Utility of the Behavior Rating Inventory of Executive Function – Preschool version (BRIEF-P) in young children with epilepsy

Abstract

Executive functioning deficits are prominent in children with epilepsy. Although instruments, such as the Behavior Rating Inventory of Executive Function (BRIEF), are useful in detecting executive dysfunction in school-age children with epilepsy, little data are available for younger children. The present study evaluates the ability of the Behavior Rating Inventory of Executive Function - Preschool Version (BRIEF-P) to detect executive dysfunction in preschool-age children with epilepsy. Parents of 51 clinically referred children with epilepsy (age: M = 1.99 years, SD = 1.29 years, range = 2-5 years) completed the BRIEF-P. Using a cutoff t score of ≥65 as the threshold for impairment, the BRIEF-P's ability to detect executive dysfunction within this clinical population was established. Additionally, correlational analyses were used to assess the relations between epilepsy severity factors and BRIEF-P indices. Epilepsy severity variables that were significantly related to BRIEF-P indices were entered into a linear regression model to explore their predictive ability. Emergent metacognition (emergent metacognition index [EMI]; 59%) and the global executive composite (43%) were the most frequently elevated indices. The most commonly elevated subscales were working memory (65%), inhibition (37%), and planning/organization (35%). Age of seizure onset, seizure frequency, and number of antiepileptic drugs were not significantly correlated with BRIEF-P indices. However, children with lower intellectual ability were rated as having greater executive dysfunction, specifically with EMI (r = -.30). Still, intellectual functioning only accounted for a small percentage (9%) of the variance in EMI scores. The current pilot study demonstrates that the BRIEF-P shows promise in identifying executive dysfunction in preschool-age children with epilepsy.

Usefulness of preschool and school versions of the Behavioral Rating Inventory of Executive Functions in the evaluation of the daily life executive function in myoclonic–atonic epilepsy

“…WM domain was the only domain significantly affected in BRIEF-P questionnaire in our series. A previous study using BRIEF-P in a group of 51 patients with either focal, generalized or mixed epilepsies reported disturbances as well for Inhibit, Emotional Control and Plan/Organize [33].Our results suggest specific WM impairment in MAE in daily life. For the BRIEF, Initiate, Plan/Organize and Monitor show deficits in addition to WM.…”

“…Previous studies failed to show a correlation between EF and epilepsy characteristics [28][29][30]33,34,41]. Only one study reported that patients with early onset frontal lobe epilepsy have greater EF disorders [25].…”

“…Interestingly, Krivitsky and collaborators found that this profile on BRIEF with higher deficits in WM domain is present in several pediatric disorders such as brain tumors, leukemia, fibromatosis type 1 [29]. One study using the original American version of the BRIEF-P in young patients with various types of epilepsies found 65% of scores in the clinical rang for the WM domain, showing the highest frequency among all domains and a mean T score in the clinical range [33]. WM deficits are observed in patients with Attention Deficit Disorder without hyperactivity (ADD) [20].…”

“…Both are translated and validated in French [19,20]. These questionnaires allow an ecological evaluation of FE in the personal living spaces of the children and were already used in pediatric epilepsies studies [21][22][23][24][25][26][27][28][29][30][31][32][33][34] but none focused on MAE population. As MAE is characterized by normal initial development and the absence of cerebral lesion, it constitutes an interesting model for the evaluation of the impact of epilepsy on the cognitive and behavioral areas in young childhood.…”

Fenfluramine below the age of 2 years in Dravet syndrome: What about safety and efficacy?

“…Neurodevelopmental delay and early impairment in executive functions significantly lower health-related quality of life and may predict progressive deterioration of cognitive abilities later in life. [16][17][18] DS patients treated with FFA who experienced ≥50% reduction in MCSF during at least 1 year of treatment were significantly more likely to experience clinically meaningful improvement in executive functions if compared with patients not reaching this seizure response threshold. 10 In our sample of patients, after a median follow-up of 13 months, we found an MCSF reduction of 54% and a reduction of seizures of ≥50% in two of five patients.…”