Neuropsychological status at seizure onset in children: risk factors for early cognitive deficits.
OBJECTIVE
This large, prospective, community-based study characterized neuropsychological functioning and academic achievement at the time of the first recognized seizure and identified risk factors for cognitive deficits.


METHODS
We compared 282 children (ages 6-14 years, IQ > or =70) with a first recognized seizure to 147 healthy siblings on a battery of well-standardized and widely used neuropsychological and academic achievement tests and examined relationships with demographic and clinical variables.


RESULTS
In this intellectually normal cohort, 27% with just one seizure and up to 40% of those with risk factors exhibited neuropsychological deficits at or near onset. Risk factors associated with neuropsychological deficits included multiple seizures (i.e., second unprovoked seizure; odds ratio [OR] = 1.96), use of antiepileptic drugs (OR = 2.27), symptomatic/cryptogenic etiology (OR = 2.15), and epileptiform activity on the initial EEG (OR = 1.90); a child with all 4 risks is 3.00 times more likely than healthy siblings to experience neuropsychological deficits by the first clinic visit. Absence epilepsy carried increased odds for neuropsychological impairment (OR = 2.00).


CONCLUSIONS
A subgroup of intellectually normal children with seizures showed neuropsychological deficits at onset. Academic achievement was unaffected, suggesting that there is a window early in the disorder for intervention to ameliorate the impact on school performance. Therefore, the risk factors identified here (especially if multiple risks are present) warrant swift referral for neuropsychological evaluation early in the course of the condition.
Fastenau
P S
PS
Department of Psychology, Indiana University, Purdue University, Indianapolis, USA. Philip.Fastenau@uhhospitals.org
Johnson
C S
CS
Perkins
S M
SM
Byars
A W
AW
deGrauw
T J
TJ
Austin
J K
JK
Dunn
D W
DW
D000293:Adolescent; D017668:Age of Onset; D000927:Anticonvulsants / Q000627:therapeutic use; D001921:Brain / Q000254:growth & development / Q000503:physiopathology; D002648:Child; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D042241:Early Diagnosis; D004569:Electroencephalography; D004827:Epilepsy / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology; D005260:Female; D006801:Humans; D007859:Learning Disabilities / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D008297:Male; D009483:Neuropsychological Tests / Q000592:standards*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D012680:Sensitivity and Specificity
D000927:Anticonvulsants
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