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Published on: May 16, 2019
Preventing cognitive impairment in children with epilepsy
1Department of Child Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands.
Insights
Cognitive impairments in children with epilepsy can be mitigated through targeted interventions. Early diagnosis, personalized treatments, and seizure control are key to preventing further cognitive decline.
Area of Science:
- Pediatric Neurology
- Neuroscience
- Epileptology
Background:
- Cognitive impairments are prevalent in children with epilepsy, manifesting before or during the condition's course.
- Numerous factors contribute to cognitive dysfunction in this population.
- Understanding modifiable variables is crucial for intervention.
Purpose of the Study:
- To review targeted strategies for preventing or mitigating cognitive impairment in children with epilepsy.
- To highlight variables that can be addressed to improve cognitive outcomes.
Main Methods:
- Review of current literature on epilepsy and cognitive function in children.
- Analysis of factors influencing cognitive outcomes in pediatric epilepsy.
- Identification of potential therapeutic targets.
Main Results:
- Early diagnosis and treatment of epileptic encephalopathy improve cognitive outcomes.
- Effective seizure control is vital for optimizing cognitive functioning.
- Interventions targeting interictal epileptiform discharges may benefit children with unexplained cognitive impairments.
Conclusions:
- While some factors are immutable, targeted interventions can significantly improve cognitive outcomes in children with epilepsy.
- Early etiological diagnosis, personalized therapies, presurgical evaluation, and seizure control are essential.
- Monitoring and managing antiepileptic drug side effects are critical.
Purpose Of Review:
Cognitive impairments are common in children with epilepsy. They may already be present before the onset of epilepsy or occur - and even progress - during its course. Many variables contribute to cognitive dysfunction. Those that can be targeted to prevent (further) cognitive impairment will be highlighted in this review.
Recent Findings:
Ideally, but not yet realistically, epileptogenesis is prevented to avert seizures and cognitive impairments in high-risk patients. New and targeted treatments of progressive epileptogenic disorders and precision medicine approaches in genetic epilepsies are increasingly applied. Cognitive outcome benefits from early diagnosis and treatment of epileptic encephalopathy. Ongoing seizures may cause permanent and progressive changes in brain structure and connectivity, suggesting that early seizure control optimizes eventual cognitive functioning. Frequent interictal epileptiform discharges justify treatment in children with cognitive impairments that are otherwise unexplained. Cognitive adverse effects of antiepileptic drugs should be closely monitored and balanced against potential benefits. Finally, early surgical treatment in selected candidates will improve their cognitive outcome.
Summary:
Although important determinants of intellectual functioning - including the child's genetic and environmental background and the epileptogenic pathology - may not be modifiable, several variables that contribute to cognitive impairment can be targeted to improve outcome. Early etiological diagnosis, personalized therapies, presurgical evaluation, and strict control of seizures - or in some patients interictal discharges - can prevent (further) cognitive impairments.
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