Cognitive and neurodevelopmental comorbidities in paediatric epilepsy
Katherine C Nickels1, Michael J Zaccariello1, Lorie D Hamiwka2
1Child and Adolescent Neurology and Epilepsy, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA.
Insights
Children with epilepsy, especially refractory epilepsy, often experience cognitive and behavioral issues. Early screening and targeted therapies are crucial for improving quality of life and long-term psychosocial outcomes.
Area of Science:
- Neurology
- Pediatric Neurology
- Neurodevelopmental Disorders
Background:
- Cognitive and behavioral comorbidities are prevalent in children with epilepsy, particularly in refractory cases.
- These comorbidities significantly impact quality of life, language, behavior, and social skills, affecting long-term psychosocial functioning.
- Epileptic focus location can predict comorbidity type, but broad disability spectra suggest network dysfunction.
Purpose of the Study:
- To highlight the importance of periodic screening for cognitive comorbidities in children and adolescents with epilepsy.
- To emphasize the need for early intervention and therapy to mitigate adverse outcomes.
- To discuss the relationship between underlying pathology, seizures, and cognitive impairment.
Main Methods:
- Review of existing literature on cognitive and behavioral comorbidities in pediatric epilepsy.
- Analysis of the impact of epileptic focus and underlying pathology on neurocognitive function.
- Discussion of therapeutic strategies, including targeted treatments and antiepileptic therapies.
Main Results:
- Cognitive comorbidities are common and severe in refractory epilepsy, leading to poorer psychosocial functioning.
- Underlying structural or functional pathology causing seizures often underlies these comorbidities.
- While some conditions (e.g., GLUT1 deficiency) may improve with targeted therapy, cognitive impairment often persists despite seizure control.
- In epileptic encephalopathies, frequent seizures and epileptiform abnormalities worsen neurocognitive dysfunction.
Conclusions:
- Periodic screening for cognitive comorbidities in children and teens with epilepsy is essential for early intervention.
- Understanding the link between epilepsy, underlying pathology, and network dysfunction is key to managing comorbidities.
- Prompt and effective antiepileptic therapy is crucial, especially in epileptic encephalopathies, to limit cognitive comorbidities and support neurodevelopment.
Abstract:
Cognitive and behavioural comorbidities are often seen in children with epilepsy, and are more common and severe in refractory epilepsy. These comorbidities are associated with worse quality of life, increased behavioural and language problems and worse social skills, all of which adversely affect long-term psychosocial functioning. To enable early intervention and therapy, children and teens with epilepsy should be periodically screened for cognitive comorbidities. The location of the epileptic focus can, to a certain degree, predict the type(s) of comorbidity; however, the spectrum of disability is often broad, presumably because focal perturbations can cause network dysfunction. Comorbidities often result from underlying structural or functional pathology that has led to seizures. In selected cases, therapy targeting the underlying cause, such as the ketogenic diet for GLUT1 deficiency syndromes, may be remarkably effective in ameliorating both seizures and cognitive concerns. In many cases, however, cognitive impairment persists despite seizure control. In epileptic encephalopathies, frequent seizures and/or interictal epileptiform abnormalities exacerbate neurocognitive dysfunction, owing to synaptic reorganization or impaired neurogenesis, or to other effects on developing neural circuits, and prompt initiation of effective antiepileptic therapy is essential to limit cognitive comorbidities.
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