Language in pediatric epilepsy

Abstract

SUMMARYPurpose: This study examined the severity and range of linguistic impairments in young, intermediate, and adolescent youth with epilepsy and how these deficits were associated with illness effects, nonverbal intelligence, psychopathology, and reading. Methods: Tests of language, intelligence, achievement, and structured psychiatric interviews were administered to 182 epilepsy youth, aged 6.3-8.1, 9.1-11.7, and 13.0-15.2 years, as well as to 102 age-and gender-matched normal children. Parents provided demographic, seizure-related, and behavioral information on their children. Results: Significantly more epilepsy subjects had language scores 1 standard deviation (SD) below average than the age-matched control groups did. The intermediate and adolescent epilepsy groups also had significantly lower mean language scores compared to their matched controls. The older compared to the younger epilepsy groups had more language impairment and a wider range of linguistic deficits. Longer duration of illness, childhood absence epilepsy, psychiatric diagnosis, and socioeconomic status were associated with linguistic deficits in the young group. Prolonged seizures, lower Performance IQ, and minority status predicted low language scores in the intermediate epilepsy group. In the adolescent group, language impairment was associated with poor seizure control, decreased Performance IQ, and lower socioeconomic status. Linguistic and reading deficits were significantly related in each epilepsy group. Conclusions: The age-related increase in linguistic impairment, different profiles of predictors in each age group, and the relationship of linguistic deficits with poor reading skills have important clinical, developmental, theoretical, and academic implications.

Impaired language function in generalized epilepsy: Inadequate suppression of the default mode network

“…We hypothesized that adult people with GE would have language deficits as previously have been shown in children with GE [13,14]. We also hypothesized that people with GE would have inadequate suppression of DMN during language processing expressed by abnormal task-related functional DMN segregation, in line with the recent resting-state findings by McGill et al [22].…”

“…Previous findings suggest subtle frontal executive impairments in GE patients having normal IQ [12]. Language decline has been found in children with GE [13,14]. However, language function in adults with GE has not been studied as thoroughly as in individuals with epilepsy of focal origin.…”

Impaired performance on advanced Theory of Mind tasks in children with epilepsy is related to poor communication and increased attention problems

“…In school-aged CWE cohorts, poorer cognition and language have been linked to an early age at epilepsy onset [46,47], illness duration [28], persistent seizures [48], and multiple AEDs [47]. These factors can be correlated in small samples of chronic epilepsies that can make it difficult to distinguish between separate effects and can be confounded with low IQ.…”

“…Studies often report that the mean IQ of groups with epilepsy is at the lower end of the normal range [23,24], and the ability to reason about belief states and to understand the causes and consequences of emotions is impaired in children with global developmental delay [25,26]. Children with epilepsy with normal global cognition are also at higher risk for disorders of language and communication [27][28][29]. Preschool CWE have been found to have lower verbal IQ and deficits in basic language functions [30][31][32], whereas school-aged CWE cohorts have displayed additional problems with more complex skills that include pragmatic language [33,34] and conversational discourse functions [28,35].…”

“…Children with epilepsy with normal global cognition are also at higher risk for disorders of language and communication [27][28][29]. Preschool CWE have been found to have lower verbal IQ and deficits in basic language functions [30][31][32], whereas school-aged CWE cohorts have displayed additional problems with more complex skills that include pragmatic language [33,34] and conversational discourse functions [28,35]. There is also a higher risk of thought disorder that is characterized by an impaired ability to use coherent casual reasoning and to monitor higherorder topic maintenance in communication [36].…”