Benign Childhood Epilepsy with Centrotemporal Spikes - delineation of executive profile

Benign Childhood Epilepsy with Centrotemporal Spikes (BECTS) is focal epilepsy with undetermined etiology. At the moment, the term benign has been questioned by the recognition that despite the complete remission of epileptic seizures in 80% of cases and pharmaco-responsivity, there are cognitive and psychiatric comorbidities that may compromise quality of life and school performance. The most frequent psychiatric comorbidity is Attention Deficit Hyperactivity Disorder (ADHD). One of the most important cognitive functions, the Executive Functions (EF), in its cool (mental flexibility, mental information tracking, abstraction capacity and attention) and hot domains (decision making, social cognition and impulse control), may be impaired in both disorders, BECTS and ADHD. Despite the high prevalence of this syndrome, ADHD and EF are poorly investigated and described in this population. Moreover, with the few studies previously done, it is not possible to describe if the executive deficits found are related to the clinical variables of epilepsy, the epileptiform activity itself, the psychiatric comorbidity or the sum of these factors. Thus, the general objective of this study was to analyze the profile of executive performance in children and adolescents with BECTS. This was a cross-sectional, controlled (double-matched) and non-randomized cohort study. The executive profile of children and adolescents of both genders, aged 6 to 16 years, was evaluated through a comparative analysis of three groups (total of 63 subjects): Group I (23 patients with BECTS); Group II (20 patients with ADHD and without epilepsy) and Group III (20 healthy children and adolescents without epilepsy, without ADHD and without any neurological or psychiatric diagnosis). The neuropsychological evaluation consisted of a comprehensive battery with 22 instruments for detailed executive functions evaluation in its multiple domains (attention, cool and hot EF), intellectual potential and academic performance. Our results showed that patients with BECTS presented worse performance in the areas of cold and hot executive functioning compared to controls. The presence of ADHD was associated with greater impairment in the executive functioning of patients with BECTS. In addition, the executive and attentional profile of these patients was different from that presented by children with ADHD and without epilepsy. There was a correlation between the clinical variables of epilepsy (especially time of seizure control, number of antiepileptic medication, presence and laterality of epileptiform discharges) and worse executive functioning. Thus, the need for greater attention to the hot executive functions and to the presence of the coexistence of ADHD in the BECTS, both neglected in the studies with this epileptic syndrome of the childhood, is emphasized. Thus, a better delineation of adequate and effective cognitive difficulties, prognosis and intervention for children and adolescents with BECTS can be provided (AU)