PHILADELPHIA — Early detection of cognitive difficulties using a brief computerized cognitive screening may help reduce delays in intervention, data presented at the 2015 American Epilepsy Society Annual Meeting in Philadelphia indicate.
It is well understood that children with epilepsy have a high rate of cognitive and behavioral problems; however current screening protocols may not identify patients at greater risk early on in treatment, ultimately delaying remediation which can affect scholastic functioning.
“Cognitive difficulties in children with epilepsy affect different domains, including memory, language, and executive function that occur during critical periods of development,” principal investigator Miya Asato, MD, of Children’s Hospital of Pittsburgh, told Neurology Advisor. “These defects are often not recognized and not treated, leading to long-term impairment.”
“While the IOM [Institute of Medicine] report suggests that deficits be characterized at diagnosis, the reality is that we have a lot of patients and it is very difficult to provide [neuropsychological] screening for all patients,” Dr. Asato said. “Identifying children at highest risk would be very valuable for physicians.”
For this study, Megan E. Bone, of the University of Pittsburgh School of Medicine, and colleagues sought to evaluate the feasibility of the brief CNS Vital Signs (CNSVS) computerized cognitive battery for the detection of comorbidities in children with new-onset epilepsy.
The researchers enrolled 33 patients (17 male; 26 generalized epilepsy, 7 focal epilepsy) aged 8-17 years with new-onset epilepsy and no previous antiepileptic drug treatment. Patients completed the CNSVS, which is completed in approximately 30 minutes, and parents completed the Strength and Difficulties Questionnaire, at two subsequent intervals (2-12 months = T2, 12-18 months= T3) during routine clinical appointments. Baseline scores were compared to subsequent scores using the Reliable Change Index (RCI).
All participants completed at least one follow up testing (mean follow-up time = 5.5 mo.), and 16 completed a third testing (mean total follow-up time = 14.5 mo.). Between baseline and first follow-up, 85% of patients had clinically significant changes in one of more cognitive domains including memory, psychomotor speed, reaction time, complex attention, and cognitive flexibility. There was no apparent relationship between change in cognitive performance and seizure medication, epilepsy type, and seizure control. Composite memory, cognitive flexibility, reaction time, and complex attention showed the most change at both follow-up intervals, while no significant changes were observed for psychomotor speed. In patients who improved or declined, change occurred at the first follow-up and remained stable thereafter. Parental concerns did not necessarily align with CNSVS score changes.
Ultimately, the CNSVS proved to be a brief but sensitive screening tool to help identify patients with epilepsy who may be at greater risk of cognitive and behavioral problems.
“The screening results, in conjunction with clinical data and parental information, can influence referral suggestion,” Dr. Asato said.
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- Bone ME, Triplett R, Rubin P, Asato MR. Abstract 1.293. Brief computerized screening detects cognitive changes in children with epilepsy. Presented at: American Epilepsy Society Annual Meeting; Dec 4-8, 2015; Philadelphia.