Cognitive impairment in children with epilepsy

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Abstract


Introduction. Epilepsy makes its debut in childhood and adolescence, being one of the main diseases in pediatric neurology. Epilepsy in children can often lead to significant cognitive disorders.

The purpose of the work is to identify the features of mental and cognitive development of children with epilepsy.

Material and methods. A group of 929 children aged 2-11 years with different forms of epilepsy was examined. Depending on the age and severity of the disease, the children underwent a complete neuropsychological examination with in-depth study of verbal-mnestic and speech functions, or a survey based on a specially developed “mental development profile” for children with mental disabilities. For children with preserved intelligence, the method of syndrome analysis was adapted and applied. Based on the results of testing, qualitative and quantitative assessment of the parameters of the analyzed processes was carried out. The “mental development profile” for the child was displayed graphically, with the introduction of quantitative and qualitative assessments of certain areas of cognitive activity. Electrophysiological, neuroimaging and standard clinical diagnostic methods were used in all children.

Results. The specificity of neuropsychological deficiency in children with epilepsy is determined by the locus of epiactivity. The peculiarity of the deviant type of formation of mental functions is manifested in children already at the early stages of epilepsy, it is associated with dysfunction of different brain zones due to the negative impact of epileptiform activity.

Neuropsychological syndromes in different forms of epilepsy are variable, their psychological content is determined by factors related to the localization of the focus of epiactivity, the child’s mental development, and the severity of the disease.

The interhemispheric asymmetry of neuropsychological deficits was established for different locations of the epiactivity focus. The greatest severity of cognitive impairment is observed when the focus is located in the left hemisphere. The location of the epicenter of epiactivity in the frontotemporal regions can lead to cerebral dementia (the collapse of simple programs and purposeful subject activity), and behavior disorders.

Children with epilepsy who have an epiactivity locus in the parietal-occipital regions of the brain have violations of constructive praxis and visual-spatial gnosis, as well as difficulties in learning to read and write.

Conclusion. The neuropsychological method of studying the structural and functional foundations of mnestic, speech, and other types of cognitive activity in children with epilepsy has allowed us to establish that deviations in the development of mental functions in this category of children arise from insufficiently formed individual links of the functional system and the relationship between them. The presence of an epicenter of epilepsy in children with epilepsy at the early stages of the disease can cause a neuropsychological deficit in the development of higher mental functions.


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About the authors

L. A. Troitskaya

Pirogov Russian National Research Medical University; Scientific and Practical Center for Child Psychoneurology

Email: epileptolog@mail.ru

Russian Federation, Moscow

O. L. Badalyan

Pirogov Russian National Research Medical University; Scientific and Practical Center for Child Psychoneurology

Author for correspondence.
Email: epileptolog@mail.ru

Russian Federation, Moscow

MD, Ph.D., DSc., Professor, Department of neurology, neurosurgery and medical genetics

K. L. Surkova

National Medical Research Center for Children’s Health

Email: epileptolog@mail.ru

Russian Federation, Moscow

V. V. Krakhalev

City Hospital named after N.I. Pirogov

Email: epileptolog@mail.ru

Russian Federation, Moscow

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Supplementary files

Supplementary Files Action
1.
Fig. 1. The location of the focus of epileptic activity in different forms of epilepsy. 1 – forehead; 2 – temple; 3 – crown; 4 – nape; 5 – middle.

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2.
Fig. 2. Changes in bioelectric activity indices in children with focal forms of epilepsy in the anterior (a) and posterior (b) parts of the brain. The axis of abscissas shows the analyzed zones of the cortex; ordinate: percentages of the localization of the epileptic activity focus compared to the normative data. 1 – β; 2 – α; 3 – δ; 4 – θ; 5 – peak; 6 – half-peak; 7 – acute; 8 – slow.

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3.
Fig. 3. Location of epileptic activity focus in children with normal development (1), mental retardation (2) and mental retardation (3) with a symptomatic form of epilepsy. The axis of abscissas shows the analyzed zones of the cortex; ordinate: percentages of the localization of the epileptic activity focus compared to the normative data. 1 – forehead; 2 – temple; 3 – crown; 4 – nape.

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4.
Fig. 4. The zoning of the location of epileptic activity focus in children with partial forms of epilepsy. The axis of abscissas shows the analyzed zones of the cortex; ordinate: percentages of the localization of the epileptic activity focus compared to the normative data. 1 – forehead; 2 – temple; 3 – crown; 4 – nape; 5 – middle.

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5.
Fig. 5. Functional asymmetry of the epileptic activity focus in children with partial forms of epilepsy. The axis of abscissas shows the analyzed symmetrical zones of the cortex; ordinate: percentages of cases with different types of changes in coherence compared to normative data. 1 – forehead; 2 – temple; 3 – crown; 4 – nape; 5 – middle.

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Copyright (c) 2020 Troitskaya L.A., Badalyan O.L., Surkova K.L., Krakhalev V.V.

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