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Published online before print August 12, 2009, doi:10.1212/WNL.0b013e3181b23551)
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 Volume 73, Number 7, August 18, 2009
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Received October 3, 2008
Accepted May 11, 2009

Neuropsychological status at seizure onset in children. Risk factors for early cognitive deficits

P. S. Fastenau PhD*, C. S. Johnson MA, S. M. Perkins PhD, A. W. Byars PhD, T. J. deGrauw MD, PhD, J. K. Austin DNS, and D. W. Dunn MD

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


* To whom correspondence should be addressed. E-mail: 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≥G70) 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.


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