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Cognitive profiles in pediatric unilobar vs. multilobar epilepsy

  • Author Footnotes
    1 These authors contributed equally to this work.
    Frederik Jan Moorhouse
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
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  • Author Footnotes
    1 These authors contributed equally to this work.
    Sonia Cornell
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
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  • Lucia Gerstl
    Affiliations
    Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
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  • Johanna Wagner
    Affiliations
    Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
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  • Moritz Tacke
    Affiliations
    Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
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  • Timo Roser
    Affiliations
    Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
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  • Florian Heinen
    Affiliations
    Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
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  • Celina von Stülpnagel
    Affiliations
    Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany

    Paracelsus Medical University, Salzburg, Austria
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  • Christian Vollmar
    Affiliations
    Department of Neurology, Ludwig-Maximilians-University, Munich, Germany

    Comprehensive Epilepsy Center, Ludwig-Maximilians-University, Munich, Germany
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  • Mathias Kunz
    Affiliations
    Comprehensive Epilepsy Center, Ludwig-Maximilians-University, Munich, Germany

    Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany
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  • Author Footnotes
    1 These authors contributed equally to this work.
    Georgia Ramantani
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of Neuropediatrics, University Children's Hospital, Zurich, Switzerland

    University of Zurich, Zurich, Switzerland
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  • Author Footnotes
    1 These authors contributed equally to this work.
    Ingo Borggraefe
    Correspondence
    Corresponding author. Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. von Hauner Children's Hospital, Comprehensive Epilepsy Center (Pediatric section), University of Munich, Lindwurmstraße 4, 80337, Munich, Germany.
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany

    Comprehensive Epilepsy Center, Ludwig-Maximilians-University, Munich, Germany
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to this work.
Published:September 29, 2022DOI:https://doi.org/10.1016/j.ejpn.2022.09.006

      Highlights

      • Multilobar epilepsies manifest earlier than unilobar epilepsies.
      • Multilobar epilepsies present a lower mean IQ than unilobar epilepsies.
      • Multilobar epilepsies entail higher rates of cognitive impairment than unilobar epilepsies.

      Abstract

      Objectives

      We aimed to determine how cognitive impairment relates to the extent of the presumed epileptogenic zone in pediatric focal epilepsies. We analyzed the cognitive functions in unilobar compared to multilobar focal epilepsy patients that underwent neuropsychological testing at a tertiary epilepsy center.

      Methods

      We assessed cognitive functions of pediatric focal epilepsy patients with the German version of the Wechsler Intelligence Scales that measures full-scale IQ and subcategories. We assessed differences in IQ and epilepsy-related variables between unilobar and multilobar epilepsy patients.

      Results

      We included 62 patients (37 unilobar, 25 multilobar), aged 10.6 ± 3.7 years. Full-scale IQ values were significantly higher in unilobar (93.6 ± 17.7, 95% CI 87.7–99.6) than in multilobar epilepsy patients (77.3 ± 17.2, 95% CI 69.3–85.0; p = 0.001). In all but one IQ subcategory (working memory), significantly higher values were measured in unilobar than in multilobar epilepsy patients. The proportion of unilobar epilepsy patients with severe cognitive impairment (8.3%) and below-average intelligence (30.5%) was lower compared to multilobar epilepsy patients (47.6% and 61.9%; p = 0.002 and p = 0.021, respectively). Epilepsy onset occurred earlier in multilobar (4.0 years, 95% CI 2.6–5.5, SD ± 3.4 years) than in unilobar epilepsy patients (7.0 years, 95% CI 5.5–8.5, SD ± 4.4 years, p = 0.008).

      Conclusions

      Pediatric multilobar epilepsy patients face more cognitive issues than unilobar epilepsy patients on average. Our findings should help to identify children and adolescents who are most at risk for impaired cognitive development. A limitation of our study is the simple division into unilobar and multilobar epilepsies, with no specific account being taken of etiology/epilepsy syndrome, which can have a profound effect on cognition.

      Keywords

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