Abstracts

Rationale: The Design Fluency test has long been considered a measure of nondominant frontal function, given its sensitivity to postoperative effects of focal resection of the nondominant frontal region in adult epilepsy patients. However, there are limited data on the specificity of this measure in children. The present study was aimed at determining whether pediatric epilepsy patients who evidence a right hemisphere or frontal focus on EEG are more likely to display abnormalities on this measure of nonverbal fluency. Methods: The sample included 79 epilepsy patients, ranging in age from 6 to 19 years, who were seen for baseline neuropsychological testing. Patients were adminstered Design Fluency (DF) as part of their comprehensive test battery. A patient's performance was judged to be abnormal if he/she produced perseverative responses at greater than 50% of the number of novel designs, made more than three errors, produced fewer than 6 novel designs, or were unable to adhere to task demands. DF performance was examined in relation to side and site of ictal or interictal epileptiform activity on EEG, intellectual functioning, and presence of either ADHD or autism spectrum disorder (ASD).Results: Abnormal DF performance was observed in 35% of the patient sample. Abnormal performance was not more common in those with right hemisphere (33%), left hemisphere (30%), or frontal (41%) EEG focus. Two of five patients (40%) with a right frontal EEG focus and three of four patients (75%) with bifrontal involvement on EEG displayed impaired DF, the latter falling short of statistical significance. Impaired performance was more common in patients with IQ less than 85 in either the verbal or nonverbal domain (47%, p = .01) and somewhat more likely in those with ASD (60%, p= .15), but not in those with ADHD (38%).Conclusions: Design Fluency test performance is not highly correlated with right hemisphere or right frontal EEG findings in pediatric epilepsy patients. Impaired performance was somewhat more common in the small sample who evidenced bifrontal EEG abnormalities, those with diminished IQ, and those with ASD.