Executive Dysfunction and Depression in Pediatric Temporal Lobe Epilepsy: The Contribution of Hippocampal Sclerosis and Psychosocial Factors

Schraegle, William A.; Nussbaum, Nancy L.; Titus, Jeffrey B.

doi:10.1017/s1355617718000140

Cited by 14 publications

(19 citation statements)

References 60 publications

(84 reference statements)

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“…In our study, we found that intrinsic alertness, phasic alertness, mean RT for spatial cues, mean RT for center cues, and executive function were significantly increased when there was no difference in alertness and orientation effect in TLE patients relative to NCs at baseline. In general, these data reveal a potential cognitive decline in TLE patients, which was consistent with several other studies conducted by Schraegle and Nussbaum ( 30 ), Li et al ( 31 ), Nau et al ( 32 ), and van den Berg et al ( 33 ). TLE is associated with decreases in cognitive function, such as attention, memory and language, which may be present in most patients with epilepsy ( 34 ).…”

Section: Discussionsupporting

confidence: 92%

Alterations Functional Connectivity in Temporal Lobe Epilepsy and Their Relationships With Cognitive Function: A Longitudinal Resting-State fMRI Study

et al. 2020

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Background: Cognitive impairments in temporal lobe epilepsy (TLE) patients has been described as a chronically progressive feature of the disease. However, how severe recurrent seizures modify neuronal circuits in the human brain and subsequently degrade cognitive function, remains largely unknown. Here, we aimed to investigate longitudinal alterations by functional magnetic resonance imaging (fMRI) in TLE patients and to assess how those alterations are related to cognitive function performance. Methods: Sixteen TLE patients and 20 normal controls (NCs) were recruited for a study to observe longitudinal alterations in resting-state functional connectivity (FC) and to estimate alertness, orientation, and executive function both at baseline and at a follow-up time ~3 years later. Results: TLE patients, compared with NCs, showed impaired executive function, intrinsic alertness, and phasic alertness and exhibited lengthened reaction time (RT) in the spatial cue and center cue conditions at baseline. The orienting function of TLE patients was declined at follow-up compared to the baseline. Cross-sectional analysis demonstrated that TLE patients displayed significantly greater positive correlation than NCs between the right dorsolateral prefrontal cortex (DLPFC) and the right inferior parietal lobule (IPL) and right superior frontal gyrus (SFG). Furthermore, among TLE patients, the longitudinal study revealed a decrease in correlation between the right DLPFC and the right SFG compared to the baseline. In addition, there was a significant negative correlation between the longitudinal change in FC and the change in orienting function in TLE subjects. Conclusions: Abnormal connectivity between the DLPFC and the SFG suggests the potential of longitudinal resting-state fMRI to delineate regions relevant to cognitive dysfunction for disease progression.

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Section: Discussionsupporting

confidence: 92%

Alterations Functional Connectivity in Temporal Lobe Epilepsy and Their Relationships With Cognitive Function: A Longitudinal Resting-State fMRI Study

et al. 2020

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“…A very recent example of successful bringing together the separate camps of neuropsychology and psychopathology is a study of executive functioning and depression in children with temporal lobe epilepsy. 58 Such investigations are yet to be undertaken for children who have undergone epilepsy surgery. Finally, the effects of environmental variables on postsurgical cognitive development are debated and have to be studied further.…”

Section: Discussionmentioning

confidence: 99%

Reflection on Assessing the Development of Children after Epilepsy Surgery

Jennekens‐Schinkel

Schooneveld

2018

J Pediatr Epilepsy

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Children of schoolage having similar medical and neuropsychological conditions but entirely different life courses after left-sided hemispherectomy led us to reflect on sources of differences in development after epilepsy surgery. Two recent reviews exposed the impact of epilepsy-related variables on the cognitive outcomes and concluded that overall the surgical procedures had not caused additional harm. Our aim was to see whether facilitating or impeding influences—other than epilepsy and epilepsy surgery—were addressed in the literature regarding cognitive outcome. Further review of the literature did not yield information on influences of variables that are known to affect normal development; no study addressed influences of motor and/or sensory impairments. Few studies discussed interference of deficits in other cognitive domains with the target domains. The influences of gender and of an important environmental aspect, family factors, etc., were underexposed as well. Understanding why one child adjusts to her/his novel life situation and another child with apparently similar abilities and impairments is unable to do so, is essential for adequate counseling. A more biographical approach of cognitive development is proposed to understand the differential life courses of children and adolescents with a history of epilepsy surgery. A perspective of “functioning” rather than cognitive “functions,” conceived of as independent entities, will help bridge the gap between neurocognitive and more biographical approaches to the functioning of children after epilepsy surgery.

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“…31 Another study reported that children 8-16 years old with temporal lobe epilepsy took a mean of 1.45 antiepileptic drugs. 17 Two other studies found that more than half of children with temporal lobe epilepsy and FLE (56.7%-71.0%) were on antiepileptic drug polytherapy (defined as more than 1 antiepileptic drug). 28,33 In a severe form of the condition, PCDH19-related focal epilepsy, 82% of 2-12-year-old children were on more than 3 antiepileptic drugs.…”

Section: Humanistic Burdenmentioning

confidence: 98%

“…Studies used different instruments to test for language, reading, memory, motor, and visuospatial development delays and found that patients suffer from significant neurologic developmental delays. Instruments included the Delis-Kaplan Executive Function System (DKEFS), 17,26 the California Verbal Learning Test-Children's Version (CVLT-C), 25,17 the Trail Making Tests, 23,26 and the Behavior Rating Inventory of Executive Function (BRIEF). 17,22 Four studies reported on patient IQ, 17,23,22,26 two of which used the Wechsler Intelligence Scale for Children (WISC-IV).…”

Section: Humanistic Burdenmentioning

confidence: 99%

“…Instruments included the Delis-Kaplan Executive Function System (DKEFS), 17,26 the California Verbal Learning Test-Children's Version (CVLT-C), 25,17 the Trail Making Tests, 23,26 and the Behavior Rating Inventory of Executive Function (BRIEF). 17,22 Four studies reported on patient IQ, 17,23,22,26 two of which used the Wechsler Intelligence Scale for Children (WISC-IV). One reported low average scores (7.44-7.69 on verbal reasoning and 7.46-8.09 on spatial reasoning) among children 8-16 years old with temporal lobe epilepsy 17 and the other found average general ability index and working memory index scores among children 6-18 years old with focal epilepsy.…”

Section: Humanistic Burdenmentioning

confidence: 99%

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The Humanistic and Economic Burden of Pediatric Focal Seizures in the United States

et al. 2020

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Objective: To better understand the humanistic and economic burden of focal seizures in children 2-12 years old. Methods: We conducted a targeted literature review by searching MEDLINE for English-language publications reporting on children 2-12 years old with focal seizures published in the United States since 2008. Results: Thirty-five publications were included. Incidence of focal seizures was 23.2 to 47.1 per 100,000 children per year; prevalence was 2.0 per 1,000 children, and ranged from 1.6 - 2.6 per 1,000 in patients of any age. Life expectancy was 47.3-61.8 years among children 3-12 years old. Patients took several antiepileptic drugs and experienced frequent seizures, sleep disorders, mood disorders, migraine, and seizure-related injuries (eg, bone fractures, sprains, open wounds). Children with focal seizures scored below average on cognitive assessments and up to 42%, 16%, and 19% had depression, anxiety, and attention-deficit disorder, respectively. Patients of any age had about 10 outpatient visits (2 epilepsy-related), 2 inpatient visits (less than 1 epilepsy-related), and 24 procedures (1 epilepsy-related) per year. Medication adherence was low: only half of pediatric patients maintained ≥90% adherence over 6 months. Annual total health care costs among patients of any age ranged from $18,369 - 38,549; first-year total health care costs for children were $19,883. Conclusions: Incidence and prevalence of focal seizures is high and the humanistic and economic burdens are significant. Future studies focused exclusively on children with focal seizures are needed to more precisely describe the burden. We also suggest further research and implementation of methods to improve medication adherence as an approach to lessen burden on these young patients.

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Executive Dysfunction and Depression in Pediatric Temporal Lobe Epilepsy: The Contribution of Hippocampal Sclerosis and Psychosocial Factors

Cited by 14 publications

References 60 publications

Alterations Functional Connectivity in Temporal Lobe Epilepsy and Their Relationships With Cognitive Function: A Longitudinal Resting-State fMRI Study

Alterations Functional Connectivity in Temporal Lobe Epilepsy and Their Relationships With Cognitive Function: A Longitudinal Resting-State fMRI Study

Reflection on Assessing the Development of Children after Epilepsy Surgery

The Humanistic and Economic Burden of Pediatric Focal Seizures in the United States

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