Prospective Assessment of Cognitive Outcomes in Pediatric Self-Limited Epilepsy With Centrotemporal Spikes

Self-limited epilepsy with centrotemporal spikes (SeLECTS) is the most common focal epilepsy syndrome in childhood. Although its clinical course is generally benign, concerns remain regarding potential cognitive effects of both the disease and antiepileptic treatments. This study aimed to evaluate visuospatial abilities and cognitive perception in children newly diagnosed with SeLECTS and to compare the cognitive outcomes of levetiracetam and valproic acid monotherapy.

This prospective study included 64 children aged 5-10 years who were newly diagnosed with SeLECTS and initiated on monotherapy with either levetiracetam or valproic acid. Cognitive functions were assessed using the Bender-Gestalt Visual-Motor Perception Test at the baseline and after 6 months of treatment. Test results were compared within and between treatment groups.

Of the 64 children, 38 (59.4%) were male and 26 (40.6%) were female, with a mean age of 8.5 ± 1.7 years. Valproic acid was prescribed to 34 patients (53.1%), and levetiracetam to 30 patients (46.9%). There were no significant differences between the groups in terms of age or sex distribution (p = 0.052 and p = 0.63, respectively). In the levetiracetam group, the mean Bender-Gestalt error percentile score increased from 32.0 ± 25.0 at baseline to 37.3 ± 25.2 at month 6, while in the valproic acid group, the corresponding values were 30.6 ± 21.7 and 30.9 ± 25.4. No statistically significant differences were observed between baseline and 6-month cognitive assessments within or between the two treatment groups (p = 0.30 and p = 0.83).

In children newly diagnosed with SeLECTS, neither levetiracetam nor valproic acid monotherapy was associated with significant changes in visuospatial abilities and cognitive perception over a 6-month follow-up period. Further long-term and larger-scale studies are warranted to clarify these findings.