Brief Communication Attention impairment in childhood absence epilepsy: An impulsivity problem? Caterina Cerminara a, ⁎ , 1 , Elisa D'Agati a, 1 , Livia Casarelli a , Ivo Kaunzinger b , Klaus W. Lange b , Mariabernarda Pitzianti a , Pasquale Parisi c , Oliver Tucha d , Paolo Curatolo a a Unit of Child Neurology and Psychiatry, Department of Neuroscience, University of Rome “Tor Vergata”, Italy b Department of Experimental Psychology, University of Regensburg, Germany c Paediatric Department, II Faculty of Medicine, University of Rome “La Sapienza”, Italy d Department of Clinical and Developmental Neuropsychology, University of Groningen, The Netherlands abstract article info Article history: Received 20 September 2012 Revised 6 February 2013 Accepted 8 February 2013 Available online 27 March 2013 Keywords: Childhood absence epilepsy Neuropsychological assessment Attention Impulsivity Although attention problems have often been described in children with childhood absence epilepsy (CAE), the use of different methodological approaches, neuropsychological tests, and heterogeneous experimental groups has prevented identification of the selective areas of attention deficit in this population. In this study, we investigated several components of attention in children with CAE using a unique computerized test battery for attention performance. Participants included 24 patients with CAE and 24 controls matched for age and sex. They were tested with a computerized test battery, which included the following tasks: selective attention, impulsivity, focused attention, divided attention, alertness, and vigilance. Compared with healthy controls, patients with CAE made more commission errors in the Go/No-Go task and more omission errors in the divided attention task. Childhood absence epilepsy patients also showed decreased reaction times in mea- sures of selective attention and a great variability of reaction times in alertness and Go/No-Go tasks. Our findings suggest that patients with CAE were impaired in tonic and phasic alertness, divided attention, selective attention, and impulsivity. © 2013 Elsevier Inc. All rights reserved. 1. Introduction The association between childhood epilepsy and cognitive dys- function has long been documented. In recent years, numerous studies have attempted to identify specific epilepsy-related factors that con- tribute to predicting cognitive dysfunction with largely conflicting results. Although neuropsychological studies of pediatric populations with epilepsy have not demonstrated a specific pattern of impairment, deficits in attention and memory have been documented [1,2]. Idio- pathic generalized epilepsies that are not due to brain lesions could provide an interesting model for investigating the effects of underlying epileptic conditions on cognitive functions. Childhood absence epilepsy (CAE) is a common form of pediatric epilepsy and accounts for approximately 15.3% of all cases [3]. Typical absence seizures are characterized by brief (b 30 s), sudden, and unpredictable episodes of impaired consciousness associated with generalized-spike/polyspike-and-slow-wave discharges on electroen- cephalogram (EEG) and are often accompanied by motor automatisms [4]. Although CAE has been generally presumed to be relatively benign and occurs in children who show normal mental development, recent comparative studies suggest that patients with CAE show attentional problems even if their seizures are controlled [5–8]. The attention process can be viewed as the building block for other more complex forms of cognitive activity. Neuropsychological theories of attention include unitary concepts of attention in multidimensional models, with several distinct components of attentional functions. In their multicomponent model of attention, Van Zomeren and Brouwer include alertness, subdivided into tonic and phasic alertness, vigilance/ sustained attention, selective attention, divided attention, and strategy/ flexibility [9]. Selective attention and divided attention are regarded as aspects of selectivity, and alertness and vigilance/sustained attention represent expressions of intensity. Attention problems are commonly reported in children with epilepsy, particularly CAE [5]. They can interfere with children's academic performances and daily lives [10]. Attention seems to be particularly vulnerable to epileptic activity [11], and evaluating the effects of epilepsy on the development of cognitive functions is com- plex because of the many variables that can affect cognitive abilities [i.e., antiepileptic drugs (AEDs), educational setting, interictal EEG ab- normalities]. Recent studies have tried to systematically compare the neuropsychological performance of children with CAE with that of healthy control groups, but the findings are difficult to interpret. Epilepsy & Behavior 27 (2013) 337–341 ⁎ Corresponding author at: Department of Neuroscience, Pediatric Neurology Unit, “Tor Vergata” University of Rome, Italy, Via Montpellier 1, 00133, Rome, Italy. Fax: + 39 06 20900018. E-mail addresses: caterinacerminara@hotmail.com (C. Cerminara), elisadagati@gmail.com (E. D'Agati), liviacasarelli@hotmail.com (L. Casarelli), ivo.kaunzinger@psychologie.uni-regensburg.de (I. Kaunzinger), klaus.lange@psychologie.uni-regensburg.de (K.W. Lange), tempilunghi@libero.it (M. Pitzianti), pasquale.parisi@uniroma1.it (P. Parisi), O.M.Tucha@rug.nl (O. Tucha), pcuratolo@uniroma2.it (P. Curatolo). 1 These authors contributed equally to the present work. 1525-5050/$ – see front matter © 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.yebeh.2013.02.022 Contents lists available at SciVerse ScienceDirect Epilepsy & Behavior journal homepage: www.elsevier.com/locate/yebeh