Pretreatment cognitive deficits and treatment effects on attention in childhood
absence epilepsy.
Author(s): Masur D(1), Shinnar S, Cnaan A, Shinnar RC, Clark P, Wang J, Weiss EF, Hirtz DG,
Glauser TA; Childhood Absence Epilepsy Study Group.
Affiliation(s): Author information:
(1)From the Montefiore Medical Center (D.M., S.S., R.C.S., E.F.W.), Albert Einstein
College of Medicine, New York; Children's National Medical Center (A.C., J.W.),
Washington, DC; National Institute of Neurological Disorders and Stroke (D.G.H.),
Bethesda, MD; and Cincinnati Children's Hospital Medical Center, and University
of Cincinnati College of Medicine (P.C., T.A.G.), OH.
Publication date & source: 2013, Neurology. , 81(18):1572-80
OBJECTIVE: To determine the neurocognitive deficits associated with newly
diagnosed untreated childhood absence epilepsy (CAE), develop a model describing
the factorial structure of items measuring academic achievement and 3
neuropsychological constructs, and determine short-term differential
neuropsychological effects on attention among ethosuximide, valproic acid, and
lamotrigine.
METHODS: Subjects with newly diagnosed CAE entering a double-blind, randomized
controlled clinical trial had neuropsychological testing including assessments of
general intellectual functioning, attention, memory, executive function, and
achievement. Attention was reassessed at the week 16-20 visit.
RESULTS: At study entry, 36% of the cohort exhibited attention deficits despite
otherwise intact neurocognitive functioning. Structural equation modeling of
baseline neuropsychological data revealed a direct sequential effect among
attention, memory, executive function, and academic achievement. At the week
16-20 visit, attention deficits persisted even if seizure freedom was attained.
More subjects receiving valproic acid (49%) had attention deficits than subjects
receiving ethosuximide (32%) or lamotrigine (24%) (p = 0.0006). Parental
assessment did not reliably detect attention deficits before or after treatment
(p < 0.0001).
CONCLUSIONS: Children with CAE have a high rate of pretreatment attentional
deficits that persist despite seizure freedom. Rates are disproportionately
higher for valproic acid treatment compared with ethosuximide or lamotrigine.
Parents do not recognize these attentional deficits. These deficits present a
threat to academic achievement. Vigilant cognitive and behavioral assessment of
these children is warranted.
CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that valproic
acid is associated with more significant attentional dysfunction than
ethosuximide or lamotrigine in children with newly diagnosed CAE.
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