***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Children with epilepsy often experience poor social and educational outcomes . This study aim ed to determine the timing of services with respect to the onset of seizures . It also aim ed to identify the aspects of childhood epilepsy ( type of epilepsy , etiology , seizure control , and treatment ) that are associated with the use of special education services . As part of a prospect i ve community-based study , 613 children were recruited when first diagnosed with epilepsy . Mean age at first seizure was 5 years 11 months ( SD 4 , range 1mo to 15y 8mo ) . Parents were interviewed 5 years after children were first diagnosed with epilepsy ( n=542 ; 276 [ 51 % ] males ) . Children 's mean age at time of interview was 11 years 10 months ( SD 4y 1mo , range 5y 8mo to 21y 8mo ) . Etiology was classified as idiopathic ( n=181 , 33.4 % ) , cryptogenic ( n=261 , 48.2 % ) , and remote symptomatic ( n=100 , 18.5 % ) . Service use was reported in 315 ( 58 % ) children . Compared with neurologically intact children ( i.e. cryptogenic and idiopathic etiology ; n=415 , 77 % ) , children with a remote symptomatic etiology and /or an epileptic encephalopathy ( n=127 , 23 % ) received services more frequently ( 88 % vs 49 % , p<0.001 ) . In the former group , services were initiated for 66 ( 15 % ) children before their first seizure ; according to age at onset , services were initiated before the first seizures in 12/164 ( 7.3 % ) if < 5 years , 34/171 ( 19.9 % ) if 5 - 9 years , and 20/80 ( 25 % ) if > 10 years . A large proportion of children with epilepsy , even if neurologically otherwise normal , receive  special education services . Initiation of services often precedes onset of seizures even in neurologically intact children . This suggests that behavioral and cognitive abnormalities may pre date the onset of epilepsy and are not necessarily the direct consequences of epilepsy To explore whether attention , memory , and behavior would be more affected in children with frontal lobe epilepsy than in children with other types of epilepsy , we compared 16 children with frontal lobe epilepsy ( FLE ) , 8 with temporal lobe epilepsy ( TLE ) , and 8 with generalized absence ( GEA ) seizures on the Performance Speed ( PS ) and Freedom of Distraction ( FD ) indices of the WISC-III , the  Continuous Performance Test ( CPT ) , the  California Verbal Learning Test ( CVLT )  , and  Rey-Osterrieth Complex Figure ( ROCF ) .  Parents completed  Achenbach 's Child Behavior Check List .  Children with FLE scored significantly lower than the other two groups on the PS and CPT . On the CVLT they made more intrusion errors and were more prone to interference . Furthermore , they had more difficulties copying and recalling the ROCF . Behavior profiles revealed greater attention problems in this group . This may put children with FLE at greater risk of developing school problems than children with TLE and GEA This 12-week open label study explored cognitive and seizure outcomes of 53 children treated with topiramate ( TPM ) . The digit symbol test and verbal learning memory test were administered at baseline and study endpoint . Topiramate was started either in monotherapy or add-on therapy . Overall , 57 % of children experienced a ≥50 % seizure reduction , 36 % became seizure free and cognitive testing revealed no significant changes during TPM therapy . Due to the heterogeneity of the study population , post hoc analyses were added to compare patients in initial or conversion to TPM monotherapy as well as patients who continued add-on therapy . Verbal learning memory test parameters showed neither significant differences within any subgroup comparing baseline with endpoint nor significant differences between described subgroups except for one finding . The digit symbol test revealed no differences between each subgroup between baseline and endpoint . Comparing pre-post differences , TPM monotherapy was associated with better cognitive outcomes than treatment in add-on therapy . These results have to be interpreted with caution given the short study duration and the heterogeneity of the study population . Despite these limitations , our overall results suggest that treatment with topiramate is associated with improved seizure control without significant changes in cognitive functions at the low doses tested Results from comprehensive neuropsychological assessment s of children diagnosed with epilepsy have rarely been reported . Previous research has generally focused on the measurement of overall intellectual ability and achievement skills . In the present study , neuropsychological evaluations including  memory , attention , language , achievement , fine motor , executive function , visual motor integration , and behavior  were completed on children ( n = 79 ) diagnosed with epilepsy .  Neurocognitive skills were within expectations for measured intelligence with the exception of verbal and visual attention skills , which were significantly below expectations based on measured ability . Behaviorally , children were rated by their parents as demonstrating clinical ly elevated attentional problems . Differences in cognitive and behavioral function were not found according to seizure type . Findings suggested a more diffuse effect of childhood epilepsy reflected in a pattern of decreased attention skills Following medial temporal damage , mature humans are impaired in retaining new information over long delays but not short delays . The question of whether a similar dissociation occurs in children was addressed by testing children ( ages 7 - 16 ) with unilateral temporal lobe epilepsy ( TLE ) and controls on short- and long-term memory tasks , including a spatial delayed response task ( SDR ) . Early-onset TLE did not affect performance on short delays on SDR , but it did impair performance at the longest delay ( 60 s ) , similar to adults with unilateral medial temporal damage . In addition , early-onset TLE affected performance on pattern recall , spatial span , and verbal span with rehearsal interference . No differences were found on story recall or on a response inhibition task The development of cognitive functions and the sustainability of seizure control between two and ten years after  epilepsy surgery  were prospect ively investigated in 17 children and adolescents .  Intelligence quotient remained stable . Learning capacity improved . Verbal memory improved in half of the subjects and declined in half , whereas figurative memory declined in most patients . Working memory improved as did attention regarding sustained attention and impulse control . In contrast , reaction times were longer , and the auditory attention span was shorter . Executive functions were not affected . Six subjects ( 35 % ) were seizure free at the 10-year follow-up , and a seizure reduction of more than 75 % had been achieved in 13 ( 76 % ) . Seizure control improved in five and seizures recurred in two subjects between the two- and the 10-year follow-up OBJECTIVES Children with long-st and ing epilepsy have a significantly increased risk of academic underachievement compared with healthy controls . We prospect ively followed children from seizure onset to assess the relationship between change in neuropsychological functioning and change in academic achievement and to explore the risk and protective moderating effects of demographic , seizure , and family variables . METHODS As part of a larger study , neuropsychological and academic data were collected at both baseline and 36 months for 219 children 6 - 14 years of age with seizures . Prior factor analysis of results from a battery of well-st and ardized neuropsychological tests yielded four factors : language , processing speed , attention/executive/construction , and verbal memory/learning . Academic achievement was measured with the Woodcock-Johnson Revised Achievement Test Battery . Correlation coefficients and linear mixed models were used for analysis . RESULTS The reading and math scores of children with seizures and siblings did not differ at baseline , but children with seizures had lower scores than siblings at 36 months . Writing scores were significantly lower for affected children than siblings at both times . Among children with seizures , there were positive correlations between neuropsychological functioning and academic achievement at baseline and 36 months . Changes in language and in verbal memory/learning were positively correlated with change in reading achievement ( r = 0.25 and r = 0.17 , respectively ) . Age at onset moderated the association between change in neuropsychological functioning and change in reading and writing achievement ( P ≤ 0.006 ) , with stronger relationships among younger children ( β = 0.25 - 0.44 ) . The association between change in language and change in writing achievement was moderated by caregiver anxiety ( P = 0.04 ; stronger for more anxious parents , β = 0.40 ) , and the association between change in processing speed and change in math achievement was moderated by etiology ( P = 0.02 ; stronger for symptomatic/cryptogenic vs idiopathic , β = 0.29 ) . Gender and other family variables did not have significant moderating effects . CONCLUSIONS Changes in neuropsychological function were associated with changes in academic achievement following onset of seizures , with risk factors being younger age at onset , lower caregiver education , high parental anxiety , and symptomatic/cryptogenic etiology . Academic performance should be closely monitored in children with early-onset seizures In this study , we evaluated the impact on educational achievement of four characteristics of epilepsy individually and combined : epilepsy syndrome ( type of epilepsy ) , seizure type , the frequency of epileptiform electroencephalographic ( EEG ) discharges , and the effect of antiepileptic treatment . Simultaneously , the effect on cognitive function and the relationship between educational underachievement and cognitive impairment were evaluated , focusing on memory , attention , speed of information processing , and intelligence level . This study was an open , controlled , parallel-group , nonr and omized clinical investigation . Eligible patients were selected when referred to our center for assessment of relationships between epilepsy and learning impairment in the years 1997 to 2001 . Separately , children without neurologic deficit and without educational delay were assessed with the same tests as the children with epilepsy . This latter group is used in this study as a control group . One hundred seventy-six children with epilepsy and 113 controls were included . Gender distribution and age were comparable for the two groups . All children were in regular primary education . The children were assessed with a test battery consisting of tests for educational achievement , cognitive tests and tests for reaction time , and tests for memory and intelligence . Multivariate analysis of variance for tests of educational achievement showed a statistically significant effect for type of epilepsy ( F = 4.386 ; P = .04 ) , caused by the statistically lower scores for patients with localized epilepsy and symptomatic generalized epilepsy . For the reaction-time tests , a statistically significant effect for epileptiform EEG discharges ( F = 3.165 ; P = .01 ) and treatment ( F = 4.472 ; P = .001 ) on both vigilance tests was found , caused by patients with frequent epileptiform EEG discharges and polytherapy . Two-way interactions showed an interaction with type of epilepsy , with more patients with symptomatic generalized epilepsy having frequent epileptiform EEG discharges and polytherapy . For memory , none of the analyses showed statistically significant effects . For intelligence only for type of epilepsy , a statistically significant effect was found ( F = 10.174 ; P = < .001 ) . We propose a model with the type of epilepsy ( epilepsy syndrome ) as the dominant factor explaining educational underachievement in children with epilepsy . Such educational underachievement is most prominent for the localized and symptomatic generalized epilepsies , which suggests a dominant impact of underlying etiology ( brain dysfunction or damage ) . These epilepsies are characterized specifically by a lower intelligence ; hence , this could be the primary cognitive factor mediating between the type of epilepsy and educational underachievement . From the other factors , treatment ( the use of polytherapy ) and frequent epileptiform EEG discharges are associated with impaired vigilance , which could have an additional influence on educational achievement . These factors are , however , not independent of the type of epilepsy . ( J Child Neurol 2005;20:175—180 ) Purpose : To determine the frequency and determinants of subnormal global cognitive function in a representative , community‐based sample of children prospect ively identified at the time of initial diagnosis of epilepsy This study compares the acute cognitive effects of  short nonconvulsive seizures  with the effects of interictal epileptiform electroencephalographic ( EEG ) discharges in children . The study is a prospect i ve , st and ardized , nonr and omized , and open clinical comparative study . Eligible patients were included when they had ( a ) unclear seizures and fluctuations in cognitive performance and ( b ) frequent epileptiform EEG discharges in a recent EEG . All children were assessed with  EEG/video  ( Brainlab ® ) simultaneously with  computerized neuropsychologic testing ( FePsy ® ) assessing motor speed/alertness , mental speed/attention , and memory function .  Eleven patients with short nonconvulsive seizures during cognitive testing were included and compared with 11 matched patients  with interictal epileptiform EEG discharges during cognitive testing but without seizures . Patients included in both groups had a reconfirmed diagnosis of epilepsy . Cognitive performance for both groups was compared . Statistical analysis showed significant correlations beween the number of seizures ( during cognitive testing ) and impaired alertness and between the duration of the ictal period and memory impairment . Interictal epileptiform EEG discharges do not have an additional independent effect on cognitive function . The results demonstrate the accumulating cognitive effect of seizures and illustrate that frequent se 
    Output:
    
Children with epilepsy have a high frequency of memory impairments .