Daniel Miles, MD

Pediatric Epilepsy

Cognition, Autism, Medication effects

Pediatric EpilepsyCognition

Cognition

Memory Perception Attention Organization Planning Problem solving abilities

Pediatric Epilepsy Cognition

Children with epilepsy have a disproportionate share of problems with learning and behavior

As a group they have an average IQ that is 10 points below normal

There is a 3-fold increase in mental retardation

Even those without mental retardation are at risk of academic underachievement or school failure


On the bright side

Half of children with epilepsy have normal academic records

Two-thirds are in regular classes

More than 80% are working at grade level

A majority of children with epilepsy develop normally and have normal cognitive abilities


Perception and attention have been found to be two of the major factors associated with learning difficulties in children with epilepsy

Boys have more problems than girls

It is difficult to determine the cause for academic difficulties in children with epilepsy


Underlying factors in academic difficulties:

Intrinsic developmental capability

Associated brain disease

Parent-child interactions

Seizures

Medications


The underlying brain disease , not the seizures, is the most important factor contributing to subnormal intellect in children with epilepsy


Epileptic syndrome and prognosis for cognitive function

Unfavorable cognitive development West syndrome Lennox-Gastaut syndrome Doose’s syndrome Landau-Kleffner syndrome Rett syndrome


Epileptic syndrome and prognosis for cognitive function

Favorable cognitive development Febrile seizures Childhood absence epilepsy Benign partial epilepsy of childhood (Rolandic

epilepsy) Juvenile myoclonic epilepsy

Pediatric EpilepsyAutism

Neurodevelopmental disorder affecting primarily social communication but associated with language impairments and repetitive behaviors

Autism spectrum disorders: a broader group of children including those with autism disorder, pervasive developmental disorders not otherwise specified, and those with Asperger’s syndrome


There is no clear evidence that epilepsy causes autism

The contribution of epilepsy and interictal epileptiform discharges to ongoing cognitive deficits in children with autism remains poorly understood and controversial

There is evidence that common shared anatomical and molecular mechanisms may account for both epilepsy and autism


Epilepsy and autism coexist in up to 20% of children with either disorder

Intellectual disability show a very high prevalence in those with both autism and epilepsy

Early onset seizures may be a factor in making infants at higher risk of autism


Epilepsy was noted in 21% of individuals with autism and intellectual disability versus 8% in individuals with autism without intellectual disability.

There is consensus that there is a strong association between epilepsy, autism, intellectual and motor disability in infants with epileptic encephalopathy, the overall effect of both epilepsy and interictal epileptiform activity,


Mechanisms that lead to epilepsy may also affect the development of social cognition

A recent study revealed malformations of cortical development in 12 of 13 autism brains and in only 1 of 14 control brains. Such malformations of cortical development are commonly found in children with epilepsy


Genome wide studies are demonstrating “copy number variants” or CNVs (deletions, duplications, and insertions) that are common to both epilepsy and autism.

Pediatric EpilepsyMedication Effects on Cognition

Cognitive side effects are generally reported to be mild to moderate in magnitude compared with most of the other types of side effects.

Some studies suggest such side effects have a greater impact on function and daily living than previously suspected.


Types of cognitive impairment

Depressed capacity of the information-processing system by producing slowing

Decreased the input of working memory

Decreased mental flexibility


Many studies done only compare one agent with another that is thought to have a “favorable cognitive profile”


Phenobarbital Cognitive impairment including visual motor and

memory tests

Phenytoin (Dilantin) Attention, memory and memory speed

Valproate (Depakote) Impairment of mental speed


Carbamazepine (Tegretol) Favorable compared with other “older” AED’s

Lamotrigine (Lamictal) Does not impair cognition May benefit mental performance “Euphoria” secondary to impact of cognitive

productivity

Oxcarbazepine (Trileptal) No impairment/improved cognitive functioning


Topiramate Dose related slowing of mental speed and

inattentiveness Word finding difficulty

Felbatol (Felbamate) “Alerting” No formal studies have been done

Gabapentin (Neurontin) Well tolerated cognitively


Vigabatrin (Sabril) Few cognitive side effects

Zonisamide (Zonegran) Sedation

Lacosamide (Vimpat) Sleepiness/fatigue

Rufinamide (Banzel) Sleepiness/fatigue

Daniel Miles, MD

Health & Medicine

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