Neuropsychological Progression in New Onset Epilepsy

描述（由申请人提供）：认知、学业、社会和精神异常在儿童期癫痫中很常见，即使在那些无并发症和癫痫缓解的患者中，也会产生持续的不良后果。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）的初始资助周期检查了新诊断为特发性癫痫的儿童（8-18岁）（n=75）和健康对照（n=62），并通过神经心理学、精神病学和神经影像学技术对他们进行了2年的随访。在了解儿童癫痫的认知、解剖和精神异常的早期自然史的同时，我们还确定了癫痫诊断时的危险因素，这些因素可以预测诊断后两年的发育轨迹。我们假设这些相同的异常将预测生活表现重要领域的长期结果（例如，就业，独立生活，教育成就）。在这个竞争性的更新应用中，我们建议遵循我们的原始队列来表征和预测年轻成年期的结果，丰富新发作癫痫的队列和对照参与者（n=150），并纳入新的程序来检验关于家族史、神经回路中断和癫痫综合征对生命历程影响的假设。这项竞争性更新应用的具体目的如下：1)表征儿童癫痫发作的长期（10年）社会、教育、职业和精神轨迹，并确定有利和不利的青年结局的预测因素；2)明确家族病史对新发癫痫患儿认知和精神合并症的影响；3)表征脑容量、形状和连通性异常与认知障碍和精神状态的关系；4)识别特定综合征的认知、精神和影像学异常。

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.