Developmental outcomes of childhood-onset temporal lobe epilepsy: A community-based study

Authors

  • Sarah J. Wilson,

    1. Melbourne School of Psychological Sciences, The University of Melbourne, Victoria, Australia
    2. Comprehensive Epilepsy Program, Austin Health, Melbourne, Victoria, Australia
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  • Silvana Micallef,

    1. Melbourne School of Psychological Sciences, The University of Melbourne, Victoria, Australia
    2. Comprehensive Epilepsy Program, Austin Health, Melbourne, Victoria, Australia
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  • Asawari Henderson,

    1. Melbourne School of Psychological Sciences, The University of Melbourne, Victoria, Australia
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  • Genevieve Rayner,

    1. Melbourne School of Psychological Sciences, The University of Melbourne, Victoria, Australia
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  • Jacquie A. Wrennall,

    1. Psychology Department, The Royal Children’s Hospital, Melbourne, Victoria, Australia
    2. Children’s Neuroscience Centre, The Royal Children’s Hospital, Melbourne, Victoria, Australia
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  • Claire Spooner,

    1. Department of Neurology, Starship Children’s Hospital, Auckland, New Zealand
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  • A. Simon Harvey

    1. Children’s Neuroscience Centre, The Royal Children’s Hospital, Melbourne, Victoria, Australia
    2. Department of Paediatrics, The University of Melbourne, Victoria, Australia
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Address correspondence to Sarah Wilson, Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Vic. 3010, Australia. E-mail: sarahw@unimelb.edu.au

Summary

Purpose:  To assess the impact of childhood-onset temporal lobe epilepsy (TLE) on the attainment of normative developmental tasks and identify predictors of long-term developmental outcomes.

Methods:  In 1992–1993, a prospective longitudinal cohort study of childhood-onset TLE was commenced in the State of Victoria, Australia. At review in 2004–2006, we assessed developmental tasks, which are age-specific individual psychosocial achievements tied to particular phases of the lifespan. The cohort comprised 54 individuals (33 female) with a mean age of 20 years (range 12–29), and mean age at TLE onset of 6 years (range 0.2–15).

Key Findings:  Individuals were clustered into three groups representing distinct developmental trajectories: (1) a Normal group (52%) who achieved most of their developmental tasks, (2) an Altered group (37%) who achieved some, and (3) a Delayed group (11%) who achieved few. The groups showed significant cognitive differences, with the Normal group outperforming the Altered and Delayed groups on a range of measures (p < 0.05). Multiple discriminant function analysis indicated that membership of the groups was independently predicted by the chronicity of seizures, cognitive functioning, having surgically remediable epilepsy, and gender (p < 0.001). Seizure chronicity and cognition discriminated between all three trajectories, while surgical intervention and gender primarily discriminated between the Altered and Delayed trajectories.

Significance:  Childhood-onset TLE can disrupt achievement of normative developmental tasks that is independently predicted by medical, biologic, and cognitive factors. Assessment of developmental tasks across the lifespan provides a practical framework for guiding prognostic counseling of patients and families.

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