Abstracts

Some children with epilepsy experience slowed neuropsychological (NP) development. Risk factors include structural brain lesions, seizure severity/frequency, and polytherapy with strong antiepileptic drugs (AEDs), but many studies used small and/or chronic samples and few cognitive measures. Gender and family resources, also, have been related to some changes. The present study followed a large diverse cohort of children from their first recognized seizure (FRS) and examined changes on a broad battery of NP tests in comparison to siblings. Participants were 173 children (49.7% girls, 89.4% right-handed, 86.7% Caucasian) who had just experienced their first recognized seizure (FRS). Age at FRS ranged from 5 to 14 years (M=9.4, SD=2.4), and diverse seizure types were represented. IQ [gt] 55 was required for inclusion (M=102.1, SD=16.9). Sibling controls were comparable on age, IQ, sex, handedness, and race. At onset and again 18 months later, all children completed an IQ screening and 21 NP tests/subtests; NP variables were reduced to four factors (Language, Processing Speed, Executive/Construction, Verbal Memory). Analyses of covariance (adjusting for baseline NP scores) were conducted to assess the association of clinical/family variables with change in NP scores for affected children relative to siblings. Covariates examined were age of onset, MRI abnormality, recurrent seizures, AED use, seizure type, gender, caregiver education, and family mastery. For IQ, there was a trend suggesting that affected children might not have improved at the same rate as their siblings (p=.06); use of AEDs ([ge]1 AED improving less than AED-free and siblings, p=.01) and age of onset (p=.05) were associated with these early delays in IQ. Caregiver education was associated with greater improvement in IQ, but more so for siblings than for affected children (p[lt].0005); this is most likely due to lack of improvement in IQ in affected children. In all other NP domains, affected children changed at the same pace as unaffected siblings. Children with new onset of seizures might show delays in IQ early in the course of the disorder. Age of onset and use of AEDs seem to be risk factors, consistent with past studies with chronic populations. Adverse changes in other NP areas were not apparent as this early stage of the disorder. Continued follow-up could help to identify which children develop NP deficits and when they emerge. (Supported by NIH/NINDS #22416.)