[Interictal epileptiform discharges and cognitive impairment in children].

INTRODUCTION: Learning disorders are very frequent among children with epilepsy. The etiology is multifactorial, being affected by the type of epileptic syndrome, the cause of epilepsy, a high frequency of epileptic seizures, a previous history of status epilepticus, the age of onset of epilepsy, the antiepileptic treatment being selected, and the role of interictal epileptiform discharges. Several studies have sought to analyze to what extent cognitive impairment can be attributed to interictal epileptiform discharges among the other epilepsy factors.

AIM: To review the existing evidence on the cognitive impact of interictal epileptiform discharges in children.

DEVELOPMENT: The disruptive effect of interictal epileptiform discharges on cognition is supported by a wide range of factors, such as the concept of transient cognitive impairment, the definition of epileptic encephalopathy, the natural course of epileptic syndromes with continuous spike and wave activity during slow sleep, the concept of autistic regression related to epileptiform activity, the cognitive profile of benign rolandic epilepsy, and the cognitive impact of non convulsive status epilepticus. According to this information it has been suggested that treatment of interictal epileptiform discharges with antiepileptic drugs could improve cognition and behaviour in these children.

CONCLUSIONS: Interictal epileptiform discharges are associated with neuropsychological disorders like cognitive impairment and behavioral problems even in absence of clinical epilepsy. Uncontrolled reports and three preliminary randomised controlled trials of antiepileptic treatment of interictal epileptiform discharges have suggested that suppression of discharges is associated with significant improvement in psychosocial function. However, a greater number of controlled studies are required to be carried out, in order to confirm this hypothesis.