Abstracts

Rationale: Abnormalities in cognition, poor academic performances, and psychiatric disorders, collectively referred to as neurobehavioral comorbidities, are more prevalent in children with epilepsy, and are often present at time of diagnosis. Data regarding the course of these comorbidities during the early phase of epilepsy are limited. The current study describes the first year of our systematic, multidisciplinary evaluation protocol for new onset pediatric epilepsy (NOPE). Clinic logistics, evaluation findings, and epilepsy variables are provided. Information from the NOPE clinic has facilitated prompt assessment and treatment for children. Methods: NOPE clinic includes neuropsychological screening, pediatric psychology screening, and epilepsy education with nurse practitioner. Patients are referred by pediatric epileptologists. Inclusion criteria for referral: age 3 - 18, first diagnosis of epilepsy, first exposure to antiepileptic drug(s), ability to participate in neuropsychological testing. Most patients are scheduled within 6 weeks of diagnosis. Records from the first 25 consecutive patients were reviewed. Results: There were 12 females, 13 males, age 3-12 years (median 6.6 years). None of the children had history of head trauma or neurological disorder. All had MRI, 5 abnormal. EEG was abnormal in 23. There were focal seizures in 14, primary generalized seizures in 11. 5 had previous febrile seizures. 9 had 1 observed seizure, 6 had 2-5 seizures, 10 had >20 seizures, and 4 had an episode of status epilepticus prior to first visit. All but two children were seen in NOPE clinic within 3 months of diagnosis, 72% within 6 weeks. 23 started on AED prior to clinic visit. Mean FSIQ: 105 (SD=14), VCI: 104 (SD=13), PRI: 106 (SD=14), WMI: 99 (SD=12), PSI: 104 (SD=14). 19/25 demonstrated one or more indication(s) of neurobehavioral comorbidity: 11 showed early symptoms (sub-threshold for diagnosis), and 8 met criteria for diagnosis. Of these 19, 6 had primarily psychological (emotional/behavioral) symptoms, 6 had primarily neuropsychological (attention, cognition, learning) symptoms, and 7 had symptoms in both categories. Based on the information from the NOPE Clinic, academic accommodations were implemented for 5 patients, and outpatient psychotherapy was recommended for 10 patients. Conclusions: This study describes data for pediatric patients seen during the first year of Minnesota Epilepsy Group's multidisciplinary NOPE clinic. Despite normal intelligence, this group shows higher than normal incidence of and/or risk factors for neurobehavioral comorbidities. Early identification and intervention was made possible by coordinating a team of pediatric epileptologists, neuropsychologists, pediatric psychologists, and nurse practitioners, with combined expertise in the neurobehavioral comorbidities associated with childhood epilepsy. In future studies we will describe one-year follow-up data on these patients to help clarify understanding of relationships among epilepsy variables, initial evaluation findings, and early course following new onset pediatric epilepsy.