Speed and complexity characterize attention problems in children with localization‐related epilepsy

Abstract

SUMMARYObjective: Children with epilepsy (EPI) have a higher rate of attention-deficit/hyperactivity disorder (ADHD; 28-70%) than typically developing (TD) children (5-10%); however, attention is multidimensional. Thus, we aimed to characterize the profile of attention difficulties in children with epilepsy. Methods: Seventy-five children with localization-related epilepsy ages 6-16 years and 75 age-matched controls were evaluated using multimodal, multidimensional measures of attention including direct performance and parent ratings of attention as well as intelligence testing. We assessed group differences across attention measures, determined if parent rating predicted performance on attention measures, and examined if epilepsy characteristics were associated with attention skills. Results: The EPI group performed worse than the TD group on timed and complex attention aspects of attention (p < 0.05), whereas performance on simple visual and simple auditory attention tasks was comparable. Children with EPI were 12 times as likely as TD children to have clinically elevated symptoms of inattention as rated by parents, but ratings were a weak predictor of attention performance. Earlier age of onset was associated with slower motor speed (p < 0.01), but no other epilepsyrelated clinical characteristics were associated with attention skills. Significance: This study clarifies the nature of the attention problems in pediatric epilepsy, which may be under-recognized. Children with EPI had difficulty with complex attention and rapid response, not simple attention. As such, they may not exhibit difficulty until later in primary school when demands increase. Parent report with standard ADHD screening tools may under-detect these higher-order attention difficulties. Thus, monitoring through direct neuropsychological performance is recommended.

Systematic review of the screening, diagnosis, and management of ADHD in children with epilepsy. Consensus paper of the Task Force on Comorbidities of the ILAE Pediatric Commission

“…Continuous Performance Tasks (CPTs) have high positive predictive value but poor negative predictive value, meaning that a child who performs poorly is likely to have ADHD but a child who “passes” may also still have ADHD; thus, computerized tests do not reliably differentiate children with ADHD from those without . CPTs that rely on reaction time may also be a challenge, as children with epilepsy have slow processing speed which may interfere with performance rather than a primary attention problem . Access to free cognitive functioning tools in children with epilepsy is available, but these need to be assessed for sensitivity and specificity .…”

The role of executive functioning in memory performance in pediatric focal epilepsy

“…No group differences were found for simple auditory attention (WISC‐IV DSF) or the CVLT‐C factor of attention . A potential reason for these findings is that, both DSF and the CVLT‐C attention factor are based on the ability to remember items after a single exposure (e.g., CVLT‐C Trial 1), and our recent work suggests that simple attention is not different in pediatric epilepsy compared to complex attention . Similarly, no group differences were found for the CVLT‐C factor of organization/learning efficiency .…”

Comorbidities of Refractory Epilepsy and the Update Mechanism

“…Patients with refractory epilepsy have a higher rate of attention-deficit/hyperactivity disorder (ADHD), with a reported prevalence ranged from 28% to 70% [20], whereas 5-10% in general population [21]. Combined subtype of ADHD is believed to be more common in developmental ADHD, whereas Inattentive ADHD is more common in children with epilepsy [22].…”