Abstracts

Children with chronic epilepsy have shown cognitive deficits, and some show decline with persistent seizures. Also, Hufford et al. (2000) found inaccurate self-appraisal in children with chronic vs. recent-onset epilepsy. It was predicted that objective neuropsychological performance would be lower in children with longer duration, especially for children with persistent seizures, whereas subjective self-appraisals would be equal across groups (i.e., less accurate with longer duration). Participants (N=141) were ages 9-16 years ([italic]M[/italic]=11.8; [italic]SD[/italic]=1.8); 49.1% were female. Duration of disorder ranged 0.6 - 13.6 years ([italic]M[/italic]=6.4, [italic]SD[/italic]=3.7), 16.8% were on multiple antiepileptic drugs, and 69% had active seizures. Children completed the Subjective Awareness of Neuropsychological Deficits for Children (SAND-C; Hufford [amp] Fastenau, in press) and a neuropsychological (NP) exam. The SAND-C is a 45-item self-report measure that asks participants to rate frequency of cognitive strengths and difficulties on a 4-point scale. These measures provided two sources of cognitive performance: Objective (NP) and Subjective (SAND-C). A global composite score was calculated for each source across six cognitive domains: attention, executive functions, psychomotor ability, language, learning and memory, and visual-spatial ability. For seizure control, participants were classified as active (seizure within past 12 months) or controlled (no seizures in 12 months). A 2 x 2 x 2 Analysis of Variance (ANOVA) compared the Source (subjective v. objective) by duration (short v. long) by seizure control (active v. controlled). There was a main effect for duration at the trend level, [italic]F[/italic](1, 127)=2.92, [italic]p[/italic]=0.09, with objective neuropsychological and subjective self-appraisal scores being lower in the increased duration group for both active seizure and controlled seizure groups. Collapsing across seizure control groups in a 2 x 3 (Source x Duration) ANOVA, there was a main effect for source, [italic]F[/italic](2, 138)=4.46, [italic]p[/italic]=0.04, with subjective scores being greater than objective scores. No other main effects or interactions were observed. Based on these duration cohorts, it appears that both objective performance and subjective self-appraisal might be lower in children with longer duration, and this does not seem to be due to lack of seizure control. In addition, children with epilepsy seem to view themselves more positively than their actual performance reflects. The higher, yet declining, self-appraisal might reflect lack of awareness or perhaps denial of declining cognitive performance. (Supported by PHS R01 NR04536 from NIH/NINR to J.K.A. [amp] by Epilepsy Foundation (B. Hufford).)