First seizure may fuel thinking trouble in kids

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Children who are intellectually normal may have problems with language, memory, learning and other thinking or “cognitive” skills at or around the time they experience a first epileptic seizure, according to new research out in the medical journal Neurology.

“Our study highlights the importance of testing children with epilepsy for possible cognitive problems soon after they are diagnosed with epilepsy in order to avoid these issues affecting them later in life, especially if they have additional risk factors,” study author Dr. Philip Fastenau noted in a statement from the journal’s publisher, the American Academy of Neurology.

Fastenau, from Case Western Reserve University School of Medicine, Cleveland, and colleagues studied brain function and academic achievement in 282 school-aged children with a first seizure and 147 healthy seizure-free siblings.

In this intellectually normal group of kids, 27% of children with just one seizure showed cognitive difficulties at or near the time of the seizure, and up to 40% of those who had additional risk factors showed signs of cognitive problems, the study team found.

A child with four risk factors was three times more likely than seizure-free healthy siblings to have cognitive problems at the first doctor’s visit.

The study also found that children who took anti-seizure drugs had difficulties in processing speed, language, verbal memory, and learning, compared to children who did not take any seizure medication.

Children prescribed antiepileptic drugs “should be closely monitored for cognitive problems resulting from the epilepsy drug,” Fastenau said.

“Surprisingly,” he added, academic achievement in these children appeared to be unaffected around the time of the first seizure. This suggests that “there is a window early in epilepsy for intervention to avoid hurting a child’s performance at school,” the researchers say.

In a related editorial, Dr. David Loring, of Emory University in Atlanta, makes the point that, “Because this study found cognitive problems at the time of the first seizure or soon after, it provides strong evidence that these cognitive problems can be attributed to underlying brain abnormalities that lead to the epilepsy, rather than from extended exposure to epilepsy drugs or the effect of numerous seizures.”

SOURCE: Neurology, online August 12, 2009.

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