Fine motor impairment in children with epilepsy: Relations with seizure severity and lateralizing value.

Motor skill deficits are common in epilepsy. The Grooved Pegboard Test (GPT) is the most commonly used fine motor task and is included in the NIH Common Data Elements Battery for the assessment of epilepsy. However, there are limited data on its utility in children and adolescents. The present study investigated the effectiveness of this task in children and adolescents with epilepsy clinically referred for neuropsychological evaluation in a tertiary medical center. Two hundred and two children and adolescents (ages 6-16, 104 males, 98 females) completed the GPT. Base rates of impairment were calculated, correlational analyses determined relations with clinical variables, and ANOVAs and t-tests assessed for differences by seizure type, gender, and lateralized deficits in those with lateralized focal epilepsy. The GPT was sensitive to fine motor impairment in these children and adolescents, with over 60% having impaired performances. Further, performance was significantly correlated with IQ, age of epilepsy onset, number of medications, and seizure frequency. At the group level, those with lateralized focal epilepsy did not show significant differences between left and right hands, though the GPT correctly lateralized 63% of those with large between-hand performance disparities (i.e., one standard deviation or greater). In sum, the GPT is sensitive to fine motor deficits in pediatric epilepsy and is related to known epilepsy severity factors. However, the ability of the task to lateralize epilepsy onset is not robust.

Emotional functioning in pediatric epilepsy: Evidence of greater externalizing behavior with left hemisphere onset.

Though it is wellknown that psychiatric concerns are common in children with epilepsy, factors predicting such problems are not well understood. The present investigation studied rates of parent-reported psychological concerns in clinically referred children with epilepsy. Further, it investigated differences in psychological distress across epilepsy subtypes (i.e., focal, generalized, mixed), relationships with epilepsy severity variables, gender, and lateralization of seizure foci. The parents of 170 children and adolescents (ages 6-18 years, 78 girls, 92 boys) completed the Child Behavior Checklist (CBCL). Scale elevation frequencies (T-scores ≥ 65) were calculated and Chi square analyses examined rates of elevations between epilepsy groups. Internalizing problems (32.4%) were more common than externalizing problems (17.1%) for the sample, with attention problems being the most common concern across all epilepsy types (48.8%). While there were no significant relationships between epilepsy severity variables and CBCL broadband scales, the Total Problems scale was inversely related to intellectual functioning (r = -0.174, p = 0.023). Rates of anxiety and depression did not differ across epilepsy subtypes and no gender differences were found. Those with left-sided epilepsy had higher rates of externalizing problems (33.2%) than those with right (14.0%; χ2[1, 88] = 4.55, p = 0.03), with rule-breaking behaviors (15.4%) being more common in left-hemisphere epilepsy (15.4% versus 2.3%; χ2[1,88] = 4.66, p = 0.03). In summary, while no significant differences were found across epilepsy groups, the current study adds to the literature regarding lateralization effects and mood/behavior, with more externalizing problems in those with left hemisphere epilepsy.