Academic journal article Cognitie, Creier, Comportament

Neuropsychological Impairments on the Cantab Test Battery: Case Reports of Children with Frontal and Temporal Lobe Epilepsy

Academic journal article Cognitie, Creier, Comportament

Neuropsychological Impairments on the Cantab Test Battery: Case Reports of Children with Frontal and Temporal Lobe Epilepsy

Article excerpt

ABSTRACT

Frontal and temporal lobe epilepsy in children has been less studied compared to that seen in adults. Children with epilepsy are at significant risk for cognitive impairment. Computerized batteries can record aspects of performance that are difficult for psychometrists to achieve with traditional tests. There has been recent interest in applying computerized technology to neuropsychological assessments, especially in epilepsy. We tested two children, one with frontal lobe epilepsy (three assessments) and one with temporal lobe epilepsy (two assessments) and compared their results between assessments. The cognitive evaluation included the Cambridge Neuropsychological Automated Testing Battery (CANTAB) and also IQ measured with Raven Progressive Matrices test. Two different patterns of cognitive functioning were obtained. Performance was different on some CANTAB tasks: lower in frontal and temporal tasks for the child with frontal epilepsy and with more specific deficits for the child with temporal lobe epilepsy. The cases studied revealed differences in cognitive function between assessments; the neuropathological substrate was also discussed. The findings highlight the benefit of using neuropsychological tests rather than general intellectual outcome alone, to obtain a better distinction of the specific cognitive weaknesses associated with epilepsy in children.

KEYWORDS: frontal and temporal lobe epilepsy, CANTAB, children, memory.

INTRODUCTION

Epilepsy in childhood is a common clinical problem with frequent associated social and learning burdens. Intellectual disability is a major contributor to the psychosocial comorbidity in childhood epilepsy (Nolan et al., 2003). The psychological and cognitive consequences of epilepsy can have a major impact on the social and academic adjustment of patients with epilepsy. The learning difficulties (in mathematics, reading, spelling and writing) found in 1/3 of epileptic children are frequently the consequence of specific cognitive disabilities rather than a disorder of global intellectual function although the distribution of intelligence quotient (IQ) scores of children with epilepsy is skewed toward lower values (Chaix et al., 2006). Various factors are considered likely to induce cognitive disabilities: the age of onset, period of time since onset, the type of epilepsy, the nature and frequency of the seizures, and the effects of antiepileptic treatment. Moreover, interictal EEG discharges are implicated in transient neuropsychological disturbance and may contribute to the cognitive problems of some children with epilepsy (Binnie, 2003).

The question of whether certain types of epilepsy and their underlying etiologies are characterized by a specific profile of cognitive strengths and weaknesses is of interest for diagnosis and treatment of children with epilepsy (Jokeit & Schacher, 2005). Epilepsy is not a unitary disease entity and refers to symptoms of paroxysmal disturbance of brain activity. Seizure onset zone, seizure frequency, seizure duration, and seizure semiology may vary considerably between and within patients. Considerable efforts have been undertaken to develop a common taxonomy of epilepsy (Benga, 2003). The fundamental dichotomy between generalized and focal or localization-related epilepsies is well accepted and useful in diagnostic and treatment. In contrast the sub-classification of symptomatic, cryptogenic and idiopathic epilepsies cannot be considered as definite (Jokeit & Schacher, 2005).

We'll present some characteristics of symptomatic focal epilepsies. The "International Classification of Epilepsies" suggests four main localization-related epilepsies: temporal lobe epilepsies, frontal lobe epilepsies, parietal lobe epilepsies and occipital lobe epilepsies. There are no specific causes or etiologies of these epilepsies with the exception of hippocampal sclerosis. There is widespread agreement that temporal lobe epilepsies associated with hippocampal sclerosis represent a highly prevalent discrete syndrome. …

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