Serial Neuropsychological Evaluation of Children with Severe Epilepsy

Abstract

Cognitive impairment is common in children and adolescents with epilepsy. Though there is increasing recognition that even children with more benign epilepsy syndromes may show cognitive loss over time, this is particularly true in children with severe epilepsies, termed the epileptic encephalopathies. The current article discusses general cognition in children with epilepsy, focusing on risk factors for cognitive decline over time in severe epilepsies. The ?epileptic encephalopathies? are briefly introduced and methods for assessing cognitive loss over time are discussed with an emphasis on the use of reliable change indices. The strengths and the limitations of this approach are noted as they pertain to children. The article concludes with an illustrative case example of a young child with a severe epilepsy syndrome and apparent cognitive loss. The utility and limitations of reliable change indices are discussed within the context of this case.

Improved seizure burden and cognitive performance in a child treated with responsive neurostimulation (RNS) following febrile infection related epilepsy syndrome (FIRES)

“…Consistent with prior research, reliable change indices were used to identify change not attributable to measurement errors or practice effects (Jacobson and Truax, 1991; Duff, 2012). However, given the inherent limitations in applying these corrections within the pediatric population, particularly in the context of neurologic disease and extended retesting intervals, reported improvements are conservative (MacAllister, 2017). Although the initiation of stimulant medication may have enhanced processing efficiency and inhibitory control, the breadth and extent of improvement observed is beyond what would be expected with this medication change alone.…”