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Lozano-García A, Catalán-Aguilar J, Tormos-Pons P, Hampel KG, Villanueva V, Cano-López I, González-Bono E. Impact of Polytherapy on Memory Functioning in Patients With Drug-Resistant Epilepsy: The Role of Attention and Executive Functions. Arch Clin Neuropsychol 2024; 39:423-442. [PMID: 37987193 DOI: 10.1093/arclin/acad086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 09/10/2023] [Accepted: 09/19/2023] [Indexed: 11/22/2023] Open
Abstract
OBJECTIVE The aim was to examine the effect of polytherapy (i.e., the number of administered anti-seizure medications (ASMs)) on memory, and whether the interaction between the number of ASMs and attentional/executive functioning affect presurgical memory functioning and postsurgical memory changes in patients with drug-resistant epilepsy. METHODS Two studies were carried out. Study 1 consisted of a presurgical assessment of 125 adult patients, in which attention/executive function (EpiTrack screening tool) and memory were assessed (cross-sectional study). Of them, 72 patients underwent a second postsurgical evaluation, in which memory was assessed (Study 2). Patients were distributed into groups based on EpiTrack performance and number of ASMs. RESULTS The interaction between the number of ASMs and the attentional/executive functioning significantly affected presurgical memory, with patients with impaired EpiTrack performance taking three-four ASMs having poorer scores than patients with intact EpiTrack performance taking three-four ASMs (for all, p < .0001). This interaction also affected postsurgical memory changes, with patients with impaired Epitrack performance taking three-four ASMs having higher postsurgical decline than those with intact Epitrack performance taking three-four ASMs (for all, p < .005). No differences were found in patients taking two ASMs. Furthermore, the number of ASMs was associated with presurgical memory performance and postsurgical memory changes only in patients with impaired EpiTrack performance (for all, p < .05). CONCLUSIONS Our findings underline the utility of EpiTrack, together with the clinical information on the number of prescribed ASMs, to corroborate the impact of polytherapy on memory and to optimize the prediction of postsurgical memory changes.
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Affiliation(s)
- Alejandro Lozano-García
- Faculty of Health Sciences, Valencian International University, Valencia, Spain
- Department of Psychology, Universidad Europea de Valencia, Valencia, Spain
- Faculty of Health Sciences, Universidad Isabel I, Burgos, Spain
| | - Judit Catalán-Aguilar
- IDOCAL/Department of Psychobiology, Psychology Center, University of Valencia, Valencia, Spain
| | - Paula Tormos-Pons
- IDOCAL/Department of Psychobiology, Psychology Center, University of Valencia, Valencia, Spain
| | - Kevin G Hampel
- Refractory Epilepsy Unit, Neurology Service Member of ERN EPICARE, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Vicente Villanueva
- Refractory Epilepsy Unit, Neurology Service Member of ERN EPICARE, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Irene Cano-López
- IDOCAL/Department of Psychobiology, Psychology Center, University of Valencia, Valencia, Spain
| | - Esperanza González-Bono
- IDOCAL/Department of Psychobiology, Psychology Center, University of Valencia, Valencia, Spain
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2
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Arrotta K, Ferguson L, Thompson N, Smuk V, Najm IM, Leu C, Lal D, Busch RM. Polygenic burden and its association with baseline cognitive function and postoperative cognitive outcome in temporal lobe epilepsy. Epilepsy Behav 2024; 153:109692. [PMID: 38394790 DOI: 10.1016/j.yebeh.2024.109692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/29/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVE Demographic and disease factors are associated with cognitive deficits and postoperative cognitive declines in adults with pharmacoresistant temporal lobe epilepsy (TLE), but the role of genetic factors in cognition in TLE is not well understood. Polygenic scores (PGS) for neurological and neuropsychiatric disorders and IQ have been associated with cognition in patient and healthy populations. In this exploratory study, we examined the relationship between PGS for Alzheimer's disease (AD), depression, and IQ and cognitive outcomes in adults with TLE. METHODS 202 adults with pharmacoresistant TLE had genotyping and completed neuropsychological evaluations as part of a presurgical work-up. A subset (n = 116) underwent temporal lobe resection and returned for postoperative cognitive testing. Logistic regression was used to determine if PGS for AD, depression, and IQ predicted baseline domain-specific cognitive function and cognitive phenotypes as well as postoperative language and memory decline. RESULTS No significant findings survived correction for multiple comparisons. Prior to correction, higher PGS for AD and depression (i.e., increased genetic risk for the disorder), but lower PGS for IQ (i.e., decreased genetic likelihood of high IQ) appeared possibly associated with baseline cognitive impairment in TLE. In comparison, higher PGS for AD and IQ appeared as possible risk factors for cognitive decline following temporal lobectomy, while the possible relationship between PGS for depression and post-operative cognitive outcome was mixed. SIGNIFICANCE We did not observe any relationships of large effect between PGS and cognitive function or postsurgical outcome; however, results highlight several promising trends in the data that warrant future investigation in larger samples better powered to detect small genetic effects.
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Affiliation(s)
- Kayela Arrotta
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Departments of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Lisa Ferguson
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Nicolas Thompson
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Victoria Smuk
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Imad M Najm
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Departments of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Costin Leu
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK.
| | - Dennis Lal
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Stanley Center for Psychiatric Research, Broad Institute of Harvard and M.I.T., Cambridge, MA, USA.
| | - Robyn M Busch
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Departments of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
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Bingaman N, Ferguson L, Thompson N, Reyes A, McDonald CR, Hermann BP, Arrotta K, Busch RM. The relationship between mood and anxiety and cognitive phenotypes in adults with pharmacoresistant temporal lobe epilepsy. Epilepsia 2023; 64:3331-3341. [PMID: 37814399 DOI: 10.1111/epi.17795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/06/2023] [Accepted: 10/06/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE Patients with temporal lobe epilepsy (TLE) are often at a high risk for cognitive and psychiatric comorbidities. Several cognitive phenotypes have been identified in TLE, but it is unclear how phenotypes relate to psychiatric comorbidities, such as anxiety and depression. This observational study investigated the relationship between cognitive phenotypes and psychiatric symptomatology in TLE. METHODS A total of 826 adults (age = 40.3, 55% female) with pharmacoresistant TLE completed a neuropsychological evaluation that included at least two measures from five cognitive domains to derive International Classification of Cognitive Disorders in Epilepsy (IC-CoDE) cognitive phenotypes (i.e., intact, single-domain impairment, bi-domain impairment, generalized impairment). Participants also completed screening measures for depression and anxiety. Psychiatric history and medication data were extracted from electronic health records. Multivariable proportional odds logistic regression models examined the relationship between IC-CoDE phenotypes and psychiatric variables after controlling for relevant covariates. RESULTS Patients with elevated depressive symptoms had a greater odds of demonstrating increasingly worse cognitive phenotypes than patients without significant depressive symptomatology (odds ratio [OR] = 1.123-1.993, all corrected p's < .05). Number of psychotropic (OR = 1.584, p < .05) and anti-seizure medications (OR = 1.507, p < .001), use of anti-seizure medications with mood-worsening effects (OR = 1.748, p = .005), and history of a psychiatric diagnosis (OR = 1.928, p < .05) also increased the odds of a more severe cognitive phenotype, while anxiety symptoms were unrelated. SIGNIFICANCE This study demonstrates that psychiatric factors are not only associated with function in specific cognitive domains but also with the pattern and extent of deficits across cognitive domains. Results suggest that depressive symptoms and medications are strongly related to cognitive phenotype in adults with TLE and support the inclusion of these factors as diagnostic modifiers for cognitive phenotypes in future work. Longitudinal studies that incorporate neuroimaging findings are warranted to further our understanding of the complex relationships between cognition, mood, and seizures and to determine whether non-pharmacologic treatment of mood symptoms alters cognitive phenotype.
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Affiliation(s)
- Nolan Bingaman
- Department of Psychology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Lisa Ferguson
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Ohio, Cleveland, USA
| | - Nicolas Thompson
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anny Reyes
- Department of Radiation Medicine and Applied Sciences and Psychiatry, University of California, San Diego, California, USA
| | - Carrie R McDonald
- Department of Radiation Medicine and Applied Sciences and Psychiatry, University of California, San Diego, California, USA
| | - Bruce P Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Kayela Arrotta
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Ohio, Cleveland, USA
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Robyn M Busch
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Ohio, Cleveland, USA
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
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4
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Arrotta K, Swanson SJ, Janecek JK, Hamberger MJ, Barr WB, Baxendale S, McDonald CR, Reyes A, Hermann BP, Busch RM. Application of the International Classification of Cognitive Disorders in Epilepsy (IC-CoDE) to frontal lobe epilepsy using multicenter data. Epilepsy Behav 2023; 148:109471. [PMID: 37866248 DOI: 10.1016/j.yebeh.2023.109471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 10/24/2023]
Abstract
RATIONALE The International Classification of Cognitive Disorders in Epilepsy (IC-CoDE) was recently introduced as a consensus-based, empirically-driven taxonomy of cognitive disorders in epilepsy and has been effectively applied to patients with temporal lobe epilepsy (TLE). The purpose of this study was to apply the IC-CoDE to patients with frontal lobe epilepsy (FLE) using national multicenter data. METHODS Neuropsychological data of 455 patients with FLE aged 16 years or older were available across four US-based sites. First, we examined test-specific impairment rates across sites using two impairment thresholds (1.0 and 1.5 standard deviations below the normative mean). Following the proposed IC-CoDE guidelines, patterns of domain impairment were determined based on commonly used tests within five cognitive domains (language, memory, executive functioning, attention/processing speed, and visuospatial ability) to construct phenotypes. Impairment rates and distributions across phenotypes were then compared with those found in patients with TLE for which the IC-CoDE classification was initially validated. RESULTS The highest rates of impairment were found among tests of naming, verbal fluency, speeded sequencing and set-shifting, and complex figure copy. The following IC-CoDE phenotype distributions were observed using the two different threshold cutoffs: 23-40% cognitively intact, 24-29% single domain impairment, 13-20% bi-domain impairment, and 18-33% generalized impairment. Language was the most common single domain impairment (68% for both thresholds) followed by attention and processing speed (15-18%). Overall, patients with FLE reported higher rates of cognitive impairment compared with patients with TLE. CONCLUSIONS These results demonstrate the applicability of the IC-CoDE to epilepsy syndromes outside of TLE. Findings indicated generally stable and reproducible phenotypes across multiple epilepsy centers in the U.S. with diverse sample characteristics and varied neuropsychological test batteries. Findings also highlight opportunities for further refinement of the IC-CoDE guidelines as the application expands.
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Affiliation(s)
- Kayela Arrotta
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Sara J Swanson
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Julie K Janecek
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - William B Barr
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
| | - Sallie Baxendale
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Carrie R McDonald
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA; Department of Radiation Medicine and Applied Sciences, University of California, San Diego, CA, USA
| | - Anny Reyes
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA; Department of Radiation Medicine and Applied Sciences, University of California, San Diego, CA, USA
| | - Bruce P Hermann
- Department of Neurology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Robyn M Busch
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
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5
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Alexander HB, Allendorfer JB. The relationship between physical activity and cognitive function in people with epilepsy: A systematic review. Epilepsy Behav 2023; 142:109170. [PMID: 36940504 PMCID: PMC10173358 DOI: 10.1016/j.yebeh.2023.109170] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/28/2023] [Accepted: 03/04/2023] [Indexed: 03/22/2023]
Abstract
BACKGROUND This study aimed to systematically review the published literature evaluating the association between physical activity and cognitive function in people with epilepsy (PWE). METHODS A comprehensive search of PubMed, Cochrane, Embase, and PsychInfo was performed on June 20, 2022. Studies were excluded if they were not available in the English language, contained animal data only, did not include any original data, were not peer-reviewed, or did not include PWE as a discrete group. PRISMA guidelines were followed. The GRADE scale was used to assess the risk of bias. RESULTS Six studies were identified with a total of 123 participants. These included one observational study and five interventional studies, only one of which was a randomized controlled trial. In all studies, there was a positive association between physical activity and cognitive function in PWE. Both interventional studies showed improvement in at least one domain of cognitive functioning, though there was heterogeneity in the outcome measures used. CONCLUSIONS There is a potential positive association between physical activity and cognitive function in PWE, but available data is limited by heterogeneity, small sample size, and an overall lack of published studies in this area of research. There is a need for more robust studies to be performed in larger samples of PWE.
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Affiliation(s)
- Halley B Alexander
- Wake Forest University School of Medicine, Department of Neurology, Winston-Salem, NC, USA.
| | - Jane B Allendorfer
- University of Alabama at Birmingham, Departments of Neurology and Neurobiology, Birmingham, AL, USA
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Javurkova A, Zivnustka M, Brezinova T, Raudenska J, Zarubova J, Marusic P. Neurocognitive profile in patients with idiopathic generalized epilepsies: Differences between patients, their biological siblings, and healthy controls. Epilepsy Behav 2023; 142:109204. [PMID: 37086591 DOI: 10.1016/j.yebeh.2023.109204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/25/2023] [Accepted: 03/26/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Idiopathic generalized epilepsy (IGE) is one of the most common epilepsies and is believed to have a strong genetic origin. Patients with IGE present largely heterogeneous neurocognitive profiles and might show some neurocognitive impairments. Furthermore, IGE siblings may demonstrate worse results in neuropsychological tests as well. In our study, we aimed to map the neurocognitive profile both in patients with IGE and the siblings. We also sought to establish a neurocognitive profile for each IGE syndrome. METHODS The research sample included 110 subjects (IGE n = 46, biological siblings BS n = 16, and healthy controls n = 48) examined. Subjects were neuropsychologically examined in domains of intelligence, attention, memory, executive, and motor functions. The data obtained from the examination were statistically processed to determine whether and how IGE patients (including distinct syndromes) and the siblings differed neurocognitively from healthy controls (adjusted z-scores by age, education, and gender, and composite z-scores of cognitive domains). Data on anti-seizure medication, including defined daily doses, were obtained and included in the analysis. RESULTS IGE patients and their biological siblings performed significantly worse in most of the neuropsychological tests than healthy controls. The neurocognitive profile of composite z-scores showed that IGE and biological siblings had equally significantly impaired performance in executive functions. IGE group also demonstrated impaired composite attention and motor function scores. The profile of individual IGE syndromes showed that JAE, JME, and EGTCS had significantly worse performance in composite execution score and motor function score. JAE presented significantly worse performance in intelligence and attention. JME exhibited significantly worse composite score in the attention domain. Anti-seizure medication, depression, and quality of life were unrelated to cognitive performance in IGE group. The level of depression significantly predicted the overall value of quality of life in patients with IGE, while cognitive domains, sociodemographic, and clinical factors were unrelated. CONCLUSION Our study highlights the importance to consider the neurocognitive profile of IGE patients that can lead to difficulties in their education, acceptance, and management of coping strategies. Cognitive difficulties of IGE siblings could support a hypothesis that these impairments emerge from heritable traits.
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Affiliation(s)
- A Javurkova
- Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic; Department of Nursing, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.
| | - M Zivnustka
- Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.
| | - T Brezinova
- Department of Clinical Neuropsychology, University of Groningen, Netherlands.
| | - J Raudenska
- Department of Nursing, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.
| | - J Zarubova
- Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.
| | - P Marusic
- Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.
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Jeżowska-Jurczyk K, Jurczyk P, Budrewicz S, Pokryszko-Dragan A. Evaluation of Event-Related Potentials in Assessing Cognitive Functions of Adult Patients with Epilepsy of Unknown Etiology. J Clin Med 2023; 12:jcm12072500. [PMID: 37048584 PMCID: PMC10094758 DOI: 10.3390/jcm12072500] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
Background: Cognitive impairment (CI) is an important consequence of epilepsy. The aim of the study was to assess cognitive performance in patients with epilepsy, using neuropsychological tests (NT) and event-related potentials (ERPs), with regard to demographic and clinical data. Methods: The study comprised 50 patients with epilepsy of unknown etiology and 46 healthy controls. Based on the NT results, the patients were divided into subgroups with/without CI. Parameters of P300 potential were compared between the patients and controls. P300 parameters and NT results were referred to demographics and clinical characteristics of epilepsy. Results: Based on the NT, 66% of patients were assigned as cognitively impaired. Median P300 latency was significantly (p < 0.0002) prolonged in the study group. Subgroups of patients with and without CI significantly (p < 0.034) differed in education level and vocational activity, duration of epilepsy, age at its onset and frequency of polytherapy. P300 parameters showed significant (p < 0.03) relationships with duration of epilepsy, type and frequency of seizures and polytherapy. Conclusions: Cognitive impairment and ERPs abnormalities occur in a majority of patients with epilepsy of unknown etiology. Characteristics of epilepsy and socioeconomic status are related to cognitive performance. ERPs may complement neuropsychological methods in the assessment of cognition in patients with epilepsy.
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Peplow P, Martinez B. MicroRNAs as potential biomarkers in temporal lobe epilepsy and mesial temporal lobe epilepsy. Neural Regen Res 2023; 18:716-726. [DOI: 10.4103/1673-5374.354510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Huang CW, Boonyapisit K, Gunadharma S, Casanova-Gutierrez J, Jin L, Nayak D, Akamatsu N. Optimal Use of Perampanel in Elderly Asian Patients with Epilepsy: Expert Opinion. Ther Clin Risk Manag 2022; 18:825-832. [PMID: 35996554 PMCID: PMC9392486 DOI: 10.2147/tcrm.s371396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/31/2022] [Indexed: 12/05/2022] Open
Abstract
Managing epilepsy in the elderly remains complicated largely due to factors related to aging. In this population, management practices are increasingly shifting towards the use of newer-generation anti-seizure medications (ASMs) as they are generally associated with better tolerability and safety profiles than older ones. Perampanel is a new ASM with broad-spectrum efficacy and a favorable safety profile. However, because of the lack of information and experience in its use, the prescription of perampanel has not been optimized in the elderly in the real-world setting in Asia. A group of epilepsy experts across the region convened at a series of virtual meetings to share their experience and discuss recommendations on perampanel use in elderly patients, including dose optimization, considerations with treatment initiation, and strategies to manage adverse events and maximize tolerability. This article summarizes key clinical and real-world evidence for perampanel in the elderly and consolidates the experts’ opinions on optimizing perampanel use in elderly Asian patients with epilepsy, providing practical guidance for clinicians to address challenges related to treatment initiation and tolerance.
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Affiliation(s)
- Chin-Wei Huang
- Division of Epileptology, Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kanokwan Boonyapisit
- Division of Neurology, Department of Medicine, Siriraj Hospital, Bangkok, Thailand
| | - Suryani Gunadharma
- Department of Neurology, Faculty of Medicine, Padjadjaran University, Hasan Sadikin Hospital, Bandung, Indonesia
| | - Josephine Casanova-Gutierrez
- Department of Internal Medicine, Section of Neurology, De La Salle University Medical Center and College of Medicine, Dasmariñas, Philippines.,Department of Neurosciences, University of the Philippines College of Medicine-Philippine General Hospital, Manila, Philippines
| | - Liri Jin
- Department of Neurology, Peking Union Medical College Hospital, Beijing, People's Republic of China
| | - Dinesh Nayak
- Department of Neurology, Gleneagles Global Health City, Chennai, India
| | - Naoki Akamatsu
- Department of Neurology, International University of Health and Welfare, Narita, Japan.,Epilepsy and Sleep Disorders Center, Fukuoka Sanno Hospital, Fukuoka, Japan
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10
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Hansen B, Allendorfer JB. Considering social determinants of health in the relationship between physical activity and exercise engagement and cognitive impairment among persons with epilepsy. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:923856. [PMID: 36188918 PMCID: PMC9397670 DOI: 10.3389/fresc.2022.923856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/04/2022] [Indexed: 11/21/2022]
Abstract
Many persons with epilepsy (PWE) are not as active or physically fit as compared to the general population. This lack of engagement in physical activity has been attributed to a number of factors, few of which take into consideration the social determinants of health (SDH). In this perspective, we highlight how SDH are considered in explaining lower levels of physical activity engagement among PWE, particularly for those experiencing cognitive impairment. We also discuss how these data can be applied in research to yield a greater impact on the quality of life among PWE. Consideration of SDH allows for increased understanding of how cognition can be both a determinant of physical activity and an outcome of environments conducive to physical activity in PWE.
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Affiliation(s)
- Barbara Hansen
- Division of Preventive Medicine, University of Alabama Heersink School of Medicine, Birmingham, AL, United States
| | - Jane B. Allendorfer
- Departments of Neurology and Neurobiology, University of Alabama Heersink School of Medicine, Birmingham, AL, United States
- *Correspondence: Jane B. Allendorfer
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11
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Lozano-García A, Hampel KG, Gutiérrez A, Villanueva V, Cano-López I, González-Bono E. Clinical utility of Epitrack for differentiating profiles and patterns of post-surgical change in memory and quality of life in patients with drug-resistant epilepsy. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-12. [PMID: 35148237 DOI: 10.1080/23279095.2022.2036990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE To assess whether performance in attention and executive functions evaluated with the Epitrack screening tool before surgery can differentiate memory and quality of life (QOL) profiles, and detect different post-surgical change patterns in these variables in patients with epilepsy. METHODS This is a longitudinal study. Seventy-seven patients with drug-resistant epilepsy (mean age = 37.91) underwent a neuropsychological assessment before and one year after surgery. Epitrack, a screening tool that exclusively evaluates attention and executive functioning, was administered in the pre-surgical assessment, and verbal and visual memory and QOL were assessed before and after surgery. RESULTS Patients with impaired Epitrack performance had poorer verbal and visual memory than those with intact Epitrack performance, regardless of the time point (for all, p < 0.0001). They also showed a post-surgical decline in immediate verbal recall (p = 0.04) and discriminability (p = 0.001). Patients with intact Epitrack performance did not exhibit this decline. Epitrack total score significantly contributed to 13 and 11% of the variance of post-surgical changes in immediate verbal recall and discriminability, respectively. Epitrack groups did not differ in QOL profiles or changes, but post-surgical immediate verbal recall improvements were related to post-surgical QOL improvements. CONCLUSION Our findings underline the utility of Epitrack screening tool to detect different patterns of verbal and visual memory dysfunction, as well as to predict post-surgical verbal memory decline in patients with drug-resistant epilepsy. Patients with lower pre-surgical Epitrack scores appear to be at increased risk for post-surgical memory decline.
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Affiliation(s)
- Alejandro Lozano-García
- IDOCAL/Department of Psychobiology, Psychology Center, University of Valencia, Valencia, Spain
| | - Kevin G Hampel
- Refractory Epilepsy Unit, Neurology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Antonio Gutiérrez
- Refractory Epilepsy Unit, Neurology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Vicente Villanueva
- Refractory Epilepsy Unit, Neurology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Esperanza González-Bono
- IDOCAL/Department of Psychobiology, Psychology Center, University of Valencia, Valencia, Spain
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12
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Gauffin H, Landtblom AM, Vigren P, Frick A, Engström M, McAllister A, Karlsson T. Similar Profile and Magnitude of Cognitive Impairments in Focal and Generalized Epilepsy: A Pilot Study. Front Neurol 2022; 12:746381. [PMID: 35095714 PMCID: PMC8790571 DOI: 10.3389/fneur.2021.746381] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/14/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction: Cognitive impairments in epilepsy are not well-understood. In addition, long-term emotional, interpersonal, and social consequences of the underlying disturbances are important to evaluate. Purpose: To compare cognitive function including language in young adults with focal or generalized epilepsy. In addition, quality of life and self-esteem were investigated. Patients and Methods: Young adults with no primary intellectual disability, 17 with focal epilepsy and 11 with generalized epilepsy participated and were compared to 28 healthy controls. Groups were matched on age (mean = 26 years), sex, and education. Participants were administered a battery of neuropsychological tasks and carried out self-ratings of quality of life, self-esteem, and psychological problems. Results: Similar impairments regarding cognitive function were noted in focal and generalized epilepsy. The cognitive domains tested were episodic long-term memory, executive functions, attention, working memory, visuospatial functions, and language. Both epilepsy groups had lower results compared to controls (effect sizes 0.24–1.07). The total number of convulsive seizures was predictive of episodic long-term memory function. Participants with focal epilepsy reported lower quality of life than participants with generalized epilepsy. Lowered self-esteem values were seen in both epilepsy groups and particularly in those with focal epilepsy. Along with measures of cognitive speed and depression, the total number of seizures explained more than 50% of variation in quality of life. Conclusion: Interestingly, similarities rather than differences characterized the widespread cognitive deficits that were seen in focal and generalized epilepsy, ranging from mild to moderate. These similarities were modified by quality of life and self-esteem. This study confirms the notion that epilepsy is a network disorder.
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Affiliation(s)
- Helena Gauffin
- Department of Neurology, Faculty of Medicine and Health Sciences Linköping University, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences Linköping University, Linköping, Sweden
| | - Anne-Marie Landtblom
- Department of Neurology, Faculty of Medicine and Health Sciences Linköping University, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences Linköping University, Linköping, Sweden.,Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden.,Neurology Division, Clinic of Medical Specialist, Motala General Hospital, Motala, Sweden.,Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | - Patrick Vigren
- Department of Neurology, Faculty of Medicine and Health Sciences Linköping University, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences Linköping University, Linköping, Sweden
| | - Andreas Frick
- The Beijer Laboratory, Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Maria Engström
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden.,Department of Medical, Health and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anita McAllister
- Division of Speech Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.,Women's Health and Allied Health Professionals Theme, Medical Unit Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Thomas Karlsson
- Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden.,Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
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13
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Tedrus GMDAS, Lange LA. Memory complaints, clinical aspects, and self-esteem in adult people with epilepsy. Dement Neuropsychol 2021; 15:357-360. [PMID: 34630923 PMCID: PMC8485644 DOI: 10.1590/1980-57642021dn15-030007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/21/2021] [Indexed: 11/21/2022] Open
Abstract
Memory complaints are common in adult people with epilepsy (PWEs). However, the associated clinical aspects are not yet fully understood. Objective This study aims to relate the occurrence of memory complaints in PWEs with clinical aspects and self-esteem. Methods To relate the data obtained from the Memory Complaint Questionnaire (MAC-Q) with clinical aspects, 71 PWEs were assessed using the Rosenberg Self-Esteem Scale (SES), the Mini Mental State Examination (MMSE), and the Brief Cognitive Battery-Edu. These data were compared with 55 individuals in a control group (CG). Results Memory complaints (MAC-Q≥25) were significantly higher in PWEs, when compared with individuals in the CG [35 (49.3%) vs. 15 (27.2%); Student's t-test; p=0.012]. Objective cognitive performance was lower in PWEs. Memory complaints were associated with a lower educational level, the presence of depression, SES, MMSE, incidental memory, and the clock-drawing test scores in PWEs. Conclusions Memory complaints were more frequent in PWEs than in individuals in the CG, and there was a relationship with cognitive deficit, educational level, depression, and low self-esteem.
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Affiliation(s)
| | - Laura Annoni Lange
- School of Medicine, Pontificia Universidade Católica de Campinas - Campinas, SP, Brazil
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14
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Moncrief GG, Aita SL, Tyson BT, Abecassis M, Roth RM, Caller TA, Schmidt SS, Jobst BC. Self-rated executive dysfunction in adults with epilepsy and effects of a cognitive-behavioral intervention (HOBSCOTCH). Epilepsy Behav 2021; 121:108042. [PMID: 34058488 DOI: 10.1016/j.yebeh.2021.108042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/30/2021] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
RATIONALE Cognitive problems are common in adults with epilepsy and significantly affect their quality of life. HOBSCOTCH (HOme Based Self-management and COgnitive Training CHanges lives) was developed to teach problem-solving and compensatory memory strategies to these individuals. This study examined whether HOBSCOTCH is associated with improvement in specific aspects of subjective executive functions. METHODS Fifty-one adults, age 18-65, with epilepsy and subjective cognitive concerns were randomized to receive HOBSCOTCH (n = 31) or a care-as-usual control sample (n = 20). Participants completed the Behavior Rating Inventory of Executive Function-Adult version (BRIEF-A), as well as the Patient Health Questionnaire-9 (PHQ-9) to assess depression. Rates of elevated (i.e., T ≥ 65, impaired) BRIEF-A scores at baseline, as well as pre-post score changes for the BRIEF-A clinical scales were evaluated. Significance was set at α = 0.05, one-tailed, given our directional hypothesis. RESULTS At baseline, a considerable percentage of patients in the overall sample endorsed executive dysfunction on BRIEF-A scales: Inhibit = 28%, Shift = 51%, Emotional Control = 45%, Self-Monitor = 33%, Initiate = 35%, Working Memory = 88%, Plan/Organize = 45%, Task Monitor = 47%, Organization of Materials = 28%. Significant improvement was seen in mean T-scores for Inhibit, Shift, Initiate, and Working Memory in the treatment group, but only Working Memory improved in the control group. The control group endorsed worse task monitoring and organization of materials at baseline and follow-up. Change in depression was not observed for either group, and there was no association between changes in depression and BRIEF-A scores. CONCLUSIONS A sizeable subset of adults with epilepsy reported experiencing executive dysfunction in their everyday lives, especially for working memory. HOBSCOTCH resulted in amelioration of subjective executive functioning independent of changes in mood.
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Affiliation(s)
- Grant G Moncrief
- Neuropsychology Program, Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, United States.
| | - Stephen L Aita
- Neuropsychology Program, Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Brad T Tyson
- EvergreenHealth Neuroscience Institute, EvergreenHealth Medical Center, Kirkland, WA, United States
| | - Maurissa Abecassis
- Neuropsychology Program, Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Robert M Roth
- Neuropsychology Program, Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Tracie A Caller
- Cheyenne Regional Medical Center, Cheyenne, WY, United States; Department of Neurology, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Samantha S Schmidt
- Department of Neurology, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Barbara C Jobst
- Department of Neurology, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
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15
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Busch RM, Hogue O, Miller M, Ferguson L, McAndrews MP, Hamberger M, Kim M, McDonald CR, Reyes A, Drane DL, Hermann BP, Bingaman W, Najm IM, Kattan MW, Jehi L. Nomograms to Predict Verbal Memory Decline After Temporal Lobe Resection in Adults With Epilepsy. Neurology 2021; 97:e263-e274. [PMID: 34011574 PMCID: PMC8302146 DOI: 10.1212/wnl.0000000000012221] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 04/14/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To develop and externally validate models to predict the probability of postoperative verbal memory decline in adults after temporal lobe resection (TLR) for epilepsy using easily accessible preoperative clinical predictors. METHODS Multivariable models were developed to predict delayed verbal memory outcome on 3 commonly used measures: Rey Auditory Verbal Learning Test (RAVLT) and Logical Memory (LM) and Verbal Paired Associates (VPA) subtests from Wechsler Memory Scale-Third Edition. With the use of the Harrell step-down procedure for variable selection, models were developed in 359 adults who underwent TLR at the Cleveland Clinic and validated in 290 adults at 1 of 5 epilepsy surgery centers in the United States or Canada. RESULTS Twenty-nine percent of the development cohort and 26% of the validation cohort demonstrated significant decline on at least 1 verbal memory measure. Initial models had good to excellent predictive accuracy (calibration [c] statistic range 0.77-0.80) in identifying patients with memory decline; however, models slightly underestimated decline in the validation cohort. Model coefficients were updated with data from both cohorts to improve stability. The model for RAVLT included surgery side, baseline memory score, and hippocampal resection. The models for LM and VPA included surgery side, baseline score, and education. Updated model performance was good to excellent (RAVLT c = 0.81, LM c = 0.76, VPA c = 0.78). Model calibration was very good, indicating no systematic overestimation or underestimation of risk. CONCLUSIONS Nomograms are provided in 2 easy-to-use formats to assist clinicians in estimating the probability of verbal memory decline in adults considering TLR for treatment of epilepsy. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that multivariable prediction models accurately predict verbal memory decline after TLR for epilepsy in adults.
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Affiliation(s)
- Robyn M Busch
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison.
| | - Olivia Hogue
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Margaret Miller
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Lisa Ferguson
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Mary Pat McAndrews
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Marla Hamberger
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Michelle Kim
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Carrie R McDonald
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Anny Reyes
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Daniel L Drane
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Bruce P Hermann
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - William Bingaman
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Imad M Najm
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Michael W Kattan
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Lara Jehi
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
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EpiTrack is a feasible tool for assessing attention and executive functions in patients with refractory epilepsy. Epilepsy Behav 2021; 115:107691. [PMID: 33360402 DOI: 10.1016/j.yebeh.2020.107691] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/02/2020] [Accepted: 12/02/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The purpose of this cross-sectional retrospective study was to utilize EpiTrack to assess cognitive performance within the domain of attention and executive functions in patients with refractory epilepsy in consideration for treatment interventions either with antiepileptic drug (AED) changes and/or neuromodulation therapies. We also aimed to identify the relevant clinical and treatment factors possibly affecting EpiTrack performance. METHODS The patient group consisted of 95 consecutive refractory epilepsy patients who were evaluated with EpiTrack. Based on their EpiTrack performance, the patients could be categorized as cognitively unimpaired, mildly, or severely impaired. The patients were also divided into three groups based on the planned treatment modification: AED group (n = 38) with only AED treatment, vagal nerve stimulation (VNS) group (n = 40) and deep-brain stimulation (DBS) group (n = 17). However, the effect of planned interventions was not the subject of this study. We retrospectively reviewed the medical records for detailed clinical characterization. RESULTS EpiTrack performance was severely impaired in 48 (50.5%), mildly impaired in 22 (23.2%) and unimpaired in 25 (26.3%) of the patients. The DBS group had significantly lower EpiTrack scores (mean (SD) and median, 25.5 (4.81) and 27.0, respectively) compared to the AED group (28.6 (6.2) and 30.0, respectively, p = 0.049). Sixty-three (66.3%) of the whole study population had more than 2 AEDs. When comparing EpiTrack scores between patient groups based on the number of AEDs administered, there was a trend toward better performance in EpiTrack with 2 AEDs as compared to 3-4 AEDs. CONCLUSIONS Deficits in attention and executive functions were frequent among patients with refractory epilepsy. Deficits were evident in all three treatment groups being most severe in the DBS group reflecting the patient selection. Furthermore, the effect of AED burden on executive functions was remarkable since two thirds of the patients had more than two AEDs and the deficits were more prominent among those with a higher AED burden. These results highlight the benefits of a feasible screening tool such as EpiTrack for assessing attention and executive functions when optimizing the treatment effects of neurostimulation therapies on cognition, and when evaluating the impacts of the AED burden.
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Lozano-García A, Hampel KG, Villanueva V, González-Bono E, Cano-López I. The number of anti-seizure medications mediates the relationship between cognitive performance and quality of life in temporal lobe epilepsy. Epilepsy Behav 2021; 115:107699. [PMID: 33412368 DOI: 10.1016/j.yebeh.2020.107699] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/30/2020] [Accepted: 12/08/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To assess whether cognitive performance predicts quality of life (QOL) in patients with drug-resistant temporal lobe epilepsy (TLE), using the Epitrack cognitive screening tool, while considering the mediating role of the number of anti-seizure medications (ASMs) and controlling for seizure-related, social, and emotional factors. METHODS Seventy-five adult patients with drug-resistant TLE (mean age = 39.76 years, SD = 11.66) underwent a presurgical neuropsychological assessment. MAIN OUTCOME MEASURES Cognitive performance (Epitrack), depression (BDI-II), trait anxiety (STAI); and QOL (QOLIE-31) were assessed. RESULTS Adjusting for seizure-related, social, and emotional factors, the Epitrack total score significantly contributed to QOL composite score, and energy and cognitive self-rating subscales. We found a significant indirect effect of the Epitrack total score on QOL composite score and seizure worry and social functioning subscales via the number of ASMs. CONCLUSION Our findings underline the relevance of cognitive functioning on QOL and the clinical utility of Epitrack to track cognitive side effects of ASMs and, consequently, to predict and manage QOL in this population.
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Affiliation(s)
- Alejandro Lozano-García
- IDOCAL/Department of Psychobiology, Psychology Center, University of Valencia, Avda. Blasco Ibañez, 21, 46010 Valencia, Spain
| | - Kevin G Hampel
- Refractory Epilepsy Unit, Neurology Service, Hospital Universitario y Politécnico La Fe, Bulevar sur, s/n Carretera de Malilla, 46026 Valencia, Spain
| | - Vicente Villanueva
- Refractory Epilepsy Unit, Neurology Service, Hospital Universitario y Politécnico La Fe, Bulevar sur, s/n Carretera de Malilla, 46026 Valencia, Spain
| | - Esperanza González-Bono
- IDOCAL/Department of Psychobiology, Psychology Center, University of Valencia, Avda. Blasco Ibañez, 21, 46010 Valencia, Spain
| | - Irene Cano-López
- Valencian International University, C/Pintor Sorolla, 21, 46002 Valencia, Spain.
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18
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Guery D, Rheims S. Clinical Management of Drug Resistant Epilepsy: A Review on Current Strategies. Neuropsychiatr Dis Treat 2021; 17:2229-2242. [PMID: 34285484 PMCID: PMC8286073 DOI: 10.2147/ndt.s256699] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/07/2021] [Indexed: 12/13/2022] Open
Abstract
Drug resistant epilepsy (DRE) is defined as the persistence of seizures despite at least two syndrome-adapted antiseizure drugs (ASD) used at efficacious daily dose. Despite the increasing number of available ASD, about a third of patients with epilepsy still suffer from drug resistance. Several factors are associated with the risk of evolution to DRE in patients with newly diagnosed epilepsy, including epilepsy onset in the infancy, intellectual disability, symptomatic epilepsy and abnormal neurological exam. Pharmacological management often consists in ASD polytherapy. However, because quality of life is driven by several factors in patients with DRE, including the tolerability of the treatment, ASD management should try to optimize efficacy while anticipating the risks of drug-related adverse events. All patients with DRE should be evaluated at least once in a tertiary epilepsy center, especially to discuss eligibility for non-pharmacological therapies. This is of paramount importance in patients with drug resistant focal epilepsy in whom epilepsy surgery can result in long-term seizure freedom. Vagus nerve stimulation, deep brain stimulation or cortical stimulation can also improve seizure control. Lastly, considering the effect of DRE on psychologic status and social integration, comprehensive care adaptations are always needed in order to improve patients' quality of life.
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Affiliation(s)
- Deborah Guery
- Department of Functional Neurology and Epileptology, Hospices Civils De Lyon and University of Lyon, Lyon, France
| | - Sylvain Rheims
- Department of Functional Neurology and Epileptology, Hospices Civils De Lyon and University of Lyon, Lyon, France.,Lyon's Neuroscience Research Center, INSERM U1028/CNRS UMR 5292, Lyon, France.,Epilepsy Institute, Lyon, France
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19
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Busch RM, Yehia L, Bazeley P, Seyfi M, Blümcke I, Hermann BP, Najm IM, Eng C. Verbal memory dysfunction is associated with alterations in brain transcriptome in dominant temporal lobe epilepsy. Epilepsia 2020; 61:2203-2213. [PMID: 32945555 DOI: 10.1111/epi.16673] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/08/2020] [Accepted: 08/09/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Memory dysfunction is prevalent in many neurological disorders and can have a significant negative impact on quality of life. The genetic contributions to memory impairment in epilepsy, particularly temporal lobe epilepsy (TLE), remain poorly understood. Here, we compare the brain transcriptome between TLE patients with and without verbal memory impairments to identify genes and signaling networks important for episodic memory. METHODS Brain tissues were resected from 23 adults who underwent dominant temporal lobectomy for treatment of pharmacoresistant epilepsy. To control for potential effects of APOE on memory, only those homozygous for the APOE ε3 allele were included. A battery of memory tests was performed, and patients were stratified into two groups based on preoperative memory performance. The groups were well matched on demographic and disease-related variables. Total RNA-Seq and small RNA-Seq were performed on RNA extracted from the brain tissues. Pathway and integrative analyses were subsequently performed. RESULTS We identified 1092 differentially expressed transcripts (DETs), with the majority (71%) being underexpressed in brain tissues from patients with impaired memory compared to those from patients with intact memory. Enrichment analysis revealed overrepresentation of genes in pathways pertaining to brain-related neurological dysfunction, including a subset associated with neurodegenerative diseases, memory, and cognition (APP, MAPT, PINK1). Despite including patients with identical APOE genotypes, we identify APOE as a differentially expressed gene associated with memory status. Small RNA-Seq identified four differentially expressed microRNAs (miRNAs) that were predicted to target a subset (22%) of all DETs. Integrative analysis showed that these miRNA-predicted DET targets impact brain-related pathways and biological processes also pertinent to memory and cognition. SIGNIFICANCE TLE-associated memory status may be influenced by differences in gene expression profiles within the temporal lobe. Upstream processes influencing differential expression signatures, such as miRNAs, could serve as biomarkers and potential treatment targets for memory impairment in TLE.
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Affiliation(s)
- Robyn M Busch
- Epilepsy Center and Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.,Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lamis Yehia
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Peter Bazeley
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Marilyn Seyfi
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ingmar Blümcke
- Epilepsy Center and Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.,Institute of Neuropathology, University Hospitals Erlangen, Erlangen, Germany
| | - Bruce P Hermann
- Department of Neurology, University of Wisconsin, Madison, Wisconsin
| | - Imad M Najm
- Epilepsy Center and Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Charis Eng
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.,Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Genetics and Genome Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
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20
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Factors associated with subjective cognitive function in epilepsy and psychogenic non-epileptic seizures. Epilepsy Res 2020; 163:106342. [PMID: 32353671 DOI: 10.1016/j.eplepsyres.2020.106342] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/30/2020] [Accepted: 04/11/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To identify factors associated with subjective cognitive complaints in people with presumed seizure disorders referred for video electroencephalogram monitoring (VEM). METHODS Adult patients admitted for inpatient VEM were recruited. Objective cognitive function was measured with the Neuropsychiatry Unit Cognitive Screening Tool, subjective cognitive function with the Quality of Life in Epilepsy Inventory-89 subscales, and anxiety and depressive symptoms with the Hospital Anxiety and Depression Scale. Multivariate Bayesian general linear models were used to identify predictors of subjective cognitive function. RESULTS 331 patients met inclusion criteria. Mean age was 39.3 years and 61.9 % patients were female. Diagnoses included epilepsy, psychogenic non-epileptic seizures (PNES) or both conditions. Depression, anxiety and objective cognitive function were predictors of subjective cognitive function across all domains. Depression was the strongest predictor of subjective memory and attention, whilst objective cognition was the strongest predictor of subjective language function. Mood also mediated the relationship between objective function and subjective function across all domains to varying extents; depression exerted the strongest effect of 22 % for the memory domain; conversely, language domain was least influenced by mood, with depression mediating 11 % and anxiety mediating only 9% of the subjective-objective relationship. SIGNIFICANCE Mood and objective cognitive function are both important contributors to subjective cognitive function for patients undergoing VEM. Clinicians should consider referring patients with cognitive complaints for both neurocognitive workup and neuropsychiatric evaluation. Future work may examine the effects of treating concomitant mood disorders on subjective cognitive function.
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21
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Pinto HPP, de Oliveira Lucas EL, Carvalho VR, Mourão FAG, de Oliveira Guarnieri L, Mendes EMAM, de Castro Medeiros D, Moraes MFD. Seizure Susceptibility Corrupts Inferior Colliculus Acoustic Integration. Front Syst Neurosci 2019; 13:63. [PMID: 31780904 PMCID: PMC6851260 DOI: 10.3389/fnsys.2019.00063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 10/11/2019] [Indexed: 01/20/2023] Open
Abstract
Evidence suggests that the pathophysiology associated with epileptic susceptibility may disturb the functional connectivity of neural circuits and compromise the brain functions, even when seizures are absent. Although memory impairment is a common comorbidity found in patients with epilepsy, it is still unclear whether more caudal structures may play a role in cognitive deficits, particularly in those cases where there is no evidence of hippocampal sclerosis. This work used a genetically selected rat strain for seizure susceptibility (Wistar audiogenic rat, WAR) and distinct behavioral (motor and memory-related tasks) and electrophysiological (inferior colliculus, IC) approaches to access acoustic primary integrative network properties. The IC neural assemblies' response was evaluated by auditory transient (focusing on bottom-up processing) and steady-state evoked response (ASSR, centering on feedforward and feedback forces over neural circuitry). The results show that WAR displayed no disturbance in motor performance or hippocampus-dependent memory tasks. Nonetheless, WAR animals exhibited significative impairment for auditory fear conditioning (AFC) along with no indicative of IC plastic changes between the pre-conditioning and test phases (ASSR coherence analysis). Furthermore, WAR's IC response to transient stimuli presented shorter latency and higher amplitude compared with Wistar; and the ASSR analysis showed similar results for WAR and Wistar animals under subthreshold dose of pentylenetetrazol (pro-convulsive drug) for seizure-induction. Our work demonstrated alterations at WAR IC neural network processing, which may explain the associated disturbance on AFC memory.
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Affiliation(s)
- Hyorrana Priscila Pereira Pinto
- Núcleo de Neurociências, Departamento de Fisiologia e Biofísica, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Eric Levi de Oliveira Lucas
- Núcleo de Neurociências, Departamento de Fisiologia e Biofísica, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Vinícius Rezende Carvalho
- Núcleo de Neurociências, Departamento de Fisiologia e Biofísica, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Centro de Tecnologia e Pesquisa em Magneto Ressonância, Programa de Pós-Graduação em Engenharia Elétrica, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Flávio Afonso Gonçalves Mourão
- Núcleo de Neurociências, Departamento de Fisiologia e Biofísica, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Centro de Tecnologia e Pesquisa em Magneto Ressonância, Programa de Pós-Graduação em Engenharia Elétrica, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Leonardo de Oliveira Guarnieri
- Núcleo de Neurociências, Departamento de Fisiologia e Biofísica, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Centro de Tecnologia e Pesquisa em Magneto Ressonância, Programa de Pós-Graduação em Engenharia Elétrica, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Eduardo Mazoni Andrade Marçal Mendes
- Centro de Tecnologia e Pesquisa em Magneto Ressonância, Programa de Pós-Graduação em Engenharia Elétrica, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Daniel de Castro Medeiros
- Núcleo de Neurociências, Departamento de Fisiologia e Biofísica, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Centro de Tecnologia e Pesquisa em Magneto Ressonância, Programa de Pós-Graduação em Engenharia Elétrica, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Márcio Flávio Dutra Moraes
- Núcleo de Neurociências, Departamento de Fisiologia e Biofísica, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Centro de Tecnologia e Pesquisa em Magneto Ressonância, Programa de Pós-Graduação em Engenharia Elétrica, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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22
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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: 21] [Impact Index Per Article: 4.2] [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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23
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Allendorfer JB, Nenert R, Bebin EM, Gaston TE, Grayson LE, Hernando KA, Houston JT, Hansen B, Szaflarski JP. fMRI study of cannabidiol-induced changes in attention control in treatment-resistant epilepsy. Epilepsy Behav 2019; 96:114-121. [PMID: 31129526 DOI: 10.1016/j.yebeh.2019.04.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/08/2019] [Accepted: 04/08/2019] [Indexed: 11/16/2022]
Abstract
Patients with treatment-resistant epilepsy (TRE) frequently exhibit memory and attention deficits that contribute to their poor personal and societal outcomes. We studied the effects of adjunct treatment with pharmaceutical grade cannabidiol (CBD) oral solution (Epidiolex®; Greenwich Biosciences, Inc.) on attention control processes related to stimulus conflict resolution in patients with TRE. Twenty-two patients with TRE underwent 3 T magnetic resonance imaging (MRI) before receiving (PRE) and after achieving a stable dose of CBD (ON). Functional MRI (fMRI) data were collected while patients performed 2 runs of a flanker task (FT). Patients were instructed to indicate via button press the congruent (CON) and incongruent (INC) conditions. We performed t-tests to examine with FT attention control processes at PRE and ON visits and to compare the 2 visits using derived general linear model (GLM) data (INC - CON). We performed generalized psychophysiological interaction (gPPI) analyses to assess changes in condition-based functional connectivity on FT. Median time between fMRI visits was 10 weeks, and median CBD dose at follow-up was 25 mg/kg/d. From PRE to ON, participants experienced improvements in seizure frequency (SF) (p = 0.0009), seizure severity (Chalfont Seizure Severity Scale (CSSS); p < 0.0001), and mood (Total Mood Disturbance (TMD) score from Profile of Mood States (POMS); p = 0.0026). Repeated measures analysis of variance showed nonsignificant improvements in executive function from 34.6 (23.5)% to 41.9 (22.4)% CON accuracy and from 34.2 (25.7)% to 37.6 (24.4)% INC accuracy (p = 0.199). Change in CON accuracy was associated with change in INC accuracy (rS = 0.81, p = 0.0005). Participants exhibited CBD-induced increases in fMRI activation in the right superior frontal gyrus (SFG) and right insula/middle frontal gyrus (MFG) and decrease in activation for both regions at ON relative to PRE (corrected p = 0.05). The subset of patients who improved in FT accuracy with CBD showed a negative association between change in right insula/MFG activation and change in accuracy for the INC condition (rS = -0.893, p = 0.0068). The gPPI analysis revealed a CBD-induced decrease in condition-based functional connectivity differences for the right SFG seed region (corrected p = 0.05). Whole-brain regression analysis documented a negative association of change in right insula/MFG condition-based connectivity with change in INC accuracy (corrected p = 0.005). Our results suggest that CBD modulates attention control processing in patients with TRE by reducing right SFG and right insula/MFG activation related to stimulus conflict resolution and by dampening differences in condition-based functional connectivity of the right SFG. Our study is the first to provide insight into how CBD affects the neural substrates involved in attention processing and how modulation of the activity and functional connectivity related to attentional control processes in the right insula/MFG may be working to improve cognitive performance in TRE.
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Affiliation(s)
- Jane B Allendorfer
- Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Rodolphe Nenert
- Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - E Martina Bebin
- Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tyler E Gaston
- Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA; Veteran's Administration Medical Center, Birmingham, AL, USA
| | - Leslie E Grayson
- Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA; Veteran's Administration Medical Center, Birmingham, AL, USA
| | - Kathleen A Hernando
- Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James T Houston
- Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Barbara Hansen
- Department of Sociology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jerzy P Szaflarski
- Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
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24
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Ehrlich T, Reyes A, Paul BM, Uttarwar V, Hartman S, Mathur K, Chang YHA, Hegde M, Shih JJ, McDonald CR. Beyond depression: The impact of executive functioning on quality of life in patients with temporal lobe epilepsy. Epilepsy Res 2019; 149:30-36. [PMID: 30468945 PMCID: PMC6326842 DOI: 10.1016/j.eplepsyres.2018.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/14/2018] [Accepted: 11/12/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Individuals with temporal lobe epilepsy (TLE) often experience diminished quality of life (QoL). Although comorbid depression is one of the most recognized predictors of poor QoL in TLE, impairments in verbal memory (VM) and executive functioning (EF), have also been identified as risk factors, independent of other biological and psychosocial factors. In this study, we examine the contribution of depression, VM, and EF to QoL in 52 well-characterized medically-refractory TLE patients. METHODS Quality of life was assessed with the Quality of Life in Epilepsy (QOLIE-31) questionnaire and depression symptomatology was evaluated with the Beck Depression Inventory-II (BDI-II). Tests of VM included the California Verbal Learning Test-Second Edition and the Wechsler Memory Scale-Third Edition, Logical Memory and Verbal Paired Associates subtests. Tests of EF included the D-KEFS Category Switching and Color Word Interference Tests, and the Trail Making Test. Using these measures, a principal component (PC) was derived for VM and for EF. Hierarchical multiple linear regression analysis was used to evaluate the unique contributions of BDI-II Score, VM PC, and EF PC to the QOLIE-31 Total Score, while controlling for important clinical and demographic variables. Post-hoc analyses were also performed to examine the contribution of each variable to specific QOLIE subscales. RESULTS Of the clinical variables, only number of antiepileptic drugs contributed to QOLIE scores. As expected, severity of depressive symptoms was the most significant predictor of QOLIE Total Score, explaining 43.4% of the variance in total QoL. The VM PC did not contribute to the QOLIE Total Score. Rather, our EF PC emerged as an important predictor of QoL, explaining an additional 5% of the variance, after controlling for clinical variables, depression severity, and VM performance. SIGNIFICANCE These findings suggest that a combination of clinical, affective, and cognitive factors influence QoL in patients with TLE. Designing interventions with careful attention to depression and EF may be needed to optimize QoL in patients with refractory TLE and potentially other epilepsy syndromes.
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Affiliation(s)
- Tobin Ehrlich
- Palo Alto University, 1971 Arastradero Drive, Palo Alto, CA 94304, USA
| | - Anny Reyes
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA; Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA
| | - Brianna M Paul
- UCSF Comprehensive Epilepsy Center, San Francisco, CA, USA; Department of Neurology, University of California - San Francisco, San Francisco, CA, USA
| | - Vedang Uttarwar
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA
| | - Stephen Hartman
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA
| | - Kushagra Mathur
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA
| | - Yu-Hsuan A Chang
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA
| | - Manu Hegde
- UCSF Comprehensive Epilepsy Center, San Francisco, CA, USA
| | - Jerry J Shih
- UCSD Comphrensive Epilepsy Center, San Diego, CA, USA
| | - Carrie R McDonald
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA; Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA; UCSD Comphrensive Epilepsy Center, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA.
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25
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Chen YY, Huang S, Wu WY, Liu CR, Yang XY, Zhao HT, Wu LC, Tan LZ, Long LL, Xiao B. Associated and predictive factors of quality of life in patients with temporal lobe epilepsy. Epilepsy Behav 2018; 86:85-90. [PMID: 30017833 DOI: 10.1016/j.yebeh.2018.06.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 05/02/2018] [Accepted: 06/15/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Identifying the factors that are correlated with and predictive of reduced quality of life (QOL) is essential to optimize the treatment of epilepsy and the management of comorbidities. METHODS We analyzed the independent associations between the Quality of Life in Epilepsy-31 (QOLIE-31) inventory and the demographic, clinical, psychiatric, and cognitive variables of 47 consecutive patients with temporal lobe epilepsy (TLE). Predictors of the correlated variables were analyzed by multiple linear regression analysis. RESULTS The QOLIE-31 total score was positively correlated with occupational status and Mini-Mental State Examination (MMSE) scores (r = 0.290 and 0.295, respectively; P < 0.05) and negatively correlated with the duration of seizures, adverse effects of antiepileptic drugs (AEDs), and the Pittsburgh Sleep Quality Inventory (PSQI), Self-rating Anxiety Scale (SAS), and Self-rating Depression Scale (SDS) scores (r = -0.357, 0.321, 0.328, -0.672, and -0.565, respectively; P < 0.05; P < 0.01 for the SAS and SDS). In the final multivariate regression model, anxiety, long durations of seizures, adverse effects of AEDs, and depression explained approximately 60.6% (adjusted R2 = 0.606, R coefficient = 0.800) of the QOLIE-31 overall score variance. CONCLUSION Anxiety, long durations of seizures, adverse effects of AEDs, and depression were significant predictors of QOL, and these variables had relatively high prediction capacities for the overall QOLIE-31 in the regression model. Comorbid anxiety is the most powerful negative determinant of the QOLIE-31.
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Affiliation(s)
- Ya-Yu Chen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China
| | - Sha Huang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China
| | - Wen-Yue Wu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China
| | - Chao-Rong Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China
| | - Xiao-Yan Yang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China
| | - Hai-Ting Zhao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China
| | - Ling-Chao Wu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China
| | - Lang-Zi Tan
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China
| | - Li-Li Long
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China.
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China.
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26
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Villanueva V, Montoya J, Castillo A, Mauri-Llerda JÁ, Giner P, López-González FJ, Piera A, Villanueva-Hernández P, Bertol V, Garcia-Escrivá A, Garcia-Peñas JJ, Garamendi I, Esteve-Belloch P, Baiges-Octavio JJ, Miró J, Falip M, Garcés M, Gómez A, Gil-López FJ, Carreño M, Rodriguez-Uranga JJ, Campos D, Bonet M, Querol R, Molins A, Tortosa D, Salas-Puig J. Perampanel in routine clinical use in idiopathic generalized epilepsy: The 12-month GENERAL study. Epilepsia 2018; 59:1740-1752. [PMID: 30062784 DOI: 10.1111/epi.14522] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/02/2018] [Accepted: 07/06/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To analyze the effectiveness and tolerability of perampanel across different seizure types in routine clinical care of patients with idiopathic generalized epilepsy (IGE). METHODS This multicenter, retrospective, 1-year observational study collected data from patient records at 21 specialist epilepsy units in Spain. All patients who were aged ≥12 years, prescribed perampanel before December 2016, and had a confirmed diagnosis of IGE were included. RESULTS The population comprised 149 patients with IGE (60 with juvenile myoclonic epilepsy, 51 generalized tonic-clonic seizures [GTCS] only, 21 juvenile absence epilepsy, 10 childhood absence epilepsy, 6 adulthood absence epilepsy, and one Jeavons syndrome). Mean age was 36 years. The retention rate at 12 months was 83% (124/149), and 4 mg was the most common dose. At 12 months, the seizure-free rate was 59% for all seizures (88/149); 63% for GTCS (72/115), 65% for myoclonic seizures (31/48), and 51% for absence seizures (24/47). Seizure frequency was reduced significantly at 12 months relative to baseline for GTCS (78%), myoclonic (65%), and absence seizures (48%). Increase from baseline seizure frequency was seen in 5.2% of patients with GTCS seizures, 6.3% with myoclonic, and 4.3% with absence seizures. Perampanel was effective regardless of epilepsy syndrome, concomitant antiepileptic drugs (AEDs), and prior AEDs, but retention and seizure freedom were significantly higher when used as early add-on (after ≤2 prior AEDs) than late (≥3 prior AEDs). Adverse events were reported in 50% of patients over 12 months, mostly mild or moderate, and irritability (23%), somnolence (15%), and dizziness (14%) were most frequent. SIGNIFICANCE In routine clinical care of patients with IGE, perampanel improved seizure outcomes for GTCS, myoclonic seizures, and absence seizures, with few discontinuations due to adverse events. This is the first real-world evidence with perampanel across different seizure types in IGE.
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Affiliation(s)
| | - Javier Montoya
- Lluis Alcanyis Hospital, Xátiva, Spain.,General University Hospital Valencia, Valencia, Spain
| | | | | | - Pau Giner
- University Hospital Dr Peset, Valencia, Spain
| | | | - Anna Piera
- University Hospital Clinic Valencia, Valencia, Spain
| | | | | | | | | | | | | | | | - Júlia Miró
- University Hospital Bellvitge, Barcelona, Spain
| | - Mercè Falip
- University Hospital Bellvitge, Barcelona, Spain
| | | | - Asier Gómez
- University Hospital and Polytechnic La Fe, Valencia, Spain
| | | | | | | | | | | | - Rosa Querol
- University Complex Infanta Cristina, Badajoz, Spain
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Allendorfer JB, Arida RM. Role of Physical Activity and Exercise in Alleviating Cognitive Impairment in People With Epilepsy. Clin Ther 2018; 40:26-34. [DOI: 10.1016/j.clinthera.2017.12.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 12/01/2017] [Accepted: 12/07/2017] [Indexed: 01/02/2023]
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Villanueva V, Bermejo P, Montoya J, Toledo M, Gómez-Ibáñez A, Garcés M, Vilella L, López-González FJ, Rodriguez-Osorio X, Campos D, Martínez P, Giner P, Zurita J, Rodríguez-Uranga J, Ojeda J, Mauri JA, Camacho JL, Ruiz-Giménez J, Poza JJ, Massot-Tarrús A, Galiano ML, Bonet M. EARLY-ESLI study: Long-term experience with eslicarbazepine acetate after first monotherapy failure. Acta Neurol Scand 2017; 136:254-264. [PMID: 27935017 DOI: 10.1111/ane.12720] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2016] [Indexed: 02/01/2023]
Abstract
PURPOSE Evaluate real-life experience with eslicarbazepine acetate (ESL) after first monotherapy failure in a large series of patients with focal epilepsy. METHOD Multicentre, retrospective, 1-year, observational study in patients older than 18 years, with focal epilepsy, who had failed first antiepileptic drug monotherapy and who received ESL. Data from clinical records were analysed at baseline, 3, 6 and 12 months to assess effectiveness and tolerability. RESULTS Eslicarbazepine acetate was initiated in 253 patients. The 1-year retention rate was 92.9%, and the final median dose of ESL was 800 mg. At 12 months, 62.3% of patients had been seizure free for 6 months; 37.3% had been seizure free for 1 year. During follow-up, 31.6% of the patients reported ESL-related adverse events (AEs), most commonly somnolence (8.7%) and dizziness (5.1%), and 3.6% discontinued due to AEs. Hyponatraemia was observed in seven patients (2.8%). After starting ESL, 137 patients (54.2%) withdrew the prior monotherapy and converted to ESL monotherapy; 75.9% were seizure free, 87.6% were responders, 4.4% worsened, and 23.4% reported ESL-related AEs. CONCLUSION Use of ESL after first monotherapy failure was associated with an optimal seizure control and tolerability profile. Over half of patients were converted to ESL monotherapy during follow-up.
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Affiliation(s)
- V. Villanueva
- Hospital Universitario y Politécnico La Fe; Valencia Spain
| | - P. Bermejo
- Hospital Universitario Puerta Hierro; Madrid Spain
| | | | - M. Toledo
- Hospital Universitario Vall d′Hebron; Barcelona Spain
| | | | - M. Garcés
- Hospital Universitario y Politécnico La Fe; Valencia Spain
| | - L. Vilella
- Hospital Universitario Vall d′Hebron; Barcelona Spain
| | | | | | - D. Campos
- Hospital Clínico Universitario; Valladolid Spain
| | - P. Martínez
- Hospital Universitario Virgen del Rocio; Sevilla Spain
| | - P. Giner
- Hospital Universitario Dr. Peset; Valencia Spain
| | - J. Zurita
- Hospital Universitario Infanta Leonor; Madrid Spain
| | - J. Rodríguez-Uranga
- Clínica Sagrado Corazón; Instituto de Especialidades Neurológicas; Sevilla Spain
| | - J. Ojeda
- Hospital Universitario Infanta Sofía; Madrid Spain
| | - J. A. Mauri
- Hospital Clinico Universitario Lozano Blesa; Zaragoza Spain
| | - J. L. Camacho
- Hospital Clinico Universitario Lozano Blesa; Zaragoza Spain
| | | | - J. J. Poza
- Hospital Universitario Donosti; San Sebastian Spain
| | | | - M. L. Galiano
- Hospital Universitario Gregorio Marañon; Madrid Spain
| | - M. Bonet
- Hospital Arnau de Vilanova; Valencia Spain
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Buonfiglio M, Di Sabato F, Mandillo S, Albini M, Di Bonaventura C, Giallonardo A, Avanzini G. Analytic information processing style in epilepsy patients. Epilepsy Behav 2017; 73:18-22. [PMID: 28605629 DOI: 10.1016/j.yebeh.2017.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/20/2017] [Accepted: 05/13/2017] [Indexed: 11/19/2022]
Abstract
Relevant to the study of epileptogenesis is learning processing, given the pivotal role that neuroplasticity assumes in both mechanisms. Recently, evoked potential analyses showed a link between analytic cognitive style and altered neural excitability in both migraine and healthy subjects, regardless of cognitive impairment or psychological disorders. In this study we evaluated analytic/global and visual/auditory perceptual dimensions of cognitive style in patients with epilepsy. Twenty-five cryptogenic temporal lobe epilepsy (TLE) patients matched with 25 idiopathic generalized epilepsy (IGE) sufferers and 25 healthy volunteers were recruited and participated in three cognitive style tests: "Sternberg-Wagner Self-Assessment Inventory", the C. Cornoldi test series called AMOS, and the Mariani Learning style Questionnaire. Our results demonstrate a significant association between analytic cognitive style and both IGE and TLE and respectively a predominant auditory and visual analytic style (ANOVA: p values <0,0001). These findings should encourage further research to investigate information processing style and its neurophysiological correlates in epilepsy.
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Affiliation(s)
- Marzia Buonfiglio
- Department of Clinical Medicine, "Sapienza" University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy.
| | - Francesco Di Sabato
- Department of Clinical Medicine, "Sapienza" University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy
| | - Silvia Mandillo
- CNR - Institute of Cell Biology and Neurobiology - Roma, 00015 Monterotondo Scalo, Italy
| | - Mariarita Albini
- Epilepsy Unit, Department of Neurology and Psychiatry, "Sapienza" University, Rome, Italy
| | - Carlo Di Bonaventura
- Epilepsy Unit, Department of Neurology and Psychiatry, "Sapienza" University, Rome, Italy
| | - Annateresa Giallonardo
- Epilepsy Unit, Department of Neurology and Psychiatry, "Sapienza" University, Rome, Italy
| | - Giuliano Avanzini
- Department of Neurophysiology, Istituto Neurologico C. Besta, Milano, Italy
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Rayner G, Tailby C. Current Concepts of Memory Disorder in Epilepsy: Edging Towards a Network Account. Curr Neurol Neurosci Rep 2017. [DOI: 10.1007/s11910-017-0765-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Petruzzi A, Rigamonti A, Finocchiaro CY, Borelli P, Lamperti E, Silvani A, Regazzoni R, Stanzani L, Salmaggi A. Psychological features and quality of life in 50 adult patients with epilepsy and their caregivers from the Lecco epilepsy center, Italy. Epilepsy Behav 2017; 71:13-16. [PMID: 28441636 DOI: 10.1016/j.yebeh.2017.03.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/15/2017] [Accepted: 03/17/2017] [Indexed: 11/27/2022]
Abstract
Epilepsy is one of the most common neurological disorders. To the best of our knowledge, in Italy, the relationship between patients' and caregivers' psychological state has rarely been analyzed. Thus, we sought to evaluate both the psychological state of patients with epilepsy and that of their caregivers and the interrelationship between them. We also assessed the existing relation between psychological features and some clinical and demographic information, such as number of antiepileptic drugs (AEDs), epilepsy duration and education level of patients and their caregivers. We enrolled in the study 50 consecutive adult patients attending the epilepsy clinic of "A. Manzoni" Hospital and their caregivers. Both patients and their caregivers were administered Hospital Anxiety and Depression Scale (HADS) and 36-item Short-Form Health Survey (SF-36). Anxiety, depression and quality of life values of both patients and their caregivers did not differ significantly from the normative samples. No statistically significant correlation between epilepsy duration and patients' and caregivers' psychological features was found. Patients which took more than one AED reported lower values of "Vitality" (p <.05) and "Social Functioning" (p <.05) than their own caregivers. Caregivers with higher education level presented lower "Vitality" values than caregivers with lower education level (p <.05). Patients with pharmacoresistant seizures reported lower values of "Mental Health" than patients with non-pharmacoresistant seizures (p <.05). In this context, the role of coping mechanisms by patients and caregivers may explain apparently unexpected findings and suggests that strategies aimed at reinforcing them may be effective in selected cases. Therefore, while the severity of epilepsy may have an impact on the psychological state of adult patients with epilepsy and their caregivers, our results highlight the role of multidimensional determinants, including stigma. Further studies are needed to identify the factors related to epilepsy, patients, caregivers, treatments, and the environment that may be modifiable in order to improve self-perceived QoL.
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Affiliation(s)
- Alessandra Petruzzi
- Department of Neuroncology, Unit of Neurology II, Fondazione I.R.C.C.S. Istituto Neurologico "C. Besta", Milan, Italy; Department of Neurosciences - Unit of Neurology - Stroke Unit, "A. Manzoni" Hospital, Lecco, Italy.
| | - Andrea Rigamonti
- Department of Neurosciences - Unit of Neurology - Stroke Unit, "A. Manzoni" Hospital, Lecco, Italy
| | | | - Paolo Borelli
- Department of Neurosciences - Unit of Neurology - Stroke Unit, "A. Manzoni" Hospital, Lecco, Italy
| | - Elena Lamperti
- Department of Neuroncology, Unit of Neurology II, Fondazione I.R.C.C.S. Istituto Neurologico "C. Besta", Milan, Italy
| | - Antonio Silvani
- Department of Neuroncology, Unit of Neurology II, Fondazione I.R.C.C.S. Istituto Neurologico "C. Besta", Milan, Italy
| | - Rossana Regazzoni
- Department of Neurosciences - Unit of Neurology - Stroke Unit, "A. Manzoni" Hospital, Lecco, Italy
| | - Lorenzo Stanzani
- Department of Neurosciences - Unit of Neurology - Stroke Unit, "A. Manzoni" Hospital, Lecco, Italy
| | - Andrea Salmaggi
- Department of Neurosciences - Unit of Neurology - Stroke Unit, "A. Manzoni" Hospital, Lecco, Italy
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Liu XY, Shi T, Yin WN, Ren ZY, Deng YL, Chen SD. Interictal epileptiform discharges were associated with poorer cognitive performance in adult epileptic patients. Epilepsy Res 2016; 128:1-5. [DOI: 10.1016/j.eplepsyres.2016.09.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 09/23/2016] [Accepted: 09/29/2016] [Indexed: 11/17/2022]
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Realmuto S, Zummo L, Cerami C, Agrò L, Dodich A, Canessa N, Zizzo A, Fierro B, Daniele O. Social cognition dysfunctions in patients with epilepsy: Evidence from patients with temporal lobe and idiopathic generalized epilepsies. Epilepsy Behav 2015; 47:98-103. [PMID: 25982884 DOI: 10.1016/j.yebeh.2015.04.048] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 04/18/2015] [Accepted: 04/20/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Despite an extensive literature on cognitive impairments in focal and generalized epilepsy, only a few number of studies specifically explored social cognition disorders in epilepsy syndromes. The aim of our study was to investigate social cognition abilities in patients with temporal lobe epilepsy (TLE) and in patients with idiopathic generalized epilepsy (IGE). MATERIALS AND METHODS Thirty-nine patients (21 patients with TLE and 18 patients with IGE) and 21 matched healthy controls (HCs) were recruited. All subjects underwent a basic neuropsychological battery plus two experimental tasks evaluating emotion recognition from facial expression (Ekman-60-Faces test, Ek-60F) and mental state attribution (Story-based Empathy Task, SET). In particular, the latter is a newly developed task that assesses the ability to infer others' intentions (i.e., intention attribution - IA) and emotions (i.e., emotion attribution - EA) compared with a control condition of physical causality (i.e., causal inferences - CI). RESULTS Compared with HCs, patients with TLE showed significantly lower performances on both social cognition tasks. In particular, all SET subconditions as well as the recognition of negative emotions were significantly impaired in patients with TLE vs. HCs. On the contrary, patients with IGE showed impairments on anger recognition only without any deficit at the SET task. DISCUSSION Emotion recognition deficits occur in patients with epilepsy, possibly because of a global disruption of a pathway involving frontal, temporal, and limbic regions. Impairments of mental state attribution specifically characterize the neuropsychological profile of patients with TLE in the context of the in-depth temporal dysfunction typical of such patients. CONCLUSION Impairments of socioemotional processing have to be considered as part of the neuropsychological assessment in both TLE and IGE in view of a correct management and for future therapeutic interventions.
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Affiliation(s)
- Sabrina Realmuto
- Experimental Biomedicine and Clinical Neuroscience Department (BioNeC), University of Palermo, Palermo, Italy.
| | - Leila Zummo
- Experimental Biomedicine and Clinical Neuroscience Department (BioNeC), University of Palermo, Palermo, Italy
| | - Chiara Cerami
- Vita-Salute San Raffaele University, Milan, Italy; Neuroscience Division, San Raffaele Scientific Institute, Milan, Italy; Clinical Neuroscience Department, San Raffaele Hospital, Milan, Italy
| | - Luigi Agrò
- Experimental Biomedicine and Clinical Neuroscience Department (BioNeC), University of Palermo, Palermo, Italy
| | - Alessandra Dodich
- Vita-Salute San Raffaele University, Milan, Italy; Neuroscience Division, San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Canessa
- Neuroscience Division, San Raffaele Scientific Institute, Milan, Italy; Istituto Universitario di Studi Superiori, Pavia, Italy
| | - Andrea Zizzo
- Experimental Biomedicine and Clinical Neuroscience Department (BioNeC), University of Palermo, Palermo, Italy
| | - Brigida Fierro
- Experimental Biomedicine and Clinical Neuroscience Department (BioNeC), University of Palermo, Palermo, Italy
| | - Ornella Daniele
- Experimental Biomedicine and Clinical Neuroscience Department (BioNeC), University of Palermo, Palermo, Italy
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Farina E, Raglio A, Giovagnoli AR. Cognitive rehabilitation in epilepsy: An evidence-based review. Epilepsy Res 2015; 109:210-8. [DOI: 10.1016/j.eplepsyres.2014.10.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 10/19/2014] [Accepted: 10/26/2014] [Indexed: 11/29/2022]
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Giovagnoli AR. Cognition, behavior, and the role of Epilepsy & behavior in advancing knowledge about epilepsy. Epilepsy Behav 2014; 40:105-6. [PMID: 25281298 DOI: 10.1016/j.yebeh.2014.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 09/02/2014] [Indexed: 10/24/2022]
Affiliation(s)
- A R Giovagnoli
- Department of Diagnostics and Applied Technology, Fondazione IRCCS Istituto Neurologico C. Besta, Via Celoria 11, 20133 Milano, Italy.
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