Abstracts

Rationale: Executive function impairments are common co-morbidities in children with epilepsy. These impairments have been associated with decreased quality of life. A computerized cognitive training program was developed to improve working memory skills and has demonstrated efficacy in children with ADHD. We present preliminary results using this computerized cognitive training program in children with epilepsy. Methods: Twenty-one children with well controlled epilepsy (ages 8-15; mean=11.7; 6 female) completed training and received pre- and post-neuropsychological assessment. Successful completion criteria is a minimum of 20 sessions within an 8-week timeframe. Entry criteria was elevated parent rating of working memory skills (T>60) but IQ>80. Patients had relatively "smooth sailing" epilepsy being well controlled but experiencing cognitive problems; epilepsy was type was localization-related, absence, or benign rolandic with no major abnormality on MRI and one AED. Patients were randomized to a "hi" or "low" dose. Hi dose was the standard Cogmed RM program of 12 game-like activities with success-adapted trials. Low dose includes all components of hi dose but, difficulty is consistently low intensity (span of two items). Outcome measures included parent ratings and direct measures of working memory skills. Descriptive and repeated measures MANOVA were conducted to examine differences in treatment group across measures of working memory skills. Effect sizes were also calculated given the small sample sizes. Results: There were no differences between treatment groups for age or IQ. There was a main effect of Time (p<.001) with improved parent ratings of working memory (Hi Dose mean fell below clinical significance) and better performance on direct measures of verbal and visual short term memory. There was an interaction of Time by Condition (p<.05) such that improvements for verbal and spatial short term memory were greatest for the Hi Dose condition (See Figure). Effect sizes consistently were larger for Hi Dose compared to Low Dose, and ranged from small to large (See Figure). Conclusions: Preliminary results demonstrate that Cogmed significantly improved verbal and visual short term memory and everyday working memory skills in children with pediatric epilepsy. Although the Hi Dose was most effective, it appears that the Low Dose also had moderate treatment effects. Future work will investigate further which patients demonstrate the greatest gains to elucidate what factors may be important for optimizing treatment. In addition, another follow-up assessment at 3 months post treatment is underway and reliable change indices will be calculated to determine more rigorously if observed changes are more than might be expected on test-retest. This is the first study in children with epilepsy to demonstrate the effects of a non-pharmacological treatment for a cognitive comorbidity associated with epilepsy. It is feasible and may be effective at both hi and low dose. A low dose option may be beneficial to maintain a child's motivation related to a greater number of success trials.