الفهرس 
EPILEPSYOnly 14 pages are availabe for public view
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Abstract
Epilepsy is a chronic disorder or group of chronic disorders, in which the indispensable feature is recurrence of seizures that are typically unprovoked and usually unpredictable. Seizures are periods of neural hyperactivity, caused by imbalance between excitation and inhibition in the central nervous system. During a seizure, the neurons in the brain cease their normal activities and fire in massive, synchronized bursts. the incidence of epilepsy in developing countries is more than 100 per 100.000 of normal population. This high rate in developing countries is mainly due to acute infections, parasitic infestations and poor postnatal care. In Egypt, a prevalence rate of epilepsy of 3.5/ 1000 among primary school children.
Cognition is the ability to recognize and process complex tasks adequately. It is the operation of the mind by which we become aware of objects , thoughts or perception. So stage the cognition is considered the third and highest stage of association occurring in the brain after it passes through sensation and perception. It depends on the function of a complex interrelated and distributed neuronal network, and it includes the following:
1- Attention and Vigilance.
2- Memory functions.
3- Language and Verbal functions.
4- Visuospatial abilities.
5- Psychomotor speed.
6- Executive functions.
7- Concept formation.
8- Global cognitive functions.
The association between childhood epilepsy and cognitive dysfunction has long been documented. It has been suggested that seizures can modify, slow down or accelerate a wide range of unique processes that take place during development and are essential for the correct formation and function of brain circuity. These cognitive deficiencies were postulated to be responsible for the poorer performance in skills such as reading, spelling, arithmetic and comprehension that has been observed in children with epilepsy.
Thus, this study aimed to evaluate the extent of cognitive affection among epileptic children and adolescents, and its relation to the duration of antiepileptic drug therapy.
This case control study was conducted on 27 idiopathic epileptic children following up in our Neurology clinic, Ain Shams University Pediatric Hospitals. They were subdivided into 3 groups; 10 patients on monotherapy (valproate or carbamazepine), 10 patients on polytherapy (valproate and carbamazepine) and 7 newly diagnosed patients who haven’t start any antiepileptic drug yet. They were compared to healthy age and sex matched controls. The exclusion criteria included use of antiepileptic drugs other than valproate or carbamazepine, seizures secondary to other causes (such as fever, infection, head injury, cerebrovascular disease), patients with visual and/or hearing impairment, musculoskeletal abnormalities, intelligence quotient < 80 and seizures occurring 24 hours preceding cognitive functions assessment.
All groups were assessed regarding full history taking and full neurological assessment. In addition to previous assessment, all the four groups underwent
- Wechsler Intelligence Scale (comprehension , arithmetics, similarities, block design, digit span, picture completion and coding) to test intellectual abilities.
- Benton Visual Retention test to assess recall and visual memory.
- Wisconson Card Sorting test to assess the executive functions, attention and sustained attention.
The results of our study revealed that, the Chalfont Severity Score was significantly higher in epileptic patients on monotherapy and polytherapy as compared to newly diagnosed ones, with no significant difference between those on monotherapy as compared to those on polytherapy.
The mean values of WIS (VIQ, PIQ & TIQ) were significantly lower in all epileptic patients as compared to controls. Moreover, the mean values of the PIQ were significantly lower in patients on polytherapy and monotherapy as compared to newly dignosed ones and controls, showing the least scores in patients on polytherapy. On the other hand, the mean values of VIQ and TIQ were significantly lower in patients on monotherapy and polytherapy as compared to newly diagnosed ones and controls, yet the difference between those on monotherapy as compared to those on polytherapy didn’t reach statistical significance.
The mean scores of OCS & ECS difference and the OES & EES difference were significantly higher in patients on monotherapy and polytherapy as compared to newly diagnosed ones and controls, with highest scores for those on polytherapy. On the other hand, there is no statistical significant difference between those on monotherapy as compared to those on polytherapy. Also, there was no statistical significant difference between newly diagnosed ones and controls.
The mean scores of failure to maintain set were significantly higher in all patients and their subgroups as compared to controls, whereas, the mean scores of categories completed were significantly lower all patients, those on mono and polytherapy as compared to controls. On the other hand, the mean scores of categories completed were lower in those on mono and polytherapy as compared to newly diagnosed ones, yet they didn’t reach statistical significance.
Meanwhile, all WCST scores were not statistically different between those on mono compared to those on polytherapy. Similarly, they were not statistically different between newly diagnosed ones as compared to controls.
There was a significant negative correlation between the WIS and the frequency of seizers, duration of illness and Chalfont severity scoring. whereas, there was negative correlation between the WIS and the frequency of seizers, yet statistically insignificant.
There was negative correlation between BVRT and the frequency of seizers before & after therapy, duration of illness and Chalfont severity scoring. This correlation showed significance between OES & EES difference and frequency of seizers before therapy & Chalfont severity scoring.
There was positive correlation between failure to maintain set and frequency before therapy, frequency after therapy, duration and Chalfont severity scoring. On the other hand there was negative correlation between categories completed and frequency before therapy, frequency after therapy , duration and Chalfont severity scoring.
The mean values of WIS were significantly lower in patients with age of onset of seizers less than 5 years as compared to those with age of onset more than 5 years.
Also, the mean values of BVRT subscales were not significantly different in patients with age of onset less than 5 years as to those more than 5 years.
Similarly, the mean values of WCST subscales were not significantly different in patients with age of onset less than 5 years as compared to those with age of onset more than 5 years.
The mean scores of WIS were significantly lower in patients with abnormal EEG as compared to those with normal EEG findings.
Also, the mean values of BVRT subscales were not significantly different in patients with abnormal EEG as compared to those with normal EEG findings.
Similarly, the mean values of WCST subscales were not significantly different in patients with abnormal EEG as compared to those with normal EEG findings.
The mean scores of WIS were not significantly different among patients on valproate as compared to those on carbamazepene therapy.