Children newly diagnosed with epilepsy may not show signs of academic problems early on, but a new study suggests they could benefit from early cognitive testing to spot potential learning disabilities before they surface in school.
"There appears to be a window early in epilepsy for intervention to alleviate the impact of learning disabilities on school performance," says Philip Fastenau, professor of neurology at Case Western Reserve University School of Medicine in Cleveland and author of a study in this week's online issue of Neurology.
The government-funded research, conducted by Fastenau and colleagues at Indiana University Medical Center and Cincinnati Children's Hospital, included 282 school-aged children (ages 6 to 14) who had IQs of at least 70 -- in the normal range -- and who experienced their first seizure within the previous three months. They were compared with 147 of their healthy siblings who did not have seizures.
Scientists examined whether the children with seizures also had other risk factors linked with cognitive problems, including multiple seizures, use of anti-seizure medication and signs of epilepsy on early brain-wave tests.
Of the children who experienced one seizure, 27% showed cognitive difficulties at or near the time of their first seizure, and 40% of children who had additional risk factors showed signs of cognitive problems at that time. A child with four risk factors was three times more likely to experience cognitive problems compared with children who were seizure-free.
Typically, doctors wait until a child with epilepsy shows academic difficulties before they send the child for a neuropsychological evaluation. But by then, Fastenau says, a child already may be behind academically.
"Early evaluation of these children with targeted intervention might mitigate some of the long-term academic underachievement that is common in children with epilepsy," say the authors of an accompanying editorial, David Loring and Kimford Meador, professors of neurology at Emory University.
Fastenau says even the simplest accommodations could be made to improve a child's performance as he progresses into higher grade levels. For example, a child with attention problems could be placed in the front row or given attention-enhancing medication earlier, he says.
Jason Lerner, a pediatric epileptologist at UCLA, says one benefit of earlier testing would be capturing a baseline reading that would help sort out the debate about whether anti-epileptic drugs are the cause of learning problems.
"People are quick to point fingers at the anti-epileptic medications," Lerner says. But, he points out, the study shows that children who are not on medications also can experience cognitive problems.
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