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3 Latent Wechsler Profiles in Presurgical Pediatric Epilepsy

Published online by Cambridge University Press:  21 December 2023

Madison M Berl*
Affiliation:
Children’s National Hospital, Washington, DC, USA.
Erin T Kaseda
Affiliation:
Rosalind Franklin University of Medicine and Science, Chicago, IL, USA.
Jennifer I Koop
Affiliation:
Medical College of Wisconsin, Milwaukee, WI, USA.
Brandon Almy
Affiliation:
University of Michigan, Ann Arbor, MI, USA.
Alyssa Ailion
Affiliation:
Boston Children’s Hospital, Boston, MA, USA.
Donald J Bearden
Affiliation:
Children’s Hospital of Atlanta, Atlanta, GA, USA.
Katrina Boyer
Affiliation:
Boston Children’s Hospital, Boston, MA, USA.
Crystal M Cooper
Affiliation:
Cook Children’s Medical Center, Ft. Worth, TX, USA.
Amanda M DeCrow
Affiliation:
Atrium Health/Levine Children’s Hospital, Charlotte, NC, USA.
Priscilla H Duong
Affiliation:
Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA.
Patricia Espe-Pfeifer
Affiliation:
University of Iowa, Iowa City, IA, USA.
Marsha Gabriel
Affiliation:
Cook Children’s Medical Center, Ft. Worth, TX, USA.
Elise Hodges
Affiliation:
University of Michigan, Ann Arbor, MI, USA.
David Marshall
Affiliation:
University of Michigan, Ann Arbor, MI, USA.
Kelly A McNally
Affiliation:
Nationwide Children’s Hospital, Columbus, OH, USA.
Andrew Molnar
Affiliation:
Vanderbilt Kennedy Center, Nashville, TN, USA.
Emily Olsen
Affiliation:
Oregon Health & Science University, Portland, OR, USA.
Kim E Ono
Affiliation:
Children’s Hospital of Atlanta, Atlanta, GA, USA.
Kristina E Patrick
Affiliation:
University of Washington/Seattle Children’s Hospital, Seattle, WA, USA.
Brianna Paul
Affiliation:
UCSF, San Francisco, CA, USA.
Jonathan Romain
Affiliation:
Children’s Hospital of Orange County, Orange, CA, USA.
Leigh N Sepeta
Affiliation:
Children’s National Hospital, Washington, DC, USA.
Rebecca LH Stilp
Affiliation:
Norton Healthcare, Louisville, KY, USA.
Greta Wilkening
Affiliation:
Children’s Hospital Colorado, Aurora, CO, USA.
Michael Zaccariello
Affiliation:
19 Mayo Clinic, Rochester, MN, USA
Frank Zelko
Affiliation:
Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA.
PERC Epilepsy Surgery Database Project
Affiliation:
Children’s National Hospital, Washington, DC, USA.
*
Correspondence: Madison M. Berl, Children’s National Hosptial, mberl@childrensnational.org
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Abstract

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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.

Type
Poster Session 03: Dementia | Amnesia | Memory | Language | Executive Functions
Copyright
Copyright © INS. Published by Cambridge University Press, 2023