Abstracts

Rationale: Children with epilepsy have high rates of cognitive and behavioral problems, which can affect learning and scholastic functioning. While screening for cognitive comorbidities in epilepsy patients is recommended, there is limited information about the ability of clinical screening protocols to identify high risk patients. In this ongoing study, we used a brief computerized cognitive battery and parent screening tools to screen for cognitive and behavioral difficulties prior to initiation of epilepsy medication treatment. Our aim is to determine if a brief battery can aid in the detection of potential comorbidities early in the course of epilepsy.Methods: 33 patients 8-17 years of age with new-onset epilepsy and no previous AED treatment were recruited from the outpatient neurology clinic at a children’s hospital. Patients completed CNS Vital Signs computerized cognitive battery (CNSVS), and parents completed screening questionnaires. The testing was repeated at two subsequent intervals at routine clinical appointments. To measure change of cognitive performance over time and to determine its clinical significance, we compared each child’s scores at baseline to their subsequent scores using the Reliable Change Index (RCI). Patients’ medical records for the same time points were reviewed to relate clinically reported problems to testing scores. The patients’ results were reviewed individually and then summarized to assess the most commonly affected cognitive domains over time.Results: 33 patients were enrolled and completed at least one follow up testing, with a mean follow up time of 5.5 months. Average patient age was 11.9 years and 17 subjects were male. 26 had generalized and 7 had focal epilepsy. 16 patients completed a third testing, with a mean total follow up time of 14.5 months. Between enrollment and first follow up, 85% of patients had clinically significant changes in one or more cognitive domains. The domains showing the most common changes at both follow up intervals were composite memory, cognitive flexibility, reaction time and complex attention. The only test that did not change significantly was psychomotor speed. We did not see specific patterns of change based on seizure type, medication, or other clinical factors. For the patients who improved or declined, the change occurred at the first follow up interval and remained stable. Chart review of parental reports did not consistently correspond with CNSVS score changes.Conclusions: Our study shows that brief computerized cognitive screening at the time of epilepsy diagnosis and shortly after initiation of treatment can help identify patients at elevated risk for cognitive difficulties. Parental reports alone may not prompt referral for further evaluation. Utilizing cognitive screening may increase recognition of cognitive change in early stages of the disease and decrease delays in remediation. Using an approach such as the RCI can guide clinicians in detecting potential problems over time and could impact long term scholastic and quality of life outcomes.