Localization of seizure foci in pediatric populations : development of a predictive pediatric model

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2020-09-14

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Dickson, Duncan Martin

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Abstract

Epilepsy is the second most common neurological condition of childhood in the United States. Its deleterious effects on neuropsychological functioning are associated with significant direct and indirect costs at both the individual and societal level. Despite this, relatively few studies have systematically compared neuropsychological functioning by epilepsy type in pediatric populations. This study aimed to address a significant gap in the literature by performing a broad, multi-domain comparative analysis of neuropsychological functioning in the two most common localization-related symptomatic epilepsies: temporal lobe epilepsy (TLE) and frontal lobe epilepsy (FLE). Past findings, primarily with adults, have supported a localizationist model of focal epilepsy. Based on these studies, it was hypothesized that the TLE group would perform better on measures of executive functioning, motor functioning, and externalizing behaviors, and the FLE group would demonstrate better performance on measures of memory and language. Retrospective case review of patients referred for neuropsychological evaluation at the Dell Children’s Medical Center Comprehensive Epilepsy Program resulted in the identification of 107 eligible participants (ages 6 to 18) with either TLE or FLE. Demographic, epilepsy related, and neuropsychological variables were included in the data set. Neuropsychological performance was compared between groups (TLE vs FLE) in the domains of memory, executive functioning, language, motor functioning, intellectual functioning, academic achievement, and psychosocial functioning. Contrary to expectations, no significant differences were observed between the TLE and FLE groups on any of the 54 measures of neuropsychological performance analyzed in the current study. This lack of significant findings in a pediatric sample runs counter to the traditional conceptualization from the adult literature that TLE and FLE present with distinct neuropsychological phenotypes. Furthermore, these findings support a paradigm shift towards a developmental network dysfunction model in pediatric epilepsy. Exploratory analyses suggest promising targets for future research.

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