Abstracts

Rationale: Children with epilepsy show higher than typical rates of neurocognitive abnormalities. Recent literature has demonstrated the presence of neurocognitive comorbidities at or shortly after initial onset of epilepsy. There is limited data describing changes in cognitive functioning over the first year after initial epilepsy diagnosis in children. The current study quantifies rates of significant intra-individual changes in cognitive profiles within the first year after epilepsy diagnosis, and analyzes factors associated with these changes. Methods: 63 participants, 32 female, mean age at baseline: 8.5 years (SD: 3.88, range 3–16). 84% evaluated within 12 weeks of initial epilepsy diagnosis. No prior neurologic history or AED treatment. Baseline neuropsychological evaluation occurred in the context of a New Onset Pediatric Epilepsy (NOPE) multidisciplinary clinic. Neuropsychological re-evaluation completed one year after baseline. Only those with FSIQ>70 were included in current analyses. 57/63 had abnormal EEG. 11/63 had abnormal MRI.Change scores for each participant were computed on multiple cognitive variables of interest by subtracting the participant’s time 1 (T1, baseline) score from their time 2 (T2, one year post-baseline) score. T-tests were then used to examine differences in change scores across various cognitive test scores between two groups: those participants who were on a polytherapy AED medication regimen at T2 and those who were on a monotherapy regimen at T2. Results: At one year post-diagnosis (T2), 11% of all participants showed a decrease of > 15 points on FSIQ from T1 to T2. The average change in FSIQ from T1 to T2 was -3.92 (SD: 9.21). At T2, 17.5% of participants were on polytherapy AED treatment.T-tests showed significant differences in cognitive change over time between patients prescribed polytherapy versus monotherapy AED regimens. Specifically, compared to patients on monotherapy treatment at T2, patients on polytherapy treatment at T2 exhibited significantly larger score decreases from their baseline (T1) to T2 on FSIQ (mean monotherapy group change score: -2.71 points from T1 to T2; mean polytherapy group change score: -9.64 points from T1 to T2; p=0.02). T-tests also showed significantly larger decreases for the polytherapy vs. monotherapy group on verbal learning (p=0.04), naming (p < 0.05), and pegs non-dominant (p=0.03) from T1 to T2. Conclusions: Analysis of intra-individual score changes in cognitive profiles suggest that patients who require polytherapy for seizure management within the first year show significantly larger decreases in cognitive functioning from baseline across a variety of domains. The multiple factors implied by need for polytherapy (e.g., ongoing seizures, possibly more complicated epilepsy, possibly different epilepsy etiology) may be associated with risk for cognitive changes. Those patients who require multiple AEDs within the first year of epilepsy diagnosis should be monitored more closely for cognitive changes. Funding: N/A