PHILADELPHIA—A brief computerized test may help clinicians identify children with epilepsy who have a greater risk of cognitive difficulties and might benefit from referrals for neuropsychologic assessment, according to research presented at the 69th Annual Meeting of the American Epilepsy Society.
“Parental reports alone may not identify all patients who would benefit from further evaluation. Brief computerized screening could enhance clinical interviewing, provide objective data, and expedite referral at earlier stages,” the researchers said.
Clinical research and practice guidelines emphasize the need for neuropsychologic screening at the time of diagnosis and during the course of epilepsy. To test the feasibility of using a cognitive screening tool in the clinical setting, Miya Asato, MD, Associate Professor of Pediatrics at the Children’s Hospital of Pittsburgh of UPMC, conducted a longitudinal observational study. Patients completed the CNS Vital Signs computerized cognitive screening battery during routine visits. Parents also completed a short questionnaire about behavioral and learning concerns.
Miya Asato, MD
The battery included components of traditional neuropsychology tests of attention, visual and verbal memory, reaction time, and task switching. The screening tool was administered at the time of epilepsy diagnosis and during follow-up epilepsy care.
The investigators tested a total of 43 typically developing children ages 8 to 17. As part of an ongoing pilot study, 33 children have completed two tests, and 16 children have completed three tests. The testing has been well-received by parents and children.
The researchers found that 85% of patients had clinically significant changes in one or more domains from the first testing to the second follow-up testing, which was conducted a mean of 5.5 months after the first test.
“We saw a mixture of results. Some patients improved, and some showed declines over time,” said Dr. Asato. Researchers saw significant changes in memory, reaction time, complex attention, and cognitive flexibility.
“Because the patterns of change were heterogeneous across the population studied… we should consider the results on an individual basis to guide clinical decision making,” Dr. Asato said.
Screening results could be used in conjunction with elicited parental concerns. For example, if the scores are stable, but parents have concerns, the clinician can still refer the patient for formal neuropsychologic testing, but perhaps less urgently. “If scores declined, and the parents are also concerned, then an immediate referral should be made,” Dr. Asato said.
—Jake Remaly
