Abstracts

RATIONALE: A prior study suggested that neuropsychological (NP) deficits are present near onset of epilepsy in children (Fastenau et al., 1999), especially in children who have had prior unrecognized seizures (PURS). Attention, psychomotor speed, receptive language, and memory were most affected. Children with PURS showed greater NP deficits than those without PURS (Powrozek et al., 2000), similar to the effect of PURS on behavior problems (Austin et al., 2001). However, those NP studies were limited by small sample size, and time between onset and testing was prolonged for many children. The present study compared children with first-recognized seizures (FRS) to sibling controls on NP functioning in a larger sample and closer to onset of the FRS. In addition, children with PURS were compared to those without PURS. At the end of this activity, participants should be able to discuss the effects of prior untreated seizures on NP functioning.
METHODS: Children were tested within 6 months (M=2.5) of their FRS. Children with a FRS (n=105) ranged in age from 6 to 15 (M=9.4, SD=2.4); 49% were girls, and 7% were left-handed. A healthy sibling closest in age to the child was recruited as a control; not all children with FRS had an eligible sibling resulting in a smaller control group (n=67). Controls ranged in age from 5 to 16 (M=10.1, SD=2.8); 49% were girls. There was no difference (p[gt].10) on IQ between affected children (M=100.2, SD=16.2) and controls (M=101.1, SD=12.5). During a detailed interview at the time of enrollment into the study, 60% of children with FRS reported having had a PURS. All children completed a three-hour battery of NP tests measuring processing speed, attention, memory, language, executive processing, spatial skills, and academic achievement.
RESULTS: MANCOVA (covarying on site) comparing affected children to their matched sibling controls using patient-sibling difference scores on NP variables (organized by a priori constructs) revealed no differences between the groups (p [gt] .10). MANCOVA comparing children with PURS to those without PURS revealed three trends, all in the predicted direction; the PURS group performed worse on attention (p=.06), processing speed (p=.09), and visuospatial skills (p=.09).
CONCLUSIONS: Although these data are preliminary, there was some support for our hypothesis; trends were observed showing possible adverse effects of prior unrecognized, untreated seizures. Because NP evaluation was conducted soon after the FRS, the cognitive inefficiencies among children with FRS are not likely to be due to medication effects. Our other hypothesis was not supported; we failed to find differences between children with a FRS and their siblings. Because the present analyses are based on baseline data following the FRS, it is not yet known which of these children will experience a second unprovoked seizure (i.e., be diagnosed with epilepsy); consequently, these results likely underestimate the effects of seizures at the onset of epilepsy. [Supported by NIH/NINDS #NS 22416]
[Supported by: NIH/NINDS #NS 22416]