cognitive functions in children with epilepsy. Several neuropsychological studies have been carried out but only on epileptic syndromes as West syndrome and Lennox-Gastaut syndrome. It looks very important to study the neuropsychological profiles in the different types of epilepsy in childhood (generalized and partial epilepsy, idiopathic and non idiopathic). Different tools are now available for detection of cognitive deficits.
Patrice Gillet, Dominique Sauvage, Catherine Billard
a usefull assessment tool enabling identification of the structural disturbances that will affect the learning process. For school-age children, assessment can be made in regard to the DSM IV criteria of specific learning disabilities, and within a neuropsychological framework that pays a particular attention to the executive functions.
Anne de Saint-Martin, Caroline Seegmuller, Roberta Carcangiu, Catherine Kleitz, Edouard Hirsch, Christian Marescaux, Marie-Noëlle Metz-Lutz
syndrome in 1959 by Beaussart and Nayrac was a great progress for childhood epileptology: the existence of a focal epilepsy with a good prognosis and no underlying brain lesion, so-called "benign" epilepsy, was recognized. Since the first descriptions, numerous neuropsychological studies were performed showing variable results. All the studies agree with the fact that children with rolandic epilepsy keep a normal global intellectual efficiency and a good long-term outcome. Nevertheless, some children may suffer transiently during the active phase of the epilepsy from oromotor dysfunction, neuropsychological deficits, or attention deficits with learning disorders. The analysis of cognitive and neurophysiological correlations evidenced a significant correlation between the epileptic focus localization and few specific dysfunctions. We evidenced mainly a significant effect of the persistence of a prolonged slow focus and a strong activation of night EEG spike and waves on cognitive decline and attention disorders. These abnormalities are mainly observed during severe or atypical evolutions of rolandic epilepsy. Preliminary longitudinal studies show that these cognitive deficits are transient. Thus, the presence of an active epileptic focus, without underlying brain lesion, could interfere with normal maturation of cognitive function.
Bernard Echenne, Renée Cheminal, Agathe Roubertie, François Rivier
school difficulties observed in children with idiopathic generalized epilepsies, especially absence epilepsies, myoclonic epilepsies considered as non-severe, and generalized epilepsies with tonico-clonic seizures.
In a controlled study concerning typical absence epilepsy, we have shown a lack of high or moderately elevated level of non-verbal and total IQ scores on Wechsler's tests (WISC III); we also observed a significant impairment of memory, a lengthening of school realisations, concerning motor skills and alertness and also hyperactivity and/or attention disorders, concerning 35 to 50% of cases. Most of these children present with school difficulties, of variable degree.
These results show that the term "benign" is not appropriate in many cases of so-called benign idiopathic generalized epilepsies.
mental retardation. Neuropsychological evaluation may provide useful information on the nature and severity of these deficits which interfere with school achievement. Advances in medical knowledge have shown that childhood epilepsy should not be considered as a single disorder but encompasses a whole range of different conditions that exhibit specific clinical, EEG and outcome characteristics. It is known becoming apparent that these various clinical entities have different cognitive expressions that yet need to be specified according to the age of onset and the location of seizure focus. A few neuropsychological studies have demonstrated that both ictal and interictal EEG epileptiform discharges can lead to cognitive deterioration. There is now evidence that the topographic impact of epilepsy needs to be considered in epileptic children to optimize their cognitive evaluation and guide their neuropsychological rehabilitation.
reducing EEG paroxysmal activity should be considered. This applies particularly to Landau-Kleffner syndrome and to the syndrome of continuous spike-waves during slow sleep. In developmental language disorders, EEG paroxysmal activity is present in almost 30% of the cases. Paroxysmal abnormalities are usually less frequent than what is observed in epilepsy with continuous spike-waves during slow sleep. Pathogenesis remains unknown and the relationship between EEG evolution and language improvement is not as clear as in Landau-Kleffner syndrome.
Sylvie Nguyen The Tich, Yann Péréon
to identify, especially in severe epilepsy. Nevertheless, the possible negative effect of treatment on cognitive performance is a constant preoccupation for parents.
Despite numerous clinical investigations this remains questionable. Methodological difficulties could in part explain contradictory results obtained for a given drug.
The most recent data suggest that antiepileptic drugs used in monotherapy (with the exception of phenobarbital) do not have clear effect on cognitive and behavioral development in children. This does not exclude individual sensibility observed in clinical practice. Identifying clinical risk factors for significant cognitive adverse effects may help prescription. For the new antiepileptic drugs few additional studies are needed to define cognitive and behavioral profiles.
be considered as a major task by the treating physician. Quality of the information provided by the physician and listening to the parents and the child are important factors that will influence the follow-up.