Abstracts

Organizational strategy, planning, and self-monitoring are aspects of executive functioning subserved by a neural network that includes the frontal lobes. FLE could therefore be expected to disrupt the development of these and other executive functions. Deficits of planning and executive function but intact memory have been described for children and adults with FLE. Some persons with TLE have shown the opposite pattern. The Rey-Osterrieth Complex Figure Test (CFT), as scored with the BQSS, is potentially useful for assessing executive function in addition to visuoconstructional ability and memory. This potential was therefore evaluated by comparing BQSS performance of children with FLE vs. those with TLE. Convergent validity of the BQSS was also evaluated.
Neuropsychological assessments were conducted on children/adolescents with FLE (n=10) or TLE (n=10) undergoing video-EEG for medical intractability/diagnostic clarification. In addition to the CFT, assessment included tests of sustained attention/impulsivity (Conners[apos] CPT), memory (Rey AVLT, WRAML), executive function (Trails B, COWA, verbal and visual working memory), academic skills (WRAT3), and psychosocial development (Child Behavior Checklist). In order to control for developmental differences in BQSS performance, groups were matched for gender, handedness, age (M=12.08 years), Full Scale IQ (M=99/SD=14.4), and laterality of seizure focus. Group comparisons were done by Student[apos]s t tests.
Group comparisons showed no differences in BQSS performance for any scores, including Planning, Organization, and Perseveration. Significant differences were found for traditional measures of executive function. Children with FLE performed worse than children with TLE on Trails B (.02) and WRAML Finger Windows, i.e., visual working memory (.0001). Groups did not differ for verbal fluency (COWA) but arithmetic skills were lower for FLE (.03). Consistent with prior research, both groups of children with epilepsy were rated by parents as having greater than normal social problems, internalizing tendencies, and inattention. No group differences were found for tests of memory.
Differences in executive functioning in children with FLE vs. those with TLE were not detected with the BQSS for the CFT but were evident for two traditional measures of executive function (switching mental set and visual working memory). Although FLE is relatively common in children, there are few studies of the effects of FLE on cognitive development and psychosocial function. The results of this study indicate that WRAML Finger Windows and Trail Making B may be useful for detecting adverse effects of FLE. Results also indicate that children with FLE may be at special risk for difficulties in mathematics. Whether the BQSS is useful for discriminating adults with FLE from persons with or without TLE remains to be established.