Abstracts

Rationale: There is a tendency in current neuropsychology to use a smaller number of paradigms to evaluate cognitive functions in order to decrease the time with each patient.Evaluation of executive function with a comprehensive battery takes about 3 hours.Several studies show the presence of executive dysfunction in adults and children with temporal lobe epilepsy (TLE).To our knowledge, there are no studies trying to develop a short and reliable neuropsychological battery to assess executive performance in children with TLE.We previously studied a sample of 35 children with TLE presenting executive dysfunction measured by an extensive neuropsychological testing, made up by eight paradigms (Rzezak et al.2007).Herein, we aimed to develop a shorter battery that would realiably show executive performance in children with TLE compared to the previously used comprehensive neuropsychological testing. Methods: 35 children with TLE were evaluated using:Wisconsin Card Sorting Test(WCST),Digit Span(DS),Matching Familiar Figures Test(MFFT),Trail Making Test(TMT),Verbal Fluency(VF), Finger Windows(FW)and Number and Letter(NL-WRAML).The performance of these patients was compared to 25 healthy volunteers, matched as to age, sociodemographic and educational background to the subjects of the study. In the first analysis, the neuropsychological performance in this sample of patients with TLE was compared to controls using Student’s t test. In the second analysis, a statistical linear regression model was used in order to determine the best set of tests that assess executive dysfunction in this group. Results: In the 1st analysis, patients had worse performance than controls in: number of categories achieved and non-perseverative errors of WCST, Digit Forward, number of errors in MFFT, TMTB,VF for foods and animals, FW and NL. Individual analysis showed that 96% children with TLE had worse performance than controls. In the 2nd analysis, using the statistical linear regression, we observed that the set of tests with statistical significance consisted of number of categories achieved in WCST, contributing with 42.6% of discrimination between groups (p:0.001). WCST and TMTB was responsible for 53.0% (p:0.001) and, WCST plus TMTB and VF for foods differentiated 56.4% of patients (p:0.001). DS, MFFT, FW and NL were not discriminative. Individual analysis showed that 91.42% had worse performance than controls. Conclusions: The use of three reliable paradigms reproduced results previously observed with eight paradigms, showing executive and attentional deficits in children with TLE. Clinical neuropsychologists must be careful in their attempt to use screening measures to study such a complex structure as the frontal lobe. However, studies are indeed necessary in order to develop brief neuropsychological testing procedures as long as they may reproduce the same results obtained with an extensive and sometimes unnecessary testing, especially in children who present a shorter time span, which may produce false positives results.