Abstracts

Rationale: Individuals with epilepsy have greater complaints of psychosocial functioning including educational and vocational difficulties. Early-onset of seizures can potentially affect cognitive development as well as disrupt school and work routines. We hypothesized early-onset would create greater psychosocial difficulties in adulthood because of risk of greater cognitive disability and disruption of school/work routine due to seizures from an earlier age. Methods: Participants were consecutive adult epilepsy patients with intractable complex partial seizures. To reduce the noise on cognitive data created by different epilepsy types, participants were limited to unilateral temporal lobe focus (n=47). Early seizure onset was defined as at or before the age of 5 years (n=15) and late-onset was defined as older than 5 (n=32). There were no significant differences in gender, age at evaluation, or side of seizure focus between the early- and late-onset groups. The participants underwent a comprehensive neuropsychological evaluation as part of a presurgical assessment. Neuropsychological variables considered in this study include IQ as determined by Wechsler Adult Intelligence Scale-III (WAIS-III), Boston Naming Test (BNT), and Washington Psychosocial Inventory (WPSI). Results: WAIS-III IQ in the early-onset group (M=84.7) compared to the late-onset group (M=93.2) was borderline worse (F=3.84, p=.056). Naming ability(BNT) in the early-onset group (M=43.7) compared to late-onset group (M=50.7) was significantly worse (F=8.55, p<.01). Educational attainment in early-onset (M=12.7) and late-onset (M=13.2) were comparable (F=.58, p=.45). Both the early- and late-onset groups reported elevated complaints on the WPSI Vocational Adjustment, Financial Status, Emotional Adjustment, and Overall Psychosocial Functioning scales. However, there was no significant difference between the early- and late-onset groups on those scales. Conclusions: These findings suggest that an epilepsy diagnosis rather than age of seizure onset or specific cognitive deficits affects psychosocial functioning including educational attainment, vocational adjustment, and emotional distress. Individuals with early-onset seizures may have been able to recruit more coping resources from their environment to compensate for earlier disability such as special education services in school etc. It is also possible that the early-onset group has become inured to their disabilities, and is reporting fewer psychosocial difficulties in adulthood. This was a retrospective study; ideally, a prospective longitudinal study would be useful in understanding the psychosocial sequelae of early-onset seizures.