Abstracts

Rationale: Children with epilepsy may have deficits in visual-perception as a result of dysfunction in not only the visual system, but also adjacent frontal regions. The frontal lobe is a center for executive functions, which are required for conscious control of thought and action in everyday life. Previous studies have associated pediatric epilepsy with executive dysfunction including impulse control, planning abilities, and working memory. Many of these nonverbal executive skills may be impacted by perception, particularly since the initial input from the visual system passes through the frontal lobe via the eye fields. This raises the question of whether problems in nonverbal executive functions and visual-perception skills are linked. Problems in both of these areas can have a negative impact on a number of applied skills for children including reading, spelling, written output, visual-motor integration, and mathematics. The purpose of the current study was to examine the role of visual-perception on executive functions, particularly nonverbal aspects, in children with epilepsy. Methods: A retrospective chart review was performed for 22 pediatric patients diagnosed with epilepsy who participated in comprehensive clinical neuropsychological evaluations. The sample consisted of 13 males and 9 females, having a mean age of 11.05 years (SD = 3.77). Ethnicities included Caucasian (86.4%) and Hispanic (9.1%); 4.5% of the sample did not endorse ethnicity. Types of epilepsy represented were absence, frontal, and temporal lobe. Patients were administered tests which measured visual-perception (e.g. Test of Visual-Perceptual Skills [TVPS] and Test of Visual-Motor Integration [VMI]). Verbal and nonverbal executive functions were measured by administering the Conners’ Continuous Performance Test (CPT); WISC-IV working memory subtests; Delis-Kaplan Executive Function System (DKEFS) selected subtests; Wisconsin Card Sorting Test (WCST). Results: The participants were found to have IQ scores within the average range, as determined by Wechsler Intelligence Scale for Children - Fourth Edition (WISC-IV). They had low average to average visual perception and motor integration skills as measured by the TVPS and VMI. Nonverbal executive functioning was in the average range for inhibitory control and visual working memory, and fell below average in cognitive flexibility, strategy development, and sustained attention. Pearson correlation was performed to better understand the relationship between visual perception and nonverbal executive functions. The analysis revealed significant associations between visual-perception and nonverbal executive functions (TVPS and CPT omission errors [r=-.642 p<0.05]; TVPS and DKEFS Trail Making [r=.917 p<0.01]); and VMI and DKEFS Color-Word [r=-.848 p<0.05]). Conclusions: The results highlight the combined role of visual-perception and executive functions in children with pediatric epilepsy. Considering these domains in tandem will have practical utility for therapeutic interventions and school planning.