Abstracts

Rationale: The impact of seizure activity on executive functioning of youth with Paroxysmal Non-Epileptic Events (PNE) and epilepsy (E) was compared. The cognitive construct of executive function (e.g. planning, judgment, initiation, inhibition, set shifting, organization, self-monitoring, self-care, working memory, and meta-cognitive activities) is essential for daily functioning. Seizure activity could impact executive functioning in this population (Sherman et al., 2006). Addressing the level of executive dysfunction of individuals with PNE vs. E would assist in diagnosis and treatment planning, improving the delivery of services to this population.Methods: Fifteen patients (ages 5-17) recruited from March to July 2012 (at a children s hospital) met the inclusion criteria. Executive functioning was measured by the Behavior Rating Inventory of Executive Function-Parent (BRIEF-Parent); used in previous research protocols. The BRIEF-Parent is a standard measure with internal consistency, reliability, good construct and convergent/divergent validity, with a cutoff score of 65 (Slick et al., 2006). All were consented; the BRIEF-Parent was completed, including demographics. All received standard neurological care. After the participants EEG was evaluated by the attending epileptologist, a PNE or E diagnosis was determined, and they were assigned to either the PNE n=6 or the E n=9 group. The Global Executive Composite (GEC) score was compared between both groups, using the two-sample t-test and the nonparametric Wilcoxon rank-sum test. Potential confounders (e.g. gender, age, or years of education) were included in a linear model; a backward elimination procedure was performed. Association between abnormal GEC score and PNE/E status was investigated by the Fisher's exact test also used to check the association of abnormal GEC score with each of the three potential confounders. All tests were two-sided with significance level 0.05. The study was approved by the hospital IRB.Results: Neither the two-sample t-test and the Wilcoxon rank-sum test showed statistical significance between the PNE/E groups (p=0.157 and 0.152, respectively). Adjusting for the potential confounders yielded no statistical significance (all p-values > 0.1). Fisher's exact test showed no association between abnormal GEC score and PNE/E status (p=0.089).Conclusions: Given the small sample size and group heterogeneity, the results are to be taken with caution. Descriptively the PNE group scores were in the direction of higher executive dysfunction as compared to the E group. PNE is highly associated with psychogenic concerns, which may imply a level of dysregulation (and cognitive inflexibility highly impacting executive functioning) not experienced in E. Anti-epileptic drugs may serve as moderator variable in lowering executive dysfunction. An adverse impact can be experienced in PNE when the pharmacological treatment is not suitable. Targeted PNE (including psychological) treatment can address patients developmental and biopsychosocial trajectory.