Potential risk for neuropsychological deficits from subclinical epileptiform discharges in children with benign rolandic epilepsy

Benign rolandic epilepsy (BRE) is a benign condition, but may display different degrees of neuropsychological deficits, such as cognitive disturbances, attention deficit hyperactivity disorder, and other behavioral deficits. The aim of this study was to assess the neuropsychological functions and their relationship to the characteristics of interictal epileptiform discharges in children with BRE. A total of 33 children with newly diagnosed BRE (19 males/14 females, 8.2 ± 2.4 yr) were involved in the study. All children underwent a sleep electroencephalography and a comprehensive neuropsychological evaluation, which included Korean versions of the Wechsler intelligence scale for children III, frontal executive neuropsychological test, Rey complex figure test, Wisconsin card sorting test, attention deficit diagnostic scale, and child behavior checklist. The average monthly seizure frequency of the subjects was 0.8 ± 0.8, and the spike index was 14.1 ± 18.4/min (right) and 18.8 ± 22.1/min (left). On the whole, subjects exhibited normal cognitive function, frontal executive function, memory and other neuropsychological sub-domain scores. The group with a higher spike index on the left hemisphere scored lower on attention deficit diagnostic scale, auditory verbal learning test, and stroop test (P < 0.05), and the group with a high spike index (10 > min) scored lower on full scale and performance intelligence quotient (110.7 ± 18.0 vs. 96.8 ± 11.2; 107.4 ± 16.4 vs. 94.3 ± 12.8) (P < 0.05). In addition, five of 33 children (15%) exhibited attention difficulties as well as behavioral and emotional difficulties even though they are mild. The data show that the BRE sufferers are at risk for cognitive, attention, behavioral, and emotional impairment, which might have relevance to localized interictal epileptiform discharges. However, further studies are still needed to elucidate the core nature of BRE.