Abstract
IntroductionEpilepsy has long been associated with cognitive dysfunction and educational underachievement. The purpose of the study was to describe the baseline findings from a larger prospective study.MethodsNew cases of epilepsy aged 6-16 years seen at a paediatric neurology clinic in Ibadan, Nigeria were evaluated for any evidence of cognitive impairment. Intelligence quotient (IQ) of the participants was measured using the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV). Scores on cognitive subtests and Full Scale IQ (FSIQ) were computed and association between the subsets scores and seizure variables were calculated.Results40 children, 24 males and 16 females were studied and their ages ranged from 6 to 16 years with a mean of 10.8 (SD=3.0) years. Global intellectual functioning as measured by the WISC-IV was in the normal range (FSIQ scores <85) for 52.5% (n = 21) of the participants and the remaining participants (47.5%) scored between the borderline and severe category for intellectual disability. The strongest correlation was between ‘caregiver's assessment of school performance’ and FSIQ, (r = 0.70; p< 0.001). Age at onset of epilepsy and seizure type had no significant association with scores on the WISC-IV composite scores.ConclusionThere is a high prevalence of significant cognitive dysfunction in Nigerian children with epilepsy, even in the absence of any known brain insult. All children with epilepsy should have routine IQ assessment following diagnosis, in order to allow for early intervention when indicated, and thus, improved outcomes.
Highlights
Epilepsy has long been associated with cognitive dysfunction and educational underachievement
It has been reported that the cognitive function of children with idiopathic generalised epilepsy is usually in the normal range but tends to be somewhat lower than the general population, [27] Our study showed cognitive impairment in nearly half of our patients even in the absence of any identifiable underlying brain injury
Many studies have attempted to link age of onset of epilepsy to cognitive functioning and academic underachievement, with conflicting and inconclusive findings; while some studies have found no significant associations between age of onset of epilepsy and cognitive functions [2,10,12], others have found significant association, especially if the epilepsy starts before the age of 3 years [4, 29,30].The mean age of onset of seizures of 6.7 years in our study is considerably higher than the 3 years reported in the other studies with significant associations [29,30]
Summary
Epilepsy has long been associated with cognitive dysfunction and educational underachievement. Other social and environmental factors have been reported to contribute to the academic underachievement and overall poor school performance seen in children and adolescents with epilepsy These factors include stigma, low self-esteem and school attendance difficulties as a result of the seizure episodes and medical appointments [15,16,17,18,19,20]. The aim of this study was to describe cognitive functions of children and adolescents with epilepsy attending a paediatric neurology clinic in a resource-poor country and to find the associations between cognitive functions and seizure variables This is a preliminary report of our initial findings in a prospective longitudinal study
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