PGR – 2 More than Just an EEG; The Role of Neuropsychological Evaluation in Pediatric Seizure Diagnosis with Complex Comorbidities

Abstract Objective Despite the prevalence of epilepsy, diagnosis remains limited by both subjective and objective examination (Urbańska et al., 2024). This is especially true of time-limited Electroencephalogram (EEG) (Baud et al., 2021). Ability to predict who will develop epilepsy after first time seizure is also limited (Drenthen et al., 2021). Neuropsychological changes inform clinical diagnosis and provides deeper understanding of functional limitations in daily life (Tolchin et al., 2020). Method Patient is a 12-year-old left-handed boy with history of in utero drug exposure and neglect prior to adoption at 3-years-old. Evaluation was sought for developmental delays concerning for Autism Spectrum Disorder (ASD). Additional concerns included frequent falls, severe migraines, reduced attention and memory, fatigue, and tremor. He had two clinical seizures around 9 years old, though subsequent EEG was normal. Given this and prophylactic treatment with Keppra, likelihood of seizures was thought to be low. Results Cognitive and adaptive skills were in the low range. Results were concerning for atypical developmental progress and a lateralizing profile. Specifically, skills associated with the left hemisphere (verbal abilities) were developing steadily, while skills associated with the right hemisphere (spatial and pattern recognition skills) were weaker. Difficulties with processing speed and higher order executive function were also present. No unifying diagnosis was identified, but addition of Keppra and Topamax resulted in marked improvement in energy, motor functioning, and cognitive functioning. Conclusion Neuropsychological evaluation was able to identify previously undetected seizure activity resulting in significant clinical impairment. Neuropsychological evaluation is invaluable in diagnosing and monitoring epilepsy (Kishk et al., 2022).