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Neuropsychological profile in new-onset benign epilepsy with centrotemporal spikes (BECTS): Focusing on executive
Melissa Filippini1, Eleonora Ardu2, Silvia Stefanelli1
1Child Neurology Unit, IRCCS Istituto delle Scienze Neurologiche, via Altura 3, 40139 Bologna, Italy.
Insights
Children with new-onset benign epilepsy with centrotemporal spikes (BECTS) show early signs of neuropsychological deficits, impacting executive functions and language. Early assessment and intervention are crucial to prevent lasting academic challenges.
Area of Science:
- Neuroscience
- Pediatric Neurology
- Developmental Psychology
Background:
- Subnormal neuropsychological functioning is increasingly noted in childhood epilepsy, though findings remain limited and debated.
- Benign epilepsy with centrotemporal spikes (BECTS) is a common childhood epilepsy syndrome.
- Executive functions (EF) are critical for learning and academic success.
Purpose of the Study:
- To define the early neuropsychological profile of children with BECTS.
- To investigate the impact of BECTS on executive functions and related cognitive domains.
- To assess drug-naïve children with specific criteria to isolate BECTS effects.
Main Methods:
- A prospective study comparing 15 school-aged children with BECTS to 15 healthy controls.
- Utilized a comprehensive neuropsychological battery assessing language, EF, academic skills, visuomotor/visuospatial skills, and memory.
- Included only drug-naïve children with <85% NREM sleep discharges and Performance IQ ≥ 85.
Main Results:
- Significant differences found in language, including color naming, spoonerism, and phonemic synthesis.
- Executive functions were impaired, evidenced by difficulties in the five point test (fewer correct figures, more errors).
- Academic skills were affected, with significant differences in nonword writing/reading and word reading errors.
Conclusions:
- New-onset BECTS is associated with neuropsychological dysfunctions, particularly executive attention, even with normal IQ and low discharge frequency.
- These deficits suggest frontal lobe dysfunction with secondary impacts on language and academic abilities.
- Integrating EF assessment and intervention early is vital to mitigate persistent academic difficulties in children with BECTS.
Purpose:
Increased evidence of subnormal neuropsychological functioning in new-onset childhood epilepsy has been obtained, although results are still rare and controversial. With a prospective study, we aimed to define the very early neuropsychological profile of children with benign epilepsy with centrotemporal spikes (BECTS), including executive functions (EF) because of their key role in learning. Additionally, we enrolled drug-naïve children, with a NREM sleep frequency of discharges <85% and with a Performance Intelligence Quotient equal or superior to 85, in order to exclude additional effects on the neuropsychological functioning.
Methods:
Fifteen school-aged children with BECTS (mean age: 8.8years, standard deviation [SD]: 2.4years) and fifteen healthy children (mean age: 9.2years, [SD]: 2.5years) were enrolled and assessed with a comprehensive neuropsychological battery. The assessment included domain-specific standardized tests of language, EF, academic skills, visuomotor and visuospatial skills, and short-term memory. A p-value<0.05 was considered significant.
Results:
Significant differences between patients and controls emerged with respect to 3 domains. Language was affected in color naming (p=.026), spoonerism (p=.003), and phonemic synthesis (p=.009). Executive functions appeared inadequate in the five point test with respect to the number of correct figures (p=.003) and errors (p=.008). In the domain of academic skills, significant differences between groups emerged regarding the number of mistakes in nonword writing (p=.001), nonword reading speed (p=.027), nonword reading number of mistakes (p=.019), and word reading errors (p=.023).
Discussion:
Results showed that children with new-onset BECTS may demonstrate a range of neuropsychological dysfunctions, particularly affecting executive attention, despite a normal IQ, a low frequency of NREM sleep discharges, and the absence of drugs. These difficulties indicate a frontal dysfunction with cascading effects on language and academic skills. The inclusion of EF in the assessment battery and in the intervention since the very onset is warranted in order to avoid further and persistent academic difficulties.
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