Impact of focal interictal epileptiform discharges on behaviour and cognition in children
P Van Bogaert1, C Urbain, S Galer
1Laboratoire de cartographie fonctionnelle du cerveau (LCFC), Erasme hospital, université libre de Bruxelles (ULB), Brussels, Belgium. pvanboga@ulb.ac.be
Insights
Focal interictal epileptiform discharges (IED) may negatively impact children's behavior and cognition. Further research is needed to confirm the benefits of anti-epileptic treatments for reducing IED and improving outcomes.
Area of Science:
- Pediatric Neurology
- Neuroscience
- Developmental Psychology
Background:
- Focal interictal epileptiform discharges (IED) are frequently observed in children with developmental disorders and cognitive/behavioral deficits.
- Confounding factors like brain lesions, medication, and seizure frequency are excluded, strengthening the association between IED and neurodevelopmental issues.
Purpose of the Study:
- To investigate the hypothesis that focal interictal epileptiform discharges (IED) negatively affect behavior and cognition in children.
- To explore potential mechanisms by which IED impact cognitive functions.
Main Methods:
- Review of existing literature and neurophysiological/neuroimaging evidence.
- Analysis of the prevalence of IED in developmental disorders and cognitive deficits in epileptic children.
Main Results:
- IED may impact cognition through transient effects on brain processing or long-lasting remote inhibition.
- Sustained IED might also disrupt sleep-dependent learning and memory consolidation.
Conclusions:
- Focal IED are hypothesized to have a deleterious effect on pediatric behavior and cognition.
- The efficacy of anti-epileptic treatments for reducing IED and improving outcomes requires further investigation through well-designed studies.
Abstract:
It is hypothesised that focal interictal epileptiform discharges (IED) may exert a deleterious effect on behaviour and cognition in children. This hypothesis is supported by the abnormally high prevalence of IED in several developmental disorders, like specific language impairment, and of cognitive and behavioural deficits in epileptic children after excluding confounding factors such as underlying structural brain lesions, drug effects, or the occurrence of frequent or prolonged epileptic seizures. Neurophysiological and functional neuroimaging evidence suggests that IED may impact cognition through either transient effects on brain processing mechanisms, or through more long-lasting effects leading to prolonged inhibition of brain areas distant from but connected with the epileptic focus (i.e. remote inhibition effect). Sustained IED may also impair sleep-related learning consolidation processes. Nowadays, the benefits of anti-epileptic treatment aimed at reducing IED are not established except in specific situations like epileptic encephalopathies with continuous spike and waves during slow-wave sleep. Well-designed pharmacological studies are still necessary to address this issue.
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