Abstracts

Rationale: Attention and memory problems are common in individuals with epilepsy, and may be particularly devastating in children, for whom academic success requires ongoing acquisition and integration of new information. In adults, lateralization of seizure focus impacts the type of memory affected. Left-sided lesions primarily impact verbal memory, whereas right-sided lesions primarily impact visual memory. However, this relationship is less clear in children. In order to investigate whether attention may play a role in memory problems, and to understand the role of attention in the relationship between laterality and the recalled material’s modality, this study examined the relationship between parent-reported attention problems and material-specific memory in children with medically intractable, lateralized epilepsy. Methods: Participants were 65 children (ages 5 to 18), with IQs 70 or above. Measures included immediate and delayed visual and verbal memory composites (from the Children’s Memory Scale or Wechsler Memory Scale-3), and parent-rated attention (Child Behavior Checklist attention subscale). The association between attention and the memory composites were quantified separately for the left-lateralized (n=25) and right-lateralized (n=40) groups using Pearson correlation coefficients. Group comparisons employed t-tests, and evaluation of proportion below average used chi-square. Results: In both groups, the proportion who showed below average performance was greater than would be expected based on the normal population in the areas of verbal immediate memory, verbal delayed memory, and visual immediate memory (p<.05), and attention (p<.001), though not visual delayed memory. Lateralization of seizure focus was not associated with significant differences in visual memory, verbal memory or attention problems. However, laterality of the seizure focus had an impact on the correlation between attention and material-specific memory. In children with left-lateralized seizures, attention was significantly negatively correlated with visual delayed memory (r= -.450, p<.05), but not verbal memory. In contrast, children with right-lateralized seizures demonstrated a significant negative correlation between attention problems and verbal delayed memory (r=-.331, p<.05). Conclusions: The correlation between attention and memory differed with laterality of seizure focus. Some of the cognitive and academic problems experienced by children with epilepsy may be associated with specific epilepsy-related factors (lateralization of seizure focus), while other difficulties may be secondarily impacted by attention. The results provide initial support for the utility of interventions designed to improve attention in children with epilepsy, which can secondarily improve memory. However, improvement may be obtained in only certain aspects of memory which may vary with the laterality of the seizure focus. Verbal memory in individuals with a left-lateralized seizure focus and visual memory in individuals with a right-lateralized seizure focus may be less amenable to improvement through remediation of attention.