Publication: Alteraciones neuropsicológicas en epilepsia del lóbulo frontal en niños
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2018-03-08
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Universidad Complutense de Madrid
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Abstract
Objetivos: Estudiar las alteraciones neuropsicológicas con las que cursa la epilepsia del lóbulo frontal (ELF) pediátrica y la repercusión de las variables clínicas que definen este tipo de epilepsia. Metodología: Estudio descriptivo, transversal, observacional y retrospectivo. 45 pacientes en edad pediátrica (3 a 18 años de edad) con ELF fueron valorados mediante una evaluación neuropsicológica completa. Los resultados se compararon con un grupo clínico compuesto por niños con epilepsia benigna de la infancia rolándica (EBI-R) (n=18) y otro grupo sin patología o normativo (n=36). En el grupo con ELF se ha analizado la influencia de variables clínicas relevantes en epilepsia como la edad de aparición, duración, respuesta al tratamiento, localización del foco epileptógeno, existencia o no de patología de base, localización y extensión de la lesión en el rendimiento cognitivo. Resultados: Los niños con ELF obtienen un rendimiento cognitivo significativamente inferior que los grupos de referencia. La capacidad intelectual permanece preservada aunque en valores inferiores al rango de normalidad. Destaca el rendimiento deficitario en funciones ejecutivas cognitivas, como memoria operativa, secuenciación motora, control de la inhibición y flexibilidad cognitiva y en procesos atencionales complejos como atención dividida. Así mismo se registran déficits en procesos de codificación que favorecen el aprendizaje y recuerdo y en habilidades académicas como aritmética. De las variables clínicas analizadas, como factores de riesgo en ELF que determinan pobres resultados cognitivos se encuentra una edad de aparición temprana seguida de la duración de la epilepsia. Los pacientes con ELF cuya patología de base es una Displasia cortical focal de extensión mayor a 3 cm, y localizada en áreas Orbitofrontales y Dorsolaterales son los que presentan de forma significativa un rendimiento cognitivo más bajo. Conclusiones: La ELF en población pediátrica cursa con déficits cognitivos y conductuales extensos, que responden a la afectación de este tipo de epilepsia en el desarrollo de redes cerebrales, debido a la rápida propagación de las crisis del lóbulo frontal a otras áreas cerebrales por las extensas conexiones inter e intrahemisféricas de los lóbulos frontales. El estudio de las alteraciones neuropsicológicas en epilepsias focales permite el estudio de marcadores cognitivos que definen la red epileptógena subyacente.
Objetive: To study the neuropsychological disturbances in children with Frontal Lobe Epilepsy (FLE) and the effects of clinical variables, which define this type of epilepsy. Methods: A descriptive, cross-sectional, observational and retrospective study. 45 patients with ELF and aged 3 to 18, had a complete neuropsychological assessment. Results were compared with a clinic group of children with Benign Rolandic epilepsy (n=18) together with a group of children without pathology or normative (n=36). In the group of ELF, it was analyzed the influence of relevant clinical variables of epilepsy, such us the age of onset, the duration, the treatment response, the localization of the epileptic focus, a known or unknown etiology, the localization and the extent of injury in the cognitive functioning. Results: Children with FLE have shown a significantly lower cognitive performance than the reference groups. The intellectual functioning remains preserved, but with lower values if it is compared with the normal range. Results highlight the deficit performance in executive cognitive functions, such as the working memory, the motor sequencing, inhibition and flexibility, as well as in complex attention like divided attention. Likewise, there are deficits in coding processes, which favor learning and memory abilities, as well as in academic skills such as arithmetic. From the analyzed clinical variables regarded to be a risk factors in FLE due to lower cognitive performance involved, it can be found an earliest age of onset followed by the duration of the epilepsy. Patients with FLE, whose baseline etiology is a Focal Cortical Dysplasia of extension greater than 3 cm, and located in Orbitofrontal and Dorsolateral regions, are the ones that have significantly lower cognitive performance. Conclusions: The FLE in pediatric population, is associated with the extensive cognitive and behavioral deficits, that respond to the impact of this type of epilepsy in the development of brain networks. This is due to the fast propagation of the frontal lobe seizures to the other areas of the brain for the extensive inter and intrahemisferic connections of the frontal lobes. The study of neuropsychological impairment on the focal epilepsies, allows the study of cognitive markers that define the underlying epileptogenic network.
Objetive: To study the neuropsychological disturbances in children with Frontal Lobe Epilepsy (FLE) and the effects of clinical variables, which define this type of epilepsy. Methods: A descriptive, cross-sectional, observational and retrospective study. 45 patients with ELF and aged 3 to 18, had a complete neuropsychological assessment. Results were compared with a clinic group of children with Benign Rolandic epilepsy (n=18) together with a group of children without pathology or normative (n=36). In the group of ELF, it was analyzed the influence of relevant clinical variables of epilepsy, such us the age of onset, the duration, the treatment response, the localization of the epileptic focus, a known or unknown etiology, the localization and the extent of injury in the cognitive functioning. Results: Children with FLE have shown a significantly lower cognitive performance than the reference groups. The intellectual functioning remains preserved, but with lower values if it is compared with the normal range. Results highlight the deficit performance in executive cognitive functions, such as the working memory, the motor sequencing, inhibition and flexibility, as well as in complex attention like divided attention. Likewise, there are deficits in coding processes, which favor learning and memory abilities, as well as in academic skills such as arithmetic. From the analyzed clinical variables regarded to be a risk factors in FLE due to lower cognitive performance involved, it can be found an earliest age of onset followed by the duration of the epilepsy. Patients with FLE, whose baseline etiology is a Focal Cortical Dysplasia of extension greater than 3 cm, and located in Orbitofrontal and Dorsolateral regions, are the ones that have significantly lower cognitive performance. Conclusions: The FLE in pediatric population, is associated with the extensive cognitive and behavioral deficits, that respond to the impact of this type of epilepsy in the development of brain networks. This is due to the fast propagation of the frontal lobe seizures to the other areas of the brain for the extensive inter and intrahemisferic connections of the frontal lobes. The study of neuropsychological impairment on the focal epilepsies, allows the study of cognitive markers that define the underlying epileptogenic network.
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Psicología, Departamento de Psicología Básica II (Procesos Cognitivos), leída el 20-06-2017