Abstracts

Rationale: Executive function impairments are common co-morbidities in children with epilepsy. These impairments have been associated with decreased quality of life. Working memory impairments are especially common, with over 40% of children with epilepsy affected by them. A computerized cognitive training program (CogMed) was developed to improve working memory skills and has demonstrated efficacy in several studies of children with ADHD. The purpose of the present study is to examine the feasibility of using a computerized cognitive training program in children with epilepsy.Methods: Eight children with well controlled epilepsy (ages 10-14; mean=11.2; 2 female, 4 generalized epilepsy) are involved in various phases of the study thus far. Participants have normal MRI and FSIQ>80. Participants qualified for the intervention if they had elevated scores (T>60; Mean T-score = 66) by parent report on the Working Memory Index of the Behavior Rating Inventory of Executive Functions (BRIEF). Feasibility of the training program is evaluated by examining the number of training sessions each child was able to complete per week, which was compared to the training program s recommendation of at least five sessions per week. Descriptive data is also provided from weekly coaching call logs that record relevant data regarding progress and circumstances related to the training. Results: In our ongoing study, four children have initiated the working memory training program. The average number of training sessions completed per week is 2.5. One child (25%) was able to adhere to training program recommendations and complete at least 5 sessions per week; while the average number of training sessions completed per week by an individual child was as few as 1.7. One child (25%) was withdrawn from the study after having completed only twelve sessions in seven weeks because the treatment compliance criteria for this study is defined as completion of twenty-five training sessions within eight weeks. Obstacles cited by parents during phone conversations include conflicts with extra-curricular commitments, unanticipated family emergencies, priority of regular schoolwork, and fatigue. Conclusions: Our experience thus far with working memory training regimen adherence indicates that the training program recommendations of five sessions per week may be difficult for many children with epilepsy to follow. While our treatment compliance criteria for the study are more lenient than the recommended schedule, the pace may still prove to be too demanding for some children. The obstacles to adherence may not be unique to children with epilepsy; but may reflect the greater demands placed on households with medically involved children. We will evaluate whether a reduced intervention dose will still benefit children with epilepsy.