The WISC-V in children and adolescents with epilepsy

The relationship between neuromagnetic networks and cognitive impairment in self-limited epilepsy with centrotemporal spikes

OBJECTIVE

This was an exploratory study designed to examine the alterations in neuromagnetic networks within brain regions involved in cognitive functions in children with self-limited epilepsy with centrotemporal spikes (SeLECTS). Additionally, it sought to explore the relationship between these neural network differences and cognitive impairment.

METHODS

Magnetoencephalography (MEG) data were collected from 63 drug-naïve children diagnosed with SeLECTS and 30 healthy controls (HC). Functional connectivity (FC) across 26 cognitive-related brain regions, as defined by Desikan-Killiany, was assessed using corrected amplitude envelope correlation (AEC-c) analysis. The cognitive function of the children was evaluated using the fourth edition of the Wechsler Intelligence Scale for Children (WISC-IV). Spearman's correlation analysis was then performed to assess the relationship between AEC-c values and WISC-IV indices.

RESULTS

Children with SeLECTS showed reduced FC in the delta band between the left rostral middle frontal (rMFG.L) and the left rostral anterior cingulate (rACC.L), as well as in the gamma2 band between the left superior frontal (SFG.L) and the rACC on both sides, compared to HC (p < 0.05). On the other hand, several FC networks were enhanced, including those between the left rMFG and the right rACC, the left rMFG and the left caudal middle frontal (CMF.L), and between the right caudal middle frontal (CMF.R) and the right supramarginal (SMG.R), specifically in the gamma1 band (p < 0.05). A correlation analysis revealed a positive association between the AEC-c values between the left rMFG and the right rACC and the Verbal Comprehension Index (VCI) scores (R = 0.4228, p < 0.05).

SIGNIFICANCE

The findings of this study revealed that children with SeLECTS exhibited significant differences in the FC networks in brain regions associated with cognition, especially within the delta and gamma frequency bands, when compared to HC. We also found that these differences in FC networks are significantly correlated with verbal comprehension ability, which may contribute to the understanding of the mechanisms underlying the weaknesses in cognitive function in children with SeLECTS. Furthermore, our findings may provide hypotheses for future work dedicated to further exploring the mechanisms associated with brain network alterations in cognitive impairment in children with SeLECTS.

PLAIN LANGUAGE SUMMARY

Based on magnetoencephalography technology (MEG), this study found that there were significant differences in cognitive-related neuromagnetic networks in children with SeLECTS compared with HC, which were significantly correlated with relevant indicators in the Wechsler Scale. This finding suggested that differences in the neuromagnetic network may serve as imaging markers to predict changes in cognitive function in children with SeLECTS.

Neuropsychological outcome after surgery of frontal lobe epilepsy in children with good seizure outcome

One third of children with drug-resistant epilepsy included in surgical programmes have frontal lobe epilepsy. Frontal lobe epilepsy in itself constitutes a high risk of impacting neurocognitive and behavioral development. In this study, we characterized the long-term neuropsychological and behavioral outcomes of children with pharmacoresistant structural focal epilepsy who underwent frontal neurosurgery. The clinical variables that may influence these outcomes were also investigated. A comprehensive neuropsychological evaluation - including a behavioral questionnaire - was administered to 37 children on long-term postoperative follow-up (5.1 years ± 2.9) using the Wechsler Intelligence Scale for Children, Fluency task, Rey-Osterrieth Complex Figure, Trail Making Test, Tower of London, Wisconsin Sorting Card Test and Achenbach Child Behaviour Inventory. To assess executive functions in the youngest children, we administered the junior version of EpiTrack. The clinical characteristics were as follows (mean in years ± standard deviation): Engel I (78 % with among them 96 % without anti-seizure medication), age of onset of seizures (3.5 ± 2.9), preoperative delay (3.9 ± 2.5), neurosurgical age (7.5 ± 3.6), FCD (n = 25) versus LEAT (n = 12) aetiologies. In our series, the children had an average FSIQ (92 ± 17) with a significant difference between VCI which was higher than WMI and PSI. About a third of the children experienced weakness of the executive functions with some difficulties in phonemic verbal fluency and slowness in attentional tasks, and a long execution time in planning, as well as impaired conceptualization and organization capacities. Mild to severe alteration on the Epitrack Junior was found in the majority of the youngest patients although they had a mean FSIQ of 96. At the behavioral level, around a quarter of children reached a pathological score in the attentional, social and anxiety/depression domains. Regarding the effects of clinical variables, we demonstrated that early age at surgery, shorter disease duration and LEAT etiology, were good prognosis factors for neuropsychological outcomes. Early frontal lobe resection followed by good seizure outcome efficiently determines intellectual and neuropsychological trajectory in selected patients. Our results help to better understand the cognitive and behavioral outcomes of this pediatric population, who may benefit from cognitive follow-up and adapted intervention when weaknesses are identified.

Screening of cognitive and behavioral comorbidity in children with recently diagnosed epilepsy: A pilot study exploring the feasibility and validity of a newly composed online screening tool

OBJECTIVES

Cognitive and behavioral comorbidity is frequent in childhood epilepsy and impacts on prognosis and QOL. Comorbidity often precedes seizure onset. Early screening is recommended but no consensus exists on the screening method. The current pilot study investigated the feasibility and validity of a newly developed screening method in children with recently diagnosed epilepsy.

METHODS

An online screening method was developed using a combination of existing and validated screening instruments (i.e. 2 standardised questionnaires and 2 psychometric tests), selected to detect the most common comorbid problems in childhood epilepsies. Feasibility was studied using patient and parent questionnaires and drop-out rates. Validity was studied by comparing the screening results to an in-depth diagnostic assessment. Descriptive statistics were used to analyse results.

RESULTS

Out of twenty referred children, 13 entered the study, of whom 1 dropped out (retention rate 93 %). Of those, ten were girls. Most patients were aged 9-12 year (38 %) or 12-15-year (38 %). Eighty-three percent of tested children proved to have cognitive or behavioral comorbidity. Screening results corresponded with diagnostic assessment results in most cases (9 true positives, one true negative), there was 1 false positive and 1 false negative screening result. Sensitivity of the screening amounts to 90 % (CI 73-107).

CONCLUSIONS

The current pilot study shows promising results with regards to feasibility and validity of the tested screening method for cognitive and behavioral comorbidity in childhood epilepsy. This warrants further investigation of the method.

Patterns of WISC-V Performance in Children with Congenital Heart Disease

Congenital heart disease (CHD) is one of the most common congenital birth defects. As surgical and interventional techniques have improved, the mortality has been greatly reduced and the focus has shifted to quality of life and long-term outcomes. The impact of CHD on development and cognition is becoming increasingly recognized. However, more research is needed to understand how children with CHD perform across various cognitive and intellectual domains. This study explored the performance of children with CHD on the newest version of the Wechsler Intelligence Scale for Children compared to normative controls. Children with CHD performed more poorly than normal controls across all indices and most subtests with large effect sizes. Additionally, we explored the patterns of impairment across indices and subtests, as well as the relationships between heard disease variables and WISC-V performance. Block design, Digit Span, and Similarities were the most commonly impaired scores in children with CHD, while Symbol Search, Picture Span, Figure Weights, and Vocabulary were least likely to be impaired.

Characterizing and comparing adaptive and academic functioning in children with low average and below average intellectual abilities

Objective The recent American Academy of Clinical Neuropsychology (AACN) consensus statement on uniform labeling of performance test scores places children who were previously characterized as having "borderline intellectual functioning" within the low average (LA; full scale intellectual quotient (FSIQ) between 80-89) or below average (BA; FSIQ between 70-79) categories. Given limited research examining functional differences across FSIQ groups using AACN's uniform labeling, this study examined adaptive and academic functioning by FSIQ group in youth referred for (neuro)psychological evaluation. Primary comparisons of interest were between LA and BA groups. MethodParticipants were 2,516 children between 6 to 13 years with standardized measures of intellectual, adaptive, and academic functioning. Participants were included if their FSIQ ranged from average to exceptionally low. Group differences in adaptive functioning and academic achievement were examined. ResultsThe LA group did not differ from the BA group in overall adaptive functioning and several domains of adaptive functioning (i.e. social, practical), but demonstrated slightly stronger adaptive skills in the conceptual domain. While the LA group evidenced slightly better word reading and math computation scores than the BA group, these statistically significant differences were not clinically -meaningful. ConclusionsIn this clinically referred sample, children with LA and BA intellectual abilities demonstrated similar adaptive skills, but slightly different academic achievement. Both groups demonstrated lower adaptive and academic functioning than children with average range FSIQs. These results suggest that adaptive functioning should be assessed during (neuro)psychological evaluations even when children do not have extremely low FSIQs.

Fine motor impairment in children with epilepsy: Relations with seizure severity and lateralizing value

Motor skill deficits are common in epilepsy. The Grooved Pegboard Test (GPT) is the most commonly used fine motor task and is included in the NIH Common Data Elements Battery for the assessment of epilepsy. However, there are limited data on its utility in children and adolescents. The present study investigated the effectiveness of this task in children and adolescents with epilepsy clinically referred for neuropsychological evaluation in a tertiary medical center. Two hundred and two children and adolescents (ages 6-16, 104 males, 98 females) completed the GPT. Base rates of impairment were calculated, correlational analyses determined relations with clinical variables, and ANOVAs and t-tests assessed for differences by seizure type, gender, and lateralized deficits in those with lateralized focal epilepsy. The GPT was sensitive to fine motor impairment in these children and adolescents, with over 60% having impaired performances. Further, performance was significantly correlated with IQ, age of epilepsy onset, number of medications, and seizure frequency. At the group level, those with lateralized focal epilepsy did not show significant differences between left and right hands, though the GPT correctly lateralized 63% of those with large between-hand performance disparities (i.e., one standard deviation or greater). In sum, the GPT is sensitive to fine motor deficits in pediatric epilepsy and is related to known epilepsy severity factors. However, the ability of the task to lateralize epilepsy onset is not robust.

Effects of antiseizure monotherapy on visuospatial memory in pediatric age

INTRODUCTION

Visuospatial abilities are fundamental for good school achievements and good daily functioning. Previous studies showed an impairment of visuospatial skills in pediatric patients with epilepsy; pharmacological treatment, although indispensable for the seizure control, could further affect cognitive functions. The aim of our study was to evaluate the visuospatial skills in children and adolescents with different forms of epilepsy well-controlled by antiseizure monotherapy, both at baseline and after one year follow-up, through a standardized neuropsychological assessment.

METHODS

We recruited 207 children and adolescents (mean age = 10.35 ± 2.39 years) with epilepsy, well controlled by monotherapy with levetiracetam, valproic acid, ethosuximide, oxcarbazepine or carbamazepine and 45 age/sex-matched controls. All the participants performed the Rey-Osterrieth Complex Figure, a standardized test for visuospatial perception and visuospatial memory assessment, at baseline and after 12 month of drug therapy. Age, sex, executive functions, non-verbal intelligence, age at onset of epilepsy, epilepsy duration, epilepsy type, lobe and side of seizure onset were considered in our analysis. EEG, seizure frequency, and drug dose were also recorded.

RESULTS

At baseline, the epilepsy group performed significantly worse than controls in the Immediate Recall test but not the Direct Copy test, without differences between epilepsy subgroups. Immediate Recall scores were related to age of seizure onset and epilepsy duration and executive functions. The re-assessment after 1 year showed that the Immediate Recall mean scores were not significantly changed in the levetiracetam and oxcarbazepine group, while they significantly worsened in the valproic acid, ethosuximide and carbamazepine groups. The Immediate Recall scores were correlated to age, age at onset of epilepsy, epilepsy duration, and executive functions.

CONCLUSIONS

Children with epilepsy may exhibit visuospatial memory impairment compared to their peer, that may be correlated to some features of the epilepsy itself and to the impairment of executive functions. Different antiseizure medications can affect visuospatial memory differently, so it is important monitoring this aspect in pediatric patients.

Myelin Pathology Beyond White Matter in Tuberous Sclerosis Complex (TSC) Cortical Tubers

Tuberous sclerosis complex (TSC) is a monogenetic disease that arises due to mutations in either the TSC1 or TSC2 gene and affects multiple organ systems. One of the hallmark manifestations of TSC are cortical malformations referred to as cortical tubers. These tubers are frequently associated with treatment-resistant epilepsy. Some of these patients are candidates for epilepsy surgery. White matter abnormalities, such as loss of myelin and oligodendroglia, have been described in a small subset of resected tubers but mechanisms underlying this phenomenon are unclear. Herein, we analyzed a variety of neuropathologic and immunohistochemical features in gray and white matter areas of resected cortical tubers from 46 TSC patients using semi-automated quantitative image analysis. We observed divergent amounts of myelin basic protein as well as numbers of oligodendroglia in both gray and white matter when compared with matched controls. Analyses of clinical data indicated that reduced numbers of oligodendroglia were associated with lower numbers on the intelligence quotient scale and that lower amounts of myelin-associated oligodendrocyte basic protein were associated with the presence of autism-spectrum disorder. In conclusion, myelin pathology in cortical tubers extends beyond the white matter and may be linked to cognitive dysfunction in TSC patients.

The use of the MSVT in children and adolescents with epilepsy

Pediatric neuropsychologists are increasingly recognizing the importance of performance validity testing during evaluations. The use of such measures to detect insufficient effort is of particular importance in pediatric epilepsy evaluations, where test results are often used to guide surgical decisions and failure to detect poor task engagement can result in postsurgical cognitive decline. The present investigation assesses the utility of the Medical Symptom Validity Test (MSVT) in 104 clinically referred children and adolescents with epilepsy. Though the overall failure rate was 15.4% of the total group, children with 2nd grade or higher reading skills (a requirement of the task) passed at a very high rate (96.6%). Of the three failures, two were unequivocally deemed true positives, while the third failed due to extreme somnolence during testing. Notably, for those with ≥2nd grade reading levels, MSVT validity indices were unrelated to patient age, intellectual functioning, or age of epilepsy onset, while modest relations were seen with specific memory measures, number of epilepsy medications, and seizure frequency. Despite these associations, however, this did not result in more failures in this population of children and adolescents with substantial neurologic involvement, as pass rates exceeded 92% for those with intellectual disability, high seizure frequency, high medication burden, and even prior surgical resection of critical memory structures.