Cognitive development in the context of pediatric epilepsy

Pediatric epilepsy directly and indirectly affects cognitive development due to etiological factors, time variables and treatment-specific aspects. Structural epilepsy, e.g. due to extensive congenital malformations, is more often associated with poorer cognitive performance when compared to self-limiting epilepsies. An early onset of epilepsy and a chronic pharmacoresistant course are strongly associated with cognitive deficits. Studies on the negative effects of pharmacological treatment consistently point to the severe impact of the drug load in multidrug treatment on cognition. Even though the majority of pediatric patients with epilepsy show normal cognitive development, the mean intelligence performance of patients is below that of healthy controls. Furthermore, there are also some special features with respect to specific cognitive functions: on the one hand, patients with epilepsy reach the maximum peak of learning and memory performance earlier than healthy controls and also show signs of mental aging earlier. On the other hand, children and adolescents can more effectively compensate for postoperative memory deficits after temporal epilepsy surgery than adults. With respect to the attention and executive functions, which are important prerequisites for the learning process, the drug load in multidrug treatment has been proven to be a particularly unfavorable factor. The complex interplay between pediatric epilepsy and cognitive development is highly related to the risk of reduced school performance. Consequently, an interdisciplinary treatment of pediatric epilepsy is highly recommended with afocus on cognitive development.