title: Cognitive Outcome in Childhood-Onset Epilepsy: A Five-Decade Prospective Cohort Study.
abstract: Little is known about the very long-term cognitive outcome in patients with childhood-onset epilepsy. The aim of this unique prospective population-based cohort study was to examine cognitive outcomes in aging participants with childhood-onset epilepsy (mean onset age=5.3 years) five decades later (mean age at follow-up=56.5 years).
  
  
  
  The sample consisted of 48 participants with childhood-onset epilepsy and 48 age-matched healthy controls aged 48-63 years. Thirty-six epilepsy participants were in remission and 12 continued to have seizures. Cognitive function was examined with 11 neuropsychological tests measuring language and semantic function, episodic memory, and learning, visuomotor function, executive function, and working memory.
  
  
  
  The risk of cognitive impairment was very high in participants with continuing seizures; odds ratio (OR)=11.7 (95% confidence interval [CI] (2.8, 49.6), p=.0008). They exhibited worse performances across measures of language and semantic function, and visuomotor function compared to participants with remitted epilepsy and healthy controls. In the participants with remitted epilepsy, the risk of cognitive impairment was somewhat elevated, but not statistically significant; OR=2.6 (95% CI [0.9, 7.5], p=.08).
  
  
  
  Our results showed that the distinction of continued versus discontinued seizures was critical for determining long-term cognitive outcome in childhood-onset epilepsy. Few participants in remission exhibited marked cognitive impairment compared to age-matched peers. However, a subgroup of participants with decades long active epilepsy, continuous seizure activity and anti-epileptic drug (AED) medication, showed clinically significant cognitive impairment and are thus in a more precarious position when entering older age. (JINS, 2017, 23, 332-340).
authors.affiliation: 1Department of Psychology,Åbo Akademi University,Turku,Finland.
authors.forename: Mira
authors.initials: M
authors.lastname: Karrasch
authors.affiliation: 2Department of Public Health,University of Turku,Finland.
authors.forename: Petri
authors.initials: P
authors.lastname: Tiitta
authors.affiliation: 4Department of Neurology,University of Wisconsin School of Medicine and Public Health,Madison,Wisconsin.
authors.forename: Bruce
authors.initials: B
authors.lastname: Hermann
authors.affiliation: 5Turku PET Centre,University of Turku and Turku University Hospital,Finland.
authors.forename: Juho
authors.initials: J
authors.lastname: Joutsa
authors.affiliation: 6Division of Clinical Neurosciences,University of Turku and Turku University Hospital,Finland.
authors.forename: Shlomo
authors.initials: S
authors.lastname: Shinnar
authors.affiliation: 5Turku PET Centre,University of Turku and Turku University Hospital,Finland.
authors.forename: Juha
authors.initials: J
authors.lastname: Rinne
authors.affiliation: 7Department of Clinical Neurophysiology,University of Turku and Turku University Hospital,Finland.
authors.forename: Anu
authors.initials: A
authors.lastname: Anttinen
authors.affiliation: 9Departments of Public Health and Child Neurology,University of Turku,Finland.
authors.forename: Matti
authors.initials: M
authors.lastname: Sillanpää
mesh_terms: D017668:Age of Onset; D000375:Aging; D060825:Cognitive Dysfunction / Q000209:etiology*; D018450:Disease Progression; D004827:Epilepsy / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged
keywords: Aging; Language; Neuropsychology; Seizure; Semantic function; Visuomotor function