Many children with epilepsy have severe and permanent adverse cognitive, behavioral and quality of life outcomes. However, the relative contributions of seizures, epileptic discharges in the EEG and etiology to those long term outcomes are not usually known. Current treatment strategies emphasize the role of antiepileptic drugs (AEDs) for termination of seizures with the hope that this will also minimize cognitive and behavioral impairments. Unfortunately clinical evidence for better outcomes following AED therapy is disappointing, and may even make cognition worse. If the major determinants of outcome are not seizure related phenomena but rather the underlying brain disorder, then therapeutic approaches which are broader than antiepileptic drug use (e.g.educational programs) may ultimately have major positive impacts on outcomes of childhood epilepsy. We now propose to test the hypothesis that the additional effect of seizures in the context of malformations of cortical development is minor. We further hypothesize that these adverse outcomes are related to abnormalities in brain structure and in the integration of single unit firing with oscillatory activities. Finally, these adverse outcomes will be worsened by AEDs and improved with cognitive training. In an animal model of cortical dysplasia we will investigate the additional impact of early life seizures, during development and in adulthood, on spatial cognition and prefrontal cortex function. We will also investigate the structural and electrophysiological mechanisms underlying those outcomes and evaluate the therapeutic potential of cognitive training.
If our hypothesis that etiology is a major predictor of outcomes then the results of the proposed studies should lead to major conceptual changes in research directions and on the most appropriate therapeutic strategies for children with epilepsies.
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