The Impairment Of Attention-networks Function And Its Influence Of Different AEDs In Benign Epilepsy Children With Centrotemporal Spikes

Objective Benign epilepsy of children with normal mental development often occurs at a particular age, responses well to medication, and could be resolved completely by puberty. Although several studies have shown neuropsychological disabilities of benign epilepsy children with centrotemporal spikes (BECTS), there is no clear evidence about the impairment of attentional systems and the comorbidity of attentional problems. Cognitive and behavioral functions in individuals with epilepsy represent the outcome of multifactorial processes; underlying brain pathology and seizure frequency are the most critical aspects, apart from the detrimental effects of antiepileptic drugs (AEDs). Furthermore, there is some evidence to suggest that transient cognitive impairment during subclinical epileptiform discharges can affect attention and cognitive function even in the absence of clinical seizures. Attentional function, as a construct of cognitive psychology, can be considered a building block for other more complex forms of cognitive activity. There is no clear research about attentional networks in BECT. We want to investigate the characteristics of attentional networks impairment in BECT using Attention Networks Test (ANT) (child version) and the risk factors of this disease, besides the influence to attentional function of different AEDs.Methods Our research is based on the attention-networks model to assess the characteristics of three anatomically-defined sub-networks (alerting, orienting and executive control) of 90 children with BECTS and 90 healthy children. All the subjects enrolled in the study participated in the (ANT) with assessment of both the reaction time (RT) and accuracy of the test. We tracked all children over 6 months to investigate the influence of attentional function by different AEDs.Results1. The results indicated that the performance of healthy controls was significantly better in orienting of attentional system (P<0.001) and the accuracy of Attention Network Test (P<0.001), compared with that of children affected by BECTS. The grand mean effect (higher score worse) was significantly higher (P<0.001) in the patient group than that in the control group. The multiple linear regression analysis revealed a positive correlation between the age of onset and the accuracy of attention network test results, and a negative correlation between the age of onset and the results of grand mean effect. A negative correlation was observed between spike index(SI) of the non-REM sleep stage and the accuracy of attention-networks test results. We found no relationship between the grand mean effect and clinical factors such as gender, duration of clinical course, duration of seizures, total number of seizures, severity of seizures (seizure frequency), hemispheric lateralization of electroencephalograph (EEG), and the awake SI. Furthermore, no relationship was observed between the clinical factors and the accuracy of the test results. The findings showed that BECTS is associated with impaired attentional networks, and impairments are greater at younger ages of onset. Oxcarbazepine monotherapy in BECT could improve the attentional network, espicially the orient function.2.After a mean follow-up period of 6 months, the performance of patients on oxcarbazepine was significantly better in orienting of attentional system (P<0.001), and the accuracy of Attention Network Test (P=0.021). The grand mean effect (higher score worse) was significantly lower (P=0.002) in the children affected by BECT received monotherapy with oxcarbazepine after 6 months. Besides, the performance of children with BECT assigned to oxcarbazepine monotherapy was significantly better in orienting of attentional system (P=0.031) than that on valproate monotherapy 6 months later. Oxcarbazepine monotherapy in BECT could improve the attentional network, espicially the orient function.Conclusion Our study suggests that the benign epilepsy children with centrotemporal spikes have impaiment of attention networks, especially the orient function. the age on onset have a significant impact on the attention of children with Rolandic epilepsy. Oxcarbazepine could improve the attentional network, espicially the orient function.