The attentional networks in benign epilepsy with centrotemporal spikes
Introduction
Benign epilepsy with centrotemporal spikes (BECTS) in children is an idiopathic partial epilepsy. It is the most common childhood epilepsy syndrome and accounts for 15–24% of all the epilepsy reported in children [1]. Initially, BECTS was considered as a benign epilepsy with no comorbidity associated with it. However, the “benign” nature of BECTS has been recently called into question because of cognitive and behavioral impairments, for example speech and sound disorders, language disabilities, and memory deficit, which are frequently observed in children with BECTS [2], [3], [4], [5]. The most important behavioral impairment is an attentional problem that could seriously impact the learning process and the living condition of patients, even when the seizures have remitted [6].
Many factors, such as the age of onset, gender, frequency of seizures, duration of seizures, duration of clinical course, hemispheric lateralization, and spike frequency of electroencephalograph (EEG), may influence cognitive abilities and interact with each other. It is difficult to determine which factor has caused a particular impairment [4]. Attentional function is considered to be a foundation for complex cognitive activity [3]. Since cognition and attention are also closely related, decreased attention in children with BECTS may lead to the lack of a specific neuropsychological profile [7]. The attentional system can be divided into three subsystems: alerting, orienting, and executive control, based on their neuroanatomical and physiological mechanisms, amid these three systems are coordinated to complete the entire information procession of attentional networks. Their functions are independent of each other, but sometimes they interact together to complete a certain task [8].
Ponser and Petersen [9] proposed that sources of attention are formed by three networks, including the alerting network, the orienting network, and the executive control network. These networks carry out functions of alerting, orienting, and executive control. The alerting network involves the ability to tonically maintain the alert state and to physically respond to a warning signal processed by specific frontal and parietal areas, and involves the cortical projection of the norepinephrine system [10], [11]. The orienting network involves the selection of information from the cholinergic input, and numerous sensory inputs related to the superior parietal lobe and temporal parietal junction [11], [12]. Executive control of attention involves conflict processing, which could respond to relevant aspects and ignore irrelevant aspects of a stimulus. It may relate to the anterior cingulate cortex and lateral prefrontal cortex, which is modulated by dopamine [13], [14], [15].
The attentional network test (ANT) is a combination of the cued reaction time task and the flanker task, examining the effects of cues and targets within a single-reaction time limit, in order to explore the efficiency of alerting, orienting, and executive control networks [8]. The ANT has been previously applied in the assessment of attentional function in healthy children as well as in patients with Alzheimer's disease or schizophrenia [16], [17].
It has been reported that frontoparietal developmental disorders, metabolic abnormalities, and damage to the corpus callosum and cingulate gyrus are factors closely related to the impairment of attention networks in children with BECTS [18], [19], [20], [21], [22]. We designed this study to explore whether there is attentional deficit in children with BECTS using ANT, and to evaluate the prognosis of the disease more effectively.
Section snippets
Subjects
Written informed consent was obtained from parents and/or guardians of all the subjects before enrolling. The following inclusion criteria were used to enroll children with BECTS: (1) each subject was diagnosed in a pediatric neurology unit with BECTS based on clinical history and recent EEG recordings, according to the criteria of the International League Against Epilepsy (ILAE) classification; (2) only subjects that had not taken any antiepileptic drug; (3) subjects had no history of birth
Clinical presentation
There were 57 boys and 33 girls recruited in the present study. Twelve out of ninety had family history of convulsions, and only 4 had febrile seizures. The average age at first seizure was 7.09 ± 1.81 years. Thirty-four out of ninety had only one seizure, and 24 among them had two seizures, the rest had three or more seizures. Seizure severity was assessed and categorized by the average number of seizures each month: mild (the number of seizures was less than or equal to one each month); moderate
Discussion
Recent studies on cognitive abilities of patients with BECTS reported that children with BECTS performed poorly in various attention tests. However, the profile of effects across attentional systems has not yet been described [23]. This study found that BECTS mainly affected the orienting function, the grand mean effect, and the accuracy, other than the alerting function and the conflict control.
In the last two decades, a number of findings regarding abnormal anatomical structures and
Acknowledgments
This work was supported by grants from the National Natural Science Foundation of China (no. 91432301 and no. 81171273), the National Basic Research Program of China (973 Program) (no. 2015CB856400), and the Young Scientist Project of Natural Science Foundation of China (no. 31300925). The authors declare that they have no competing interests.
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