Abstracts

Children with epilepsy are at risk for neurocognitive deficits, attention deficits, learning disorders, and psychiatric disorders. Many variables are believed to affect neurocognitive profiles including etiology and type of seizure disorder, severity and frequency of seizure activity, medications, and age of seizure onset. To ascertain the effects of these variables on cognition, we performed a retrospective study of neuropsychological profiles of children with epilepsy followed by the Pediatric Epilepsy Program at Massachusetts General Hospital. We reviewed patient records of children who received neurologic care through the Massachusetts General Hospital Pediatric Epilepsy Program. For each child, we ascertained age of onset of epilepsy, etiology of seizure disorder, seizure frequency, seizure focus, and antiepileptic treatment regimen. Patients were labeled [quot]on-track[quot] if cognition was within the broad average range, and [quot]off-track[quot] otherwise. Chi-square and ANOVA analyses were performed using SPSS v. 11.5. One hundred thirty children were studied. Seventy-seven (59.2%) patients were cognitively on track. Significant correlations were observed between [quot]off-track[quot] cognition and (1) symptomatic (rather than idiopathic/cryptogenic) seizure disorders (p[lt]0.001); (2) mixed (rather than generalized or partial) seizure disorders (p[lt]0.001); (3) seizure frequency; seizure severity (p[lt]0.001); (4) age of seizure onset less than four years (p[lt]0.001); and (5) polypharmacotherapy (p[lt]0.001). Among those with partial-onset seizures, a significant correlation was observed between off-track cognition and left-hemisphere seizure foci (p[lt]0.05).
Within the [quot]on-track[quot] group, there were significant differences on a number of language and working memory tasks based on right hemisphere seizure focus, symptomatic seizure disorders, and polypharmacotherapy.
A number of children in the [quot]on-track[quot] group performed in the low to below average range (below the 25^th %ile) on academic measures of the WIAT-II. Nineteen (50%) performed below the 25^th %ile on a single word reading test, 17 (41%) on a spelling test, and 22 (46.8%) on a mathematics test. Children with epilepsy are at risk for neurodevelopmental and neurobehavioral dysfunction. Of the patients in our population who had neuropsychological evaluations at our institution, over 40% had significant deficits; many of the children who were considered developmentally on-track had cognitive difficulties that affected their level of academic functioning. Risk factors for significant cognitive difficulties in our population included symptomatic epilepsy, seizure focus, age of onset, and polypharmacotherapy. Children with epilepsy should be carefully evaluated and followed for concomitant learning difficulties in order to help optimize their neurocognitive development.