BLAST paradigm: A new test to assess brief attentional fluctuations in children with epilepsy, ADHD, and normally developing children

Marine Thieux; Julien Jung; Romain Bouet; Daniel Gerard; Prisca R Bauer; Olivier Bertrand; Marcela Perrone-Bertolotti; Alexis Arzimanoglou; Philippe Kahane; Jean-Philippe Lachaux; Julitta De Bellescize; Vania Herbillon

doi:10.1016/j.yebeh.2019.106470

BLAST paradigm: A new test to assess brief attentional fluctuations in children with epilepsy, ADHD, and normally developing children

Epilepsy Behav. 2019 Oct:99:106470. doi: 10.1016/j.yebeh.2019.106470. Epub 2019 Aug 17.

Affiliations

¹ INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, Lyon, France; Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Member of the European Reference Network on Rare and Complex Epilepsies EpiCARE, Hospices Civils de Lyon and University Lyon, Lyon, France. Electronic address: marine.thieux@live.fr.
² INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, Lyon, France; Department of Functional Neurology and Epileptology, Member of the European Reference Network on Rare and Complex Epilepsies EpiCARE, Hospices Civils de Lyon and University Lyon, Lyon, France.
³ INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, Lyon, France.
⁴ Department of Developmental Psychopathology of Child, Hospices Civils de Lyon, Lyon, France.
⁵ University Grenoble Alpes, CNRS, LPNC, Grenoble, France.
⁶ INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, Lyon, France; Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Member of the European Reference Network on Rare and Complex Epilepsies EpiCARE, Hospices Civils de Lyon and University Lyon, Lyon, France.
⁷ University Grenoble Alpes, Inserm, CHU Grenoble Alpes, GIN, Grenoble, France; Department of Neurology, CHU Grenoble-Alpes, Grenoble, France.
⁸ Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Member of the European Reference Network on Rare and Complex Epilepsies EpiCARE, Hospices Civils de Lyon and University Lyon, Lyon, France.

PMID: 31430660
DOI: 10.1016/j.yebeh.2019.106470

Abstract

Background: Pure attentional deficits are still underdiagnosed in children with epilepsy. While attention-deficit hyperactivity disorder (ADHD) is historically the most studied cause of attentional disorders, an important number of children with epilepsy and attentional complaints do not fully meet the DSM-V (Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition) criteria for ADHD and may be excluded from specific care. Clinical tools currently available are insufficient to detect more subtle but clinically relevant attentional fluctuations.

Objective/methods: The recently developed Bron-Lyon Attention Stability Test (BLAST) was used to evaluate brief attentional fluctuations with a high temporal precision. Drawing on two new attentional indices, we evaluated spontaneous fluctuations of response accuracy and timing, underlying attentional stability. The main objective was to assess attentional stability in children with i) epilepsy with comorbid ADHD, ii) epilepsy without comorbid ADHD, iii) ADHD not medicated and without epilepsy, and iv) normal development. Further objectives were to assess the main determinants of attentional stability in those groups, including the effect of factors related to the epileptic condition.

Results: In 122 children with epilepsy (67 with comorbid ADHD), 52 children with ADHD, and 53 healthy controls, we demonstrated lower attentional stability in both the groups with epilepsy and ADHD compared with healthy children. In children with epilepsy, BLAST scores were negatively associated with earlier seizure onset and AED (antiepileptic drug) polytherapy, while the seizure frequency, epilepsy duration, or type did not influence BLAST scores.

Conclusions: This study demonstrates that attentional stability is impaired in children with epilepsy and/or ADHD. Bron-Lyon Attention Stability Test seems to be a sensitive test to detect attentional stability deficit in children with epilepsy and with attentional complaints who did not meet all criteria of ADHD. We propose that BLAST could be a useful clinical neuropsychological tool to assess attentional disorders in children.

Keywords: Attention-deficit hyperactivity disorder (ADHD); Attentional stability; BLAST; Childhood epilepsy; Neuropsychological.

MeSH terms

Adolescent
Attention / physiology*
Attention Deficit Disorder with Hyperactivity / diagnosis
Attention Deficit Disorder with Hyperactivity / epidemiology
Attention Deficit Disorder with Hyperactivity / psychology*
Child
Child Development / physiology*
Comorbidity
Cross-Sectional Studies
Diagnostic and Statistical Manual of Mental Disorders
Epilepsy / diagnosis
Epilepsy / epidemiology
Epilepsy / psychology*
Female
Humans
Male
Neuropsychological Tests*
Photic Stimulation / methods
Reaction Time / physiology*