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PEDIATRICS Vol. 112 No. 6 December 2003, pp. 1338-1344

Not Only a Matter of Epilepsy: Early Problems of Cognition and Behavior in Children With "Epilepsy Only"—A Prospective, Longitudinal, Controlled Study Starting at Diagnosis

Kim J. Oostrom, PhD*, Anneke Smeets-Schouten, PhD{ddagger}, Cas L. J. J. Kruitwagen, MSc§, A. C. Boudewyn Peters, MD, PhD||, Aagje Jennekens-Schinkel, PhD* for the Dutch Study Group of Epilepsy in Childhood (DuSECh)

* Division of Neuropsychology
|| Department of Child Neurology, Wilhelmina Children’s Hospital, University Medical Center, Center for Biostatistics, Utrecht, The Netherlands
§ Center for Biostatistics, Utrecht University, Utrecht, The Netherlands
{ddagger} Division of Clinical Psychology, Medical Spectrum Twente, Enschede, The Netherlands

Objective. To understand early educational and behavioral predicament in childhood "epilepsy only."

Methods. A multicenter, prospective, longitudinal study was conducted of 51 outpatient schoolchildren with newly diagnosed idiopathic or cryptogenic epilepsy and 48 sex-matched classmate control subjects. All children underwent neuropsychological assessment 3 times within the first year after diagnosis; parents and teachers completed behavior questionnaires, and patients’ parents were interviewed to inventory contextual adversity. Principal components analysis of cognition and behavior disclosed 6 major components that were related with the interview data (repeated measures analysis of variance).

Results. Despite similar intelligence and educational background, significantly more patients (51%) than control subjects (27%) required special educational assistance. Patients obtained worse scores across components of cognition and behavior. Parents and teachers perceived patients to have more behavioral problems. Differences between groups existed at pretreatment baseline. Over time, notwithstanding stable percentages of poor scores in both groups, nonpersistence of poor scores was impressive (each time other children scored poorly in other domains). Rather than epilepsy characteristics, contextual adversities were significant risk factors.

Conclusion. Already in the earliest stage of the illness, children with epilepsy are liable to vicissitudes in cognitive and behavioral functioning. Contextual variables are all-important.

Key Words: adversity • behavior • context • cryptogenic • epilepsy • idiopathic • predicament • school

Abbreviations: SEA, special educational assistance • DuSECh, Dutch Study of Epilepsy in Childhood • AED, antiepileptic drug • SE, size of effect

Received for publication Nov 21, 2002; Accepted Feb 18, 2003.


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