Cognitive outcomes in children who present with a first unprovoked seizure.
OBJECTIVE
To determine the long-term cognitive and educational outcomes in children prospectively identified at the time of a first unprovoked seizure.


METHODS
A cohort of children with a first unprovoked seizure was enrolled and followed for a mean of 15 years. Cognitive function and educational outcomes were determined 10 or more years after the first seizure via standardized neuropsychological tests, school records, and structured interviews. Children with symptomatic etiology were excluded from the analysis. When available, siblings of study subjects were recruited as normal controls. Primary educational outcome was defined as enrollment into special education services or grade repetition.


RESULTS
Twenty-eight percent of (43 of 153) of children with a single seizure and 40% (42 of 105) of children with epilepsy received special education service or repeated a grade (p = 0.05). There was a statistically significant trend in which the children with more seizures tended to require special education or repeat a grade more often (28% in single seizure group vs. 34% in 2-9 seizure group vs. 64% in ≥10 seizure group; p = 0.004). Of 163 subjects who completed neuropsychological testing, children with single seizures tended to score higher than children with epilepsy on Wide Range Achievement Test-3 (WRAT) reading (p = 0.08), Test of Non-Verbal Intelligence-II (TONI-II) (p = 0.02), and Wechsler Intelligence Scale for Children (WISC)/Wechsler Adult Intelligence Scale (WAIS) (p = 0.07). There was no statistically significant difference between children with a single seizure and sibling controls.


CONCLUSIONS
The results suggest that children with a single seizure represent a group that is distinctly different from children with epilepsy and are more similar to sibling controls. In contrast, even children with very mild epilepsy have significantly worse educational outcomes.
Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA. YSogawa@montefiore.org
Yoshimi
Y
Sogawa
David
D
Masur
Christine
C
O'Dell
Solomon L
SL
Moshe
Shlomo
S
Shinnar
D000293:Adolescent; D000328:Adult; D002648:Child; D003072:Cognition Disorders / Q000175:diagnosis* / Q000523:psychology; D004519:Education, Special / Q000706:statistics & numerical data*; D004522:Educational Status; D004827:Epilepsy / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009483:Neuropsychological Tests; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012640:Seizures / Q000175:diagnosis* / Q000523:psychology; D014477:Underachievement; D014888:Wechsler Scales / Q000706:statistics & numerical data