Development of Visual Attention in West Syndrome

Abstract

Summary:Purpose: To study prospectively the evolution of visual attention in children with West syndrome to evaluate its development before the onset of spasms, its possible deterioration as a consequence of epileptic disorders, and its outcome at the age of 2 years, and the possible relation between the impairment of visual attention and cognitive development.Methods: Infants with symptomatic West syndrome were examined before the onset of spasms and until age 24 ± 2 months. Visual attention study (through a clinical observation and the fixation-shift test), cognitive assessment, and complete clinical examination including brain magnetic resonance imaging were performed.Results: A maturation defect of fixation shift skills was generally observed in infants with West syndrome. In some cases, the impaired visual-attention abilities paralleled a cognitive deterioration, even months before the onset of spasms. During the acute stage of West syndrome, infants lost the previously acquired visual and cognitive abilities, with a typical fluctuation of arousal. Usually at 2 years, there was a persistent defective visual attention detected with the fixation-shift test.Conclusions: The parallel defect of visual attention and of cognitive competencies is a constant finding in infants with West syndrome; these can precede the clinical onset of epileptic spasms. The severity and persistence of visual inattention might be explained by the age of visual maturation, corresponding to the usual onset of West syndrome.

Neuronal Networks in West Syndrome as Revealed by Source Analysis and Renormalized Partial Directed Coherence

“…These findings are supported by previous observations that the posterior cortex may be important in the pathogenesis of infantile spasms (Wenzel, 1987, Guzzetta et al, 2002, Metsahonkala et al, 2002, Rando et al, 2005, Siniatchkin et al, 2007, Juhasz et al, 2001. It has been…”

“…shown that the visual abnormalities such as poor visual responsiveness, abnormal visual evoked potentials, and deficits in fixation shift can already be detected at the early stages of West syndrome and even before (Wenzel, 1987, Guzzetta et al, 2002, Rando et al, 2005. Focal posterior cortical hypometabolism has been found in a great proportion of children with the West syndrome (Chugani et al, 1990, Jambaque et al, 1993, Metsahonkala et al, 2002.…”

Cerebral Visual Impairment in Children

“…West syndrome (infantile spasms): Lack of visual attention manifesting as lack of visual eye movements may precede the onset of epilepsy (Guzzetta et al 2002 ), and it is essential to suspect this diagnosis in all infants who appear not to see from birth.…”

Neuropsychological Deficits in Childhood Epilepsy Syndromes

“…Impaired eye-hand coordination was found to be deficient when infants were evaluated, even in idiopathic patients who appear to be functioning normally otherwise (Rando et al 2005). Impaired visual functioning involving acuity, ocular motility, visual field, visual attention, and visual scanning skills have been found in several studies with infants (Guzzetta et al 2002;Rando et al 2004). Guzzetta (2006) reported an associated deficit in auditory attention, and visual and auditory functions were both correlated with cognitive competence on the Griffith Scales of Infant Development.…”