The relative influence of epileptic EEG discharges, short nonconvulsive seizures, and type of epilepsy on cognitive function.
OBJECTIVE
This study addressed whether cognitive impairment in children with epilepsy is caused by disease-related stable factors, such as the type of epilepsy, or by acute effects of paroxysmal epileptic activity such as epileptic EEG discharges. We studied a nonselected group with short nonconvulsive seizures, as these seizures may elude detection and may therefore persist over a longer period. In this group, the diagnostic issue is to differentiate between the combined effects of several epilepsy-related factors on cognition.


METHODS
All children were assessed with 32-channel EEG, synchronized with a computerized cognitive test system and a video-monitoring system. Recording time was 2 h. The primary inclusion criteria were unclear seizures and fluctuations in cognitive performance and/or frequent epileptic EEG discharges in a recent EEG.


RESULTS
One hundred fifty-two patients met the inclusion criteria; 31 patients appeared not to have a diagnosis of epilepsy and were used as a nonepilepsy control group. Our results show that type of epilepsy has an impact on stable cognitive functions, such as educational achievement. Paroxysmal epileptic activity (acute effects of seizures and epileptic EEG discharges) affects primarily transient mechanistic cognitive processes (alertness, mental speed).


CONCLUSIONS
These results suggest that the effects of paroxysmal epileptic activity on transient cognitive mechanisms may accumulate over time and consequently affect the more stable aspects of cognitive function such as educational achievement. The clinical relevance is that early detection of the cognitive impact of seizure-related activity and subsequent treatment may prevent its detrimental impact on cognitive and educational development.
Aldenkamp
Albert
A
Department of Behavioral Sciences, Epilepsy Center Kempenhaeghe, Heeze, The Netherlands. aldenkampB@kempenhaeghe.nl
Arends
Johan
J
D000704:Analysis of Variance; D002648:Child; D003072:Cognition Disorders / Q000503:physiopathology* / Q000523:psychology; D004569:Electroencephalography / Q000706:statistics & numerical data*; D004827:Epilepsy / Q000145:classification* / Q000503:physiopathology* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012640:Seizures / Q000145:classification / Q000503:physiopathology / Q000523:psychology; D018709:Statistics, Nonparametric; D014888:Wechsler Scales / Q000706:statistics & numerical data