Abstracts

RATIONALE: Previous studies have suggested that neuropsychological deficits may be present very early in the course of childhood epilepsy (Fastenau et al., 1999; Powrozek et al., 2000). Attention, psychomotor speed, receptive language, and memory were most affected, although not all children with newly recognized seizures demonstrated such deficits. This study of 75 children with newly-recognized seizures compared those with abnormal findings on magnetic resonance imaging (MRI) of the brain to those with normal MRIs in terms of neurospychological functioning. At the end of this activity, participants should be able to discuss the relationship between brain imaging abnormalities and neuropsychological functioning in children with newly recognized seizures.
METHODS: Children and adolescents were recruited for this study within 6 months of their first recognized seizure. The sample ranged in age from 6 to 15 years (mean age = 9.27, s.d. = 2.29). Forty-nine percent of the children were female. The majority of the children were Caucasian (87%), with African-American (9%), multi-ethnic (3%), and Hispanic (1%) children making up the remainder of the sample. Children underwent MRI an average of 1.3 months after the first recognized seizure. They underwent neuropsychological evaluation an average of 2.5 months after the first recognized seizure. The evaluation consisted of a three-hour battery of tests measuring intellectual ability, academic achievement, language, memory, psychomotor speed, attention, and executive function.
RESULTS: Eight of the 75 children (11%) with newly recognized seizures had MRI abnormalities that were judged to be significant and possibly related to their seizures. These included gray matter heterotopia, cortical dysplasia, leukomalacia, and volume loss. There were no mass lesions. Another 19 children (25%) had MRI abnormalities that were judged to be insignificant and unlikely related to their seizures such as Chiari I malformation and dilated perivascular spaces. Multivariate analysis of variance comparing those children with and without significant MRI abnormality on neuropsychological testing showed marginally significant differences on verbal memory (p = .095) and psychomotor speed (p = .096). There were no differences in other neuropsychological domains, including intelligence, academic achievement, language, attention, or executive function.
CONCLUSIONS: These findings suggest that the variability in neuropsychological functioning in children with newly recognized seizures may be due to underlying brain abnormalities. The group with significant MRI abnormalities was very small (n = 8), however, and therefore the findings should be viewed with caution. Memory and psychomotor speed are likely to be most impaired in children who demonstrate deficit early in the course of epilepsy, consistent with previous research.
[Supported by: NIH grant NS 22416 to J.K. Austin.]; (Disclosure: Grant - NS 22416 (NIH) J.K. Austin, Principal Investigator)