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Dusanter C, Houot M, Mere M, Denos M, Samson S, Herlin B, Navarro V, Dupont S. Cognitive effect of antiseizure medications in medial temporal lobe epilepsy. Eur J Neurol 2023; 30:3692-3702. [PMID: 37650365 DOI: 10.1111/ene.16050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/23/2023] [Accepted: 08/14/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND AND PURPOSE The specific effects of antiseizure medications (ASMs) on cognition are a rich field of study, with many ongoing questions. The aim of this study was to evaluate these effects in a homogeneous group of patients with epilepsy to guide clinicians to choose the most appropriate medications. METHODS We retrospectively identified 287 refractory patients with medial temporal lobe epilepsy associated with hippocampal sclerosis. Scores measuring general cognition (global, verbal and performance IQ), working memory, episodic memory, executive functions, and language abilities were correlated with ASM type, number, dosage and generation (old vs. new). We also assessed non-modifiable factors affecting cognition, such as demographics and epilepsy-related factors. RESULTS Key parameters were total number of ASMs and specific medications, especially topiramate (TPM) and sodium valproate (VPA). Four cognitive profiles of the ASMs were identified: (i) drugs with an overall detrimental effect on cognition (TPM, VPA); (ii) drugs with negative effects on specific areas: verbal memory and language skills (carbamazepine), and language functions (zonisamide); (iii) drugs affecting a single function in a specific and limited area: visual denomination (oxcarbazepine, lacosamide); and (iv) drugs without documented cognitive side effects. Non-modifiable factors such as age at testing, age at seizure onset, and history of febrile seizures also influenced cognition and were notably influenced by total number of ASMs. CONCLUSION We conclude that ASMs significantly impact cognition. Key parameters were total number of ASMs and specific medications, especially TPM and VPA. These results should lead to a reduction in the number of drugs received and the avoidance of medications with unfavorable cognitive profiles.
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Affiliation(s)
- Cedric Dusanter
- Department of Neurology, Epileptology Unit, Reference Center for Rare Epilepsies, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Marion Houot
- Centre of Excellence of Neurodegenerative Disease (CoEN), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Department of Neurology, Institute of Memory and Alzheimer's Disease (IM2A), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Clinical Investigation Centre, Institut du Cerveau et de la Moelle épinière (ICM), Pitié-Salpêtrière Hospital, Paris, France
| | - Marie Mere
- Department of Neurology, Epileptology Unit, Reference Center for Rare Epilepsies, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Marisa Denos
- Rehabilitation Unit, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Séverine Samson
- Univ. Lille, ULR 4072 - PSITEC - Psychologie: Interactions Temps Émotions Cognition, Lille, France
| | - Bastien Herlin
- CEA Neurospin, Unité Mixte de Recherche BAOBAB (Building Large Instruments for Neuroimaging: From Population Imaging to Ultra-High Magnetic Fields), Paris, France
| | - Vincent Navarro
- Department of Neurology, Epileptology Unit, Reference Center for Rare Epilepsies, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Neurophysiology Unit, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Université Paris Sorbonne, Paris, France
- Centre de Recherche de l'Institut du Cerveau et de la Moelle Epinière (ICM), UMPC-UMR 7225 CNRS-UMRS 975 Inserm, Paris, France
| | - Sophie Dupont
- Department of Neurology, Epileptology Unit, Reference Center for Rare Epilepsies, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Rehabilitation Unit, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Université Paris Sorbonne, Paris, France
- Centre de Recherche de l'Institut du Cerveau et de la Moelle Epinière (ICM), UMPC-UMR 7225 CNRS-UMRS 975 Inserm, Paris, France
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2
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Tai XY, Torzillo E, Lyall DM, Manohar S, Husain M, Sen A. Association of Dementia Risk With Focal Epilepsy and Modifiable Cardiovascular Risk Factors. JAMA Neurol 2023; 80:445-454. [PMID: 36972059 PMCID: PMC10043806 DOI: 10.1001/jamaneurol.2023.0339] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/26/2023] [Indexed: 03/29/2023]
Abstract
Importance Epilepsy has been associated with cognitive impairment and potentially dementia in older individuals. However, the extent to which epilepsy may increase dementia risk, how this compares with other neurological conditions, and how modifiable cardiovascular risk factors may affect this risk remain unclear. Objective To compare the differential risks of subsequent dementia for focal epilepsy compared with stroke and migraine as well as healthy controls, stratified by cardiovascular risk. Design, Setting, and Participants This cross-sectional study is based on data from the UK Biobank, a population-based cohort of more than 500 000 participants aged 38 to 72 years who underwent physiological measurements and cognitive testing and provided biological samples at 1 of 22 centers across the United Kingdom. Participants were eligible for this study if they were without dementia at baseline and had clinical data pertaining to a history of focal epilepsy, stroke, or migraine. The baseline assessment was performed from 2006 to 2010, and participants were followed up until 2021. Exposures Mutually exclusive groups of participants with epilepsy, stroke, and migraine at baseline assessment and controls (who had none of these conditions). Individuals were divided into low, moderate, or high cardiovascular risk groups based on factors that included waist to hip ratio, history of hypertension, hypercholesterolemia, diabetes, and smoking pack-years. Main Outcomes and Measures Incident all-cause dementia; measures of executive function; and brain total hippocampal, gray matter, and white matter hyperintensity volumes. Results Of 495 149 participants (225 481 [45.5%] men; mean [SD] age, 57.5 [8.1] years), 3864 had a diagnosis of focal epilepsy only, 6397 had a history of stroke only, and 14 518 had migraine only. Executive function was comparable between participants with epilepsy and stroke and worse than the control and migraine group. Focal epilepsy was associated with a higher risk of developing dementia (hazard ratio [HR], 4.02; 95% CI, 3.45 to 4.68; P < .001), compared with stroke (HR, 2.56; 95% CI, 2.28 to 2.87; P < .001), or migraine (HR, 1.02; 95% CI, 0.85 to 1.21; P = .94). Participants with focal epilepsy and high cardiovascular risk were more than 13 times more likely to develop dementia (HR, 13.66; 95% CI, 10.61 to 17.60; P < .001) compared with controls with low cardiovascular risk. The imaging subsample included 42 353 participants. Focal epilepsy was associated with lower hippocampal volume (mean difference, -0.17; 95% CI, -0.02 to -0.32; t = -2.18; P = .03) and lower total gray matter volume (mean difference, -0.33; 95% CI, -0.18 to -0.48; t = -4.29; P < .001) compared with controls. There was no significant difference in white matter hyperintensity volume (mean difference, 0.10; 95% CI, -0.07 to 0.26; t = 1.14; P = .26). Conclusions and Relevance In this study, focal epilepsy was associated with a significant risk of developing dementia, to a greater extent than stroke, which was magnified substantially in individuals with high cardiovascular risk. Further findings suggest that targeting modifiable cardiovascular risk factors may be an effective intervention to reduce dementia risk in individuals with epilepsy.
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Affiliation(s)
- Xin You Tai
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Division of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, United Kingdom
| | - Emma Torzillo
- Epilepsy Department, National Hospital for Neurology and Neurosurgery, University College London, London, United Kingdom
| | - Donald M. Lyall
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Sanjay Manohar
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Division of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, United Kingdom
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Masud Husain
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Division of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, United Kingdom
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Arjune Sen
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Division of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, United Kingdom
- Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom
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3
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Heerwig C, Möller H, Brückner K. Neuropsychology of epilepsy in old age – English Version. ZEITSCHRIFT FÜR EPILEPTOLOGIE 2022. [DOI: 10.1007/s10309-022-00479-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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4
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DiFrancesco JC, Labate A, Romoli M, Chipi E, Salvadori N, Galimberti CA, Perani D, Ferrarese C, Costa C. Clinical and Instrumental Characterization of Patients With Late-Onset Epilepsy. Front Neurol 2022; 13:851897. [PMID: 35359649 PMCID: PMC8963711 DOI: 10.3389/fneur.2022.851897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/04/2022] [Indexed: 11/13/2022] Open
Abstract
Epilepsy is classically considered a childhood disease. However, it represents the third most frequent neurological condition in the elderly, following stroke, and dementia. With the progressive aging of the general population, the number of patients with Late-Onset Epilepsy (LOE) is constantly growing, with important economic and social consequences, in particular for the more developed countries where the percentage of elderly people is higher. The most common causes of LOE are structural, mainly secondary to cerebrovascular or infectious diseases, brain tumors, trauma, and metabolic or toxic conditions. Moreover, there is a growing body of evidence linking LOE with neurodegenerative diseases, particularly Alzheimer's disease (AD). However, despite a thorough characterization, the causes of LOE remain unknown in a considerable portion of patients, thus termed as Late-Onset Epilepsy of Unknown origin (LOEU). In order to identify the possible causes of the disease, with an important impact in terms of treatment and prognosis, LOE patients should always undergo an exhaustive phenotypic characterization. In this work, we provide a detailed review of the main clinical and instrumental techniques for the adequate characterization of LOE patients in the clinical practice. This work aims to provide an easy and effective tool that supports routine activity of the clinicians facing LOE.
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Affiliation(s)
- Jacopo C. DiFrancesco
- Department of Neurology, ASST S. Gerardo Hospital, School of Medicine and Surgery and Milan Center for Neuroscience, University of Milano - Bicocca, Monza, Italy
- *Correspondence: Jacopo C. DiFrancesco
| | - Angelo Labate
- Neurophysiopathology Unit, Department of Biomedical and Dental Sciences, Morphological and Functional Images (BIOMORF), University of Messina, Messina, Italy
| | - Michele Romoli
- Section of Neurology, S. Maria della Misericordia Hospital, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Elena Chipi
- Section of Neurology, S. Maria della Misericordia Hospital, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Nicola Salvadori
- Section of Neurology, S. Maria della Misericordia Hospital, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | | | - Daniela Perani
- Nuclear Medicine Unit and Division of Neuroscience, San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Carlo Ferrarese
- Department of Neurology, ASST S. Gerardo Hospital, School of Medicine and Surgery and Milan Center for Neuroscience, University of Milano - Bicocca, Monza, Italy
| | - Cinzia Costa
- Section of Neurology, S. Maria della Misericordia Hospital, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Cinzia Costa
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Wang H, Zhao P, Zhao J, Zhong J, Pan P, Wang G, Yi Z. Theory of Mind and Empathy in Adults With Epilepsy: A Meta-Analysis. Front Psychiatry 2022; 13:877957. [PMID: 35573343 PMCID: PMC9093035 DOI: 10.3389/fpsyt.2022.877957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/04/2022] [Indexed: 12/18/2022] Open
Abstract
Mounting evidence suggests that social cognitive abilities [including theory of mind (ToM) and empathy] are impaired in adult patients with epilepsy. Although the deficits in overall ToM in epilepsy have been documented well, the effects of epilepsy on empathic ability and specific subcomponents of ToM remain unclear. The primary aim of this study was to provide the first meta-analytic integration of ToM and empathy in adult patients with epilepsy, and to decompose these constructs to clearly differentiate their distinct (cognitive ToM and affective empathy) and overlapping (affective ToM/cognitive empathy) components. This meta-analysis included 28 studies. Adult patients with temporal lobe epilepsy (TLE) and frontal lobe epilepsy (FLE) showed impairments in cognitive ToM and affective ToM/cognitive empathy compared to the healthy controls (HCs); no group differences were identified for affective empathy. Besides, cognitive ToM was impaired in adult patients with idiopathic generalized epilepsy (IGE) and focal seizures (caused by epileptogenic foci) outside the temporal and frontal lobes (extra-TLE/FLE) and no group differences were evident for affective ToM/cognitive empathy compared to the HCs. Moreover, relative to the HCs, no group differences were identified for affective empathy in adult patients with IGE. Additionally, no (statistically) significant difference was observed between the magnitude of ToM/empathy impairment in adult patients who underwent and those who did not undergo epilepsy surgery. These quantitative findings suggest differential impairment of the core aspects of social cognitive processing in adult patients with epilepsy, which may contribute to the development of structured cognitive interventions (i.e., social cognitive training) for adult patients with epilepsy.
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Affiliation(s)
- HongZhou Wang
- Department of Neurology, Anting Hospital, Shanghai, China
| | - PanWen Zhao
- Department of Central Laboratory, Yancheng Third People's Hospital, The Sixth Affiliated Hospital of Nantong University, Yancheng, China
| | - Jing Zhao
- Department of Central Laboratory, Yancheng Third People's Hospital, The Sixth Affiliated Hospital of Nantong University, Yancheng, China
| | - JianGuo Zhong
- Department of Neurology, Yancheng Third People's Hospital, The Sixth Affiliated Hospital of Nantong University, Yancheng, China
| | - PingLei Pan
- Department of Central Laboratory, Yancheng Third People's Hospital, The Sixth Affiliated Hospital of Nantong University, Yancheng, China.,Department of Neurology, Yancheng Third People's Hospital, The Sixth Affiliated Hospital of Nantong University, Yancheng, China
| | - GenDi Wang
- Department of Neurology, Yancheng Third People's Hospital, The Sixth Affiliated Hospital of Nantong University, Yancheng, China
| | - ZhongQuan Yi
- Department of Central Laboratory, Yancheng Third People's Hospital, The Sixth Affiliated Hospital of Nantong University, Yancheng, China
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Romoli M, Sen A, Parnetti L, Calabresi P, Costa C. Amyloid-β: a potential link between epilepsy and cognitive decline. Nat Rev Neurol 2021; 17:469-485. [PMID: 34117482 DOI: 10.1038/s41582-021-00505-9] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 02/05/2023]
Abstract
People with epilepsy - in particular, late-onset epilepsy of unknown aetiology - have an elevated risk of dementia, and seizures have been detected in the early stages of Alzheimer disease (AD), supporting the concept of an epileptic AD prodrome. However, the relationship between epilepsy and cognitive decline remains controversial, with substantial uncertainties about whether epilepsy drives cognitive decline or vice versa, and whether shared pathways underlie both conditions. Here, we review evidence that amyloid-β (Aβ) forms part of a shared pathway between epilepsy and cognitive decline, particularly in the context of AD. People with epilepsy show an increased burden of Aβ pathology in the brain, and Aβ-mediated epileptogenic alterations have been demonstrated in experimental studies, with evidence suggesting that Aβ pathology might already be pro-epileptogenic at the soluble stage, long before plaque deposition. We discuss the hypothesis that Aβ mediates - or is at least a major determinant of - a continuum spanning epilepsy and cognitive decline. Serial cognitive testing and assessment of Aβ levels might be worthwhile to stratify the risk of developing dementia in people with late-onset epilepsy. If seizures are a clinical harbinger of dementia, people with late-onset epilepsy could be an ideal group in which to implement preventive or therapeutic strategies to slow cognitive decline.
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Affiliation(s)
- Michele Romoli
- Neurology Clinic, Department of Medicine and Surgery, University of Perugia - S. Maria della Misericordia Hospital, Perugia, Italy.,Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.,Neurology and Stroke Unit, "Maurizio Bufalini" Hospital, Cesena, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore, Bologna, Italy
| | - Arjune Sen
- Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Lucilla Parnetti
- Neurology Clinic, Department of Medicine and Surgery, University of Perugia - S. Maria della Misericordia Hospital, Perugia, Italy
| | - Paolo Calabresi
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Neurologia, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Rome, Italy
| | - Cinzia Costa
- Neurology Clinic, Department of Medicine and Surgery, University of Perugia - S. Maria della Misericordia Hospital, Perugia, Italy.
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Choi H, Thacker EL, Longstreth WT, Elkind MSV, Boehme AK. Cognitive decline in older adults with epilepsy: The Cardiovascular Health Study. Epilepsia 2020; 62:85-97. [PMID: 33227164 DOI: 10.1111/epi.16748] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/09/2020] [Accepted: 10/09/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Cognitive decline is a major concern for older adults with epilepsy. Whether and how much faster older adults with epilepsy experience cognitive decline beyond expected age-related cognitive change remain unclear. We sought to estimate and compare rates of cognitive decline in older adults with and without epilepsy. METHODS The Cardiovascular Health Study is a population-based longitudinal cohort study of 5888 US adults aged 65+. Cognitive function was assessed annually with Modified Mini-Mental State Exam (3MS) and Digit Symbol Substitution Test (DSST). We used linear mixed models to estimate average rates of decline in 3MS and DSST scores by epilepsy status (prevalent, incident, or no epilepsy), adjusted for risk factors associated with cognitive decline. RESULTS The rate of decline in 3MS was significantly faster in prevalent epilepsy (P < .001) and after incident epilepsy (P = .002) compared with no epilepsy. Prevalent epilepsy and apolipoprotein E gene (APOE) ε4 (ApoE4) had a synergistic interaction, whereby prevalent epilepsy and ApoE4 together were associated with 1.51 points faster annual decline in 3MS than would be expected if prevalent epilepsy and ApoE4 did not interact (P < .001). Older adults with prevalent epilepsy had a significantly lower initial DSST score and faster rate of decline compared to those with no epilepsy (P < .001). SIGNIFICANCE Faster decline in global cognitive ability seen in this study validates concerns of patients. ApoE4 allele status was an effect modifier of the relationship between cognitive decline and prevalent epilepsy. Further research is warranted to explore biological mechanisms and possible interventions to mitigate cognitive decline.
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Affiliation(s)
- Hyunmi Choi
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Evan L Thacker
- Department of Public Health, Brigham Young University, Provo, UT, USA
| | | | - Mitchell S V Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Amelia K Boehme
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Tedrus GMAS, Passos MLGA, Vargas LM, Menezes LEFJ. Cognition and epilepsy: Cognitive screening test. Dement Neuropsychol 2020; 14:186-193. [PMID: 32595889 PMCID: PMC7304275 DOI: 10.1590/1980-57642020dn14-020013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Cognitive deficits often occur in people with epilepsy (PWE). However, in Brazil, PWE might not undergo neurocognitive evaluation due to the low number of validated tests available and lack of multidisciplinary teams in general epilepsy outpatient clinics.
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Affiliation(s)
| | | | - Letícia Muniz Vargas
- Undergraduate Student - Faculty of Medicine, Pontifical Catholic University of Campinas, Campinas, SP, Brazil
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9
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Epilepsy and aging. HANDBOOK OF CLINICAL NEUROLOGY 2020. [PMID: 31753149 DOI: 10.1016/b978-0-12-804766-8.00025-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
The intersection of epilepsy and aging has broad, significant implications. Substantial increases in seizures occur both in the elderly population, who are at a higher risk of developing new-onset epilepsy, and in those with chronic epilepsy who become aged. There are notable gaps in our understanding of aging and epilepsy at the basic and practical levels, which have important consequences. We are in the early stages of understanding the complex relationships between epilepsy and other age-related brain diseases such as stroke, dementia, traumatic brain injury (TBI), and cancer. Furthermore, the clinician must recognize that the presentation and treatment of epilepsy in the elderly are different from those of younger populations. Given the developing awareness of the problem and the capabilities of contemporary, multidisciplinary approaches to advance understanding about the biology of aging and epilepsy, it is reasonable to expect that we will unravel some of the intricacies of epilepsy in the elderly; it is also reasonable to expect that these gains will lead to further improvements in our understanding and treatment of epilepsy for all age groups.
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Sen A, Jette N, Husain M, Sander JW. Epilepsy in older people. Lancet 2020; 395:735-748. [PMID: 32113502 DOI: 10.1016/s0140-6736(19)33064-8] [Citation(s) in RCA: 161] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/23/2019] [Accepted: 11/29/2019] [Indexed: 02/07/2023]
Abstract
Globally, as populations age there will be challenges and opportunities to deliver optimal health care to senior citizens. Epilepsy, a condition characterised by spontaneous recurrent seizures, is common in older adults (aged >65 years) and yet has received comparatively little attention in this age group. In this Review, we evaluate the underlying causes of epilepsy in older people, explore difficulties in establishing a diagnosis of epilepsy in this population, discuss appropriate antiseizure medications, and evaluate potential surgical treatment options. We consider cognitive, psychological, and psychosocial comorbidities and the effect that epilepsy might have on an older person's broader social or care network in high-income versus middle-income and low-income countries. We emphasise the need for clinical trials to be more inclusive of older people with epilepsy to help inform therapeutic decision making and discuss whether measures to improve vascular risk factors might be an important strategy to reduce the probability of developing epilepsy.
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Affiliation(s)
- Arjune Sen
- Oxford Epilepsy Research Group, National Institute for Health Research Oxford Biomedical Research Centre, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.
| | - Nathalie Jette
- Departments of Neurology and Population Health Sciences & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Masud Husain
- Department of Psychology, University of Oxford, Oxford UK
| | - Josemir W Sander
- National Institute for Health Research, Biomedical Research Centre, University College London Hospitals, UCL Queen Square Institute of Neurology, London, UK; Chalfont Centre for Epilepsy, Chalfont St Peter, UK; Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, Netherlands
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11
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Wang L, Chen S, Liu C, Lin W, Huang H. Factors for cognitive impairment in adult epileptic patients. Brain Behav 2020; 10:e01475. [PMID: 31863643 PMCID: PMC6955925 DOI: 10.1002/brb3.1475] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/11/2019] [Accepted: 04/24/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To analyze factors for cognitive impairment in epileptic patients. METHODS A total of 257 epileptic patients completed clinical memory scale (CMS) and 70 of them were further surveyed with mini-mental state examination (MMSE), Montreal cognitive assessment (MoCA), digital symbol test (DSy), verbal fluency test, digit span test (DSp), Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD). Monadic linear related analysis and multiple stepwise regression analysis were performed to evaluate the potential factors for cognitive impairment. RESULTS Educational level was correlated with scores of cognitive tests (p < .01), with a difference between the junior high school group and senior high school group (p < .01 or p < .05). Seizure frequency was negatively correlated with CMS scores (p < .01), with a difference between the group with a seizure frequency of less than once a year and other groups (p < .01). The kind of antiepileptic drugs (AEDs) was negatively correlated with CMS scores (p < .01), with a difference between the single-drug group and the group taking more than two kinds of AEDs (p < .01). Depression scores were negatively correlated with MMSE, MoCA, DSy, DSp (p < .01 or p < .05), disease duration negatively with DSy (p < .01), and age negatively with MoCA (p < .05). Seizure type was correlated with DSy, and general seizure fared worse in the tests than other seizure types (p < .05). CONCLUSION Educational level, seizure frequency, kinds of AEDs and depression can affect the cognitive function of epileptic patients. High educational level, good seizure control, single-drug treatment and healthy psychological state are protective factors for cognitive function of epileptic patients.
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Affiliation(s)
- Lei Wang
- Department of Neurology, Union Hospital of Fujian Medical University, Fuzhou, China.,Department of Cardiac Surgery, Union Hospital of Fujian Medical University, Fuzhou, China
| | - Shenggen Chen
- Department of Neurology, Union Hospital of Fujian Medical University, Fuzhou, China
| | - Changyun Liu
- Department of Neurology, Union Hospital of Fujian Medical University, Fuzhou, China
| | - Wanhui Lin
- Department of Neurology and Geriatrics, Union Hospital of Fujian Medical University, Fuzhou, China
| | - Huapin Huang
- Department of Neurology, Union Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Molecular Neurology, Fuzhou, China
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12
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A pilot study of combined endurance and resistance exercise rehabilitation for verbal memory and functional connectivity improvement in epilepsy. Epilepsy Behav 2019; 96:44-56. [PMID: 31078935 DOI: 10.1016/j.yebeh.2019.04.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/12/2019] [Accepted: 04/13/2019] [Indexed: 12/18/2022]
Abstract
Memory impairment is common in persons with epilepsy (PWE), and exercise may be a strategy for its improvement. In this pilot study, we hypothesized that exercise rehabilitation would improve physical fitness and verbal memory and induce changes in brain networks involved in memory processes. We examined the effects of combined endurance and resistance exercise rehabilitation on memory and resting state functional connectivity (rsFC). Participants were randomized to exercise (PWE-E) or control (PWE-noE). The exercise intervention consisted of 18 supervised sessions on nonconsecutive days over 6 weeks. Before and after the intervention period, both groups completed self-report assessments (Short Form-36 (SF-36), Baecke Questionnaire (BQ) of habitual physical activity, and Profile of Mood States (POMS)), cognitive testing (California Verbal Learning Test-II (CVLT-II)), and magnetic resonance imaging (MRI); PWE-E also completed exercise performance tests. After completing the study, PWE-noE were offered cross-over to the exercise arm. There were no differences in baseline demographic, clinical, or assessment variables between 8 PWE-noE and 9 PWE-E. Persons with epilepsy that participated in exercise intervention increased maximum voluntary strength (all strength tests p < 0.05) and exhibited nonsignificant improvement in cardiorespiratory fitness (p = 0.15). Groups did not show significant changes in quality of life (QOL) or habitual physical activity between visits. However, there was an effect of visit on POMS total mood disturbance (TMD) measure showing improvement from baseline to visit 2 (p = 0.023). There were significant group by visit interactions on CVLT-II learning score (p = 0.044) and total recognition discriminability (d') (p = 0.007). Persons with epilepsy that participated in exercise intervention had significant reductions in paracingulate rsFC with the anterior cingulate and increases in rsFC for the cerebellum, thalamus, posterior cingulate cortex (PCC), and left and right inferior parietal lobule (IPL) (corrected p < 0.05). Change in CVLT-II learning score was associated with rsFC changes for the paracingulate cortex (rS = -0.67; p = 0.0033), left IPL (rS = 0.70; p = 0.0019), and right IPL (rS = 0.71; p = 0.0015) while change in d' was associated with change in cerebellum rsFC to angular/middle occipital gyrus (rS = 0.68; p = 0.0025). Our conclusion is that exercise rehabilitation may facilitate verbal memory improvement and brain network functional connectivity changes in PWE and that improved memory performance is associated with changes in rsFC. A larger randomized controlled trial of exercise rehabilitation for cognitive improvement in PWE is warranted.
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Semple BD, Zamani A, Rayner G, Shultz SR, Jones NC. Affective, neurocognitive and psychosocial disorders associated with traumatic brain injury and post-traumatic epilepsy. Neurobiol Dis 2018; 123:27-41. [PMID: 30059725 DOI: 10.1016/j.nbd.2018.07.018] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 07/08/2018] [Accepted: 07/16/2018] [Indexed: 12/13/2022] Open
Abstract
Survivors of traumatic brain injury (TBI) often develop chronic neurological, neurocognitive, psychological, and psychosocial deficits that can have a profound impact on an individual's wellbeing and quality of life. TBI is also a common cause of acquired epilepsy, which is itself associated with significant behavioral morbidity. This review considers the clinical and preclinical evidence that post-traumatic epilepsy (PTE) acts as a 'second-hit' insult to worsen chronic behavioral outcomes for brain-injured patients, across the domains of emotional, cognitive, and psychosocial functioning. Surprisingly, few well-designed studies have specifically examined the relationship between seizures and behavioral outcomes after TBI. The complex mechanisms underlying these comorbidities remain incompletely understood, although many of the biological processes that precipitate seizure occurrence and epileptogenesis may also contribute to the development of chronic behavioral deficits. Further, the relationship between PTE and behavioral dysfunction is increasingly recognized to be a bidirectional one, whereby premorbid conditions are a risk factor for PTE. Clinical studies in this arena are often challenged by the confounding effects of anti-seizure medications, while preclinical studies have rarely examined an adequately extended time course to fully capture the time course of epilepsy development after a TBI. To drive the field forward towards improved treatment strategies, it is imperative that both seizures and neurobehavioral outcomes are assessed in parallel after TBI, both in patient populations and preclinical models.
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Affiliation(s)
- Bridgette D Semple
- Department of Neuroscience, Monash University, 99 Commercial Road, Melbourne, VIC, Australia; Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Royal Parade, Parkville, VIC, Australia.
| | - Akram Zamani
- Department of Neuroscience, Monash University, 99 Commercial Road, Melbourne, VIC, Australia.
| | - Genevieve Rayner
- Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre (Austin Campus), Heidelberg, VIC, Australia; Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia; Comprehensive Epilepsy Program, Alfred Health, Australia.
| | - Sandy R Shultz
- Department of Neuroscience, Monash University, 99 Commercial Road, Melbourne, VIC, Australia; Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Royal Parade, Parkville, VIC, Australia.
| | - Nigel C Jones
- Department of Neuroscience, Monash University, 99 Commercial Road, Melbourne, VIC, Australia; Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Royal Parade, Parkville, VIC, Australia.
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Sen A, Capelli V, Husain M. Cognition and dementia in older patients with epilepsy. Brain 2018; 141:1592-1608. [PMID: 29506031 PMCID: PMC5972564 DOI: 10.1093/brain/awy022] [Citation(s) in RCA: 159] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 12/12/2017] [Accepted: 12/14/2017] [Indexed: 12/12/2022] Open
Abstract
With advances in healthcare and an ageing population, the number of older adults with epilepsy is set to rise substantially across the world. In developed countries the highest incidence of epilepsy is already in people over 65 and, as life expectancy increases, individuals who developed epilepsy at a young age are also living longer. Recent findings show that older persons with epilepsy are more likely to suffer from cognitive dysfunction and that there might be an important bidirectional relationship between epilepsy and dementia. Thus some people with epilepsy may be at a higher risk of developing dementia, while individuals with some forms of dementia, particularly Alzheimer's disease and vascular dementia, are at significantly higher risk of developing epilepsy. Consistent with this emerging view, epidemiological findings reveal that people with epilepsy and individuals with Alzheimer's disease share common risk factors. Recent studies in Alzheimer's disease and late-onset epilepsy also suggest common pathological links mediated by underlying vascular changes and/or tau pathology. Meanwhile electrophysiological and neuroimaging investigations in epilepsy, Alzheimer's disease, and vascular dementia have focused interest on network level dysfunction, which might be important in mediating cognitive dysfunction across all three of these conditions. In this review we consider whether seizures promote dementia, whether dementia causes seizures, or if common underlying pathophysiological mechanisms cause both. We examine the evidence that cognitive impairment is associated with epilepsy in older people (aged over 65) and the prognosis for patients with epilepsy developing dementia, with a specific emphasis on common mechanisms that might underlie the cognitive deficits observed in epilepsy and Alzheimer's disease. Our analyses suggest that there is considerable intersection between epilepsy, Alzheimer's disease and cerebrovascular disease raising the possibility that better understanding of shared mechanisms in these conditions might help to ameliorate not just seizures, but also epileptogenesis and cognitive dysfunction.
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Affiliation(s)
- Arjune Sen
- Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield Department Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Valentina Capelli
- Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield Department Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Masud Husain
- Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield Department Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
- Department of Experimental Psychology, University of Oxford, UK
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Moura LMVR, Eskandar EN, Hassan M, Salinas J, Cole AJ, Hoch DB, Cash SS, Hsu J. Anterior temporal lobectomy for older adults with mesial temporal sclerosis. Epilepsy Res 2016; 127:358-365. [PMID: 27760412 DOI: 10.1016/j.eplepsyres.2016.09.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 09/07/2016] [Accepted: 09/29/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare postoperative seizure-free survival between older and younger adults. METHODS A retrospective cohort of 107 temporal lobe epilepsy patients with a diagnosis of mesial temporal sclerosis (MTS) received anterior temporal lobectomy (ATL) between 1993 and 2014. We divided the lower three quartiles (younger) and top quartile (older, all 47+ years) of patients, then reviewed patient registry and electronic medical records to determine time to first self-reported seizure after ATL, the primary outcome (mean=3.5years of follow-up, SD=3.6). We also assessed Engel classifications, intraoperative and postoperative treatment complications, and social disability. We used Cox proportional hazard models to assess the association between individual traits and time of seizure recurrence. RESULTS During follow-up, 35/107 (32.7%) patients had post-operative seizure(s). After adjustment for potential confounders there were no significant differences in the probability of post-operative seizures between the older and younger groups, though we had limited precision (hazard ratio of 0.67 [0.28-1.59]), (p=0.36). There were more treatment complications and disability in older patients (18% vs. 1.3% for any complications, 84.62% vs. 58.23% for driving disability, and 84.6% vs. 60.7% for work disability, p<0.05). CONCLUSION Older patients appear to have more complications after ATL, compared with younger patients. Age, however, does not appear to have a large independent association with seizure recurrence.
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Affiliation(s)
- Lidia M V R Moura
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, United States.
| | - Emad N Eskandar
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Mursal Hassan
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Joel Salinas
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Andrew J Cole
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Daniel B Hoch
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Sydney S Cash
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - John Hsu
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA 02114, United States; Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, United States
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Tai XY, Koepp M, Duncan JS, Fox N, Thompson P, Baxendale S, Liu JYW, Reeves C, Michalak Z, Thom M. Hyperphosphorylated tau in patients with refractory epilepsy correlates with cognitive decline: a study of temporal lobe resections. Brain 2016; 139:2441-55. [PMID: 27497924 DOI: 10.1093/brain/aww187] [Citation(s) in RCA: 178] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 06/24/2016] [Indexed: 12/14/2022] Open
Abstract
SEE BERNASCONI DOI101093/AWW202 FOR A SCIENTIFIC COMMENTARY ON THIS ARTICLE: Temporal lobe epilepsy, the most prevalent form of chronic focal epilepsy, is associated with a high prevalence of cognitive impairment but the responsible underlying pathological mechanisms are unknown. Tau, the microtubule-associated protein, is a hallmark of several neurodegenerative diseases including Alzheimer's disease and chronic traumatic encephalopathy. We hypothesized that hyperphosphorylated tau pathology is associated with cognitive decline in temporal lobe epilepsy and explored this through clinico-pathological study. We first performed pathological examination on tissue from 33 patients who had undergone temporal lobe resection between ages 50 and 65 years to treat drug-refractory temporal lobe epilepsy. We identified hyperphosphorylated tau protein using AT8 immunohistochemistry and compared this distribution to Braak patterns of Alzheimer's disease and patterns of chronic traumatic encephalopathy. We quantified tau pathology using a modified tau score created specifically for analysis of temporal lobectomy tissue and the Braak staging, which was limited without extra-temporal brain areas available. Next, we correlated tau pathology with pre- and postoperative cognitive test scores and clinical risk factors including age at time of surgery, duration of epilepsy, history of secondary generalized seizures, history of head injury, handedness and side of surgery. Thirty-one of 33 cases (94%) showed hyperphosphorylated tau pathology in the form of neuropil threads and neurofibrillary tangles and pre-tangles. Braak stage analysis showed 12% of our epilepsy cohort had a Braak staging III-IV compared to an age-matched non-epilepsy control group from the literature (8%). We identified a mixture of tau pathology patterns characteristic of Alzheimer's disease and chronic traumatic encephalopathy. We also found unusual patterns of subpial tau deposition, sparing of the hippocampus and co-localization with mossy fibre sprouting, a feature of temporal lobe epilepsy. We demonstrated that the more extensive the tau pathology, the greater the decline in verbal learning (Spearman correlation, r = -0.63), recall (r = -0.44) and graded naming test scores (r = -0.50) over 1-year post-temporal lobe resection (P < 0.05). This relationship with tau burden was also present when examining decline in verbal learning from 3 months to 1 year post-resection (r = -0.54). We found an association between modified tau score and history of secondary generalized seizures (likelihood-ratio χ(2), P < 0.05) however there was no clear relationship between tau pathology and other clinical risk factors assessed. Our findings suggest an epilepsy-related tauopathy in temporal lobe epilepsy, which contributes to accelerated cognitive decline and has diagnostic and treatment implications.
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Affiliation(s)
- Xin You Tai
- 1 Division of Neuropathology and Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK 2 Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Matthias Koepp
- 2 Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - John S Duncan
- 2 Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Nick Fox
- 3 Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London WC1N 3NG, UK
| | - Pamela Thompson
- 2 Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Sallie Baxendale
- 2 Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Joan Y W Liu
- 1 Division of Neuropathology and Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Cheryl Reeves
- 1 Division of Neuropathology and Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Zuzanna Michalak
- 1 Division of Neuropathology and Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Maria Thom
- 1 Division of Neuropathology and Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
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Cognitive deterioration in adult epilepsy: Does accelerated cognitive ageing exist? Neurosci Biobehav Rev 2016; 64:1-11. [PMID: 26900650 DOI: 10.1016/j.neubiorev.2016.02.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 01/29/2016] [Accepted: 02/01/2016] [Indexed: 11/21/2022]
Abstract
A long-standing concern has been whether epilepsy contributes to cognitive decline or so-called 'epileptic dementia'. Although global cognitive decline is generally reported in the context of chronic refractory epilepsy, it is largely unknown what percentage of patients is at risk for decline. This review is focused on the identification of risk factors and characterization of aberrant cognitive trajectories in epilepsy. Evidence is found that the cognitive trajectory of patients with epilepsy over time differs from processes of cognitive ageing in healthy people, especially in adulthood-onset epilepsy. Cognitive deterioration in these patients seems to develop in a 'second hit model' and occurs when epilepsy hits on a brain that is already vulnerable or vice versa when comorbid problems develop in a person with epilepsy. Processes of ageing may be accelerated due to loss of brain plasticity and cognitive reserve capacity for which we coin the term 'accelerated cognitive ageing'. We believe that the concept of accelerated cognitive ageing can be helpful in providing a framework understanding global cognitive deterioration in epilepsy.
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Moura LMVR, Carneiro TS, Cole AJ, Hsu J, Vickrey BG, Hoch DB. Association between addressing antiseizure drug side effects and patient-reported medication adherence in epilepsy. Patient Prefer Adherence 2016; 10:2197-2207. [PMID: 27826186 PMCID: PMC5096772 DOI: 10.2147/ppa.s119973] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND AIM Adherence to treatment is a critical component of epilepsy management. This study examines whether addressing antiepileptic drug (AED) side effects at every visit is associated with increased patient-reported medication adherence. PATIENTS AND METHODS This study identified 243 adults with epilepsy who were seen at two academic outpatient neurology settings and had at least two visits over a 3-year period. Demographic and clinical characteristics were abstracted. Evidence that AED side effects were addressed was measured through 1) phone interview (patient-reported) and 2) medical records abstraction (physician-documented). Medication adherence was assessed using the validated Morisky Medication Adherence Scale-4. Complete adherence was determined as answering "no" to all questions. RESULTS Sixty-two (25%) patients completed the interviews. Participants and nonparticipants were comparable with respect to demographic and clinical characteristics; however, a smaller proportion of participants had a history of drug-resistant epilepsy than nonparticipants (17.7% vs 30.9%, P=0.04). Among the participants, evidence that AED side effects were addressed was present in 48 (77%) medical records and reported by 51 (82%) patients. Twenty-eight (45%) patients reported complete medication adherence. The most common reason for incomplete adherence was missed medication due to forgetfulness (n=31, 91%). There was no association between addressing AED side effects (neither physician-documented nor patient-reported) and complete medication adherence (P=0.22 and 0.20). DISCUSSION AND CONCLUSION Among patients with epilepsy, addressing medication side effects at every visit does not appear to increase patient-reported medication adherence.
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Affiliation(s)
- Lidia M V R Moura
- Department of Neurology
- Correspondence: Lidia M V R Moura, Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Wang 739D, Boston, MA 02114, USA, Tel +1 617 726 3311, Fax +1 617 726 9250, Email
| | | | | | - John Hsu
- Mongan Institute for Health Policy, Department of Medicine, Massachusetts General Hospital
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Barbara G Vickrey
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Höller Y, Trinka E. Is There a Relation between EEG-Slow Waves and Memory Dysfunction in Epilepsy? A Critical Appraisal. Front Hum Neurosci 2015; 9:341. [PMID: 26124717 PMCID: PMC4463866 DOI: 10.3389/fnhum.2015.00341] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 05/28/2015] [Indexed: 12/12/2022] Open
Abstract
Is there a relationship between peri-ictal slow waves, loss of consciousness, memory, and slow-wave sleep, in patients with different forms of epilepsy? We hypothesize that mechanisms, which result in peri-ictal slow-wave activity as detected by the electroencephalogram, could negatively affect memory processes. Slow waves (≤4 Hz) can be found in seizures with impairment of consciousness and also occur in focal seizures without impairment of consciousness but with inhibited access to memory functions. Peri-ictal slow waves are regarded as dysfunctional and are probably caused by mechanisms, which are essential to disturb the consolidation of memory entries in these patients. This is in strong contrast to physiological slow-wave activity during deep sleep, which is thought to group memory-consolidating fast oscillatory activity. In patients with epilepsy, slow waves may not only correlate with the peri-ictal clouding of consciousness, but could be the epiphenomenon of mechanisms, which interfere with normal brain function in a wider range. These mechanisms may have transient impacts on memory, such as temporary inhibition of memory systems, altered patterns of hippocampal-neocortical interactions during slow-wave sleep, or disturbed cross-frequency coupling of slow and fast oscillations. In addition, repeated tonic-clonic seizures over the years in uncontrolled chronic epilepsy may cause a progressive cognitive decline. This hypothesis can only be assessed in long-term prospective studies. These studies could disentangle the reversible short-term impacts of seizures, and the impacts of chronic uncontrolled seizures. Chronic uncontrolled seizures lead to irreversible memory impairment. By contrast, short-term impacts do not necessarily lead to a progressive cognitive decline but result in significantly impaired peri-ictal memory performance.
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Affiliation(s)
- Yvonne Höller
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria
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Roberson ED, Hope OA, Martin RC, Schmidt D. Geriatric epilepsy: research and clinical directions for the future. Epilepsy Behav 2011; 22:103-11. [PMID: 21596624 DOI: 10.1016/j.yebeh.2011.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 04/01/2011] [Indexed: 01/01/2023]
Abstract
There is a growing awareness of the need for improved treatment and care of older adults with epilepsy. The present review article highlights key clinical and research issues in the emerging field of geriatric epilepsy. Drs. Martin and Schmidt explore the scope of the problems in the field, outline topic areas including cognitive health/dementia, and diagnostic challenges, and also present important research questions that should be considered for the future. As part of this presentation, we will highlight the work of two promising young investigators whose work holds great promise for the field of geriatric epilepsy. Dr. Roberson will discuss his work focusing on the relationship of epilepsy and cognitive impairment, particularly as it relates to Alzheimer's disease pathology including tau and its role in epileptiform activity. Dr. Hope will outline key issues, as well as her work, relating to defining and measuring quality care in geriatric epilepsy.
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Affiliation(s)
- Erik D Roberson
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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Abstract
PURPOSE Cognitive impairment is a common comorbidity of epilepsy; however, relatively little research has been undertaken to investigate how cognitive problems develop in adults who are newly diagnosed. This study aimed to investigate changes in cognitive performance in adults with new-onset epilepsy 12 months after diagnosis compared with healthy volunteers. METHODS One hundred forty-seven people with epilepsy (PWE) were assessed using a comprehensive neuropsychological test battery before they started treatment and after 12 months. Cognitive change scores were compared with 69 healthy volunteers who were also assessed at baseline and after 12 months. KEY FINDINGS At 12 month follow-up, PWE had significantly poorer change scores for 9 of the 16 variables. For the majority of these measures, PWE had subtle declines in performance, whereas healthy volunteers improved. Poorer performance on some measures was associated with treatment with topiramate, generalized seizures and, interestingly, achieving an immediate 12-month seizure remission. SIGNIFICANCE After controlling for statistically confounding factors, people with newly diagnosed epilepsy had a different cognitive trajectory compared with healthy volunteers from the general population. Memory, psychomotor speed, and higher executive functioning were the domains most vulnerable to change over a 12-month period.
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Affiliation(s)
- Gus A Baker
- Neuroscience Research Unit, University of Liverpool, Liverpool, UK.
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Taylor J, Baker GA. Newly diagnosed epilepsy: cognitive outcome at 5 years. Epilepsy Behav 2010; 18:397-403. [PMID: 20558112 DOI: 10.1016/j.yebeh.2010.05.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Revised: 05/10/2010] [Accepted: 05/13/2010] [Indexed: 10/19/2022]
Abstract
Many people with epilepsy experience cognitive problems as a consequence of their epilepsy and its treatment. However, relatively few longitudinal studies have been conducted to investigate how these problems progress during the course of the disorder, particularly in those who are newly diagnosed. Fifty patients with newly diagnosed epilepsy were assessed using a comprehensive neuropsychological test battery before they started antiepileptic treatment and after a mean of 5 years. At the 5-year follow-up, the majority of cognitive measures remained stable, although significant (but subtle) declines were noted for memory and psychomotor speed domains in 38% of people with epilepsy.
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Affiliation(s)
- Joanne Taylor
- Neuroscience Research Unit, University of Liverpool, Liverpool, UK.
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Haut SR, Katz M, Masur J, Lipton RB. Seizures in the elderly: impact on mental status, mood, and sleep. Epilepsy Behav 2009; 14:540-4. [PMID: 19189862 PMCID: PMC2695969 DOI: 10.1016/j.yebeh.2009.01.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Revised: 01/02/2009] [Accepted: 01/10/2009] [Indexed: 11/16/2022]
Abstract
Comorbidities of epilepsy have not been well explored in the elderly. Herein, we examined mental status, mood, and sleep in elderly patients with epilepsy, compared with age- and gender-matched community controls without epilepsy from the Einstein Aging Study. Testing included a mental status test, the Blessed Information Memory and Concentration (BIMC) test; Prime-MD Patient Health Questionnaire (PHQ) Depression and Anxiety Modules; and Medical Outcomes Study Sleep Scale. Persons with epilepsy (n=31) had higher mean BIMC scores than controls (n=31, BIMC 6.3 vs.1.2, P<0.0001). Mean PHQ Depression scores were higher for cases than controls, indicating more depressive symptoms (4.2 vs 0.8, P=0.006); six cases (18%) and no controls met screening criteria for depression. Mean PHQ Anxiety scores were also higher for cases than controls (3.7 vs 0.0, P=0.001). Cases had poorer sleep scores in the categories of somnolence (P=0.009) and shortness of breath/headache (P=0.021). Thus, comorbidities of epilepsy in this elderly population included decreased mental status, a higher prevalence of depression and anxiety, and poorer sleep health when compared with agemates without epilepsy. Mental status impairment was not related to antiepileptic medication or mood disturbance. Further investigation will explore these associations prospectively.
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Affiliation(s)
- Sheryl R. Haut
- Comprehensive Epilepsy Management Center, Montefiore Medical Center and the Albert Einstein College of Medicine Bronx, New York, Department of Neurology, Montefiore Medical Center and the Albert Einstein College of Medicine Bronx, New York
| | - Mindy Katz
- Department of Epidemiology and Population Health, Montefiore Medical Center and the Albert Einstein College of Medicine Bronx, New York
| | - Jonathan Masur
- Comprehensive Epilepsy Management Center, Montefiore Medical Center and the Albert Einstein College of Medicine Bronx, New York, Department of Neurology, Montefiore Medical Center and the Albert Einstein College of Medicine Bronx, New York
| | - Richard B. Lipton
- Department of Neurology, Montefiore Medical Center and the Albert Einstein College of Medicine Bronx, New York, Department of Epidemiology and Population Health, Montefiore Medical Center and the Albert Einstein College of Medicine Bronx, New York
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25
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Hermann B, Seidenberg M, Sager M, Carlsson C, Gidal B, Sheth R, Rutecki P, Asthana S. Growing old with epilepsy: the neglected issue of cognitive and brain health in aging and elder persons with chronic epilepsy. Epilepsia 2007; 49:731-40. [PMID: 18031544 DOI: 10.1111/j.1528-1167.2007.01435.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The purpose of this review is to examine what is known about cognitive and brain aging in elders with chronic epilepsy. We contend that much remains to be learned about the ultimate course of cognition and brain structure in persons with chronic epilepsy and concern appears warranted. Individuals with chronic epilepsy are exposed to many risk factors demonstrated to be associated with abnormal cognitive and brain aging in the general population, with many of these risk factors present in persons with chronic epilepsy as early as midlife. We suggest that a research agenda be developed to systematically identify and treat known modifiable risk factors in order to protect and promote cognitive and brain health in aging and elder persons with chronic epilepsy.
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Affiliation(s)
- Bruce Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA.
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Seidenberg M, Pulsipher DT, Hermann B. Cognitive progression in epilepsy. Neuropsychol Rev 2007; 17:445-54. [PMID: 17990122 DOI: 10.1007/s11065-007-9042-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Accepted: 09/27/2007] [Indexed: 11/25/2022]
Abstract
The issue of cognitive progression in people with epilepsy is of considerable interest and has important clinical and theoretical implications. In this paper, we review recent studies in both the adult and childhood epilepsy literature which have included a longitudinal test-retest design to examine this question. Several important methodological issues of this literature are highlighted and areas which require more investigation are identified.
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Affiliation(s)
- Michael Seidenberg
- Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA.
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