Abstracts

To examine the long term cognitive outcomes of children who present with a first unprovoked seizure. In a prospective study, 407 children ages one month to 19 years (mean age 6.8 years) with a first unprovoked seizure were recruited and then followed for a mean of 14.4 years. Cognitive testing including the Connors Performance Task (CPT), a computerized measure of attention, and the TONI-2 (test of nonverbal intelligence) were administered 10 or more years after the initial seizure to subjects and when available, siblings. The TONI-2 was chosen for use in this racially and ethnically diverse predominantly inner city population as it is felt to be more culturally fair than the standard IQ tests. Psychological test data were available on 197 (48%) subjects and 59 sibling controls. Analysis for this report is restricted to the 162 subjects with idiopathic or cryptogenic seizures. Among the 162 subjects, the mean CPT score was 6.28 (median 4.51). There were 57 (35%) children with a CPT score of 0 indicating no attentional problems and 74 (46%) with a score of [gt]6 indicating significant attentional issues. Among the sibling controls the mean score was 5.93 (median 4.51) (p=0.66) with 23 (39%) with a 0 score and 23 (39%) with a score of [gt]6. There were no significant differences between the subjects and controls. Within the subjects there were no differences between the scores of those with a single seizure and those with recurrent seizures. For the TONI-2, the mean standard score in the subjects was 93.8 (s.d. 14.5) and in the controls 91.6 (s.d. 13.5, p=0.32). However, within the 162 subjects, the mean TONI-2 standard score was 96.1 (s.d 14.9) in the 92 with only one seizure and 90.7 (s.d 13.5) in the 70 subjects with recurrent seizures (p=0.018). The subgroup of 20 children with 10 or more seizures had similar standard scores with a mean 91.9 (s.d. 14.2). Children who present with a first unprovoked seizure have similar CPT scores and nonverbal intelligence as measured by the TONI-2 as sibling controls. However, children with even a few seizures have lower TONI-2 standard scores than those with a single seizure and no recurrences. The data indicate that one unprovoked seizure has little long term impact on cognitive ability. These results further emphasize the differences between children with a single unprovoked seizure and those with recurrent seizures or epilepsy. (Supported by NIH grant NS 26151 from NINDS.)