Abstracts

The study investigates the stability of neuropsychological test performance of children with Benign Epilepsy with Central-Temporal Spikes (BECTS). Children with BECTS generally have normal cognition; however, recent studies have demonstrated difficulties in various cognitive domains. It is unclear, however, whether the reported cognitive deficits are due to a fixed underlying cerebral dysfunction or if the deficits change over time, possibly related to fluctuations in interictal sharp activity. It was hypothesized that cognition would remain relatively stable over the course of 2 months. Four children were tested, ages 7-12, 2 girls and 2 boys. All were right handed and of average intelligence (FSIQ 97 -112) with no history of developmental delays, learning or psychological disorders, and observed seizures within one month of initiating the study. Clinical criteria for the diagnosis of BECTS was met, including EEG sharp activity greater than 100 microvolts with a central or central-temporal distribution, and no evidence of focal slowing. Continuous EEG recordings were obtained on the same day as the neuropsychological evaluation. Subjects underwent assessment of attention, visual/verbal working memory, visual/verbal memory, receptive/expressive language, verbal fluency, visuospatial discrimination and motor abilities in a within subject, repeated-measures design. Subjects underwent repeat testing at 1-1:5 month intervals for 2 sessions (1 subject) or for 3 sessions (3 subjects). No changes in medication between sessions occurred. Three subjects showed impaired visual attention across sessions ([gt]2SD). Impaired performance ([gt]2SD) was observed in immediate/delayed memory, visuospatial skills, response time, and auditory attention in select subjects and sessions. All subjects demonstrated significant variability ([gt]1SD) across sessions in multiple cognitive domains of receptive/expressive language, visual/verbal memory, attention, response time, and executive abilities. Three subjects had central or central-temporal sharp activity on 1or more EEG recordings on the testing day. The observed variability in performance was not related to abnormal EEG activity or practice effect. One subject had normal EEG activity with impaired cognitive performance. The youngest, most recent onset subject had no overall impairment despite abnormal EEG; however, significant variability between sessions was noted. These preliminary results suggest that children with BECTS have significantly fluctuating cognition ([gt]1SD difference) affecting attention, memory, visuospatial, and executive skills that can adversely affect their development and education. Even in a child who demonstrated no cognitive impairment, fluctuation of greater than 1SD was present, predicting alteration in academics, behavioral, and emotional functioning.