Abstracts

It was recognized in recent years that large number of children with Rolandic epilepsy (RE) often presented with learning and behavior problems. Normal intellectual and cognitive development is expected, but neuropsychological and language impairment in some RE patients challenged the benign nature of this idiopathic focal epilepsy. A prospective, neuropsychological study was conducted in 28 children with RE (13 girsl, 15 boys) aged from 7 do 13.5 years (mean 9.7). Initial assessment of cognitive functions was performed before AED was started. Retesting was conducted after one and 3 years of the clinical and EEG follow-up. Antiepileptic treatment (started in 20 patients) was discontinued for at least 6 months before retest assessment. Intelligence and cognitive functions were assessed by the WISC-R and Halstead-Reitan Battery of age-correlated tests. Reading and writen language testes were modified for native language and cyrillic alphabet. Cognitive performance of RE group was compared with 40 healthy control children. Cassette EEG 24-hour monitoring was recorded in 21/28 children Complete stable seizure control with no relapses maintained during clinical follow-up in all but two children. Neuroimaging study performed in 14/28 children with RE was normal. Initial IQ was within the average range in all but three children with borderline score. No significant test-retest difference between children with RE and controls was found in intelligence and majority of assessed cognitive functions. However, school underachievement and behavioral difficulties were found in 21.4% of patients.They showed lower test performance scores on formal assessment of language ability, attention, short-term verbal learning and visual-motor performance. Specific difficulties in written language and arithmeitics were identified in 6 children. Specific language dysfunction with difficulties in reading, expressive grammar, literacy, semantic fluency and short-term verbal memory was concluded in 9 of 28 RE children. No significant association of language deficits and lateralization of focal EEG discharges was seen. Bilateral, interictal EEG discharges however, were noted in 5 out of 9 children with cognitive difficulties. Electrical status during sleep was found in two children. One of them later showed cognitive decline and clinical and EEG characteristics of Pseudo-Lennox syndrome. Despite normal intelligence, subgroup od children with RE showed neuropsychological deficits. Language impairment seemed specific and unrelated to antiepileptic treatment or lateralization of epiletic focus. Connection between cognitive dysfunction and paroxysmal activity was considered.