INS NYC 2024 Program

Poster	Poster Session 09 Program Schedule 02/16/2024 03:30 pm - 04:45 pm Room: Majestic Complex (Posters 61-120) Poster Session 09: Epilepsy \| Oncology \| MS \| Infectious Disease Final Abstract #90 Examination of Demographic and Clinical Variables Associated with Lateralization of Cognitive Dysfunction with the Cognitive Lateralization Rating Index (CLRI) in Pediatric Epilepsy Sydney Park, Medical College of Wisconsin, Milwaukee, United States Hope Reecher, Medical College of Wisconsin, Milwaukee, United States Jennifer Koop, Medical College of Wisconsin, Milwaukee, United States Category: Epilepsy/Seizures Keyword 1: laterality Keyword 2: pediatric neuropsychology Keyword 3: epilepsy / seizure disorders - surgical treatment Objective: Optimizing cognitive outcomes of pediatric epilepsy surgery requires understanding of risk for change in function, typically based on hemispheric lateralization of language skills. Identification of cognitive lateralization in children is complicated by ongoing functional development. Systematic use of a quantitative method for assessing lateralization could assist in pre-surgical decision making. The Medical College of Wisconsin (MCW) Cognitive Lateralization Rating Index (CLRI) is used to determine degree of lateralized cognitive dysfunction and quantify risk for post-surgical cognitive decline. This study aimed to characterize demographic and clinical variables related to lateralization of cognitive dysfunction using the CLRI within a national pediatric epilepsy cohort. Participants and Methods: 176 patients (Age of seizure onset M = 7.26 ± 5.14; 33.3% female; 58% White; 3.9% Black; 2.6% Asian; 0.4% American Indian; 9.5% Hispanic/Latino; seizure type: 63.6% focal, 9.5% generalized, 2.6% unknown; seizure onset: 37.1% left, 21.1% right, 9.1% generalized) were selected from the national Pediatric Epilepsy Research Consortium database of patients presented at institutional epilepsy surgery conferences for pre-surgical consideration. The CLRI was calculated by assessing verbal and nonverbal neuropsychology test scores across intellectual, focal cognitive, memory, and fine motor domains. Participants received positive points for impaired scores on verbal/right-handed tasks (indicating dominant hemisphere dysfunction) and received negative points for impaired scores on nonverbal/left-handed tasks (nondominant hemisphere dysfunction). Domain scores were summed to produce an overall CLRI score which ranges from -3 (nondominant dysfunction) to +3 (dominant dysfunction), with 0 indicating no pattern of lateralization. Patients with left-hemisphere seizure foci and nondominant CLRI were recoded as ‘presumed reorganized’. Descriptive statistics and chi-square tests of independence were conducted with demographic, CLRI, and epilepsy variables. Results: Frequency analyses indicated 86% of the sample had lateralized dysfunction on the CLRI. Chi-square analyses revealed no significant impact of demographic variables on the CLRI including sex (p=.39), race (p=.86), and ethnicity (p=.71), as expected. Age of onset was not significantly related to CLRI classification of dysfunction (X² (9, 176) = 8.39, p = .50). Additional chi-square analyses revealed those with focal, as compared to generalized, seizures were significantly more likely to have lateralized cognitive dysfunction on the CLRI (X² (1, 168) = 4.47, p = .03). Chi-square analyses demonstrated those with left side seizure onset were significantly more likely to have dominant hemisphere dysfunction or presumed reorganization on the CLRI (X² (3, 102) = 45.60, p <.001). Conclusions: Results establish the CLRI as a quantifiable way to characterize lateralized cognitive dysfunction in children. There were no significant differences related to the demographic variables as expected. There was a significant relationship between seizure variables and the CLRI, with the exception of age of seizure onset, suggesting the CLRI is a useful tool for characterizing neuropsychological profiles in context of epilepsy surgery evaluations. Limitations include incomplete data and possible selection bias as more children with left sided lesions were referred for surgical consideration. These findings add to the limited literature on cognitive lateralization in children with epilepsy.

Poster

02/16/2024
03:30 pm - 04:45 pm
Room: Majestic Complex (Posters 61-120)

Poster Session 09: Epilepsy | Oncology | MS | Infectious Disease

Final Abstract #90

Examination of Demographic and Clinical Variables Associated with Lateralization of Cognitive Dysfunction with the Cognitive Lateralization Rating Index (CLRI) in Pediatric Epilepsy

Sydney Park, Medical College of Wisconsin, Milwaukee, United States
Hope Reecher, Medical College of Wisconsin, Milwaukee, United States
Jennifer Koop, Medical College of Wisconsin, Milwaukee, United States

Category: Epilepsy/Seizures

Keyword 1: laterality
Keyword 2: pediatric neuropsychology
Keyword 3: epilepsy / seizure disorders - surgical treatment

Objective:

Optimizing cognitive outcomes of pediatric epilepsy surgery requires understanding of risk for change in function, typically based on hemispheric lateralization of language skills. Identification of cognitive lateralization in children is complicated by ongoing functional development. Systematic use of a quantitative method for assessing lateralization could assist in pre-surgical decision making. The Medical College of Wisconsin (MCW) Cognitive Lateralization Rating Index (CLRI) is used to determine degree of lateralized cognitive dysfunction and quantify risk for post-surgical cognitive decline. This study aimed to characterize demographic and clinical variables related to lateralization of cognitive dysfunction using the CLRI within a national pediatric epilepsy cohort.

Participants and Methods:

176 patients (Age of seizure onset M = 7.26 ± 5.14; 33.3% female; 58% White; 3.9% Black; 2.6% Asian; 0.4% American Indian; 9.5% Hispanic/Latino; seizure type: 63.6% focal, 9.5% generalized, 2.6% unknown; seizure onset: 37.1% left, 21.1% right, 9.1% generalized) were selected from the national Pediatric Epilepsy Research Consortium database of patients presented at institutional epilepsy surgery conferences for pre-surgical consideration. The CLRI was calculated by assessing verbal and nonverbal neuropsychology test scores across intellectual, focal cognitive, memory, and fine motor domains. Participants received positive points for impaired scores on verbal/right-handed tasks (indicating dominant hemisphere dysfunction) and received negative points for impaired scores on nonverbal/left-handed tasks (nondominant hemisphere dysfunction). Domain scores were summed to produce an overall CLRI score which ranges from -3 (nondominant dysfunction) to +3 (dominant dysfunction), with 0 indicating no pattern of lateralization. Patients with left-hemisphere seizure foci and nondominant CLRI were recoded as ‘presumed reorganized’. Descriptive statistics and chi-square tests of independence were conducted with demographic, CLRI, and epilepsy variables.

Results:

Frequency analyses indicated 86% of the sample had lateralized dysfunction on the CLRI. Chi-square analyses revealed no significant impact of demographic variables on the CLRI including sex (p=.39), race (p=.86), and ethnicity (p=.71), as expected. Age of onset was not significantly related to CLRI classification of dysfunction (X² (9, 176) = 8.39, p = .50). Additional chi-square analyses revealed those with focal, as compared to generalized, seizures were significantly more likely to have lateralized cognitive dysfunction on the CLRI (X² (1, 168) = 4.47, p = .03). Chi-square analyses demonstrated those with left side seizure onset were significantly more likely to have dominant hemisphere dysfunction or presumed reorganization on the CLRI (X² (3, 102) = 45.60, p <.001).

Conclusions:

Results establish the CLRI as a quantifiable way to characterize lateralized cognitive dysfunction in children. There were no significant differences related to the demographic variables as expected. There was a significant relationship between seizure variables and the CLRI, with the exception of age of seizure onset, suggesting the CLRI is a useful tool for characterizing neuropsychological profiles in context of epilepsy surgery evaluations. Limitations include incomplete data and possible selection bias as more children with left sided lesions were referred for surgical consideration. These findings add to the limited literature on cognitive lateralization in children with epilepsy.