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Daniel Miles, MD

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Pediatric Epilepsy: Cognitive Problems, Medication Effects and Autism

Pediatric Epilepsy: Cognitive Problems, Medication Effects and Autism

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  • 1. Pediatric Epilepsy
    Cognition, Autism, Medication effects
  • 2. Pediatric EpilepsyCognition
    Cognition
    Memory
    Perception
    Attention
    Organization
    Planning
    Problem solving abilities
  • 3. 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
  • 4. Pediatric Epilepsy Cognition
    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
  • 5. Pediatric Epilepsy Cognition
    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
  • 6. Pediatric Epilepsy Cognition
    Underlying factors in academic difficulties:
    Intrinsic developmental capability
    Associated brain disease
    Parent-child interactions
    Seizures
    Medications
  • 7. Pediatric Epilepsy Cognition
    The underlying brain disease , not the seizures, is the most important factor contributing to subnormal intellect in children with epilepsy
  • 8. Pediatric Epilepsy Cognition
    Epileptic syndrome and prognosis for cognitive function
    Unfavorable cognitive development
    West syndrome
    Lennox-Gastaut syndrome
    Doose’s syndrome
    Landau-Kleffner syndrome
    Rett syndrome
  • 9. Pediatric Epilepsy Cognition
    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
  • 10. 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
  • 11. Pediatric EpilepsyAutism
    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
  • 12. Pediatric EpilepsyAutism
    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
  • 13. Pediatric EpilepsyAutism
    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,
  • 14. Pediatric EpilepsyAutism
    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
  • 15. Pediatric EpilepsyAutism
    Genome wide studies are demonstrating “copy number variants” or CNVs (deletions, duplications, and insertions) that are common to both epilepsy and autism.
  • 16. 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.
  • 17. Pediatric EpilepsyMedication Effects on Cognition
    Types of cognitive impairment
    Depressed capacity of the information-processing system by producing slowing
    Decreased the input of working memory
    Decreased mental flexibility
  • 18. Pediatric EpilepsyMedication Effects on Cognition
    Many studies done only compare one agent with another that is thought to have a “favorable cognitive profile”
  • 19. Pediatric EpilepsyMedication Effects on Cognition
    Phenobarbital
    Cognitive impairment including visual motor and memory tests
    Phenytoin (Dilantin)
    Attention, memory and memory speed
    Valproate (Depakote)
    Impairment of mental speed
  • 20. Pediatric EpilepsyMedication Effects on Cognition
    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
  • 21. Pediatric EpilepsyMedication Effects on Cognition
    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
  • 22. Pediatric EpilepsyMedication Effects on Cognition
    Vigabatrin (Sabril)
    Few cognitive side effects
    Zonisamide (Zonegran)
    Sedation
    Lacosamide (Vimpat)
    Sleepiness/fatigue
    Rufinamide (Banzel)
    Sleepiness/fatigue

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