Abstracts

Rationale: In order to understand the course and impact of epilepsy in childhood, we prospectively examined cognition, academic achievement and behavioral problems over a 22 month interval in children with epilepsy and healthy controls. We hypothesized the following: 1) children with epilepsy would underperform compared to controls at baseline and follow-up; 2) children with epilepsy would be less likely to demonstrate improved performance over time compared to controls; and 3) seizure related variables would be associated with poorer performance over time. Methods: The study included 40 children with complex partial seizures, 25 children with absence seizures, and 29 healthy children aged 6.1-14.7 years. The mean seizure duration was 6.33 years and age of onset was 5.99 years. At baseline and follow-up all children participated in a cognitive evaluation which included the following: Wechsler Intelligence Scale for Children-III (WISC-III), Wechsler Individual Achievement Test (WIAT), and Test of Language Development (TOLD-2). Children completed two self report measures: Child Depression Inventory (CDI) and Multidimensional Anxiety Scale for Children (MASC). Children and parents participated in a structured interview using the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS), and parents completed the Child Behavior Checklist (CBCL). Results: At baseline there were significant differences between children with epilepsy and controls. These differences were apparent in full scale IQ (96.05 v. 114.10), verbal (VIQ) (95.85 v. 115.72), performance (PIQ) (94.75 v. 109.97) and spoken language quotient (TOLD2)(95.24 v. 108.86). Academic achievement (composite score)in children with epilepsy was significantly below controls (104.71 v.114.69). Children with epilepsy had higher rates of psychopathology compared to controls (47.69 v. 3.57) and more borderline/clinically elevated scores on the CBCL (total composite, 31.25 v. 6.90) and the CDI (31.25 v. 3.57). At follow-up differences remained stable across the evaluations with one exception. On the MASC, children with epilepsy had more borderline/clinically elevated scores compared to controls (54.39 v. 28.57). We also examined children with epilepsy who demonstrated a 1.0 standard deviation decline over time. Academic achievement had the largest number of children whose performance declined in the interval. Using the WIAT composite score to model this decline, age and gender were significant predictors. Females were 3.58 times (95% CI: 1.0-12.9) more likely to decline(p = .05). For every year younger in age, children with epilepsy were 1.37 times (95%CI: 1.0-1.8)more likely to demonstrate declines (p=.05). Conclusions: As previous studies reported, seizure related variables were not associated with poorer performance over time. However, there was an increased vulnerability for academic decline over time in young children and girls with epilepsy who have average IQ scores. It is important to evaluate children prospectively to monitor their academic progress and identify problems that may require remediation.