Abstracts

Rationale: Academic underachievement is a common feature of childhood epilepsy. Previous studies have focused on the association of clinical seizure characteristics with academic functioning. Much of this work has been conducted in samples of epileptic children and adolescents with several years duration of epilepsy of varying course. Recent studies suggest that academic difficulties are evident at time of epilepsy diagnosis and in some instances appear to predate the diagnosis. Determination of the factors associated with the presence of these academic difficulties is likely to have implications for both assessment and intervention with these children. To date, there has been very limited examination of brain morphology in new onset childhood epilepsy in general, and more specifically in relation to academic functioning. Previous research from our lab has demonstrated significant relationships between cognition and specific brain structures such as the thalamus and corpus callosum among adults with chronic epilepsy. In the current study, we compared quantitative MR volumes of the thalamus and corpus callosum in three groups: (1) new onset epilepsy children without a history of educational difficulties (AP-), (2) new onset children with a history of educational difficulties (AP+), and (3) healthy controls without a history of educational difficulties (CON). Methods: 49 children with recent onset epilepsy (i.e., within one year) and 46 healthy controls were included. 17 (35%) children with epilepsy had a history of academic problems that antedated or were present at the time of seizure onset. Difficulties included a broad umbrella of educational services (e.g., tutoring, summer school, IEP). The remaining 32 children did not have any educational difficulties. There were no significant differences between the AP+ and AP- epilepsy groups on demographic (e.g., age, gender) or clinical seizure characteristics (e.g., age of epilepsy onset). All children underwent quantitative whole brain MRI volumetrics. Manual tracing of the thalamus and corpus callosum was conducted based on published guidelines. Analyses of variance were conducted examining volumetric differences, corrected for intracranial volume. Results: As expected, the AP+ group performed significantly worse than the AP- group and controls on measures of reading, spelling, and arithmetic (all p’s < .01). The AP+ group had significantly smaller right thalamic (p = .02, d = .49), total thalamic (p = .035, d = .60), and smaller anterior corpus callosum volumes than the CON group (p = .04, d =.54). In addition, the AP+ group showed a trend for a smaller anterior corpus callosum volume than the AP- group (p = .06, d = .67), while there was no difference between the CON group and the AP- group (p = .97, d = .01).Conclusions: These findings suggest that quantitative MR volume abnormalities in the corpus callosum and thalamus are evident among children with recent onset epilepsy who are experiencing academic difficulties. Our future work will track the academic and volumetric changes that occur in these children over a two-year period.