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This Article Figures Only Full Text Full Text (PDF) CME: Take the course for this article: Volume 73, Number 7, August 18, 2009 All Versions of this Article: WNL.0b013e3181b23551v1 73/7/526    most recent Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Google Scholar Articles by Fastenau, P. S. Articles by Dunn, D. W. PubMed PubMed Citation Articles by Fastenau, P. S. Articles by Dunn, D. W. Related Collections All Clinical Neurology All Neuropsychology/Behavior All Pediatric All Cognitive Disorders/Dementia All Epilepsy/Seizures Related Article

Neuropsychological status at seizure onset in children

Risk factors for early cognitive deficits

From the Department of Psychology (P.S.F.), Indiana University, Purdue University, Indianapolis; Department of Neurology (P.S.F.), University Hospitals Case Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH; Division of Biostatistics, Department of Medicine (C.S.J., S.M.P.), and Departments of Psychiatry and Neurology (D.W.D.), Indiana University School of Medicine, Indianapolis; Departments of Pediatrics (A.W.B.) and Neurology (T.J.d.), Cincinnati Children’s Hospital Medical Center & University of Cincinnati College of Medicine, OH; and Indiana University School of Nursing (J.K.A.), Indianapolis.

Address correspondence and reprint requests to Dr. Philip S. Fastenau, Department of Neurology, University Hospitals Case Medical Center, 11100 Euclid Avenue, HAN 5040, Cleveland, OH 44106-5040 Philip.Fastenau{at}uhhospitals.org

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 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.

Abbreviations: AED = antiepileptic drug; ANOVA = analysis of variance; CELF = Clinical Evaluation of Language Fundamentals; CI = confidence interval; CTOPP = Comprehensive Test of Phonological Processing; OR = odds ratio; PURS = prior unrecognized seizure; WCST = Wisconsin Card Sorting Test; WRAML = Wide Range Assessment of Memory and Learning.

Editorial, page 496

e-Pub ahead of print on August 12, 2009, at www.neurology.org.

Supported by the NIH/National Institute of Neurological Disorders and Stroke (NS22416, J.K. Austin, PI).

Disclosure: Author disclosures are provided at the end of the article.

Received October 3, 2008. Accepted in final form May 11, 2009.

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