Neuropsychological Progression in New Onset Epilepsy

描述(申请人提供)：认知、学习、社交和精神异常在儿童期发作的癫痫中很常见，会持续到成年，即使是在那些没有并发症和病情缓解的癫痫患者中也是如此。为了了解这些寿命问题的自然历史，我们的前瞻性队列研究(RO1-44351)的初始资金周期检查了新诊断的特发性癫痫儿童(n=75)和健康对照组(n=62)，并用神经心理学、精神病学和神经成像技术对他们进行了2年的跟踪调查。在提供儿童癫痫认知、解剖和精神异常的早期自然病史的同时，我们还确定了癫痫诊断时的危险因素，这些因素预测了诊断后两年的发展轨迹。我们假设，这些异常将预测生活表现的重要领域(例如，就业、独立生活、教育程度)的长期结果。在这个相互竞争的更新应用中，我们建议遵循我们最初的队列来表征和预测年轻成人的结果，用新发病的癫痫和对照参与者(n=150)来丰富队列，并纳入新的程序来测试关于家族史、神经回路中断和癫痫综合征对生命过程的影响的假设。这项相互竞争的更新申请的具体目标如下：1)描述较长期(10年)的儿童期癫痫发作的社会、教育、职业和精神轨迹，并确定对青少年预后有利和不利的预测因素；2)阐明家族史对新发癫痫儿童存在认知和精神并存的作用；3)表征脑容量、形状和连接异常与认知障碍和精神状态之间的关系；以及4)确定特定症状的认知、精神和成像异常。

DESCRIPTION (provided by applicant): Cognitive, academic, social and psychiatric abnormalities are common in childhood onset epilepsy, with enduring adverse consequences into adulthood, even among those with uncomplicated and remitted epilepsies. To understand the natural history of these lifespan issues, the initial funding cycle of our prospective cohort study (RO1-44351) examined children (ages 8-18) with newly diagnosed idiopathic epilepsies (n=75) and healthy controls (n=62), and followed them for 2 years with neuropsychological, psychiatric, and neuroimaging techniques. While informing the early natural history of cognitive, anatomic, and psychiatric abnormalities of childhood epilepsy, we also identified risk factors at the time of epilepsy diagnosis that predicted developmental trajectories two years following diagnosis. We hypothesize these same abnormalities will predict longer term outcomes in important areas of life performance (e.g., employment, independent living, educational attainment). In this competing renewal application, we propose to follow our original cohort to characterize and predict young adulthood outcomes, enrich the cohort with new onset epilepsy and control participants (n=150), and incorporate new procedures to test hypotheses regarding the effects of family history, disrupted neural circuitry, and epilepsy syndrome on life course. The specific aims of this competing renewal application are as follows: 1) Characterize the longer-term (10- year) social, educational, vocational, and psychiatric trajectories of childhood onset epilepsy and identify predictors of favorable and unfavorable young adult outcomes; 2) Clarify the role of family history to the presence of cognitive and psychiatric comorbidities in children with new onset epilepsy; 3) Characterize the relationship between abnormalities in brain volume, shape and connectivity with disordered cognition and psychiatric status; and 4) Identify syndrome-specific cognitive, psychiatric, and imaging abnormalities.