Abstracts

RATIONALE: The aim of this study was to evaluate cognitive and neuropsychological functioning in children with epilepsy only, (i.e. without additional neuroimpairments or significant learning disabilities) and to evaluate the possible role of various epilepsy related factors in this respect.
METHODS: The study group consisted of of 23 children aged 7-15 years with idiopathic or cryptogenic, generalized or localization-related epilepsy. All children attended mainstream school at age-appropriate level and did not have any other neurological diagnoses or therapies except AED treatment. Medical data including demographic factors, duration of epilepsy, seizure type, seizure control, EEG, MRI, current AEDs, and most recent AED levels were analyzed through medical charts and records. All children attended two test sessions for general cognitive abilities (WISC-R) and neuropsychological functioning (developmental neuropsychological assesment battery, NEPSY, Korkman et al. 1998).
RESULTS: The study group consisted of 6 boys and 17 girls with mean age of 12.5 years and mean duration of epilepsy 4.1 years at time of the study. Type of epilepsy was localization-related in 17 children and generalized in 6. Seizure control was good (over 1 year remission) in 11 children and partial (seizures randomly but less than one/month) in 12.
The general cognitive performance (WISC-R) of the study group did not differ from normative data (full scale IQ 102, verbal IQ 100, performance IQ 104). The study group performed significantly (p[lt]0.05) worse compared to norms only in one WISC-R subtest (coding) and significantly better in three subtests (arithmetic, picture arrangement and block design). Neuropsychological sumvariables showed significantly worse performance in the study group in visual short-term memory but significantly better performance in design copying, picture recognition and sentence repetition.
Children with localization-related epilepsy performed significantly worse in narrative memory and list learning and the partial control group in two WISC-R subtests (digit span and coding) and in three neuropsychological subtests (auditive attention, list learning and picture memorizing). Polytherapy group performed significantly worse in verbal fluency. Demographic factors, age at onset of epilepsy, duration of epilepsy, AED currently in use or recent AED serum levels did not show any statistical correlation with the neuropsychological or cognitive test results.
CONCLUSIONS: Some spesific neuropsychological problems do exist in school aged children with normal general cognitive ability and epilepsy. In detailed neuropsychological assesment they seem to perform significantly worse e.g. in visual short-term memory. The problems in memory, learning and attention seem to be most prevalent in children with only partial seizure control but also localization-related epilepsy and/or polytherapy seem to increase this risk. Seizures, EEG abnormalities and AED treatment have an complex - possibly cumulative - effect on cognitive performance and neuropsychological functioning.
Ref:
Korkman M, Kirk U, Kemp S. NEPSY - A Developmental Neuropsychological Assessment. Manual. San Antonio, USA: The Psychological Corporation, 1998.
[Supported by: A. & L. Ylppö Foundation]