Cognition, academic achievement, and epilepsy in school-age children: A case–control study in a developing country R. Melbourne Chambers a, ⁎, N. Morrison-Levy b , S. Chang c , J. Tapper b , S. Walker c , M. Tulloch-Reid c a Department of Child and Adolescent Health, University of the West Indies (UWI), Mona, Jamaica b Bustamante Hospital for Children, Arthur Wint Drive, Kingston, Jamaica c Epidemiology Research Unit, Tropical Medicine Research Institute, UWI, Mona, Jamaica abstract article info Article history: Received 17 December 2013 Revised 2 February 2014 Accepted 4 February 2014 Available online 13 March 2014 Keywords: Epilepsy Developing Country Jamaica Cognition Achievement We conducted a case–control study of 33 Jamaican children 7 to 12 years old with uncomplicated epilepsy and 33 of their classroom peers matched for age and gender to determine whether epilepsy resulted in differences in cognitive ability and school achievement and if socioeconomic status or the environment had a moderating effect on any differences. Intelligence, language, memory, attention, executive function, and mathematics ability were assessed using selected tests from NEPSY, WISCR, TeaCh, WRAT3 — expanded, and Raven's Coloured Progressive Matrices. The child's environment at home was measured using the Middle Childhood HOME inventory. Socio- economic status was determined from a combination of household, crowding, possessions, and sanitation. We compared the characteristics of the cases and controls and used random effects regression models (using the matched pair as the cluster) to examine the relationship between cognition and epilepsy. We found that there was no significant difference in IQ, but children with epilepsy had lower scores on tests of memory (p b 0.05), language (p b 0.05), and attention (p b 0.01) compared with their controls. In random effects models, epilepsy status had a significant effect on memory (coefficient = -0.14, CI: -0.23, -0.05), language (coefficient = -0.13, CI: -0.23, -0.04), and mathematics ability (coefficient = -0.01, CI: -0.02, -0.00). Adjustment for the home environment and socioeconomic status and inclusion of interaction terms for these variables did not alter these effects. In conclusion, we found that epilepsy status in Jamaican children has a significant effect on per- formance on tests of memory, language, and mathematics and that this effect is not modified or explained by so- cioeconomic status or the child's home environment. © 2014 Elsevier Inc. All rights reserved. 1. Introduction Epilepsy affects 1% of children globally [1] but is more prevalent in developing countries [2]. Although 60–75% of children with epilepsy will experience lifelong seizure remission [3,4], children with idiopathic epilepsy have been shown to experience cognitive deficits [5]. The cause of these cognitive deficits is not fully determined and is probably multifactorial. Investigators have reported the presence of cognitive deficits at diagnosis/onset of disease [6,7] in children with idiopathic epilepsy suggesting a role for underlying brain dysfunction. The number of recurrent seizures may also contribute to the severity of cognitive abnormality, and cognitive side effects are more common with the use of the older antiepileptic drugs (AEDs) [8–10]. Studies of cognition in children with frequent or continuous spike–wave dis- charges during sleep, even in the absence of overt clinical seizures, suggest a role for the excessive EEG spike discharges in the impairment of language and other areas of cognition and memory [11]. A range of cognitive deficits have been documented in idiopathic epilepsy includ- ing memory [12–14], processing speed, attention [15], and language [16]. These cognitive deficits may impact academic performance. Chil- dren with epilepsy access special education services more frequently than their peers [5]. Aldenkamp et al. have shown that educational un- derachievement is more likely in children with localized or symptomat- ic generalized epilepsy [17]. Interestingly, in a prospective community- based study, Berg et al. showed that 49% of children with idiopathic/ cryptogenic epilepsy were receiving special education services at 5 years of follow-up and that 15% had accessed services prior to their first seizure, thereby suggesting that the cognitive deficits antedate the onset of epilepsy [18]. The cognitive and motor deficits in idiopathic epilepsy in children aged 7 to 16 years have been shown to remain stable over two years [16]. Similarly, academic achievement in children with varying degrees of severity of epilepsy aged 11 to 18 years has not been shown to decline over a period of follow-up of 4 years [19]. Epilepsy & Behavior 33 (2014) 39–44 ⁎ Corresponding author. Tel.: +1 876 927 1446. E-mail addresses: roxanne.melbournechambers@uwimona.edu.jm (R. Melbourne Chambers), nadinelevy.morrison74@gmail.com (N. Morrison-Levy), susan.changlopez@uwimona.edu.jm (S. Chang), judymtapper@yahoo.com (J. Tapper), susan.walker@uwimona.edu.jm (S. Walker), marshall.tullochreid@uwimona.edu.jm (M. Tulloch-Reid). http://dx.doi.org/10.1016/j.yebeh.2014.02.002 1525-5050/© 2014 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Epilepsy & Behavior journal homepage: www.elsevier.com/locate/yebeh