Authors :
Presenting Author: Dace Almane, MS – University of Wisconsin School of Medicine and Public Health
Presenting Author: Bruce Hermann, PhD – University of Wisconsin School of Medicine and Public Health
Presenting Author: Bruce Hermann, PhD – University of Wisconsin School of Medicine and Public Health
Presenting Author: Bruce Hermann, PhD – University of Wisconsin School of Medicine and Public Health
Presenting Author: Bruce Hermann, PhD – University of Wisconsin School of Medicine and Public Health
Robyn Busch, PhD – Epilepsy Center, Neurological Institute – Cleveland Clinic; Lisa Ferguson, MA – Epilepsy Center, Neurological Institute – Cleveland Clinic; Ana Arenivas, PhD, MPH – Epilepsy Center, Neurological Institute – Cleveland Clinic; Anny Reyes, PhD – Radiation Medicine and Applied Sciences – University of California-San Diego; Carrie McDonald, PhD – Radiation Medicine and Applied Sciences – University of California-San Diego; Alanna Kessler-Jones, PhD – Neurology – University of Wisconsin School of Medicine and Public Health; Jana Jones, PhD – Neurology – University of Wisconsin School of Medicine and Public Health; Bruce Hermann, PhD – Neurology – University of Wisconsin School of Medicine and Public Health
Rationale:
The International Classification of Cognitive Disorders in Epilepsy (IC-CoDE) is an algorithmic approach to deriving cognitive diagnoses from neuropsychological data in persons with epilepsy. IC-CoDE has been designed to improve clinical and research communication at an international level and to facilitate big data research collaborations. To date, proof of principle for IC-CoDE has been demonstrated including its applicability to diverse epilepsy syndromes, multicenter usability, and homogeneity of findings across centers. IC-CoDE has not been examined in relation to neuropsychological data in pediatric epilepsy in general and children with new or recent onset epilepsy in particular which is the intent of this project.
Methods:
A total of 134 youth with new/recent onset epilepsy (seen within 12 months of diagnosis) and 88 typically developing controls (age 8-18) underwent formal neuropsychological assessment including evaluation of intelligence, language, visuospatial skills, verbal and visual learning and memory, motor/psychomotor speed, and attention and executive function. Age and gender adjusted z-scores were derived based on control performance. Tests were allocated to five cognitive domains specified by the IC-CoDE working group (language, visuospatial, memory, attention/psychomotor speed, executive function). Each cognitive domain was then composed of two test metrics based on test sensitivity (base rate abnormality) and cognitive diagnoses derived (i.e., intact cognition, single domain impairment, bi-domain impairment, generalized impairment) along with specification of the distribution of specific single domain impairments (e.g., memory, language).
Results:
Rates of IC-CoDE diagnostics using a -1.5z threshold of test impairment were as follows: Intact: epilepsy= 72.4%, controls= 89.8%; Single domain impairment: epilepsy= 13.2%, controls= 9.1%; Bi-domain impairment: epilepsy= 7.5%, controls= 1.1%; Generalized impairment: epilepsy= 6%, controls= 0%. For youth with epilepsy with a single domain impairment the most abnormal cognitive domains were Language (47.4%), Executive (21.1%) and Memory (11.1%). Using a -1.0z threshold to define test impairment, rates of IC-CoDE diagnostics were as follows: Intact: epilepsy= 53.7%, controls= 79.5%; Single domain impairment: epilepsy = 20.9%, controls= 13.6%; Bi-domain impairment: epilepsy= 12.7%, controls= 4.5%: Generalized impairment: epilepsy= 12.7%, controls= 2.3%.
Conclusions:
This investigation demonstrates the following: 1) the applicability of IC-CoDE to youth with new/recent onset epilepsies, 2) the distribution of IC-CoDE cognitive classifications in youth with epilepsy compared to typically developing controls, and 3) the influence of varying clinically useful thresholds of abnormality of IC-CoDE classifications.
Funding: NINDS RO1-44351