Abstracts

Rationale: Memory impairment is a well-known component of hippocampal injury, hippocampal sclerosis (HS) and temporal lobe epilepsy (TLE). Febrile Status Epilepticus (FSE) has been causally linked to HS and TLE. Although retrospective studies have examined cognitive functioning in individuals who have developed epilepsy, there is a dearth of prospective research evaluating memory in children with FSE.  We describe the relationship between imaging findings, seizure factors, and verbal and visual memory performances in children with FSE. Methods: One hundred and thirteen children (mean age: 7.59 years old, 46% female) enrolled in the FEBSTAT study were seen for cognitive testing >5 years following FSE.  As part of the larger cognitive battery, the Wide Range Assessment of Memory and Learning, 2nd Edition (WRAML-2) was administered to evaluate components of verbal and visual memory.  Mean memory composite index scores (Screening Memory Index, Verbal Memory Index, and Visual Memory Index) were compared on factors including salient demographic information, and baseline imaging characteristics in this group of participants of grossly average IQ (mean FSIQ:95.25 (SD:17.08)). Results: Preliminary findings indicate that children with FSE and imaging correlates including Hippocampal Malrotation (HIMAL) and Acute T2 hyperintensities (Acute T2) demonstrated weaker overall memory performances compared to children with FSE without comorbid imaging findings ( p=.03 and p= < .001). When verbal and visual memory functions are analyzed separately, the findings were statistically significant for lower visual memory (SS = 82.5 versus SS = 94.3) in children with HIMAL (p = .01) and lower verbal memory (SS = 79.0 versus SS = 102.0) in children with Acute T2 (p = < .001).  There was also a trend toward lower visual memory in children with Acute T2 (p=0.06) and lower verbal memory performances in children who had focal FSE seizures (p=0.09).  There were no significant differences on memory task performances based on age at time of FSE or gender. Conclusions: Despite generally average overall intellectual functioning, children with a history of FSE are at risk for memory impairment when they present with acute hippocampal injury (Acute T2), abnormal hippocampal development (HIMAL), or focal seizures. This is the case even prior to the development of seizures.  Reassuringly, in those without additional risk factors memory remains relatively intact.  Our results provide the first prospective data in ultimately determining significant risk factors for cognitive dysfunction in FSE.  As we continue to gather data in our ongoing prospective study, we hope to be able to further assess the long term consequences of FSE and cognitive functioning, including memory. Funding: NINDS grant 2R37 NS43209 (PI: S. Shinnar, MD, PhD) and Virginia Commonwealth University Center for Clinical and Translational Research grant UL1TR000058.