Frontal Lobe Dysfunction in Children With Temporal Lobe Epilepsy

Rzezak, Patrícia; Fuentes, Daniel; Guimarães, Catarina A.; Thome-Souza, Sigride; Kuczynski, Evelyn; Li, Li M.; Franzon, Renata C.; Leite, Claudia C.; Guerreiro, Marilisa; Valente, Kette D.

doi:10.1016/j.pediatrneurol.2007.05.009

« Previous Next »Pediatric Neurology
Volume 37, Issue 3 , Pages 176-185, September 2007

Frontal Lobe Dysfunction in Children With Temporal Lobe Epilepsy

Patrícia Rzezak, BSc
- Psychology and Neuropsychology Unit, Institute of Psychiatry, Clinical Hospital, Medical School, University of São Paulo, São Paulo, Brazil
Daniel Fuentes, PhD
- Psychology and Neuropsychology Unit, Institute of Psychiatry, Clinical Hospital, Medical School, University of São Paulo, São Paulo, Brazil
Catarina A. Guimarães, PhD
- Department of Neurology, University of Campinas, Campinas, Brazil
Sigride Thome-Souza, MD
- Laboratory of Clinical Neurophysiology, Institute of Psychiatry and Department of Psychiatry, University of São Paulo, São Paulo, Brazil
- Project for the Study of Psychiatric Disorders in Children and Adolescents with Epilepsy, Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
Evelyn Kuczynski, MD, PhD
- Project for the Study of Psychiatric Disorders in Children and Adolescents with Epilepsy, Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
Li M. Li, MD, PhD
- Department of Neurology, University of Campinas, Campinas, Brazil
Renata C. Franzon, MD, PhD
- Department of Neurology, University of Campinas, Campinas, Brazil
Claudia C. Leite, MD, PhD
- Institute and Department of Radiology, Clinical Hospital, Medical School, University of São Paulo, São Paulo, Brazil.
Marilisa Guerreiro, MD, PhD
- Department of Neurology, University of Campinas, Campinas, Brazil
Kette D. Valente, MD, PhD
- Laboratory of Clinical Neurophysiology, Institute of Psychiatry and Department of Psychiatry, University of São Paulo, São Paulo, Brazil
- Project for the Study of Psychiatric Disorders in Children and Adolescents with Epilepsy, Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
- Communications should be addressed to: Dr. Valente; Rua Jesuíno Arruda 901/51; São Paulo, 04532-082 São Paulo, Brazil.

Received 31 July 2006; accepted 25 May 2007.

There is evidence that adults with temporal lobe epilepsy present executive impairments. However, there is limited information in children, especially when using a comprehensive neuropsychologic battery. We aimed to: 1) investigate the presence and severity of executive dysfunctions in children with temporal lobe epilepsy, and 2) determine the implications of clinical variables (including etiology) in the occurrence and severity of executive dysfunction, using eight paradigms. Thirty-one children with temporal lobe epilepsy were evaluated and compared with 21 age-matched controls. Patients with temporal lobe epilepsy had significantly worse performance than controls. Intragroup analysis indicated that patients with symptomatic epilepsy were more impaired than those with cryptogenic epilepsy. In the former group, patients with mesial lesions performed worse than those with lateral lesions. Regarding the severity of executive dysfunction, 83.87% manifested severe to moderate executive impairment. Early age of onset, longer duration of epilepsy, and use of polytherapy were correlated with worse executive dysfunction. These findings indicated the presence of frontal lobe dysfunction in children with temporal lobe epilepsy, with worse performance in those with mesial temporal lobe epilepsy, early onset, longer duration of disease, and use of polytherapy. Our study corroborates the hypothesis that temporal lobe epileptogenic activity affects the extratemporal regions that mediate attentional and executive functions.