Intelligence and memory outcomes within 10 years of childhood convulsive status epilepticus

Long-term intelligence and memory outcomes of children post convulsive status epilepticus (CSE) have not been systematically investigated despite evidence of short-term impairments in CSE. The present study aimed to describe intelligence and memory outcomes in children within 10 years of CSE and identify potential risk factors for adverse outcomes. In this cohort study, children originally identified by the population-based North London Convulsive Status Epilepticus in Childhood Surveillance Study (NLSTEPSS) were prospectively recruited between July 2009 and February 2013 and invited for neuropsychological assessments and magnetic resonance imaging (MRI) scans. Full-scale intelligence quotients (FSIQs) were measured using the Wechsler Abbreviated Scales of Intelligence (WASI), and global memory scores (GMS) was assessed using the Children's Memory Scale (CMS). The cohort was analyzed as a whole and stratified into a prolonged febrile seizures (PFS) and non-PFS group. Their performance was compared with population norms and controls. Regression models were fitted to identify predictors of outcomes. With a mean of 8.9 years post-CSE, 28.5% of eligible participants were unable to undertake testing because of their severe neurodevelopmental deficits. Children with CSE who undertook formal testing (N = 94) were shown to have significantly lower FSIQ (p = 0.001) and GMS (p = 0.025) from controls; the PFS group (N = 34) had lower FSIQs (p = 0.022) but similar memory quotients (p = 0.88) with controls. Intracranial volume (ICV), developmental delay at baseline, and active epilepsy at follow-up were predictive of longterm outcomes in the non-PFS group. The relationship between ICV and outcomes was absent in the PFS group despite its presence in the control and non-PFS groups. Post-CSE, survivors reveal significant intelligence and memory impairments, but prognosis differs by CSE type; memory scores are uncompromised in the PFS group despite evidence of their lower FSIQ whereas both are compromised in the non-PFS group. Correlations between brain volumes and outcomes differ in the PFS, non-PFS, and control groups and require further investigatio

Child and parental sleep in young children with epilepsy: A population-based case-control study

Objective: To determine the prevalence of parent-reported sleep problems in young children with epilepsy and their parents, and to compare findings with those in a non-epilepsy-related neurodisability (neurodevelopmental/neurological difficulties) group. Method: Parents of young children (1-7 years) with epilepsy (n = 48 [91% ascertainment]) completed the Child Sleep Habits Questionnaire (CSHQ). Parents (mothers and fathers) also completed the Pittsburgh Sleep Quality Index (PSQI) and the Iowa Fatigue Scale (IFS) in relation to their own functioning. The responses of parents of children with epilepsy were compared with parents of developmental-, age-, and gender-matched children with nonepilepsy-related neurodisability (n = 48). Results: There was not a significant difference in the proportion of children with epilepsy and the children with neurodisability scoring in the at-risk range on the CSHQ (81% vs. 71% respectively) (p = 0.232). 62% of mothers and 44% of fathers of children with epilepsy had 'poor quality sleep' on the PSQI; there was not a significant difference between mothers of children with epilepsy and those of children with neurodisability (p = 0.526) or IFS (p = 0.245) total scores. However, mothers of children with epilepsy had significantly more difficulties on the productivity subscale of the IFS (p = 0.004). There were no significant differences between fathers' scores on either measure. In the epilepsy group, child behavioral problems (p = 0.001) were independently associated with child sleep difficulties and maternal mental health problems were associated with parental sleep difficulties (p = 0.04) and fatigue (p = 0.018). Significance: Young children with epilepsy and their parents have a high rate of sleep difficulties. There is a need to develop effective interventions for this population, taking into consideration of the role of child behavioral problems and parental mental health difficulties

Reversible disability associated with epilepsy

Let G be a graph embedded on a surface of genus g with b boundary cycles. We describe algorithms to compute multiple types of non-trivial cycles in G, using different techniques depending on whether or not G is an undirected graph. If G is undirected, then we give an algorithm to compute a shortest non-separating cycle in 2^O(g) n log log n time. Similar algorithms are given to compute a shortest non-contractible or non-null-homologous cycle in 2^O(g+b) n log log n time. Our algorithms for undirected G combine an algorithm of Kutz with known techniques for efficiently enumerating homotopy classes of curves that may be shortest non-trivial cycles. Our main technical contributions in this work arise from assuming G is a directed graph with possibly asymmetric edge weights. For this case, we give an algorithm to compute a shortest non-contractible cycle in G in O((g^3 + g b)n log n) time. In order to achieve this time bound, we use a restriction of the infinite cyclic cover that may be useful in other contexts. We also describe an algorithm to compute a shortest non-null-homologous cycle in G in O((g^2 + g b)n log n) time, extending a known algorithm of Erickson to compute a shortest non-separating cycle. In both the undirected and directed cases, our algorithms improve the best time bounds known for many values of g and b.Comment: Accepted to SODA 2013. Updated for reviewer comments, to include new results for undirected graphs, and to include new titl