By Uzair Ali, Second-year Student
Dr. Jennifer Koop is a pediatric neuropsychologist and associate professor of neurology and neurosurgery at the Medical College of Wisconsin. Dr. Jennifer Koop is also the sister of faculty member Dr. Gregory Koop. Dr. Jennifer Koop presented on the role neuropsychology has in the treatment of pediatric epileptic patients are using. Dr. Koop graduated from Goshen College and then pursued her Master’s and Ph.D. from Purdue. Afterwards, she interned for one year at Baylor College of Medicine Texas Children’s Hospital.
Neuropsychology is the study of the behavior brain relationship. It is the neural mechanism that underlies human behavior. Clinical neuropsychology uses tests and tasks to assess areas of cognitive functioning. The patterns witnessed informs how well an individual’s brain functions. This is compared to normative data in order to determine the cognitive profile of the individual, which is a list of strengths and weaknesses. Different regions of the brain control different functions. Theories in neuropsychology are mostly based on adults. This is problematic because adult cognition is static and not dynamic as pediatric. Adults also respond differently to neuropsychological disorders and abnormalities than children. Children undergo critical periods during their development. A critical period is a spurt of development and is noted by an increased period of plasticity, which affects the ability to learn a skill. These critical windows are important because any medical or traumatic experiences that occur during this time can have dramatic consequences.
The predisposed brain in children is more exposed to seizures than adults. Epilepsy is the most common neurological disorder and can alter behavior or emotional development. A normal developmental trajectory increases in a hyperbolic trajectory. Seizures alter this development, by decreasing development. Epilepsy does not have one cognitive profile. Functional reorganization is a reorganization of neurons and is the brain’s response to a seizure. It can occur interhemispherically where function transfers contralaterally to the other hemisphere. Intrahemispheric is a transfer of function to a different area in the same hemisphere. Age of onset is important in the prognosis of epilepsy and seizures. Earlier age of onset, longer duration of the disorder, certain types, and increased number of seizures are correlated with worse prognosis and lower cognitive functioning. Epilepsy affects behavior, psychology, and academics in children and adolescence.
Medication is the typical treatment for epilepsy, but it does come with side-effects such as slower cognition and behavioral problems. Medically intractable epilepsy is when medication is not effective, and surgery is then considered. Before surgery, certain evaluations need to be performed; this includes neuropsychological and lateral testing. Only 27 articles presented on childhood surgery for epilepsy, which was inconsistent. One article showed that only 20-30% of children who underwent surgery showed cognitive improvement, many showed cognitive decline. Patients who make great progress in cognition also are at higher risk of decline in cognition. Jasmine, a patient of Dr. Koop, is a 16 yo Black female with two-lifetime seizures over 5 years caused by a lesion in the front left region of the brain and the seizures were not able to be managed by medication. No developmental delays were seen, in fact, most of Jasmine’s scores were within normal range, but deficits in visual-spatial recognition and naming were observed.
In summation evidence of cognitive impacts, identifying the risks associated with cognitive change, minimizing the surgical impact on cognition, evaluation of post-surgical outcomes need to be studied further in order to advance the treatment of epilepsy and the subject of neuropsychology.