Uncovering the neurobehavioral comorbidities of epilepsy over the lifespan

Department of Neurology, University of California at Irvine, Irvine, CA, USA.
The Lancet (Impact Factor: 45.22). 09/2012; 380(9848):1180-92. DOI: 10.1016/S0140-6736(12)61455-X
Source: PubMed


Epilepsy is a common neurological disorder that is complicated by psychiatric, cognitive, and social comorbidities that have become a major target of concern and investigation in view of their adverse effect on the course and quality of life. In this report we define the specific psychiatric, cognitive, and social comorbidities of paediatric and adult epilepsy, their epidemiology, and real life effects; examine the relation between epilepsy syndromes and the risk of neurobehavioural comorbidities; address the lifespan effect of epilepsy on brain neurodevelopment and brain ageing and the risk of neurobehavioural comorbidities; consider the overarching effect of broader brain disorders on both epilepsy and neurobehavioural comorbidities; examine directions of causality and the contribution of selected epilepsy-related characteristics; and outline clinic-friendly screening approaches for these problems and recommended pharmacological, behavioural, and educational interventions.


Available from: Jack Lin, Dec 18, 2013
    • "Using a co-normed battery to test the neuropsychological profile of children thus allows estimating the expected amount of variance in common between different tests and controlling for the effects of specific deficits on other cognitive domains. Several studies have documented the effectiveness of NEPSY-II in identifying the strengths and weaknesses associated with various clinical conditions in children, such as restrictivetype anorexia (Calderoni et al., 2013), highfunctioning autism spectrum disorder (Narzisi, Muratori, Calderoni, Fabbro, & Urgesi, 2013), prematurity with very low birth weight (Lind et al., 2010, 2011; Olivieri et al., 2012), fetal alcohol spectrum disorders (Rasmussen et al., 2013), and organ transplantation (Haavisto, Korkman, Jalanko, Holmberg, & Qvist, 2010; Haavisto, Korkman, Holmberg, Jalanko, & Qvist, 2012; Haavisto et al., 2011). Because of its widespread clinical use and multidimensional approach to neuropsychological evaluation, NEPSY-II tests may be particularly apt for testing the neuropsychological profile of clinically referred children with epilepsy. "
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    ABSTRACT: Many studies have shown altered neuropsychological functioning of children with epilepsy even in the absence of intellectual disability, with notable concerns for both patients and their families. Although studies have described the cognitive profiles associated with specific epilepsy syndromes, there is incomplete agreement on the relation between spared and impaired abilities in different cognitive domains and on how deficits in one neuropsychological ability can secondarily affect performance in other cognitive domains. The aim of this study was to investigate the neuropsychological profile and vulnerabilities of children with epilepsy without intellectual disability or borderline intellectual functioning. 23 children aged 7-15 years, with a diagnosis of epilepsy of genetic or unknown cause and average intellectual functioning (IQ >85), were administered all age-appropriate tests of the Italian-language version (Urgesi, Campanella, & Fabbro, 2011) of a comprehensive neuropsychological battery (NEPSY-II: A Developmental Neuropsychological Assessment, Second Edition; Korkman, Kirk, & Kemp, 2007). Their performance was compared with that of a control group matched for gender, age, handedness and education. Children with epilepsy showed significant impairments as compared to the control group in tests of attention and executive functions and sensorimotor skills. Notably, particular difficulties were observed also in social perception tasks that require affect recognition, an ability that has been so far poorly considered in children with epilepsy. The results highlight the importance of performing extensive evaluation of cognitive functions, including social cognition processes, in children with epilepsy with average intelligence in order to design appropriate interventions aimed at minimizing long-term consequences on educational and behavioral outcome.
    Journal of Clinical and Experimental Neuropsychology 09/2015; 37(10):1-16. DOI:10.1080/13803395.2015.1076380 · 2.08 Impact Factor
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    • "Academic struggles and clinically significant academic underachievement are known complications of childhood epilepsies [1] [2] [3]. These are critical issues as they may contribute to subsequent adverse impacts on career trajectories, income, and socioeconomic status— long-term complications of childhood-onset epilepsy that have been reported by many investigators [4]. These issues associated with severe and intractable epilepsies are not unanticipated, but in children with " epilepsy only " without comorbid neurological disease, who have average intelligence and are attending regular classes, ongoing academic difficulties are often unrecognized [5]. "
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    ABSTRACT: Objective: This study was conducted to determine the lifetime rate and distribution of supportive academic and educational services provided to children with new- or recent-onset epilepsy and typically developing controls, the relationship of this history to objective academic test performance, and the course of performance over serial evaluations (baseline and 2 and 5years later). Methods: Research participants were 91 children aged 8-18 at study entry, including 50 youth with recent-onset epilepsy (28 focal [FE] and 22 generalized [GE] epilepsy) and healthy first-degree cousin controls (n=41). The sample with epilepsy included children with uncomplicated epilepsy and normal imaging and development. Lifetime history of a diversity of supportive educational services was determined via a structured interview with parents at the baseline study visit. Associations were examined between these support services and participants' academic performance in reading, spelling, and arithmetic (Wide Range Achievement Test-Revision 3 [WRAT3] [12]) during three serial study visits including baseline and 2 and 5years later. Results: Children with epilepsy had a higher lifetime rate of provision of diverse academic supportive services compared to controls at the baseline visit (52% vs. 18%). These services antedated epilepsy diagnosis in the majority (80.8%) of the children with epilepsy. Among children with epilepsy, children who presented with academic services had significantly lower WRAT3 reading, spelling, and arithmetic performance at baseline and at 2- and 5-year follow-ups. Conclusion: A brief structured clinical interview conducted with parents identifies children with epilepsy who are at academic risk at the time of diagnosis, with that risk persisting up to 5years later.
    Epilepsy & Behavior 02/2015; 43. DOI:10.1016/j.yebeh.2014.12.002 · 2.26 Impact Factor
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    • "For ASDs and epilepsy, associations between language disorders have been described [33], but literature on patterns of verbal and nonverbal abilities in epilepsy and ASDs is still scarce. Some features of a disorder may be masked and others may be emphasized in light of epilepsy [29], and more work has to be done to understand cognitive patterns seen in children with epilepsy with or without a comorbid condition. One aim of the current study was to compare the cognitive patterns of children across conditions, both isolated conditions (that is, without an additional comorbid diagnosis) as well as conditions comorbid with epilepsy. "
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    ABSTRACT: In pediatric epilepsy, comorbidities are reported to be frequent. The present study focusedon the cognitive patterns of children with isolated epilepsy, children with isolated neurodevelopmental disorders (reading disorders, math disorders, autism spectrum disorders), and children with epilepsy and these neurodevelopmental disorders as comorbidities. Based on two samples of referred children, one with epilepsy, reading disorders, math disorders, or ASDs occurring in "isolation" (n=117) and one with reading disorders, math disorders, and ASDs occurring comorbid with epilepsy (n=171), cognitive patterns were compared. The patterns displayed by verbal and nonverbal abilities from the WISC series were studied with repeated measures ANOVA. Thereafter, an exploratory 2∗3∗2 factorial analysis was done to study the independent contribution of the type of comorbidity and of the presence or absence of epilepsy to the VIQ-PIQ pattern. In isolated epilepsy, a VIQ>PIQ pattern was found, which was not seen in the other disorders. When epilepsy and another disorder co-occurred, patterns were altered. They resembled partly the pattern seen in isolated epilepsy and partly the pattern seen in the isolated neurodevelopmental disorder. In comorbid reading disorders, the VIQ>PIQ pattern was mitigated; in comorbid math disorders, it was exacerbated. In comorbid ASDs, no clear pattern emerged. In the presence of epilepsy, patterns characteristic of isolated disorders appeared systematically shifted toward relatively lowered performance abilities or relatively spared verbal abilities. The similar "impact" exerted by epilepsy on the patterns of the various conditions suggested shared mechanisms. Copyright © 2015 Elsevier Inc. All rights reserved.
    Epilepsy & Behavior 02/2015; 44C:159-168. DOI:10.1016/j.yebeh.2015.02.007 · 2.26 Impact Factor
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