospital, Belgrade 11000, Serbia.
| | - Aleksandar Dimitrijević
- University Children's Hospital, Belgrade 11000, Serbia; University of Belgrade - School of Medicine, Belgrade 11000, Serbia.
| | - Dragana Bogićević
- University Children's Hospital, Belgrade 11000, Serbia; University of Belgrade - School of Medicine, Belgrade 11000, Serbia.
| | | | | | - Dimitrije Nikolić
- University Children's Hospital, Belgrade 11000, Serbia; University of Belgrade - School of Medicine, Belgrade 11000, Serbia.
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13
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Lopes E Santos LE, de Angelis G, Velasco TR, Thome U, Santos MV, Machado HR, Hamad APA, Sakamoto AC, Wichert-Ana L. The intellectual profile of pediatric patients with posterior cortex epilepsy. Epilepsy Behav 2021; 125:108447. [PMID: 34839240 DOI: 10.1016/j.yebeh.2021.108447] [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: 09/01/2021] [Revised: 10/27/2021] [Accepted: 11/12/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cognitive functioning in epileptic syndromes has been widely explored in patients with temporal lobe epilepsy (TLE), but few studies have investigated the neuropsychological profile in posterior cortex epilepsy (PCE). In this study, we investigated the presurgical intellectual profile of children and adolescents with drug-resistant PCE. METHODS Children and adolescents diagnosed with PCE (n = 25) participated in this study. The data were obtained from medical records, with assessments carried out between the years 2003 and 2019. To compare the intellectual profile, we also included patients diagnosed with frontal (n = 26) and temporal lobe epilepsy (n = 40). The Wechsler Intelligence Scales were used for the assessment of general intelligence. RESULTS There was an effect of the brain region on the Working Memory Index (p < 0.01), in which patients with TLE had significantly higher scores than groups with FLE (p < 0.01) and PCE (p < 0.05). We also demonstrated that patients with PCE tended to perform worse in the Processing Speed Index than patients with TLE (p = 0.055). The Full-Scale Intelligence Quotient, Verbal Comprehension, and Perceptual Reasoning indexes did not differ among the brain regions. CONCLUSIONS Children and adolescents with PCE demonstrated significant impairment in working memory and processing speed. The pattern of cognitive dysfunction in PCE was similar to that observed in FLE, which expands the evidence of the involvement of frontoparietal networks on cognitive proficiency.
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Affiliation(s)
- Lucas Emmanuel Lopes E Santos
- Department of Radiology, Hematology and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil; Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Geisa de Angelis
- Department of Radiology, Hematology and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil; Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Tonicarlo Rodrigues Velasco
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Ursula Thome
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Marcelo Volpon Santos
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Hélio Rubens Machado
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Ana Paula Andrade Hamad
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Américo Ceiki Sakamoto
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Lauro Wichert-Ana
- Department of Radiology, Hematology and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
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14
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Arski ON, Wong SM, Warsi NM, Martire DJ, Ochi A, Otsubo H, Donner E, Jain P, Kerr EN, Smith ML, Ibrahim GM. Spectral changes following resective epilepsy surgery and neurocognitive function in children with epilepsy. J Neurophysiol 2021; 126:1614-1621. [PMID: 34550020 DOI: 10.1152/jn.00434.2020] [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] [Indexed: 11/22/2022] Open
Abstract
Decelerated resting cortical oscillations, high-frequency activity, and enhanced cross-frequency interactions are features of focal epilepsy. The association between electrophysiological signal properties and neurocognitive function, particularly following resective surgery, is, however, unclear. In the current report, we studied intraoperative recordings from intracranial electrodes implanted in seven children with focal epilepsy and analyzed the spectral dynamics both before and after surgical resection of the hypothesized seizure focus. The associations between electrophysiological spectral signatures and each child's neurocognitive profiles were characterized using a partial least squares analysis. We find that extent of spectral alteration at the periphery of surgical resection, as indexed by slowed resting frequency and its acceleration following surgery, is associated with baseline cognitive deficits in children. The current report provides evidence supporting the relationship between altered spectral properties in focal epilepsy and neuropsychological deficits in children. In particular, these findings suggest a critical role of disrupted thalamocortical rhythms, which are believed to underlie the spectral alterations we describe, in both epileptogenicity and neurocognitive function.NEW & NOTEWORTHY Spectral alterations marked by decelerated resting oscillations and ectopic high-frequency activity have been noted in focal epilepsy. We leveraged intraoperative recordings from chronically implanted electrodes pre- and postresection to understand the association between these electrophysiological phenomena and neuropsychological function. We find that the extent of spectral alteration, indexed by slowed resting frequency and its acceleration following resection, is associated with baseline cognitive deficits. These findings provide novel insights into neurocognitive impairments in focal epilepsy.
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Affiliation(s)
- Olivia N Arski
- Program in Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Simeon M Wong
- Program in Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Nebras M Warsi
- Program in Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada.,Division of Neurosurgery, Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Daniel J Martire
- Program in Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Ayako Ochi
- Division of Neurology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Hiroshi Otsubo
- Division of Neurology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Donner
- Division of Neurology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Puneet Jain
- Division of Neurology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth N Kerr
- Division of Psychology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Mary Lou Smith
- Division of Psychology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - George M Ibrahim
- Program in Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada.,Division of Neurosurgery, Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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15
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Ikhurionan PE, Okunola OP, Abhulimhen-Iyoha BI, Ofovwe GE. Psychomotor function in children with epilepsy seen at a tertiary hospital in southern Nigeria: does treatment with anti-epileptic drugs have any effect? THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00388-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Psychomotor slowing is more commonly reported in children with epilepsy (CWE) compared to healthy controls. The effect of anti-epileptic drug (AED) treatment on psychomotor abilities of CWE remains controversial. In Nigeria, psychomotor abilities of CWE are scarcely investigated and the impact of AEDs is not known. The present study sought to assess psychomotor performance of CWE compared to healthy controls and to determine any association with seizure characteristics and treatment.
Method
A comparative cross-sectional study involving 160 children with idiopathic epilepsy and 80 controls aged 6–16 years. Psychomotor function was assessed using reaction times and tapping task of the Iron psychology computerised test battery. The criterion for impairment was fixed at two standard deviations (SD) worse than the mean of age-matched controls. The relationship between seizure variables and psychomotor function was assess with the one-way analysis of variance (ANOVA).
Result
Fifty-nine (36.9%) CWE had impaired auditory reaction, 50 (31.3%) with impaired visual reaction and 11 (6.9%) had fine motor control impairment. There was no significant difference in psychomotor performance between CWE on AED and the newly diagnosed counterparts yet to start AED treatment (auditory reaction time—p = 0.226; visual reaction time—p = 0.349; tapping task—p = 0.818). AED treatment duration over 5 years was associated with better auditory reaction time (F = 4.631, p = 0.034) in CWE. Also, seizure onset before 5 years of age was associated with slower auditory reaction (F = 4.912, p = 0.028) and verbal reaction (F = 14.560, p < 0.001).
Conclusion
Nigerian CWE perform less favourably on tests of psychomotor function than healthy controls. The performance of children on AED is not significantly different from those not on AED. Longer duration of AED treatment may result in psychomotor improvement in CWE. CWE should be closely monitored for psychomotor slowness so that deficits can be identified and appropriate interventions instituted.
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16
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Aburahma SK, Hammouri H, Hazaimeh E, Jbarah O, Nassar A, Almasri A, Al Momani M, Bashtawi M. Social impairment in children with epilepsy assessed by the social responsiveness scale. Clin Child Psychol Psychiatry 2021; 26:1170-1181. [PMID: 34271834 DOI: 10.1177/13591045211033176] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Children with epilepsy are at risk for impaired social cognition and autism. We aimed at evaluating the utility of the social responsiveness scale (SRS) for assessment of social impairment in these children. Prospective study; the SRS was applied to a group of children with epilepsy and a healthy control group. Intellectual disability in the epilepsy group was assessed utilizing adapted versions of the Wechsler Intelligence and adaptive behavior scales. One hundred and one children with epilepsy and 92 healthy children were included. The majority of children in both groups had normal SRS scores. Significant differences were identified in children with high total scores indicating significant deficiencies in reciprocal social behavior; high scores were found in 16% of children with epilepsy versus 7% of normal children, p < .05, particularly involving social communication, p < .05. Intellectual disability was identified in 42% of children with epilepsy, particularly processing speed index, p < .001. Intellectual disability had a significant effect on total scores, p = .016. Children with epilepsy have increased risk of social impairments. Social impairments are more likely in the presence of intellectual disability. The SRS is a quick identification tool that can be employed in the outpatient setting.
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Affiliation(s)
- Samah K Aburahma
- Faculty of Medicine, 37251Jordan University of Science and Technology, Irbid, Jordan
| | - Hanan Hammouri
- Faculty of Mathematics, 37251Jordan University of Science and Technology, Irbid, Jordan
| | - Ethar Hazaimeh
- Faculty of Medicine, 37251Jordan University of Science and Technology, Irbid, Jordan
| | - Omar Jbarah
- Faculty of Medicine, 37251Jordan University of Science and Technology, Irbid, Jordan
| | - Ahmad Nassar
- Department of Medicine, 8405MedStar Washington Hospital Center, Washington, DC
| | - Ayham Almasri
- Faculty of Medicine, 37251Jordan University of Science and Technology, Irbid, Jordan
| | - Miral Al Momani
- Faculty of Medicine, 37251Jordan University of Science and Technology, Irbid, Jordan
| | - Mahmoud Bashtawi
- Faculty of Medicine, 37251Jordan University of Science and Technology, Irbid, Jordan
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17
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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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18
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Zhu G, Wang J, Xiao L, Yang K, Huang K, Li B, Huang S, Hu B, Xiao B, Liu D, Feng L, Wang Q. Memory Deficit in Patients With Temporal Lobe Epilepsy: Evidence From Eye Tracking Technology. Front Neurosci 2021; 15:716476. [PMID: 34557066 PMCID: PMC8453169 DOI: 10.3389/fnins.2021.716476] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/16/2021] [Indexed: 11/24/2022] Open
Abstract
Objective: To explore quantitative measurements of the visual attention and neuroelectrophysiological relevance of memory deficits in temporal lobe epilepsy (TLE) by eye tracking and electroencephalography (EEG). Methods: Thirty-four TLE patients and twenty-eight healthy controls were invited to complete neurobehavioral assessments, cognitive oculomotor tasks, and 24-h video EEG (VEEG) recordings using an automated computer-based memory assessment platform with an eye tracker. Visit counts, visit time, and time of first fixation on areas of interest (AOIs) were recorded and analyzed in combination with interictal epileptic discharge (IED) characteristics from the bilateral temporal lobes. Results: The TLE patients had significantly worse Wechsler Digit Span scores [F(1, 58) = 7.49, p = 0.008]. In the Short-Term Memory Game with eye tracking, TLE patients took a longer time to find the memorized items [F(1, 57) = 17.30, p < 0.001]. They had longer first fixation [F(1, 57) = 4.06, p = 0.049] and more visit counts [F(1, 57) = 7.58, p = 0.008] on the target during the recall. Furthermore, the performance of the patients in the Digit Span task was negatively correlated with the total number of IEDs [r(28) = −0.463, p = 0.013] and the number of spikes per sleep cycle [r(28) = −0.420, p = 0.026]. Conclusion: Eye tracking appears to be a quantitative, objective measure of memory evaluation, demonstrating memory retrieval deficits but preserved visual attention in TLE patients. Nocturnal temporal lobe IEDs are closely associated with memory performance, which might be the electrophysiological mechanism for memory impairment in TLE.
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Affiliation(s)
- Guangpu Zhu
- Key Laboratory of Spectral Imaging Technology, Xi'an Institute of Optics and Precision Mechanics of the Chinese Academy of Sciences, Xi'an, China.,University of Chinese Academy of Sciences, Beijing, China.,Key Laboratory of Biomedical Spectroscopy of Xi'an, Xi'an Institute of Optics and Precision Mechanics of the Chinese Academy of Sciences, Xi'an, China
| | - Jing Wang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Ling Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Ke Yang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Kailing Huang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Beibin Li
- Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, WA, United States
| | - Sha Huang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Bingliang Hu
- Key Laboratory of Biomedical Spectroscopy of Xi'an, Xi'an Institute of Optics and Precision Mechanics of the Chinese Academy of Sciences, Xi'an, China
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Ding Liu
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Li Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Quan Wang
- Key Laboratory of Spectral Imaging Technology, Xi'an Institute of Optics and Precision Mechanics of the Chinese Academy of Sciences, Xi'an, China.,Key Laboratory of Biomedical Spectroscopy of Xi'an, Xi'an Institute of Optics and Precision Mechanics of the Chinese Academy of Sciences, Xi'an, China
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19
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Johnson EC, Atkinson P, Muggeridge A, Cross JH, Reilly C. Epilepsy in schools: Views on educational and therapeutic provision, understanding of epilepsy and seizure management. Epilepsy Behav 2021; 122:108179. [PMID: 34256338 DOI: 10.1016/j.yebeh.2021.108179] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/07/2021] [Accepted: 06/11/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To gain an understanding of the views of young people with epilepsy, their parents and school staff regarding educational and therapeutic provision, understanding of epilepsy and seizure management in schools. METHODS School-aged children (n = 20) with 'active epilepsy' (taking Anti-Seizure Medications (ASMs) for epilepsy), their parents (n = 68), and school staff (n = 56) were interviewed or completed bespoke questionnaires. In addition, all participating children underwent psychological assessment including measures of behavior and cognition. RESULTS Only 15% of participating children had received psychological support despite 60% scoring within the at-risk range on a measure of behavioral and emotional difficulties. More than half of the responding children reported that some of their teachers and friends did not know that they had epilepsy. A significant minority of parents (32%) did not feel that the child's transition from preschool to primary, or primary to secondary school was managed well. Knowledge of the child's epilepsy was felt to be significantly better in special schools than mainstream schools according to both parents and school staff. Staff in special schools perceived they were more knowledgeable about the child's ASMs and changes to ASMs than staff in mainstream schools. Staff in special schools were significantly more likely to have received training on general aspects of epilepsy, seizure management, and impacts on learning and/or behavior. Parental interviews indicated difficulties accessing educational and therapeutic supports. Parents often felt that they had to drive the process to gain supports themselves. They also reported limited professional support, and inadequate communication between themselves and the school and school staff and medical/therapeutic professionals regarding their child's needs. Parents would like more school staff to recognize the impacts of epilepsy on learning and behavior and to support their child more holistically. Many parents wanted more resources for assessment and therapeutic provision in relation to their child's learning, behavior, and emotions. CONCLUSION Knowledge of epilepsy is felt by parents and staff to be significantly better in special schools compared with mainstream schools. Parents highlighted the need for increased knowledge of the impacts of epilepsy on learning and behavior and perceived a need for more resources for assessment of these difficulties.
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Affiliation(s)
- Emma C Johnson
- Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, UK
| | - Patricia Atkinson
- Child Development Centre, Crawley Hospital, West Green Drive, Crawley RH11 7DH, West Sussex, UK
| | - Amy Muggeridge
- Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, UK
| | - J Helen Cross
- Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, UK; Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH, UK; UCL, NIHR BRC Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street London WC1N 1EH, UK
| | - Colin Reilly
- Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, UK; UCL, NIHR BRC Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street London WC1N 1EH, UK.
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20
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Esteso Orduña B, Fournier Del Castillo MDLC, Cámara Barrio S, García Fernández M, Andrés Esteban EM, Álvarez-Linera Prado J, Budke M, Maldonado Belmonte MJ, González Marqués J, Pérez Jiménez MÁ. Cognitive and behavioral profiles of pediatric surgical candidates with frontal and temporal lobe epilepsy. Epilepsy Behav 2021; 117:107808. [PMID: 33640566 DOI: 10.1016/j.yebeh.2021.107808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/17/2021] [Accepted: 01/19/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND We aimed to prospectively analyze memory and executive and social cognitive functioning in patients with drug-resistant frontal lobe epilepsy (FLE) and temporal lobe epilepsy (TLE) with focal lesions and isolate the impact of intellectual ability on specific deficits. METHODS A neuropsychological evaluation was performed in 23 children with FLE, 22 children with TLE, and 36 healthy pediatric controls (HCs). Patients in the epilepsy groups had a range of lesions, including low-grade epilepsy-associated tumors (LEAT), focal cortical dysplasia (FCD) type II, and mesial temporal sclerosis (MS). RESULTS There were no significant differences between children with FLE and TLE regarding memory, executive, or social cognitive functioning. General Ability Index (GAI) was a predictor of memory, executive function, and social cognition scores and was influenced by age at onset, duration of epilepsy, and number of antiepileptic drugs (AEDs) prescribed at the time of assessment. Working Memory Index scores of patients with TLE, which measure verbal mnesic processing, were significantly lower than those of HCs and patients with TLE. The greatest differences in both clinical groups compared to HCs were recorded in cognitive executive functions, and patients with FLE had lower scores in this domain. Regarding behavioral executive functions, patients with TLE presented impaired emotional control and impulse inhibition and patients with FLE exhibited decreased flexibility. CONCLUSION Consistent with previous research, our findings provide further detailed evidence of small differences in cognitive performance among children with FLE and TLE. These differences emerge on analysis of the factors with which deficits are associated.
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Affiliation(s)
- Borja Esteso Orduña
- Clinical Neuropsychology Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
| | | | - Silvia Cámara Barrio
- Clinical Neuropsychology Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Marta García Fernández
- Epilepsy Monitoring Unit, Clinical Neurophysiology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | | | - Marcelo Budke
- Neurosurgery Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - Javier González Marqués
- Cognitive Processes Department, Faculty of Psychology, Universidad Complutense de Madrid, Madrid, Spain
| | - María Ángeles Pérez Jiménez
- Epilepsy Monitoring Unit, Clinical Neurophysiology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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21
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Holmes H, Sawer F, Clark M. Autism spectrum disorders and epilepsy in children: A commentary on the occurrence of autism in epilepsy; how it can present differently and the challenges associated with diagnosis. Epilepsy Behav 2021; 117:107813. [PMID: 33642176 DOI: 10.1016/j.yebeh.2021.107813] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/17/2021] [Accepted: 01/20/2021] [Indexed: 01/02/2023]
Abstract
Autism occurs more frequently in epilepsy, but is often not diagnosed. This could be due to a focus on medical issues, or because it presents differently from classic autism in its timing, phenotype, fluctuating profiles, and high level of comorbidity. Without a diagnosis, these children miss out on interventions that could modify outcome and their families and local teams will struggle to understand and support them. They also become a hidden group that does not participate in or benefit from research. This paper examined the issues and challenges of diagnosing autism in a population with a high-risk of epilepsy, drawing on more than 20 years' experience of a specialist multi-disciplinary Developmental Epilepsy Clinic (DEC).
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Affiliation(s)
- Harriet Holmes
- Developmental Epilepsy Clinic, Great Ormond Street Hospital, London WC1N3JH, UK
| | - Francesca Sawer
- Developmental Epilepsy Clinic, Great Ormond Street Hospital, London WC1N3JH, UK
| | - Maria Clark
- Developmental Epilepsy Clinic, Great Ormond Street Hospital, London WC1N3JH, UK.
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22
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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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23
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Cognitive performance and behavior across idiopathic/genetic epilepsies in children and adolescents. Sci Rep 2020; 10:21543. [PMID: 33298990 PMCID: PMC7725836 DOI: 10.1038/s41598-020-78218-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/23/2020] [Indexed: 11/25/2022] Open
Abstract
We investigated the cognitive and behavioral profile of three distinct groups of epilepsies with a genetic background for intergroup differences: (1) idiopathic/genetic generalized epilepsies (IGE/GGE group); (2) idiopathic focal epilepsies (IFE group); and (3) epilepsies with proven or strongly suggested monogenic or structural/numeric chromosomal etiology (genetic epilepsies, GE group). Cognitive (total IQ and subcategories) and behavioral parameters (CBCL) were assessed at the tertiary epilepsy center of the University of Munich (Germany). We used ANOVA with post-hoc Bonferroni-correction to explore significant mean differences and Fisher’s exact test for significant proportional differences of intelligence impairment and behavioral problems. 126 (56 IGE/GGE, 26 IFE, 44 GE) patients were available. Total IQ was 89.0 ± 15.9 (95% CI 84.5–93.4) for IGE/GGE, 94.8 ± 18.1 (95% CI 87.3–102.3) for IFE and 76.4 ± 22.4 (95% CI 67.6–85.3) for GE (p = 0.001). The same trend was significant for all but one IQ subcategory. The rate of patients with an intelligence impairment (total IQ < 70) was higher for GE (40%) than for IGE/GGE (14%) and for IFE (7%) patients (p = 0.033). There were no significant differences between groups for behavior scores and behavioral problems. This study shows that the current ILAE classification of epilepsies with genetic etiology creates a heterogeneous group of patients with respect to cognitive performance but not behavior. These findings may help in further delineating epilepsies as regards cognitive performance, notwithstanding their closely related etiological classification.
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24
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Syvertsen M, Vasantharajan S, Moth T, Enger U, Koht J. Predictors of high school dropout, anxiety, and depression in genetic generalized epilepsy. Epilepsia Open 2020; 5:611-615. [PMID: 33336132 PMCID: PMC7733661 DOI: 10.1002/epi4.12434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/18/2020] [Accepted: 09/02/2020] [Indexed: 11/11/2022] Open
Abstract
Affective disorders are overrepresented in epilepsy, and people with epilepsy may be at risk of dropping out from school. The aim of the present study was to assess factors influencing high school dropout, anxiety, and depression in genetic generalized epilepsy (GGE). One hundred and ten people with GGE aged 19-40 years underwent a clinical interview, including the Hospital Anxiety and Depression Scale (HADS) questionnaire. Potential predictors of high school dropout were analyzed with logistic regression, and factors influencing total HADS score were analyzed with linear regression. Having felt excluded because of epilepsy was significantly associated with high school dropout (odds ratio 7.80, P = .009), as was total HADS score (odds ratio 1.22, P = .005). If a participant was currently employed or undergoing education, previous high school dropout was less likely (odds ratio 0.07, P = .005). High school dropout was associated with increased current anxiety and depression (β = 0.32, P = .005). Epilepsy severity (current drug resistance, current polytherapy, and active generalized tonic-clonic seizures) was not associated with high school dropout, nor with total HADS score. The issue of stigma in epilepsy must be thoroughly addressed in comprehensive care and may be as important as seizure control when it comes to education and quality of life.
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Affiliation(s)
- Marte Syvertsen
- Department of NeurologyDrammen HospitalVestre Viken Hospital TrustDrammenNorway
| | | | - Thea Moth
- Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Ulla Enger
- Department of NeurologyDrammen HospitalVestre Viken Hospital TrustDrammenNorway
| | - Jeanette Koht
- Department of NeurologyDrammen HospitalVestre Viken Hospital TrustDrammenNorway
- Institute of Clinical MedicineUniversity of OsloOsloNorway
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25
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Silberg T, Ahoniska-Assa J, Bord A, Levav M, Polack O, Tzadok M, Heimer G, Bar-Yosef O, Geva R, Ben-Zeev B. In the eye of the beholder: Using a multiple-informant approach to examine the mediating effect of cognitive functioning on emotional and behavioral problems in children with an active epilepsy. Seizure 2020; 82:31-38. [PMID: 32979603 DOI: 10.1016/j.seizure.2020.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 08/21/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE Childhood epilepsy is often associated with cognitive impairments and psychosocial problems. However, it is not clear which factors mediate symptom severity and child's resilience. Emotional and behavioral problems have been associated with various home and school environments, suggesting that information collected may vary depending on both context and informant. In this study we examined the mediating effect of child's cognitive functions on the association between child and epilepsy-related factors and psychosocial problems. Additionally, the differences in psychosocial problems reported by various informants (parents, teachers) in different school settings were explored. METHODS Participants were 155 children with epilepsy (50 % girls), age range 5-18 years who completed a brief neuropsychological battery. Parents completed the Child Behavior Checklist (CBCL) and teachers completed the corresponding Teacher's Rating Form (TRF), to assess a child's emotional and behavior problems. RESULTS The cognitive profile of the sample was within average to low-average range. Parents and teachers both reported high levels of emotional and behavioral problems, and teachers reported relatively higher levels of symptoms. A mediation effect of cognition on the association between child and epilepsy-related factors (i.e., number of antiseizure medications and illness duration) and child's emotional and behavioral problems was evident only for teachers' reports. CONCLUSIONS The results emphasize that the complex interactions between epilepsy, cognition and psychosocial outcomes are perceived differently in diverse contexts by different informants. The incongruities in informants' perceptions regarding the role of cognition in child's psychological state should be acknowledged and incorporated when planning effective educational and rehabilitation interventions for children with epilepsy.
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Affiliation(s)
- Tamar Silberg
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel; Pediatric Rehabilitation Department, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel.
| | - Jaana Ahoniska-Assa
- Pediatric Rehabilitation Department, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel; School of Behavioral Sciences, Tel Aviv-Yaffo Academic College, Tel-Aviv, Israel
| | - Ayelet Bord
- Pediatric Neurology Department, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel
| | - Miram Levav
- Child Development Center, Kupat Holim Leumit, Jerusalem, Israel
| | - Orli Polack
- Pediatric Neurology Department, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel
| | - Michal Tzadok
- Pediatric Neurology Department, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel; The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Gali Heimer
- Pediatric Neurology Department, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel; The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Omer Bar-Yosef
- Pediatric Neurology Department, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel; The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ronny Geva
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Bruria Ben-Zeev
- Pediatric Neurology Department, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel; The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
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26
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Sakpichaisakul K, Byars AW, Horn PS, Aungaroon G, Greiner HM, Mangano FT, Holland KD, Arya R. Neuropsychological outcomes after pediatric epilepsy surgery: Role of electrical stimulation language mapping. Seizure 2020; 80:183-191. [PMID: 32604001 DOI: 10.1016/j.seizure.2020.06.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 01/06/2023] Open
Abstract
PURPOSE We studied the association between electrical stimulation mapping (ESM) with a visual naming task and post-operative neuropsychological outcomes after pediatric epilepsy surgery. METHODS Children who underwent epilepsy surgery, having pre- and 1-year post-surgery neuropsychological evaluation (NPE) available, were included. NPE scores were transformed using principal components (PC) analysis. The relationship between post-surgical PC scores, adjusted for pre-surgery PC scores, and ESM was analyzed. Clinical variables influencing this relationship were also sought. RESULTS One hundred and four children (89 patients >5 years-old, and 15 patients 3-5 years-old) were included. Among children >5 years-of-age, a significant effect of language ESM was observed on all 3 post-surgery PC scores adjusted for respective pre-surgery PC scores. Specifically, only 30 % patients who underwent language ESM had a decrease in PC1 scores ≥1-year after epilepsy surgery, compared to 68 % those who did not undergo language ESM (p = 0.001). Seizure outcomes, age at the time of surgery, predominant seizure type, and family history of epilepsy were other significant determinants of post-surgical PC scores including a change in PC scores from pre-surgery baseline. Combinations of pre-surgical variables were able to predict post-surgical PC scores with high specificity. In children aged 3-5 years, no significant effect of language ESM was seen on post-surgery PC scores adjusted for respective pre-surgery PC scores. CONCLUSIONS Speech/language ESM should be performed more widely in patients >5 years-of-age undergoing epilepsy surgery. Also, more efficient brain mapping techniques and language paradigms are needed for younger children.
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Affiliation(s)
- Kullasate Sakpichaisakul
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Division of Neurology, Department of Pediatrics, Queen Sirikit National Institute of Child Health, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Anna W Byars
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Paul S Horn
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Gewalin Aungaroon
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Hansel M Greiner
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Francesco T Mangano
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Katherine D Holland
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ravindra Arya
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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27
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Youness ER, Shady MMA, Abd Elaziz A, Galal E, El-Sonbaty M, El-Sonbaty MM, Masoud MM, Abu Elhamd WA. Association of folic acid, vitamin B12, and intelligence scores in epileptic children. APPLIED NEUROPSYCHOLOGY-CHILD 2020; 11:45-49. [PMID: 32356452 DOI: 10.1080/21622965.2020.1747020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Epilepsy is a serious childhood disease associated with cognitive impairment. Our aim was to investigate the possible association of serum folic acid, vitamin B12, and intelligence scores in epileptic children. A group of 30 children with established diagnosis of idiopathic epilepsy for at least one year as well as another group of 30 nonepileptic healthy children as the control group were recruited for analysis. Cognitive performance was assessed by a battery of psychological tests that covers verbal and nonverbal intelligence. Serum B12 level was significantly lower in patients than the control group (264.17 ± 58.07, 450.55 ± 134.9, respectively). No significant difference was detected between patients and the control group regarding serum folic acid level. Verbal, performance, and total IQ were significantly lower in patients than the control group (83.2 ± 3.08 vs. 95.8 ± 6.22, 78.4 ± 10.68 vs. 91.3 ± 2.45, and 180.6 ± 6.58 vs. 93.5 ± 3.02, respectively). However, no significant correlation was detected in folic acid, vitamin B 12, and cognitive scores. Epileptic children were five times more at risk of having low IQ (verbal, performance, and total) < 85 than the control group (OR = 4.754, 95% CI 13.047-1031.316, p = .000). In conclusion, children with epilepsy might be at higher risk for cognitive dysfunction than normal children. No significant association was detected between cognitive performance and either folic acid or vitamin B12 in epileptic children receiving sodium valproate. Supplementation of those vitamins should be restricted to those with documented deficiency.
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Affiliation(s)
| | - Mones M Abu Shady
- Child Health Department, Medical Research Division, National Research Centre, Cairo, Egypt
| | - Ali Abd Elaziz
- Child Health Department, Medical Research Division, National Research Centre, Cairo, Egypt
| | - Esam Galal
- Child Health Department, Medical Research Division, National Research Centre, Cairo, Egypt
| | - Mohamed El-Sonbaty
- Child Health Department, Medical Research Division, National Research Centre, Cairo, Egypt
| | - Marwa M El-Sonbaty
- Child Health Department, Medical Research Division, National Research Centre, Cairo, Egypt
| | - Mahmoud M Masoud
- Medical Biochemistry Department, National Research Centre, Cairo, Egypt
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28
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Saard M, Pertens L, Sepp K, Kornet K, Kolk A. Attention profile in children with epilepsy compared to healthy children using computer-based ForamenRehab program. APPLIED NEUROPSYCHOLOGY-CHILD 2019; 10:266-275. [PMID: 31679405 DOI: 10.1080/21622965.2019.1681995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Attention is a key component in cognitive functioning. Attention impairment is often present in children with epilepsy, which is one of the most common neurological disorders in children and adolescents. Evaluating the attention profiles is important for describing the patients' cognitive weaknesses and planning individual-based cognitive neurorehabilitation. The aim of this study was to assess the attention profiles of children with epilepsy and compare the results to neurologically healthy children. Twenty-nine children with epilepsy aged 8-12 years and 19 neurologically healthy age-matched comparison group participated in assessments with baseline tasks of the Attention module of ForamenRehab computer-program. Four separate attention components were measured - focused, sustained, complex, and tracking - to reveal the most impaired aspects of attention. At the baseline level, patients showed impairments in different attention function components compared to comparison group. Children with epilepsy had significantly lower results in sustained, complex attention, and tracking components (p < 0.05). The patients had similar results with comparison group only in one component - focused attention. All children had quicker visual reaction times compared to their auditory reaction times. The results emphasize the need for attention rehabilitation in children with epilepsy and help to focus on specific components of attention in planning the intervention process.
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Affiliation(s)
- Marianne Saard
- Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Lisanna Pertens
- Department of Pediatrics and Neurology, Tartu University Hospital Children's Clinic, Tartu, Estonia
| | - Kirsi Sepp
- Faculty of Social Sciences, Institute of Education, University of Tartu, Tartu, Estonia
| | - Kai Kornet
- Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Anneli Kolk
- Faculty of Medicine, University of Tartu, Tartu, Estonia.,Department of Pediatrics and Neurology, Tartu University Hospital Children's Clinic, Tartu, Estonia
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29
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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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Paldino MJ, Golriz F, Zhang W, Chu ZD. Normalization enhances brain network features that predict individual intelligence in children with epilepsy. PLoS One 2019; 14:e0212901. [PMID: 30835738 PMCID: PMC6400436 DOI: 10.1371/journal.pone.0212901] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 02/12/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND PURPOSE Architecture of the cerebral network has been shown to associate with IQ in children with epilepsy. However, subject-level prediction on this basis, a crucial step toward harnessing network analyses for the benefit of children with epilepsy, has yet to be achieved. We compared two network normalization strategies in terms of their ability to optimize subject-level inferences on the relationship between brain network architecture and brain function. MATERIALS AND METHODS Patients with epilepsy and resting state fMRI were retrospectively identified. Brain network nodes were defined by anatomic parcellation, first in patient space (nodes defined for each patient) and again in template space (same nodes for all patients). Whole-brain weighted graphs were constructed according to pair-wise correlation of BOLD-signal time courses between nodes. The following metrics were then calculated: clustering coefficient, transitivity, modularity, path length, and global efficiency. Metrics computed on graphs in patient space were normalized to the same metric computed on a random network of identical size. A machine learning algorithm was used to predict patient IQ given access to only the network metrics. RESULTS Twenty-seven patients (8-18 years) comprised the final study group. All brain networks demonstrated expected small world properties. Accounting for intrinsic population heterogeneity had a significant effect on prediction accuracy. Specifically, transformation of all patients into a common standard space as well as normalization of metrics to those computed on a random network both substantially outperformed the use of non-normalized metrics. CONCLUSION Normalization contributed significantly to accurate subject-level prediction of cognitive function in children with epilepsy. These findings support the potential for quantitative network approaches to contribute clinically meaningful information in children with neurological disorders.
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Affiliation(s)
- Michael J. Paldino
- Department of Radiology, Texas Children’s Hospital, Houston, TX, United States of America
- * E-mail:
| | - Farahnaz Golriz
- Department of Radiology, Texas Children’s Hospital, Houston, TX, United States of America
| | - Wei Zhang
- Department of Radiology, Texas Children’s Hospital, Houston, TX, United States of America
| | - Zili D. Chu
- Department of Radiology, Texas Children’s Hospital, Houston, TX, United States of America
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MacAllister WS, Maiman M, Vasserman M, Fay-Mcclymont T, Brooks BL, Sherman EMS. The WISC-V in children and adolescents with epilepsy. Child Neuropsychol 2019; 25:992-1002. [PMID: 30676259 DOI: 10.1080/09297049.2019.1571181] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Despite its popularity in the neuropsychological evaluation of children, the utility of the Wechsler Intelligence Scale for Children - Fifth Edition (WISC-V) has not yet been investigated in children with epilepsy. Eighty clinically referred children and adolescents with epilepsy were administered the WISC-V as part of a comprehensive assessment and scores were compared to matched controls from the WISC-V standardization sample. T tests compared WISC-V indices and subtests between patients and controls and Chi-square analyses compared the rates of low scores. Correlational analyses assessed the relationships between epilepsy severity variables (e.g., age of onset, duration of epilepsy, number of antiepileptic drugs, seizure frequency). All WISC-V composites and subtests were significantly lower in patients versus controls and the rate of low scores was higher in patients than controls for all composites and subtests with the exception of Figure Weights. The Working Memory Index and Processing Speed Index were most sensitive to impairment, while the Verbal Comprehension Index and Fluid Reasoning Index were least sensitive. Of the epilepsy severity variables, age of seizure onset and number of antiepileptic drugs were strong predictors of deficits, whereas seizure frequency was the weakest predictor. Importantly, no significant differences were seen in children with right hemisphere epilepsy versus left on the five WISC-V composites, though a trend was seen towards a lower Visual-Spatial Index in those with right-sided focal seizures.
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Affiliation(s)
- William S MacAllister
- a Neuropsychology Service , Alberta Children's Hospital.,b Department of Paediatrics , University of Calgary.,c Alberta Children's Hospital Research Institute.,d Department of Neurology, Epilepsy Center , New York University School of Medicine
| | | | - Marsha Vasserman
- a Neuropsychology Service , Alberta Children's Hospital.,c Alberta Children's Hospital Research Institute.,f Department of Child Adolescent Psychiatry, Child Study Center , New York University School of Medicine
| | - Taryn Fay-Mcclymont
- a Neuropsychology Service , Alberta Children's Hospital.,b Department of Paediatrics , University of Calgary.,c Alberta Children's Hospital Research Institute
| | - Brian L Brooks
- a Neuropsychology Service , Alberta Children's Hospital.,b Department of Paediatrics , University of Calgary.,c Alberta Children's Hospital Research Institute
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Memory in children with epilepsy: Utility of the WRAML-2 in generalized and focal epilepsy syndromes. Epilepsy Behav 2018; 89:30-36. [PMID: 30384096 DOI: 10.1016/j.yebeh.2018.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/02/2018] [Accepted: 10/03/2018] [Indexed: 11/21/2022]
Abstract
The material-specific model for memory impairment predicts that verbal memory deficits are seen with left temporal seizures, and visual memory deficits are seen with right temporal seizures (Henkin et al., 2005). In pediatric epilepsy, seizure pathology has not always yielded the expected material-specific memory profiles. This study used the Wide Range Assessment of Memory and Learning-Second Edition (WRAML-2) to assess memory functioning among pediatric patients with epilepsy. The WRAML-2 was administered to 180 youth with epilepsy during their neuropsychological evaluations. Memory and recognition scores correlated significantly with epilepsy severity variables. There were no significant differences in verbal and visual memory and recognition index scores among patients with generalized epilepsy or among those with lateralized or localized electroencephalography (EEG) patterns and lesions on imaging. However, clinically meaningful verbal versus visual discrepancy scores were significantly related to lateralized abnormalities on EEG and magnetic resonance imaging (MRI) results. Most patients with right hemisphere pathology showed the expected material-specific visual memory deficits, while fewer than 15% of the left hemisphere cases showed the expected verbal memory deficits. Over one-third of those with identified left-sided pathology showed clinically significant deficits in visual memory. Findings are incongruent with the material-specific memory model and reflect the fact that early developmental neurological insults can lead to functional reorganization/crowding effects in children with left hemisphere epilepsy. On exploratory analyses, there were no significant differences in discrepancy scores among participants with left, right, and bilateral languages on Wada and functional MRI (fMRI). However, those with right and bilateral language dominance were more likely to show discrepancies that were incongruent with the material-specific model.
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Jiang LW, Qian RB, Fu XM, Zhang D, Peng N, Niu CS, Wang YH. Altered attention networks and DMN in refractory epilepsy: A resting-state functional and causal connectivity study. Epilepsy Behav 2018; 88:81-86. [PMID: 30243110 DOI: 10.1016/j.yebeh.2018.06.045] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 06/21/2018] [Accepted: 06/21/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE Epilepsy is considered a disorder of neural networks. Patients diagnosed with refractory epilepsy frequently experience attention impairments. Seizure activity in epilepsy may disturb brain networks and damage the brain function of attention. The aims of this study were to assess functional and causal connectivities of the attention networks and default mode network using resting-state functional magnetic resonance imaging (fMRI). METHOD Resting-state fMRI data were gathered from 19 patients with refractory epilepsy (mixed localization and aetiologies) and 21 healthy people. The fMRI data were analyzed by group independent component analysis (ICA) fMRI toolbox to extract dorsal attention network (DAN), ventral attention network (VAN), and default mode network (DMN). The components of the selected networks were compared between patients and healthy controls to explore the change in functional connectivity (FC). Granger causality analysis was performed by taking the aforementioned significant brain areas as regions of interest (ROIs) to calculate autoregression coefficients of each pair of ROIs. Comparisons were done to find the significantly different causal connectivity when FC was changed between patients and healthy controls. RESULTS In DAN, the FC values of the bilateral frontal eye field (FEF) and left intraparietal sulcus (IPS) were decreased. In VAN, the FC values of the double-side ventral prefrontal cortex (vPFC) and the temporoparietal junction (TPJ) were reduced. As for DMN, the FC values of the bilateral medial prefrontal cortices (mPFC) were decreased whereas those for the bilateral precuneus (PCUN) were increased. Granger causal connectivity values were correlated: causal influence was decreased significantly from the left IPS (in DAN) to the double side of the vPFC but remained the same for the right FEF (in DAN) to the right TPJ. The value was decreased from the left PCUN (in DMN) to the right TPJ and FEF, and the causal flow from the right PCUN to the right TPJ and bilateral vPFC was also significantly inhibited (p < 0.05). CONCLUSION Frequent seizures in patients with refractory epilepsy may damage the cortex and disturb DAN, VAN, and DMN, leading to functional and causal connectivity alteration. In addition, epileptic activity may disrupt network interactions and further influence information communication.
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Affiliation(s)
- Lu-Wei Jiang
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Anhui Provincial Hospital Affiliated to Anhui Medical University, 17 Lujiang Road, Hefei, Anhui Province 230001, China; School of Neurosurgery, Anhui Medical University, 81 Meishan Road, Hefei, Anhui Province 230032, China
| | - Ruo-Bing Qian
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Anhui Provincial Hospital Affiliated to Anhui Medical University, 17 Lujiang Road, Hefei, Anhui Province 230001, China; Anhui Provincial Institute of Stereotactic Neurosurgery, 9 Lujiang Road, Hefei, Anhui Province 230001, China.
| | - Xian-Ming Fu
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Anhui Provincial Hospital Affiliated to Anhui Medical University, 17 Lujiang Road, Hefei, Anhui Province 230001, China; Anhui Provincial Institute of Stereotactic Neurosurgery, 9 Lujiang Road, Hefei, Anhui Province 230001, China
| | - Dong Zhang
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Anhui Provincial Hospital Affiliated to Anhui Medical University, 17 Lujiang Road, Hefei, Anhui Province 230001, China
| | - Nan Peng
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Anhui Provincial Hospital Affiliated to Anhui Medical University, 17 Lujiang Road, Hefei, Anhui Province 230001, China
| | - Chao-Shi Niu
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Anhui Provincial Hospital Affiliated to Anhui Medical University, 17 Lujiang Road, Hefei, Anhui Province 230001, China; Anhui Provincial Institute of Stereotactic Neurosurgery, 9 Lujiang Road, Hefei, Anhui Province 230001, China
| | - Ye-Han Wang
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Anhui Provincial Hospital Affiliated to Anhui Medical University, 17 Lujiang Road, Hefei, Anhui Province 230001, China; Anhui Provincial Institute of Stereotactic Neurosurgery, 9 Lujiang Road, Hefei, Anhui Province 230001, China
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Morrison CE, MacAllister WS, Barr WB. Neuropsychology Within a Tertiary Care Epilepsy Center. Arch Clin Neuropsychol 2018; 33:354-364. [PMID: 29718083 DOI: 10.1093/arclin/acx134] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 12/04/2017] [Indexed: 11/12/2022] Open
Abstract
Epilepsy is a prevalent condition characterized by variations in its clinical presentation, etiology, and amenability to treatment. Through history, neuropsychologists have played a significant role in performing research studies on changes in language, memory, and executive functioning in patients with epilepsy, including those undergoing surgical treatment for medically refractory seizures. These studies provided a foundation for establishing neuropsychologists as critical members of interdisciplinary clinical teams specializing in evaluation and treatment of epilepsy. This article describes a number of elements of specialized neuropsychological practice that have evolved over the years within a tertiary care epilepsy center. Through diagnostic interview and objective testing, the neuropsychologist is able to provide a more complete and objective understanding of a patient's cognitive and behavioral functioning than what is obtained by other clinicians through brief office visits. While assessment of cognition, mood, and behavior is the most commonly provided service to patients with epilepsy from all age groups, there are many instances when neuropsychologists in surgical settings are called to perform more specialized procedures, including the intracarotid amytal (Wada) procedure, electrocortical stimulation mapping of language eloquent brain regions, and functional brain imaging procedures. While working as a neuropsychologist on an interdisciplinary epilepsy care team requires specialized knowledge and clinical training, it is extremely satisfying due to the diversity of the patient population and the particular challenges resulting from the often unique manner that cognition and behavior can be affected in patients with epilepsy across the lifespan.
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Affiliation(s)
- Chris E Morrison
- New York University School of Medicine, Department of Neurology, New York, NY, USA
| | | | - William B Barr
- New York University School of Medicine, Department of Neurology, New York, NY, USA
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Black CL, Shih SW, Sepeta LN, Facella-Ervolini JM, Isquith PK, Berl MM. Everyday executive function in focal onset pediatric epilepsy on the parent-report BRIEF2. Child Neuropsychol 2018; 25:22-43. [PMID: 29375005 DOI: 10.1080/09297049.2018.1424326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Executive function (EF) difficulties are a core neuropsychological feature of pediatric epilepsy, and parent-report measures of EF concerns are an important complement to task-based EF measures. The Behavior Rating Inventory of Executive Function (BRIEF) has shown sensitivity to parent-reported EF concerns in epilepsy and other pediatric populations. We compared profiles of parent-reported EF concerns using the BRIEF and its revision, the BRIEF2, in 117 pediatric patients with focal onset epilepsy to examine the clinical utility of the revised scale. We then compared BRIEF2 profiles between patients and age- and gender-matched healthy controls. Among patients, profiles on the BRIEF did not globally differ from the BRIEF2, and agreement was very good across scales. Patients and controls differed significantly on the BRIEF2, with patients showing higher EF difficulties reported by parents across most scales. High rates of clinical elevation among patients emerged on the Task Monitor, Plan/Organize, Working Memory, and Shift scales. Younger age of epilepsy onset, chronic epilepsy, and right hemisphere seizure focus were associated with higher parent-reported EF concerns. Findings suggest that the BRIEF2 demonstrates similar performance to the BRIEF among pediatric patients with focal onset epilepsy who are most at risk in the areas of task monitoring, working memory, planning and organization, and flexibility. These findings are informative when comparing literature across versions and provide additional insight into the nature of parent-reported EF difficulties among children with focal onset epilepsy.
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Affiliation(s)
- Chelsea L Black
- a Division of Pediatric Neuropsychology , Children's National Medical Center , Washington , DC , USA
| | - Sharon W Shih
- a Division of Pediatric Neuropsychology , Children's National Medical Center , Washington , DC , USA.,b Department of Psychology , Georgia State University , Atlanta , GA , USA
| | - Leigh N Sepeta
- a Division of Pediatric Neuropsychology , Children's National Medical Center , Washington , DC , USA
| | - Joy M Facella-Ervolini
- a Division of Pediatric Neuropsychology , Children's National Medical Center , Washington , DC , USA.,c Institute of Health Professions , Massachusetts General Hospital , Charlestown , MA , USA
| | - Peter K Isquith
- d Department of Psychiatry , Boston Children's Hospital, Harvard Medical School , Boston , MA , USA
| | - Madison M Berl
- a Division of Pediatric Neuropsychology , Children's National Medical Center , Washington , DC , USA
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van Iterson L, de Jong PF. Development of verbal short-term memory and working memory in children with epilepsy: Developmental delay and impact of time-related variables. A cross-sectional study. Epilepsy Behav 2018; 78:166-174. [PMID: 29128471 DOI: 10.1016/j.yebeh.2017.10.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/12/2017] [Accepted: 10/12/2017] [Indexed: 10/18/2022]
Abstract
While short-term memory (STM) and working memory (WM) are understood as being crucial for learning, and children with epilepsy often experience learning difficulties, little is known about the age-related development of memory span tasks in children with epilepsy. Short-term memory and WM, operationalized as digit span forwards (DSF) or digit span backwards (DSB), respectively, were studied. Participants were 314 children with epilepsy and 327 typically developing children in ages between 5 and 15years and full scale intelligence quotient (FS-IQ)≥75. Cross-sectional analyses of the data were done with analyses of variance and analyses of covariance ((M)ANCOVAs) and generalized linear analyses. The analyses revealed that STM problems in epilepsy were mediated by age-related gains in WM as well as by differences in IQ. Working memory developed at a quick pace in the younger children, the pace slowed down to some extent in the later primary school years and resumed again later on. Working memory problems prevailed in epilepsy, independent of IQ and development of STM. Timing of the epilepsy in terms of age at onset and duration determined memory development. The youngest children with epilepsy showed age-appropriate development in STM but were the most vulnerable in terms of WM development. Later in the course of the epilepsy, the WM problems of the young children attenuated. In later onset epilepsy, WM problems were smaller but persisted over time.
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Affiliation(s)
- Loretta van Iterson
- SEIN, Epilepsy Institute in the Netherlands Foundation, Department of Psychology, The Netherlands; School De Waterlelie, The Netherlands.
| | - Peter F de Jong
- Research Institute of Child Development and Education, University of Amsterdam, The Netherlands
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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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Paldino MJ, Zhang W, Chu ZD, Golriz F. Metrics of brain network architecture capture the impact of disease in children with epilepsy. NEUROIMAGE-CLINICAL 2016; 13:201-208. [PMID: 28003958 PMCID: PMC5157798 DOI: 10.1016/j.nicl.2016.12.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 11/04/2016] [Accepted: 12/07/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVE Epilepsy is associated with alterations in the structural framework of the cerebral network. The aim of this study was to measure the potential of global metrics of network architecture derived from resting state functional MRI to capture the impact of epilepsy on the developing brain. METHODS Pediatric patients were retrospectively identified with: 1. Focal epilepsy; 2. Brain MRI at 3 Tesla, including resting state functional MRI; 3. Full scale IQ measured by a pediatric neuropsychologist. The cerebral cortex was parcellated into approximately 700 gray matter network nodes. The strength of a connection between two nodes was defined as the correlation between their resting BOLD signal time series. The following global network metrics were then calculated: clustering coefficient, transitivity, modularity, path length, and global efficiency. Epilepsy duration was used as an index for the cumulative impact of epilepsy on the brain. RESULTS 45 patients met criteria (age: 4-19 years). After accounting for age of epilepsy onset, epilepsy duration was inversely related to IQ (p: 0.01). Epilepsy duration predicted by a machine learning algorithm on the basis of the five global network metrics was highly correlated with actual epilepsy duration (r: 0.95; p: 0.0001). Specifically, modularity and to a lesser extent path length and global efficiency were independently associated with epilepsy duration. CONCLUSIONS We observed that a machine learning algorithm accurately predicted epilepsy duration based on global metrics of network architecture derived from resting state fMRI. These findings suggest that network metrics have the potential to form the basis for statistical models that translate quantitative imaging data into patient-level markers of cognitive deterioration.
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Affiliation(s)
- Michael J. Paldino
- Department of Radiology, Texas Children's Hospital, 6621 Fannin St, Houston, TX 77030, United States
- Corresponding author at: Texas Children's Hospital, 6621 Fannin St., Houston, TX 77030, United States.Texas Children's Hospital6621 Fannin St.HoustonTX77030United States
| | - Wei Zhang
- Outcomes and Impact Service, Texas Children's Hospital, 6621 Fannin St., Houston, TX 77030, United States
| | - Zili D. Chu
- Department of Radiology, Texas Children's Hospital, 6621 Fannin St, Houston, TX 77030, United States
| | - Farahnaz Golriz
- Department of Radiology, Texas Children's Hospital, 6621 Fannin St, Houston, TX 77030, United States
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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. Predictors of language skills in the long term after pediatric epilepsy surgery. Epilepsy Behav 2016; 63:1-8. [PMID: 27538014 DOI: 10.1016/j.yebeh.2016.07.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 07/18/2016] [Accepted: 07/24/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate language skills in a heterogeneous cohort of patients who underwent or were considered for epilepsy surgery in childhood 4-11years earlier. 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, of whom 61 underwent surgery. They completed standardized tests of picture naming, vocabulary, letter fluency, semantic fluency and intelligence at baseline and, on average, 7years later. RESULTS Among all patient groups, scores across language tasks were similar at baseline and follow-up. Language skills were largely independent of surgical status but were associated with seizure control. Seizure freedom and/or a longer proportion of life without seizures were associated with higher scores across all language tasks at follow-up. However, few patients showed meaningful improvements or deterioration at the individual level. Older age at epilepsy onset, higher IQ, and higher baseline scores were associated with higher follow-up scores on all language tasks. Localization and lateralization of epileptogenic foci and language lateralization were associated with higher scores on some language tasks at follow-up. Most of these variables were also predictive of change in scores over time on some of the language tasks. SIGNIFICANCE Language skills largely remained similar at baseline and follow-up. Seizure freedom was associated with a modest advantage at the group level, and no significant change at the individual level, suggesting an abnormal neural substrate or epileptic activity prior to seizure control may hinder the long-term capacity for improvement, even in the absence of seizure activity.
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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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Whitman L, Scharaga EA, Blackmon K, Wiener J, Bender HA, Weiner HL, MacAllister WS. Material specificity of memory deficits in children with temporal tumors and seizures: A case series. APPLIED NEUROPSYCHOLOGY-CHILD 2016; 6:335-344. [PMID: 27366934 DOI: 10.1080/21622965.2016.1197126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In adults, left temporal lobe pathology is typically associated with verbal memory deficits, whereas right temporal lobe pathology is thought to produce visual memory deficits in right-handed individuals. However, in children and adolescents with temporal lobe pathology, conclusions regarding material specificity of memory deficits remain unclear. The goal of the present case series is to examine the profile of verbal and visual memory impairment in children with temporal lobe tumors. Three patients with identified right temporal tumors and three patients with left temporal tumors are included. The Wide Range Assessment of Memory and Learning-Second Edition (WRAML-2) was administered as part of a larger neuropsychological battery. As anticipated, participants with right temporal lesions showed impaired visual memory relative to intact verbal memory. Interestingly, although the discrepancies between verbal and visual indices were less extreme, those with left temporal lesions showed a similar memory profile. These seemingly counterintuitive findings among left temporal tumor patients likely reflect less hemispheric specialization in children in comparison to adults and the fact that early developmental lesions in the left hemisphere may lead to functional reorganization of language-based skills.
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Affiliation(s)
| | - Elyssa A Scharaga
- b Ferkauf Graduate School of Psychology at Yeshiva University , New York , New York
| | - Karen Blackmon
- c Department of Neurology , New York University School of Medicine , New York , New York
| | - Jennifer Wiener
- c Department of Neurology , New York University School of Medicine , New York , New York
| | - Heidi Allison Bender
- d Mount Sinai Center for Cognitive Health, Icahn School of Medicine at Mount Sinai , New York , New York
| | - Howard L Weiner
- e Department of Neurosurgery , Baylor College of Medicine , Houston , Texas
| | - William S MacAllister
- f NYU Comprehensive Epilepsy Center, New York University School of Medicine , New York , New York
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Breuillard D, Leunen D, Chemaly N, Auclair L, Pinard JM, Kaminska A, Desguerre I, Ouss L, Nabbout R. Autism spectrum disorder phenotype and intellectual disability in females with epilepsy and PCDH-19 mutations. Epilepsy Behav 2016; 60:75-80. [PMID: 27179713 DOI: 10.1016/j.yebeh.2016.04.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/01/2016] [Accepted: 04/03/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Autism features and various degrees of cognitive deficit are reported in patients with PCDH-19 mutations and epilepsy. Autism spectrum disorder (ASD) and, often, cognitive profile are usually assessed clinically. We studied autism phenotype and cognitive outcome in a series of patients using standardized tools for development and ASD. We aimed to describe the phenotype of ASD in this series and to understand whether ASD is strictly linked to intellectual disability (ID) or is present as a comorbidity. METHODS Eight females aged 5 to 17years old with PCDH-19 mutations and epilepsy were recruited. For ASD diagnosis, the Autism Diagnostic Interview - Revised (ADI-R) and the Autism Diagnosis Observation Schedule (ADOS) were administered. Patients underwent a neuropsychological examination with tests measuring global intellectual efficiency (WPPSI-III and WISC-IV), language, and executive and social cognition abilities. Parental adaptive behavioral questionnaires were also obtained (VABS, CBCL, and BRIEF). RESULTS Six out of eight patients presented with ASD and ID. Two patients had neither ASD nor ID, and both had the latest age of onset for their epilepsy. All cognitive functions were deficient, but theory-of-mind abilities compared to other cognitive features were even impaired. Features of ASD lacked major repetitive and stereotyped behaviors and show some differences with the classical ASD features related to ID. CONCLUSION Our results show a large spectrum of ID and a very high rate of ASD in patients with epilepsy and PCDH-19 mutations. Autism spectrum disorder seems to be a genuine comorbidity, more than a consequence of ID. It highlights the importance of standardized psychiatric and cognitive evaluation in order to establish a tailored rehabilitation program.
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Affiliation(s)
- Delphine Breuillard
- Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Paris Descartes University, Necker Enfants Malades Hospital, Paris, France; INSERM U1129, Paris, France
| | - Dorothée Leunen
- Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Paris Descartes University, Necker Enfants Malades Hospital, Paris, France
| | - Nicole Chemaly
- Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Paris Descartes University, Necker Enfants Malades Hospital, Paris, France; INSERM U1129, Paris, France
| | - Laurent Auclair
- INSERM U1129, Paris, France; Paris Descartes University, France
| | - Jean Marc Pinard
- Department of Pediatric Neurology, Raymond Poincaré Hospital, Paris, France
| | - Anna Kaminska
- Clinical Electrophysiology Unit, Necker Enfants Malades Hospital, Paris, France
| | - Isabelle Desguerre
- INSERM U1129, Paris, France; Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Paris Descartes University, Necker Enfants Malades Hospital, Paris, France
| | - Lisa Ouss
- Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Paris Descartes University, Necker Enfants Malades Hospital, Paris, France
| | - Rima Nabbout
- Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Paris Descartes University, Necker Enfants Malades Hospital, Paris, France; INSERM U1129, Paris, France; Paris Descartes University, France.
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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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Neuropsychological impairment in childhood absence epilepsy: Review of the literature. J Neurol Sci 2015; 359:59-66. [DOI: 10.1016/j.jns.2015.10.035] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 10/14/2015] [Accepted: 10/15/2015] [Indexed: 11/22/2022]
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Sajobi TT, Jette N, Zhang Y, Patten SB, Fiest KM, Engbers JDT, Lowerison MW, Wiebe S. Determinants of disease severity in adults with epilepsy: Results from the Neurological Diseases and Depression Study. Epilepsy Behav 2015; 51:170-5. [PMID: 26287469 DOI: 10.1016/j.yebeh.2015.07.036] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 07/27/2015] [Accepted: 07/28/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Epilepsy severity has been recognized as a significant predictor of health-related quality of life in patients with epilepsy. However, clinical markers of epilepsy severity such as seizure frequency often fail to capture important aspects of the disease. This study investigates the factors associated with patient-reported severity of epilepsy, assessed by the Global Assessment of Severity of Epilepsy (GASE) scale in adults with epilepsy. METHODS Data from a cohort of 250 patients consecutively enrolled in the Neurological Diseases and Depression Study (NEEDS) were used to assess the determinants of epilepsy severity as measured by the GASE scale. Multiple linear regression analyses were used to examine the mediation effect of clinical and sociodemographic characteristics on patients' ratings on the GASE scale. RESULTS The mean age of the study participants was 39.8 (SD=14.9) years, of which 44.4% were male. About 66.8% of the participants reported "not at all severe" or "a little severe" epilepsy, while 0.4% reported "extremely severe" epilepsy. One-year seizure freedom, number of antiseizure medications, medication side effects, depression, anxiety, and seizure-related disability were identified as significant determinants of patients' ratings of epilepsy severity. Seizure-related disability mediated the effects of 1-year seizure freedom, number of antiseizure medications, and medication side effects on epilepsy severity. CONCLUSION Overall, patients with epilepsy who reported higher GASE scores were less likely to achieve 1-year seizure freedom and more likely to be on more antiseizure medications, experience more side effects from medication, endorse more depression and anxiety symptoms, and have increased self-reported seizure-related disability. The identified determinants of global, self-rated epilepsy severity can aid the design of appropriate interventions and support services for patients with severe epilepsy.
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Affiliation(s)
- Tolulope T Sajobi
- Department of Community Health Sciences & O'Brien Institute of Public Health, University of Calgary, Calgary, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Canada; Clinical Research Unit, University of Calgary, Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.
| | - Nathalie Jette
- Department of Community Health Sciences & O'Brien Institute of Public Health, University of Calgary, Calgary, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Yukun Zhang
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Scott B Patten
- Department of Community Health Sciences & O'Brien Institute of Public Health, University of Calgary, Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Canada; Department of Psychiatry, University of Calgary, Calgary, Canada
| | - Kirsten M Fiest
- Department of Community Health Sciences & O'Brien Institute of Public Health, University of Calgary, Calgary, Canada; Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | | | | | - Samuel Wiebe
- Department of Community Health Sciences & O'Brien Institute of Public Health, University of Calgary, Calgary, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Canada; Clinical Research Unit, University of Calgary, Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
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Zilli T, Zanini S, Conte S, Borgatti R, Urgesi C. Neuropsychological assessment of children with epilepsy and average intelligence using NEPSY II. J Clin Exp Neuropsychol 2015; 37:1036-51. [DOI: 10.1080/13803395.2015.1076380] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Puka K, Tavares TP, Smith ML. Development of intelligence 4 to 11 years after paediatric epilepsy surgery. J Neuropsychol 2015; 11:161-173. [PMID: 26184054 DOI: 10.1111/jnp.12081] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 06/01/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Little is known about the long-term intellectual outcomes following paediatric epilepsy surgery. Change is not likely within the first 2 years following surgery, and the few studies of longer term outcomes have yielded inconsistent results. This study addressed this issue by examining a large group of surgical and non-surgical patients at baseline and after 4-11 years. METHODS Participants were 97 patients (mean age 20.08 [SD: 4.44] years) with childhood-onset intractable epilepsy; 61 had undergone resective epilepsy surgery. Participants underwent neuropsychological testing with the age-appropriate Wechsler Intelligence Scale, generating Full Scale, Performance and Verbal IQs, and Working Memory and Processing Speed indices. RESULTS In total 54% of the surgical and 39% of the non-surgical patients were seizure free in the preceding 12 months (p > .05); however, surgical patients did achieve seizure freedom sooner and used fewer medications at follow-up. Surgical status was not associated with any cognitive domain. However, with the exception of processing speed, significant seizure status × time interaction effects were evident and seizure-free patients had higher scores at follow-up. Regression analyses additionally showed that low pre-operative scores were predictive of improvement overtime, whereas high pre-operative scores were predictive of high scores at follow-up. INTERPRETATION The results show similar intellectual outcomes for surgical and non-surgical paediatric patients. Four to 11 years after paediatric epilepsy surgery, seizure freedom, whether attained through epilepsy surgery or other means, was found to be associated with intellectual improvements. Seizure status and baseline scores were the most consistent predictors.
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Affiliation(s)
- Klajdi Puka
- Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Tamara P Tavares
- Graduate Program in Neuroscience, University of Western Ontario, London, ON, Canada.,The Brain and Mind Institute, University of Western Ontario, London, ON, Canada
| | - Mary Lou Smith
- Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychology, University of Toronto Mississauga, Canada.,Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, ON, Canada
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Tsai ML, Hung KL, Tsan YY, Tung WTH. Long-term neurocognitive outcome and auditory event-related potentials after complex febrile seizures in children. Epilepsy Behav 2015; 47:55-60. [PMID: 26043164 DOI: 10.1016/j.yebeh.2015.04.067] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 04/28/2015] [Accepted: 04/29/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Whether prolonged or complex febrile seizures (FS) produce long-term injury to the hippocampus is a critical question concerning the neurocognitive outcome of these seizures. Long-term event-related evoked potential (ERP) recording from the scalp is a noninvasive technique reflecting the sensory and cognitive processes associated with attention tasks. This study aimed to investigate the long-term outcome of neurocognitive and attention functions and evaluated auditory event-related potentials in children who have experienced complex FS in comparison with other types of FS. METHODS One hundred and forty-seven children aged more than 6 years who had experienced complex FS, simple single FS, simple recurrent FS, or afebrile seizures (AFS) after FS and age-matched healthy controls were enrolled. Patients were evaluated with Wechsler Intelligence Scale for Children (WISC; Chinese WISC-IV) scores, behavior test scores (Chinese version of Conners' continuous performance test, CPT II V.5), and behavior rating scales. Auditory ERPs were recorded in each patient. RESULTS Patients who had experienced complex FS exhibited significantly lower full-scale intelligence quotient (FSIQ), perceptual reasoning index, and working memory index scores than did the control group but did not show significant differences in CPT scores, behavior rating scales, or ERP latencies and amplitude compared with the other groups with FS. We found a significant decrease in the FSIQ and four indices of the WISC-IV, higher behavior rating scales, a trend of increased CPT II scores, and significantly delayed P300 latency and reduced P300 amplitude in the patients with AFS after FS. CONCLUSION We conclude that there is an effect on cognitive function in children who have experienced complex FS and patients who developed AFS after FS. The results indicated that the WISC-IV is more sensitive in detecting cognitive abnormality than ERP. Cognition impairment, including perceptual reasoning and working memory defects, was identified in patients with prolonged, multiple, or focal FS. These results may have implications for the pathogenesis of complex FS. Further comprehensive psychological evaluation and educational programs are suggested.
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Affiliation(s)
- Min-Lan Tsai
- Department of Pediatrics, Cheng-Hsin General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Kun-Long Hung
- Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan; School of Medicine, Fu-Jen Catholic University, Taipei, Taiwan
| | - Ying-Ying Tsan
- Department of Psychiatry, Cathay General Hospital, Taipei, Taiwan
| | - William Tao-Hsin Tung
- School of Medicine, Fu-Jen Catholic University, Taipei, Taiwan; Department of Medical Research and Education, Cheng-Hsin General Hospital, Taipei, Taiwan
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Reilly C, Atkinson P, Das KB, Chin RFM, Aylett SE, Burch V, Gillberg C, Scott RC, Neville BGR. Cognition in school-aged children with “active” epilepsy: A population-based study. J Clin Exp Neuropsychol 2015; 37:429-38. [DOI: 10.1080/13803395.2015.1024103] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mazur-Mosiewicz A, Carlson HL, Hartwick C, Dykeman J, Lenders T, Brooks BL, Wiebe S. Effectiveness of cognitive rehabilitation following epilepsy surgery: Current state of knowledge. Epilepsia 2015; 56:735-44. [DOI: 10.1111/epi.12963] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Anya Mazur-Mosiewicz
- The Chicago School of Professional Psychology; Chicago Illinois U.S.A
- Alberta Children's Hospital; Calgary Alberta Canada
| | - Helen L. Carlson
- Alberta Children's Hospital; Calgary Alberta Canada
- Alberta Children's Hospital Research Institute; Calgary Alberta Canada
| | | | | | | | - Brian L. Brooks
- Alberta Children's Hospital; Calgary Alberta Canada
- Alberta Children's Hospital Research Institute; Calgary Alberta Canada
- University of Calgary; Calgary Alberta Canada
| | - Samuel Wiebe
- Foothills Medical Centre; Calgary Alberta Canada
- University of Calgary; Calgary Alberta Canada
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