Executive functions and self-limited epilepsy with centro-temporal spikes: A scoping review

Executive functions are a set of high-level cognitive processes necessary for planning, organization, decision-making, self-control, and attention, and are carried out in the anterior frontal lobes. An impairment in executive functioning might present as difficulties in planning and organizing activities, in attention and concentration, in cognitive flexibility, impulsiveness, and working memory fragility. These might result in greater emotional and psychopathological difficulties and poorer academic performance. Self-limited epilepsy with centro-temporal spikes (SeLECTS), the most common epileptic syndrome occurring in the pediatric population, is characterized by seizure remission around puberty in most cases. However, despite the favorable seizure outcome, previous studies have suggested that executive function deficits might be present and persist after epilepsy remission. We conducted a scoping review to investigate the current knowledge on executive functioning in children with SeLECTS. Furthermore, we explored psychopathological and emotional dimensions and daily functioning in this population. Starting from two reviews published in 2021, we conducted a complementary search and included 41 articles, from which we analyzed clinical data, neuropsychological findings, and their respective correlations. Our results confirmed the possible presence of executive dysfunction in patients with SeLECTS in the domains of inhibition and cognitive flexibility. We also strengthen possible impairments in working memory and higher order executive functions. We confirmed the correlation between executive dysfunction and both early age at onset and high frequency of electroencephalogram abnormalities and observed a possible role for high seizure frequency, secondary bilateralization, and the use of anti-seizure medications. We also found a higher prevalence of psychopathological dimensions, most commonly attention deficit-hyperactivity disorder, compared with controls. Overall, our findings support the need for neuropsychological assessment in clinical practice for children with SeLECTS to characterize executive functioning and its impact on psychopathological and emotional dimensions, as well as academic performance.