Abstracts

Rationale: Neuropsychological evaluations can provide valuable information regarding cognitive functioning and can inform treatment recommendations including developmental, behavioral, and academic interventions. That said, a comprehensive neuropsychological evaluation may not be necessary for all children with epilepsy and many children who could benefit from an evaluation do not receive neuropsychological referrals as part of their clinical care. Therefore, the American Academy of Neurology developed a quality measure around neuropsychological screening for patients with epilepsy. However, research is lacking to inform methods of screening for neuropsychological needs. This study aimed to develop a means of identifying patients in greatest need of a comprehensive neuropsychological evaluation by evaluating variables related to neurocognitive performance including demographics, epilepsy information, parent screening questionnaires, and brief performance-based cognitive screening. Methods: Participants included 85 patients (8-16 years) diagnosed with epilepsy and prescribed antiepileptic medication. Demographic and medical information was provided through parent report and review of medical charts. Parents also completed the Strengths and Difficulties Questionnaire (SDQ) and the Pediatric Neuro-QoL System Measure of Cognitive Function. Participants completed the Dimensional Change Card Sort Test, Flanker Inhibitory Control and Attention Test, Pattern Comparison Processing Speed Test, and Picture Vocabulary Test from the NIH Toolbox on a tablet. They also completed a comprehensive neuropsychological battery that included measures of IQ, language, nonverbal, attention, executive, motor, and academic functions. Results: Hierarchical regression included four steps of predictor variables: 1) demographics (gender, race, public/private insurance, maternal education, family history of learning problems), 2) medical variables (age of seizure onset, duration of epilepsy, primarily focal or generalized seizures, EEG abnormality, MRI abnormality, seizure frequency, number of medications failed, number of current medications), 3) parent questionnaires (SDQ, Neuro-QoL), and 4) performance on a cognitive screener (NIH Toolbox battery). The outcome variable was mean z-score of neuropsychological tests on the comprehensive battery. Demographic variables did not significantly predict mean test score (p = .54, R²_Adj = -.01). Medical variables added significant predictive value above demographic variables (p = .002, R²_Adj = .20). Parent questionnaires did not add significant predictive value above demographic and clinical variables (p = .11, R²_Adj = .23). Performance on the cognitive screener added significant predictive value above demographic variables, clinical information, and questionnaires (p < .0001, R²_Adj = .55). Stepwise regression revealed that Pattern Comparison and Picture Vocabulary tests (ps < .0001) provided the best predictive value for performance on the comprehensive neuropsychological battery while Card Sort and Flanker tests provided limited additional value. Conclusions: Although demographics, medical information, and parent report can help inform the decision to refer for a comprehensive neuropsychological evaluation, they may not be sufficient. Our results suggest that performance on a two-subtest cognitive screener that can be administered in less than 10 minutes in a clinic setting may provide valuable information regarding whether a child with epilepsy should be referred for a comprehensive neuropsychological evaluation. Funding: Nationwide Children's Hospital Intramural Grant