Starting at the beginning: the neuropsychological status of children with new‐onset epilepsies^*

Abstract

This review examines the neurodevelopmental contributions to the cognitive and behavioral complications of epilepsy. Following a brief review of the lifespan complications of childhood epilepsies, attention turns to cognitive, psychiatric and social correlates of childhood epilepsies reported in population-based and tertiary care studies. The focus then becomes the neurobehavioral status of children with new onset epilepsy—a point in time not confounded by the effects of years of recurrent seizures, medications, and social reactions to epilepsy. Recent research shows that abnormalities in cognition, brain structure and behavior are present at or near the time of diagnosis. Further, careful history indicates that neurobehavioral problems may be present in advance of the first seizure suggesting the potential influence of epileptogenesis, antecedent neurodevelopmental abnormalities, genetic and environmental susceptibilities, and other risk factors. This becomes the substrate upon which to characterize the effects of epilepsy and its treatment on subsequent neurodevelopment. The review concludes with suggestions for future clinical care and research.

Attention and executive functions in the early course of pediatric epilepsy

“…Therefore, the elevated rate of impaired EF in our group suggests that biophysiological dysfunctions affect cognitive performance in an early phase of epilepsy. Several studies suggest that cognitive impairment even antecedes the first seizure [17,18]. The specificity of the deficits regarding EF remains to be a subject of future studies.…”

“…Further, there is ongoing research on potential effects of specific drug substances on cognitive performance [14]. To date, several studies focused on pediatric populations [12,[15][16][17], but there is a significant need for investigating the cognitive profile of children with new-onset epilepsy prior to initiation of drug treatment to control for the potential effect of Epilepsy & Behavior 60 (2016) 42-49 medication [18]. Additionally, recent studies point to a heightened prevalence of cognitive deficits in adults as well as in children with newonset epilepsy in the early phase of illness, i.e., before treatment is started or even prior to seizures [4,11,[19][20][21].…”

“…Specifically, according to a recent study, where almost half of the patients showed deficits in these areas, attention and EF seem to be affected in adult patients prior to AED titration [20]. Similarly, studies on the neuropsychological status of children with new-onset epilepsy reveal deficits in these crucial areas of higher cognitive functioning (for review see [17]). Although children with new-onset epilepsy showed deficits in a broad range of functions when compared with healthy controls, the domains of EF, psychomotor speed, and arithmetic seemed to be most vulnerable [22].…”

Object naming in epilepsy and epilepsy surgery

“…In addition to proximal effects within the temporal lobe, recent work has established that the structural and functional effects of TLE can extend well beyond the region of seizure onset [75][76][77][78][79]. Diffusion tensor imaging studies have shown that fiber tracts connecting the temporal lobe with other brain regions are frequently adversely affected in patients with TLE; reduced integrity of the arcuate fasciculus in particular is associated with poor object-naming performance [50].…”

Developmental stage affects cognition in children with recently-diagnosed symptomatic focal epilepsy

“…However, several studies have reported the absence of such effects across these cognitive domains [27][28][29][30][31]. These inconsistencies not only may reflect differences in methodology and sample characteristics but also may be due to limitations of utilizing age at seizure onset as a marker of development, a variable enmeshed with illness duration, medication, and cumulative burden of seizures [32].…”