Neurocognitive Profiles of Pediatric Patients with ESES, Generalized Epilepsy, or Focal Epilepsy

To date, the neurocognitive profile and comorbid psychiatric risks associated with ESES, a syndrome that commonly coincides with a seizure disorder, in contrast to generalized or partial/focal epilepsy without ESES remains unclear. Accordingly, this preliminary study aimed to characterize the neurocognitive differences across pediatric patients with ESES, generalized or focal epilepsy, and risk for comorbid diagnoses (mood disorder, autism, intellectual disability, learning disability, ADHD). We included data from a total of 79 pediatric patients, including those with recently diagnosed ESES (N = 12), generalized epilepsy (GE, N = 25), left focal epilepsy (LFE; N = 20), or right focal epilepsy (RFE; N = 22). All patients completed a neurocognitive evaluation as part of their medical workup and treatment for epilepsy. Cognitive domains assessed include intellectual functioning, verbal/non-verbal reasoning, working memory, processing speed, receptive language, learning and memory. Results showed that children with GE performed more poorly across intellectual functioning, verbal and non-verbal reasoning, working memory, processing speed, and receptive vocabulary; whereas, these areas were most preserved among those with RFE. Working memory and processing speed among those recently diagnosed with ESES was also modestly stronger compared to the GE group. A greater proportion of patients with GE met diagnostic criteria for a learning disability relative to other epilepsy types, although the rates of ADHD, autism spectrum, intellectual disability, and mood disorder were comparable across groups. Findings provide supporting evidence that GE may be associated with greater cognitive risks when refractory to treatment, highlighting the need for earlier intervention services to circumvent adverse effects on adaptive and behavioral functioning. Neuropsychological differences between ESES versus other epilepsy subtypes may emerge as a late-effect of the neurological condition and/or related medication treatment, implicating a greater need for developmentally focused investigations.