Modi Avani C, Vannest Jennifer, Combs Angela, Turnier Luke, Wade Shari L
Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
Epilepsy Behav. 2018 Mar;80:5-10. doi: 10.1016/j.yebeh.2017.12.021. Epub 2018 Feb 3.
Youth with epilepsy demonstrate deficits in executive functioning (EF), the skills necessary for goal-directed behavior (e.g., problem-solving, initiating, monitoring, organization, planning, and working memory). Despite 30-50% of youth with epilepsy demonstrating EF deficits, no extant studies have utilized both performance and questionnaire-based measures to examine the pattern of EF deficits in adolescents with epilepsy. Study aims were to 1) identify the pattern of EF deficits in adolescents with epilepsy and 2) identify which assessment tools are most sensitive to EF deficits in this population (adolescents, ages 13-17, with epilepsy). An exploratory aim was to examine group differences on measures of EF by epilepsy type. Standard performance-based neuropsychological measures (Wechsler Intelligence Scale for Children - Version V or Wechsler Adult Intelligence Scale Working Memory Index-Version IV, Delis Kaplan Executive Functioning System, NIH Toolbox, Test of Everyday Attention for Children) and the Behavior Rating Inventory of Executive Functioning (BRIEF) comprised the multimethod assessment battery. Depending on the measure, 30% of adolescents with epilepsy had deficits in working memory, 17% in cognitive flexibility/problem solving, 6% in inhibition, and 18% in planning/organization. Attention was a significant problem for 15% of adolescents with epilepsy. Correlations among the various EF measures were quite poor. Across various EF domains, results indicated that adolescents with localization-related epilepsy demonstrated better EF skills compared to adolescents with unclassified epilepsy. Overall, our findings suggest that executive functioning deficits are selective and different from those observed in other neurological populations (e.g., attention deficit hyperactivity disorder (ADHD), traumatic brain injury) where problems with self-regulation (i.e., inhibition, planning/organization) are more pronounced. These findings support utilizing multiple measures, including both performance-based neuropsychological tests and parent- and self-reports, to assess executive functioning difficulties in adolescents with epilepsy as they are uniquely sensitive to executive functioning domains. Adolescents with unclassified epilepsy also appear to be at higher risk for EF deficits and thus represent an important group to target for intervention.
患有癫痫的青少年表现出执行功能（EF）缺陷，而执行功能是目标导向行为所需的技能（例如，解决问题、发起行动、监控、组织、规划和工作记忆）。尽管30%-50%的癫痫青少年存在执行功能缺陷，但目前尚无研究同时使用基于表现和问卷的测量方法来研究癫痫青少年的执行功能缺陷模式。研究目的是：1）确定癫痫青少年的执行功能缺陷模式；2）确定哪些评估工具对该人群（13-17岁患有癫痫的青少年）的执行功能缺陷最敏感。一个探索性目的是通过癫痫类型来检验执行功能测量指标上的组间差异。基于表现的标准神经心理学测量方法（韦氏儿童智力量表第五版或韦氏成人智力量表工作记忆指数第四版、德利斯·卡普兰执行功能系统、美国国立卫生研究院工具箱、儿童日常注意力测试）和执行功能行为评定量表（BRIEF）构成了多方法评估组合。根据测量指标，30%的癫痫青少年存在工作记忆缺陷，17%存在认知灵活性/解决问题缺陷，6%存在抑制缺陷，18%存在规划/组织缺陷。15%的癫痫青少年存在注意力方面的显著问题。各种执行功能测量指标之间的相关性很差。在各个执行功能领域，结果表明，与未分类癫痫的青少年相比，与定位相关癫痫的青少年表现出更好的执行功能技能。总体而言，我们的研究结果表明，执行功能缺陷具有选择性，与其他神经疾病人群（如注意力缺陷多动障碍（ADHD）、创伤性脑损伤）中观察到的缺陷不同，在其他神经疾病人群中，自我调节问题（即抑制、规划/组织）更为明显。这些研究结果支持使用多种测量方法，包括基于表现的神经心理学测试以及家长和自我报告，来评估癫痫青少年的执行功能困难，因为他们对执行功能领域具有独特的敏感性。未分类癫痫的青少年似乎也面临更高的执行功能缺陷风险，因此是干预的重要目标群体。
