Deficits in oculomotor performance in pediatric epilepsy

Summary Purpose:  Given evidence of limitations in neuropsychological performance in epilepsy, we probed the integrity of components of cognition—including speed of processing, response inhibition, and spatial working memory—supporting executive function in pediatric epilepsy patients and matched controls. Methods:  A total of 44 pairs of controls and medically treated pediatric epilepsy patients with no known brain pathology completed cognitive oculomotor tasks, computerized neuropsychological testing, and psychiatric assessment. Key Findings:  Patients showed slower reaction time to initiate a saccadic response compared to controls but had intact saccade accuracy. Cognitively driven responses including response inhibition were impaired in the patient group. Patients had increased incidence of comorbid psychopathology, but comorbidity did not predict worse functioning compared to patients with no Attention Deficit Hyperactivity Disorder (ADHD). Epilepsy type and medication status were not predictive of outcome. More complex neuropsychological performance was impaired in tasks requiring visual memory and sequential processing, which was correlated with inhibitory control and antisaccade accuracy. Significance:  Pediatric epilepsy may be associated with vulnerabilities that specifically undermine speed of processing and response inhibition but not working memory, and may underlie known neuropsychological performance limitations. This particular profile of abnormalities may be associated with seizure‐mediated compromises in brain maturation early in development.