Pediatrics & Therapeutics
Open Access

Abstract

Cognitive and Behavioral Consequences in Children with Epilepsy: The Relationship between Paroxysmal EEG Abnormalities and Cognitive/Behavioral Disturbances

Hideaki Kanemura and Masao Aihara

A relationship between epilepsy and impairment of neuropsychological functioning has been observed in children with epilepsy. Interictal epileptiform discharges on electroencephalograms (EEGs) are regarded as a correlate of persistent pathological neuronal discharges. Paroxysmal abnormalities in the frontal area may be associated with neuropsychological impairments. Investigations of paroxysmal EEG abnormalities are also needed. Subclinical discharges contribute to the psychosocial problems of children with epilepsy. A combination of spike rate and extended periods of high-frequency paroxysmal EEG abnormalities may predict the atypical evolution of benign childhood epilepsy with centrotemporal spikes. In addition, children with epilepsy with continuous spike-waves during slow sleep have cognitive and behavioral disturbances that are correlated with frequent epileptiform discharges. On the other hand, several studies have suggested that EEG characteristics, especially the localization of paroxysmal discharges, might be important predictors for subsequent epilepsy. Patients with febrile seizure presenting with frontal paroxysmal EEG abnormalities may be at risk for epilepsy. In addition, the frontal paroxysms may indicate a higher risk of epilepsy in autism spectrum disorders. Moreover, the location of paroxysmal EEG abnormalities correlates with behavioral disturbances. Frontal EEG paroxysms may be associated with a higher risk of developing atypical clinical features such as seizure recurrence and cognitive/behavioral problems. Previous and current studies suggest that a combination of spike frequency, extended periods of high-frequency paroxysmal EEG abnormalities, and frontal EEG focus might predict atypical clinical manifestations, such as neuropsychological impairments, and ultimate neuropsychological outcome in children with epilepsy. To prevent these disturbances and problems in children with epilepsy, treatment to remit seizures and EEG abnormalities as soon as possible may be required to achieve the optimal prognosis for children with cognitive/behavioral problems.