The prospective study included 17 newly diagnosed children with epilepsy (CWE) (mean age, 32 months; 64.7% male) who underwent successful diffusion tensor imaging and cognitive testing. Age-appropriate neurocognitive assessment included use of either Bayley Scales of Infant and Toddler Development (BSID-III) or Wechsler Preschool and Primary Scales of Intelligence (WPPSI-III).

Cognitive impairment was defined as cognitive scores <1.5 standard deviations below population means.

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At first seizure, mean child age was 25 months. Seven of the 17 seizures were focal and 5 contained macroscopic abnormalities on magnetic resonance imaging.

The mean developmental quotient/intelligence quotient (DQ/IQ) score was 87, with 6 children (35.3%) having cognitive impairment.

The researchers corrected for age and found decreased fractional anisotropy in the right inferior longitudinal fasiculus (ILF) in children with cognitive impairment (0.323 vs. 0.405; P=.009), which they believe is due to increased radial diffusivity, with axial diffusivity being similar between groups.

There were no significant differences in other white matter tracts.

“Cognitive impairment is a common problem in children with epilepsy and is frequently present at diagnosis,” Dr. Yoong said. “Underlying brain structure may be a useful tool to help predict which children are at risk and require further attention and investigation.”

Dr. Yoong and his colleagues plan to examine patterns of white matter connectivity in these children to see whether the patterns can provide further information on children at risk for cognitive impairment.

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  1. Yoong M, Hunter M, Shetty J, et al. Abstract 1.143. Decreased white matter integrity associated with cognitive impairment in children with early onset epilepsy. Presented at: American Epilepsy Society Annual Meeting; Dec. 4-8, 2015; Philadelphia.