Childhood absence epilepsy: Behavioral, cognitive, and linguistic comorbidities

Abstract

SUMMARYPurpose: Evidence for a poor psychiatric, social, and vocational adult outcome in childhood absence epilepsy (CAE) suggests long-term unmet mental health, social, and vocational needs. This cross-sectional study examined behavioral/emotional, cognitive, and linguistic comorbidities as well as their correlates in children with CAE. Methods: Sixty-nine CAE children aged 9.6 (SD ¼ 2.49) years and 103 age-and gender-matched normal children had semistructured psychiatric interviews, as well as cognitive and linguistic testing. Parents provided demographic, seizure-related, and behavioral information on their children through a semi-structured psychiatric interview and the child behavior checklist (CBCL). Results: Compared to the normal group, 25% of the CAE children had subtle cognitive deficits, 43% linguistic difficulties, 61% a psychiatric diagnosis, particularly attention deficit hyperactivity disorder (ADHD) and anxiety disorders, and 30% clinically relevant CBCL broad band scores. The most frequent CBCL narrow band factor scores in the clinical/borderline range were attention and somatic complaints, followed by social and thought problems. Duration of illness, seizure frequency, and antiepileptic drug (AED) treatment were related to the severity of the cognitive, linguistic, and psychiatric comorbidities. Only 23% of the CAE subjects had intervention for these problems. Conclusions: The high rate of impaired behavior, emotions, cognition, and language and low intervention rate should alert clinicians to the need for early identification and treatment of children with CAE, particularly those with longer duration of illness, uncontrolled seizures, and AED treatment.

Determinants of Social Outcomes in Adults With Childhood-onset Epilepsy

“…Learning problems are common in school-aged children; however, they occur more often in children with uncomplicated epilepsy than in healthy peer controls. 9,[11][12][13] In fact, before diagnosis of epilepsy 11,28 or shortly thereafter, 9 children with uncomplicated epilepsy are already more likely to be receiving special education services compared with similar-aged controls. Before initiation of ASMs, adults with newly diagnosed seizures display evidence of relatively poorer memory function and processing speed compared with healthy controls.…”

“…In children with uncomplicated epilepsy, there is also ample evidence demonstrating an increased level of subtle cognitive as well as psychiatric and behavioral problems relative to healthy controls, which could also influence adult outcomes. [8][9][10][11][12][13] The respective impacts of seizure course versus learning and psychiatric problems on adult outcomes have not been distinguished. Understanding what places a child with epilepsy at risk for poorer outcomes in adulthood might contribute to management of childhood epilepsy, determining the need for early educational and psychiatric/psychological services, and planning pediatric to adult transition and transfer of care.…”

The hippocampus participates in a pharmacological rat model of absence seizures

“…Specifically, we hypothesized that the hippocampus is entrained by thalamocortical PDs in the GBL model of absence seizures in the rat. The hippocampus is particularly interesting since its involvement may explain the different degrees of cognitive impairments and memory loss in typical or atypical absence seizures (Caplan et al, 2008;Onat et al, 2013;Jackson et al, 2013). Previous recordings in genetic absence rodent models did not find evidence of hippocampal involvement during SWDs (Vergnes et al, 1990;Inoue et al, 1993;Kandel et al, 1996).…”

Paying Attention to School Achievement in Childhood Absence Epilepsy

“…Particularly problematic is attentional impairment, not only because of attention's effects on cognitive and school performance but also due to its behavioral effects such as attention deficit hyperactivity syndrome (ADHD) (1). In the absence of clinical trials characterizing performance prior to treatment initiation, however, and evaluation of specific treatment risks from drugs or potential treatment benefit from EEG normalization, potential contributions to attention performance have not been independently characterized.…”