Abstracts

RATIONALE: Children with epilepsy without associated neurologic disorders generally do less well than classmates in school. Impaired attention/concentration has been implicated as contributory to their academic difficulties and has been variably ascribed to different factors that include seizure type, drug effects, comorbid attention deficits, and psychosocial adjustment. In order to determine the nature of attentional difficulties of children with epilepsy, their performance on multiple tests of attention was compared to the performance of normal children and to those with diagnosed attention deficit hyperactivity disorder (ADHD).
METHODS: Seventy children (6 to 12 years of age) seen for research or clinical purposes were administered tests of immediate attention (auditory and visual span) and sustained attention (Conners[ssquote] CPT) as part of neuropsychological assessment. Their parents completed the ADHD Behavior Checklist and Child Behavior Checklist (CBCL). Clinical groups consisted of 20 children with ADHD and 30 children with medically controlled seizures (15 partial, 15 primary generalized). Focus for partial seizures was frontal, temporal, or occipital. There were 20 normal controls. Groups did not differ in age, gender, or intellectual functioning. Children with ADHD were unmedicated at the time of assessment. Children with seizures differed in number (focal [gt] generalized) and type of AED (primarily CBZ vs. VPA).
RESULTS: Data were analyzed by single factor ANOVA or repeated measures ANOVA. Significant differences were found between clinical groups and controls for CBCL School Competence (.05), Social Problems (.0001), and Attention (.0001). DSM-IV symptoms of inattention varied in frequency (ADHD[gt]Epilepsy[gt]Controls), as did performance for CPT accuracy and consistency (Controls [gt] ADHD/Epilepsy). Children with epilepsy did not differ from children with ADHD for sustained attention. No differences were found for immeidate attention, but children with generalized seizures did poorer than those with partial seizures on the CPT and were rated as less competent by parents (.04). Children with generalized seizures also showed slower processing speed (.01) than the other groups.
CONCLUSIONS: Children with medically controlled epielspy have significant problems with school competence and sustained attention but have fewer symptoms of inattention than children with ADHD. Children with generalized seizures have greater attentional difficulties than do children with partial seizures, as well as slower processing speed. The specific causes/neural substrates of the attention problems of children with epilepsy (partial vs. generalized) requires further study, as does the difference in attention problems between children with epilepsy and ADHD. Polytherapy may be contributory to the attention problems in epilepsy but drug type likely is not. At the end of reading this poster the participant should be able to discuss the attention problems of children with epilepsy and the relationship of these problems to lower academic achievement.