The effect of seizure type and medication on cognitive and behavioral functioning in children with idiopathic
1Department of Pediatrics, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick 08901, USA.
Insights
Antiepileptic drugs did not significantly impact cognitive or behavioral functioning in children with new-onset epilepsy. Intrinsic and environmental factors appear more influential than medication on psychological outcomes.
Area of Science:
- Pediatric Neurology
- Neuropsychology
Background:
- Antiepileptic drugs (AEDs) may cause adverse effects in children with epilepsy.
- Previous studies lacked control for baseline child status, confounding medication effect assessments.
Purpose of the Study:
- To investigate the cognitive and behavioral effects of AEDs in children with new-onset idiopathic seizures.
- To assess psychological functioning changes over 6 and 12 months of AED treatment.
Main Methods:
- Studied 43 children (4-16 years) with new-onset idiopathic seizures, naive to AEDs.
- Classified seizure types: generalized convulsive, generalized non-convulsive (absence), simple partial, complex partial.
- Evaluated cognitive and behavioral profiles at baseline and after 6/12 months of AED therapy.
Main Results:
- Children with partial seizures initially outperformed those with generalized seizures on cognitive measures.
- No significant cognitive or behavioral deterioration was observed after 6 or 12 months of AED treatment.
- Baseline cognitive differences between seizure groups diminished post-treatment.
Conclusions:
- AEDs did not appear to cause significant psychological deterioration in this cohort.
- Intrinsic and environmental factors likely play a greater role in cognitive and learning difficulties than AEDs in children with epilepsy.
Abstract:
Antiepileptic drugs have been reported to have a variety of adverse effects on behavior and performance in children with epilepsy. Previous studies investigating these side effects, however, have not controlled for the baseline status of the child (e.g. underlying neurological condition, seizure type, socioeconomic status, family variables), making it difficult to determine whether changes in function are attributable to the use of medication. We investigated the cognitive and behavioral profiles of 43 children, aged from 4 to 16 years, with new onset, idiopathic seizures. Twenty-six of these children participated in a 6-month follow-up study, and 12 in a 12-month follow-up study, investigating the effects of antiepileptic medications on psychological functioning. The children were of average intelligence (mean IQ 108) and had not previously been treated with antiepileptic medication. Children were classified as having either generalized convulsive, generalized non-convulsive (absence), simple partial, or complex partial seizures. Prior to the initiation of treatment, children with partial seizures were found to perform better than children with generalized seizures on measures of cognitive functioning. Children with convulsive seizures obtained significantly higher cognitive scores than those with non-convulsive seizures. Children with generalized non-convulsive seizures had lower cognitive scores than subjects with other types of seizure. No differences were found between groups at baseline prior to the initiation of antiepileptic medications. Analysis of subjects' performance after 6 and 12 months of antiepileptic therapy showed no significant deterioration attributable to medication. The differences in cognitive performance of the four seizure groups at baseline were not apparent at the time of follow-up. These results indicate that intrinsic and environmental variables may play a more significant role in predisposing certain children to cognitive and learning problems than do antiepileptic medications.
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