Abstracts

Rationale: Adaptive function is an important dimension of development that has a significant effect on quality of life for children with epilepsy and their caregivers. Previous research has indicated that age of onset is an important predictor variable, and that deficits in adaptive function appear early in association with seizures due to the disruption of normal function during critical periods for acquisition of social skills and developing independence in basic activities of daily living. However, the role of seizure type and severity has not been well described. In this study, we compare adaptive function in children with well documented seizures of focal or generalized onset and investigate the role of related clinical variables on adaptive behavior. Methods: The sample included 74 consecutive admissions for seizure monitoring and surgical evaluation (M=11.09 years, 60% treated with AED polytherapy). There were 35 children with localized seizure onset, and 39 with generalized onset, as documented by continuous EEG video recording of typical ictal events. Of these children, 28 focal and 28 generalized also had adaptive behavior assessment with the Adaptive Behavior Assessment Scale (ABAS-II) as part of comprehensive neuropsychological examination, and are included in this analysis. The mean age of generalized onset was 3.49 years and the mean age of focal onset was 6.42 years. 50% of the sample had at least one daily seizure, 30% had at least one seizure weekly, and 20% had seizures less than once monthly. Results: Linear regression was performed, with epilepsy (age of onset, seizure status within previous year) and treatment variables (number of AEDs) as predictors of the Global Adaptive Composite on the ABAS-II. Seizure variables accounted for 19% of the variance (p=.006) on the Adaptive Skills Composite. Age of onset (p=.001) was the best single predictor. Children with generalized onset demonstrated greater overall adaptive behavior deficits, F (2, 54) = 6.416, p=.014. A two way ANOVA revealed a significant interaction between the effects of daily seizures and epilepsy classification on adaptive behavior, F (1, 50) = 5.577, p=.022.Conclusions: Children with both focal and generalized seizure onset have overall adaptive behavior deficits. Previous research (Berg et al., 2004) suggested that adaptive behavior deficits are primarily found in children with epileptic encephalopathies and that the majority of children with seizure onset during infancy or childhood develop normal adaptive behavior skills. Our results suggest that adaptive behavior deficits are more prevalent. Although generalized seizures are associated with greater deficits, focal onset seizures also interfere with development of adaptive behavior in conceptual and practical domains. These results support the implementation of targeted interventions for adaptive behavior during initial diagnosis.