Abstracts

Rationale: Benign focal epilepsy of adolescence (BFEA) described by Loiseau et al in 1972, is considered a rare entity, but maybe underdiagnosed. Mild neuropsychological deficits have been reported in patients with benign epilepsies of childhood, but not so far described in BFEA. The aim of this study is to evaluate neuropsychological functions in BFEA with new onset seizures (<12 months). Methods: Eight patients with BFEA (focal or TCG seizures between the ages of 10-18yrs., normal neurologic examination, normal EEG or with focal abnormalities) initiated in the last 12 months were studied between July 2008 to May 2009. They were referred from the Pediatric Emergency Section of the Hospital Universitário of the University of Sao Paulo, a secondary care regionalized facility located in a district of middle-low income in Sao Paulo city, Brazil. All families signed informed consent and patients performed neurological, EEG, brain CT and neuropsychological evaluation which consisted of Raven’s Special Progressive Matrices, Wechsler Children Intelligence Scale-WISC III with ACID Profile, Trail Making Test A/B, Stroop Test, Bender Visuo-Motor Test, Rey Complex Figure, Rey Auditory Verbal Learning Test-RAVLT, Boston Naming Test, Fluency Verbal for phonological and also conceptual patterns-FAS/Animals and Hooper Visual Organization Test. For academic achievement, we used a Brazilian test named “Teste do Desempenho Escolar”, which evaluates abilities to read, write and calculate according to school grade. Results: There were 2 boys and 6 girls, with ages ranging from 10 yrs.9m to 14yrs.3m. The mean number of seizures per patient was 2.5 and only three of them received antiepileptic drugs. Six patients had mild EEG focal abnormalities and all had normal brain CT. All were literate, attended regular schools and scored in a median range for IQ, and seven showed discrete higher scores for the verbal subtests. There were low scores for attention in different modalities in six patients, mainly in alternated attention as well as inhibitory subtests (Stroop test and Trail Making Test part B). Four of the latter cases who showed impairment both in alternated and inhibitory attention were not taking antiepileptic drugs. Visual memory was impaired in five patients (Rey Complex Figure). Executive functions analysis showed deficits in working memory in five, mostly observed in Digits Indirect Order and Arithmetic tests (WISC III). Reading and writing skills were bellow average for school grade in six patients. One patient of this series who had the best scores in all tests was taking phenobarbital. Conclusions: Mild neuropsychological deficits such as in attention domain and in some executive functions like working memory and planning, as well as academic problems in reading and writing, were described in this group of patients with BFEA from community. This may reflect diffuse higher level neurological dysfunctions in adolescence idiopathic epilepsies probably caused by an underlying dysmaturative epileptogenic process. An educational approach may be necessary in some cases.