NEURAL REGENERATION RESEARCH Volume 5, Issue 21, November 2010 Cite this article as: Neural Regen Res. 2010;5(21):1663-1667. 1663 Parvaneh Karimzadeh , M.D., Associate professor, Pediatric Neurology Research Center, Shahid Beheshti University of Medical Sciences (SBMU), Mofid Children Hospital, Tehran, Iran Corresponding author: Parvaneh Karimzadeh, Pediatric Neurology Department, Pediatric Neurology Research Center, Shahid Beheshti University of Medical Sciences (SBMU), Shariati Avenue, Mofid Children Hospital, Tehran, Iran pkarimzadeh@sbmu.ac.ir Received: 2010-08-21 Accepted: 2010-10-08 (NY20100621004/H) Karimzadeh P, Tabarestani S. Promising medical treatment for childhood psycho- cognitive problems. Neural Regen Res. 2010;5(21): 1663-1667. www.crter.cn www.nrronline.org doi:10.3969/j.issn.1673-5374. 2010.21.011 Promising medical treatment for childhood psycho-cognitive problems Parvaneh Karimzadeh 1 , Sepideh Tabarestani 2 1Pediatric Neurology Research Center, Shahid Beheshti University of Medical Sciences (SBMU), Mofid Children Hospital, Tehran, Iran 2Pediatric Neurology Research Center, Mofid Children Hospital, Tehran, Iran Abstract Subclinical electroencephalogram discharges in children with psycho-cognitive problems are not uncommon. However, the clinical importance and relationship to cognitive deficits, as well as indications for medical treatment, are not well understood. Transient cognitive impairment, which accompanies electroencephalogram discharges, could negatively influence cognitive abilities over time. Studies have suggested that treatment with antiepileptic drugs normalizes electroencephalogram results, thereby preventing electrical paroxysmal discharges that could be harmful to the developing brain. Physicians should attempt to differentiate between corresponding factors, such as subtle seizures, nature of underlying etiology, stable cognitive deficits, seizure-inducing effects, and potential side effects of antiepileptic drugs prior to initiation of medical treatment for definitive diagnosis of transient cognitive impairment and its consequences. Therefore, appropriate criteria for patient selection and proper guidelines for medical therapy, should be addressed in future studies. Key Words: psycho-behavioral problems; cognitive deficits; subclinical epileptiform discharges; antiepileptic drugs INTRODUCTION Despite remarkable improvements in different areas of neurology, the electroencephalogram (EEG) remains the primary diagnostic test for brain function. In addition, it is used exclusively to provide continuous measurements of cortical function with excellent time resolution and low costs. “Global developmental delay” is typically reserved for younger children (typically < 5 years of age), whereas the term “mental retardation” is typically applied to older children, for whom IQ testing is more valid and reliable [1] . Given a higher incidence of epilepsy and behavioral disorder in children with developmental delay, EEG is often used for initial evaluation. However, the correlation between EEG abnormalities and psycho-behavioral delay or regression is not well understood. The use of antiepileptic drugs (AEDs), such as valproate, ethosuximide, clobazam, oxcarbazepine, sulthiame, levetiracetam, topiramate or lamotrigine, has been reported with courses of corticoids and adrenocorticotropic hormone [2] . According to some studies, valproate is more effective than other AEDs for cognition and behavioral disorders [3] , and sustained improvement has been reported with corticosteroids [4] . Lamotrigine is efficacious and well tolerated in patients with neurodevelopmental delay and behavioral disorders [5] . Results have suggested that epileptic activity could result in adverse effects on advanced brain function [6-7] , although the clinical importance of interictal epileptiform EEG discharges remains unclear [7] . Moreover, various factors, such as the underlying etiology of epilepsy, age at onset of epilepsy, localization of epileptogenic foci, and adverse effects of AEDs, are also involved [7-9] . The possibility of potential treatment for effects of subclinical discharges and AEDs makes them important in clinical practice. In the present study, we analyzed the effects of subclinical EEG discharge (SED) treatment on psycho-behavioral problems and cognitive deficit. This approach requires appropriate criteria for patient evaluation and proper clinical treatment. SEDS AND COGNITIVE IMPAIRMENT Interictal discharges occur without detectable clinical manifestations, although formal testing could reveal simultaneous transient cognitive impairment (TCI) [10] . The www.nrronline.org www.nrronline.org