Abstracts

Children with epilepsy are at risk for academic underachievement. Studies have found inconsistent associations between change in neuropsychological performance (NP) and demographic and seizure variables. The purpose of this study was to assess change over time in NP domains after controlling for factors that have been associated with academic underachievement. A sample of 127 children with chronic epilepsy (ages 9-15 years; 50% female, 93% White/Non-Hispanic; 65% focal seizure type, 66% with active seizures) completed baseline and 24 month NP examinations. Children with mental retardation were excluded. The NP battery was reduced to 3 factors: verbal/memory/executive (VME), rapid naming/working memory (RNWN), and psychomotor (PSY). Repeated-measures analyses (with and without inclusion of covariates) were conducted for each factor. Covariates included age, age at onset, gender, seizure control (seizures present/absent in past 12 months), primary caregiver education, antiepileptic medication use (yes/no), and seizure type (focal vs. generalized). Main effects and the interactions of time with each covariate were tested for each neuropsychological factor. For VME, there were significant improvements over time which remained significant after adjusting for covariates. Children having earlier age of onset had lower VME scores on average. For RNWM, there were significant declines over time without adjusting for covariates. In the covariate-adjusted model, there was a significant interaction between age and time, with younger children having greater declines. In addition, children on medication had lower RNWM scores on average. For PSY, there was no change over time without adjusting for covariates; however, there was a significant interaction with age and time indicating that older children[apos]s scores improved over time while younger children[apos]s scores declined. In addition, children with focal seizures had lower PSY scores on average. There were no other significant main effects or interactions with time for the covariates in any of the models. The most consistent finding was the more pronounced effect of epilepsy on neuropsychological functioning in younger children suggesting an increased vulnerability of the developing brain. Interventions need to be targeted toward these at risk children.In addition, given the integral role of RNWM in all areas of academic achievement in this population, children should be monitored for potential adverse effects of medication. (Supported by NIH/NINR NR04536 (JKA).)