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3 Latent Wechsler Profiles in Presurgical Pediatric Epilepsy
- Madison M Berl, Erin T Kaseda, Jennifer I Koop, Brandon Almy, Alyssa Ailion, Donald J Bearden, Katrina Boyer, Crystal M Cooper, Amanda M DeCrow, Priscilla H Duong, Patricia Espe-Pfeifer, Marsha Gabriel, Elise Hodges, David Marshall, Kelly A McNally, Andrew Molnar, Emily Olsen, Kim E Ono, Kristina E Patrick, Brianna Paul, Jonathan Romain, Leigh N Sepeta, Rebecca LH Stilp, Greta Wilkening, Michael Zaccariello, Frank Zelko, PERC Epilepsy Surgery Database Project
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 308-310
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- Article
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Objective:
The Pediatric Epilepsy Research Consortium (PERC) Epilepsy Surgery Database Project is a multisite collaborative that includes neuropsychological evaluations of children presenting for epilepsy surgery. There is some evidence for specific neuropsychological phenotypes within epilepsy (Hermann et al, 2016); however, this is less clear in pediatric patients. As a first step, we applied an empirically-based subtyping approach to determine if there were specific profiles using indices from the Wechsler scales [Verbal IQ (VIQ), Nonverbal IQ (NVIQ), Processing Speed Index (PSI), Working Memory Index (WMI)]. We hypothesized that there would be at least four profiles that are distinguished by slow processing speed and poor working memory as well as profiles with significant differences between verbal and nonverbal reasoning abilities.
Participants and Methods:Our study included 372 children (M=12.1 years SD=4.1; 77.4% White; 48% male) who completed an age-appropriate Wechsler measure, enough to render at least two index scores. Epilepsy characteristics included 84.4% with focal epilepsy (evenly distributed between left and right focus) and 13.5% with generalized or mixed seizure types; mean age of onset = 6.7 years, SD = 4.5; seizure frequency ranged from daily to less than monthly; 53% had structural etiology; 71% had an abnormal MRI; and mean number of antiseizure medications was two. Latent profile analysis was used to identify discrete underlying cognitive profiles based on intellectual functioning. Demographic and epilepsy characteristics were compared among profiles.
Results:Based on class enumeration procedures, a 3-cluster solution provided the best fit for the data, with profiles characterized by generally Average, Low Average, or Below Average functioning. 32.8% were in the Average profile with mean index scores ranging from 91.7-103.2; 47.6% were in the Low Average profile with mean index ranging from 80.7 to 84.5; and 19.6% were in the Below Average profile with mean index scores ranging from 55.0-63.1. Across all profiles, the lowest mean score was the PSI, followed by WMI. VIQ and NVIQ represented relatively higher scores for all three profiles. Mean discrepancy between indices within a profile was as large as 11.5 IQ points. No demographics or epilepsy characteristics were significantly different across cognitive phenotypes.
Conclusions:Latent cognitive phenotypes in a pediatric presurgical cohort were differentiated by general level of functioning; however, across profiles, processing speed was consistently the lowest index followed by working memory. These findings across phenotypes suggest a common relative weakness which may result from a global effect of antiseizure medications and/or the widespread impact of seizures on neural networks even in a largely focal epilepsy cohort; similar to adult studies with temporal lobe epilepsy (Hermann et al, 2007). Future work will use latent profile analysis to examine phenotypes across other domains relevant to pediatric epilepsy including attention, naming, motor, and memory functioning. These findings are in line with collaborative efforts towards cognitive phenotyping which is the aim of our PERC Epilepsy Surgery Database Project that has already established one of the largest pediatric epilepsy surgery cohorts.
7b - Adolescence and emerging adulthood in individuals with spina bifida: a developmental neuropsychological perspective
- from Section II - Disorders
- Edited by Jacobus Donders, Scott J. Hunter, University of Chicago
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- Book:
- Principles and Practice of Lifespan Developmental Neuropsychology
- Published online:
- 07 May 2010
- Print publication:
- 14 January 2010, pp 183-194
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Summary
Introduction
Adolescence and early adulthood are transitional periods characterized by numerous biological, psychological, cognitive, and social changes [1, 2]. More changes are seen in adolescence than in any other period of development except infancy. The late teens through twenties are marked by profound change, exploration of possible life directions, and decision-making that has enduring implications [1]. “Change” is the defining construct for these developmental periods and is particularly salient in individuals with chronic health conditions (CHC).
Spina bifida myelomeningocele (SBM) is a prototypical example of a CHC with core neurological features (Table 7b.1) and diverse complications (Table 7b.2) impacting development and outcome. Readers are referred to the previous chapter for details regarding the etiology, features, and clinical course of SBM. Individuals with SBM experience not only typical ongoing challenges of adolescence and adult development, but also unique changes owing to their health condition. Both normative and illness-specific changes occur within a larger environmental context that itself undergoes transformation over time. Individuals with SBM also face health system discontinuities such as the transition from pediatric medical care to adult care, and the transition from parent-controlled health care to self-management.
We begin this chapter with conceptual frameworks for considering the critical developmental milestones of adolescence and emerging adulthood, and a discussion of the interplay between the developmental issues of these periods and the experience of a CHC. Second, we consider major empirical findings relevant to SBM in adolescence and adulthood.