1
|
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.
Collapse
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
| |
Collapse
|
2
|
Wahed S, Ferguson L, Thompson N, Arrotta K, Busch RM. Influence of psychological factors on the relationship between subjective and objective memory in adults with pharmacoresistant temporal lobe epilepsy. Epilepsy Behav 2024; 150:109552. [PMID: 38134645 DOI: 10.1016/j.yebeh.2023.109552] [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: 08/21/2023] [Revised: 11/14/2023] [Accepted: 11/17/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE Many adults with temporal lobe epilepsy (TLE) report subjective cognitive impairment; however, prior studies have shown a discrepancy between these subjective complaints and objective cognitive deficits on neuropsychological measures. Mood disorders/symptoms are also common in TLE and have been linked to greater subjective cognitive difficulties. To further understand these relationships, this retrospective study sought to determine if symptoms of depression and anxiety moderate or mediate the relationship between subjective cognitive impairment and objective cognitive performance in adults with TLE. METHOD Participants were 345 adults (mean age = 40.7; 55 % female) with pharmacoresistant TLE who completed self-report screening measures of depression, anxiety, and subjective cognitive function along with objective memory measures as part of a pre-surgical clinical neuropsychological evaluation. A series of linear regression analyses was conducted to examine the potential moderating and mediating effects of mood on the relationship between subjective and objective memory function after adjusting for relevant covariates. RESULTS Consistent with existing literature, self-reported depression and anxiety symptoms were significantly correlated with subjective memory difficulties across all scales (all p < .001). Subjective memory impairment was also significantly correlated with objective memory performance on neuropsychological measures, albeit with small effect sizes (estimate range 0.04-0.20). Contrary to our hypothesis, depression and anxiety did not moderate or mediate the relationship between subjective memory complaints and objective memory performance. CONCLUSIONS While symptoms of depression and anxiety were associated with subjective memory ability in this cohort of adults with TLE, this study suggests that mood symptoms do not fully explain the relationship between subjective and objective memory function, likely reflecting the complex and multifactorial relationships among these variables. Nevertheless, our results highlight the importance of screening for depression and anxiety symptoms and assessing patients' subjective memory complaints as part of a neuropsychological evaluation as each of these factors tap into a different aspect of the patient functioning.
Collapse
Affiliation(s)
- Shejuti Wahed
- Department of Psychology, Case Western Reserve University, Cleveland, OH, United States.
| | - Lisa Ferguson
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States.
| | - Nicolas Thompson
- Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States.
| | - Kayela Arrotta
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States; Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States.
| | - Robyn M Busch
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States; Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States.
| |
Collapse
|
3
|
Hoxhaj P, Habiya SK, Sayabugari R, Balaji R, Xavier R, Ahmad A, Khanam M, Kachhadia MP, Patel T, Abdin ZU, Haider A, Nazir Z. Investigating the Impact of Epilepsy on Cognitive Function: A Narrative Review. Cureus 2023; 15:e41223. [PMID: 37525802 PMCID: PMC10387362 DOI: 10.7759/cureus.41223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 08/02/2023] Open
Abstract
It has been noted that people who have epilepsy have an increased propensity for cognitive dysfunction. We explored 25 relevant articles on PubMed and Cochrane Library after implementing inclusion criteria. Different factors have been postulated and studied that may cause cognitive dysfunction in these patients; structural brain abnormalities, polypharmacy of antiepileptic medication, and neuropsychiatric disorders are the most common causes. Cognitive assessments such as Montreal Cognitive Assessment (MOCA) and Mini-Mental State Exam (MMSE) are the mainstay tools used to diagnose the degree of cognitive decline, and alterations in EEG (electroencephalogram) parameters have also been noted in people with cognitive decline. The mechanisms and treatments for cognitive decline are still being studied, while attention has also been directed toward preventive and predictive methods. Early detection and treatment of cognitive impairment can help minimize its impact on the patient's quality of life. Regular cognitive assessments are essential for epileptic patients, particularly those on multiple antiepileptic drugs. While proper management of epilepsy and related comorbidities would reduce cognitive decline and improve the overall quality of life for people with epilepsy.
Collapse
Affiliation(s)
- Pranvera Hoxhaj
- Medicine, University of Medicine, Tirana, Tirana, ALB
- Obstetrics and Gynaecology, Scher & Kerenyi MDS, New York, USA
| | - Sana K Habiya
- Internal Medicine, Indian Institute of Medical Science and Research, Jalna, IND
- Public Health, Northeastern Illinois University, Chicago, USA
| | | | - Roghan Balaji
- Neurology, Ponjesly Super Speciality Hospital, Nagercoil, IND
- Neurology, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry, IND
| | - Roshni Xavier
- Internal Medicine, Rajagiri Hospital, Aluva, IND
- Internal Medicine, Carewell Hospital, Malappuram, IND
| | - Arghal Ahmad
- Internal Medicine, Ziauddin University, Karachi, PAK
| | | | | | - Tirath Patel
- Internal Medicine, American University of Antigua, St John, ATG
| | - Zain U Abdin
- Internal Medicine, District Head Quarter Hospital, Faisalabad, PAK
| | - Ali Haider
- Internal Medicine, Quetta Institute of Medical Sciences, Quetta, PAK
| | - Zahra Nazir
- Internal Medicine Clinical Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Brinkmann BH, Karoly PJ, Nurse ES, Dumanis SB, Nasseri M, Viana PF, Schulze-Bonhage A, Freestone DR, Worrell G, Richardson MP, Cook MJ. Seizure Diaries and Forecasting With Wearables: Epilepsy Monitoring Outside the Clinic. Front Neurol 2021; 12:690404. [PMID: 34326807 PMCID: PMC8315760 DOI: 10.3389/fneur.2021.690404] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/10/2021] [Indexed: 12/14/2022] Open
Abstract
It is a major challenge in clinical epilepsy to diagnose and treat a disease characterized by infrequent seizures based on patient or caregiver reports and limited duration clinical testing. The poor reliability of self-reported seizure diaries for many people with epilepsy is well-established, but these records remain necessary in clinical care and therapeutic studies. A number of wearable devices have emerged, which may be capable of detecting seizures, recording seizure data, and alerting caregivers. Developments in non-invasive wearable sensors to measure accelerometry, photoplethysmography (PPG), electrodermal activity (EDA), electromyography (EMG), and other signals outside of the traditional clinical environment may be able to identify seizure-related changes. Non-invasive scalp electroencephalography (EEG) and minimally invasive subscalp EEG may allow direct measurement of seizure activity. However, significant network and computational infrastructure is needed for continuous, secure transmission of data. The large volume of data acquired by these devices necessitates computer-assisted review and detection to reduce the burden on human reviewers. Furthermore, user acceptability of such devices must be a paramount consideration to ensure adherence with long-term device use. Such devices can identify tonic–clonic seizures, but identification of other seizure semiologies with non-EEG wearables is an ongoing challenge. Identification of electrographic seizures with subscalp EEG systems has recently been demonstrated over long (>6 month) durations, and this shows promise for accurate, objective seizure records. While the ability to detect and forecast seizures from ambulatory intracranial EEG is established, invasive devices may not be acceptable for many individuals with epilepsy. Recent studies show promising results for probabilistic forecasts of seizure risk from long-term wearable devices and electronic diaries of self-reported seizures. There may also be predictive value in individuals' symptoms, mood, and cognitive performance. However, seizure forecasting requires perpetual use of a device for monitoring, increasing the importance of the system's acceptability to users. Furthermore, long-term studies with concurrent EEG confirmation are lacking currently. This review describes the current evidence and challenges in the use of minimally and non-invasive devices for long-term epilepsy monitoring, the essential components in remote monitoring systems, and explores the feasibility to detect and forecast impending seizures via long-term use of these systems.
Collapse
Affiliation(s)
| | - Philippa J Karoly
- Department of Medicine, Graeme Clark Institute and St Vincent's Hospital, The University of Melbourne, Fitzroy, VIC, Australia
| | - Ewan S Nurse
- Department of Medicine, Graeme Clark Institute and St Vincent's Hospital, The University of Melbourne, Fitzroy, VIC, Australia.,Seer Medical, Melbourne, VIC, Australia
| | | | - Mona Nasseri
- Department of Neurology, Mayo Foundation, Rochester, MN, United States.,School of Engineering, University of North Florida, Jacksonville, FL, United States
| | - Pedro F Viana
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Faculty of Medicine, University of Lisbon, Lisboa, Portugal
| | - Andreas Schulze-Bonhage
- Faculty of Medicine, Epilepsy Center, Medical Center, University of Freiburg, Freiburg, Germany
| | | | - Greg Worrell
- Department of Neurology, Mayo Foundation, Rochester, MN, United States
| | - Mark P Richardson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Mark J Cook
- Department of Medicine, Graeme Clark Institute and St Vincent's Hospital, The University of Melbourne, Fitzroy, VIC, Australia
| |
Collapse
|
6
|
Witt JA, Meschede C, Helmstaedter C. Hazardous employment of invalid measures for cognitive outcome assessment: You only see what your test can show you. Epilepsy Behav 2021; 117:107865. [PMID: 33662843 DOI: 10.1016/j.yebeh.2021.107865] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 02/05/2023]
Affiliation(s)
| | - Carolin Meschede
- Department of Epileptology, University Hospital Bonn (UKB), Bonn, Germany
| | | |
Collapse
|
7
|
Helmstaedter C, Sadat-Hossieny Z, Kanner AM, Meador KJ. Cognitive disorders in epilepsy II: Clinical targets, indications and selection of test instruments. Seizure 2020; 83:223-231. [PMID: 33172763 DOI: 10.1016/j.seizure.2020.09.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 12/26/2022] Open
Abstract
This is the second of two narrative reviews on cognitive disorders in epilepsy (companion manuscript: Cognitive disorders in epilepsy I: Clinical experience, real-world evidence and recommendations). Its focus is on the clinical targets, indications, and the selection of neuropsychological test instruments. Cognitive assessment has become an essential tool for the diagnosis and outcome control in the clinical management of epilepsy. The diagnostics of basic and higher brain functions can provide valuable information on lateralized and localized brain dysfunctions associated with epilepsy, its underlying pathologies and treatment. In addition to the detection or verification of deficits, neuropsychology reveals the patient's cognitive strengths and, thus, information about the patient reserve capacities for functional restitution and compensation. Neuropsychology is an integral part of diagnostic evaluations mainly in the context of epilepsy surgery to avoid new or additional damage to preexisting neurocognitive impairments. In addition and increasingly, neuropsychology is being used as a tool for monitoring of the disease and its underlying pathologies, and it is suited for the quality and outcome control of pharmacological or other non-invasive medical intervention. This narrative review summarizes the present state of neuropsychological assessments in epilepsy, reveals diagnostic gaps, and shows the great need for education, homogenization, translation and standardization of instruments.
Collapse
Affiliation(s)
- C Helmstaedter
- University Clinic Bonn, Department of Epileptology, Germany.
| | - Z Sadat-Hossieny
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, 213 Quarry Road, MC 5979, CA, 94304, USA
| | - A M Kanner
- University of Miami Health System, Uhealth Neurology, 1150 NW 14th St #609, Miami, FL 33136, USA
| | - K J Meador
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, 213 Quarry Road, MC 5979, CA, 94304, USA
| |
Collapse
|
8
|
Nassiri F, Price B, Shehab A, Au K, Cusimano MD, Jenkinson MD, Jungk C, Mansouri A, Santarius T, Suppiah S, Teng KX, Toor GS, Zadeh G, Walbert T, Drummond KJ. Life after surgical resection of a meningioma: a prospective cross-sectional study evaluating health-related quality of life. Neuro Oncol 2020; 21:i32-i43. [PMID: 30649488 DOI: 10.1093/neuonc/noy152] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Few studies have evaluated the health-related quality of life (HRQoL) of patients with meningiomas. Here, we report the largest prospective, longitudinal cross-sectional cohort study of HRQoL in meningiomas to date, in order to identify possible actionable determinants of global HRQoL. Methods Adults who had undergone resection of a grade I intracranial meningioma and were in routine follow-up at a single large tertiary center underwent HRQoL assessment using the QLQ-C30 questionnaire administered opportunistically at follow-up visits. Averaged transformed QLQ-C30 scores at 12-month intervals were compared with scores from a normative reference population, with reference to known minimal clinically meaningful difference (CMD) in scores. To evaluate for possible determinants of changes in global HRQoL, global HRQoL scores were correlated (Spearman's Rho) with subdomain and symptom scores and with interval time from surgical resection. Results A total of 291 postoperative patients with histologically confirmed and surgically treated grade I meningiomas consented to participation and a total of 455 questionnaires were included for analysis. Patients with meningiomas reported reduced global HRQoL at nearly every 12-month interval with clinically and statistically significant impairments at 12, 48, 108, and 120 months postoperative compared with the normative population (P < 0.05). Meningioma patients at the 12-month interval also reported a reduction of each subdomain of HRQoL assessment (P < 0.05); however, a CMD was only seen in cognitive functioning. Physical, emotional, cognitive, and social subdomains, as well as fatigue and sleep/insomnia, were significantly associated with global HRQoL at the first 12-month interval. Overall, there was no significant correlation between time from surgery and global HRQoL or the subdomain functional or symptom sections of the QLQ-C30. Conclusions Meningioma patients report considerable limitations in HRQoL for more than 120 months after surgery, particularly in cognitive, emotional, and social function, as well as suffering significant fatigue and sleep impairment compared with a normative reference population. The majority of these reported functional impairments and symptoms are strongly associated with global HRQoL and thus can be considered determinants of global HRQoL that if treated, have the potential to improve HRQoL for our meningioma patients. This hypothesis requires future study of targeted interventions to determine their efficacy.
Collapse
Affiliation(s)
- Farshad Nassiri
- Division of Neurosurgery, University Health Network and Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Benjamin Price
- Department of Neurosurgery, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
| | - Ameer Shehab
- Department of Neurosurgery, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
| | - Karolyn Au
- Division of Neurosurgery, University of Alberta, Alberta, Ontario, Canada
| | - Michael D Cusimano
- Division of Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada
| | - Michael D Jenkinson
- Department of Neurosurgery, The Walton Center NHS Foundation Trust, Lower Lane, Liverpool, Merseyside, UK
| | - Christine Jungk
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Alireza Mansouri
- Division of Neurosurgery, University Health Network and Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Thomas Santarius
- Department of Neurosurgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Suganth Suppiah
- Division of Neurosurgery, University Health Network and Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Ken X Teng
- Department of Neurosurgery, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
| | - Gurvinder S Toor
- Department of Neurosurgery, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
| | - Gelareh Zadeh
- Division of Neurosurgery, University Health Network and Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Tobias Walbert
- Hermelin Brain Tumor Center, Henry Ford Health System, Detroit, Michigan, USA
| | - Katharine J Drummond
- Department of Neurosurgery, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
| | | |
Collapse
|
9
|
Meschede C, Witt J, Brömling S, Moskau‐Hartmann S, Rademacher M, Surges R, Wrede R, Helmstaedter C. Changes in cognition after introduction or withdrawal of zonisamide versus topiramate in epilepsy patients: A retrospective study using Bayes statistics. Epilepsia 2020; 61:1481-1490. [DOI: 10.1111/epi.16576] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/16/2020] [Accepted: 05/17/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Carolin Meschede
- Department of Epileptology University Hospital Bonn (UKB) Bonn Germany
| | | | - Sarah Brömling
- Department of Epileptology University Hospital Bonn (UKB) Bonn Germany
| | | | | | - Rainer Surges
- Department of Epileptology University Hospital Bonn (UKB) Bonn Germany
| | - Randi Wrede
- Department of Epileptology University Hospital Bonn (UKB) Bonn Germany
| | | |
Collapse
|
10
|
Which clinical and neuropsychological factors are responsible for cognitive impairment in patients with epilepsy? Int J Public Health 2020; 65:947-956. [DOI: 10.1007/s00038-020-01401-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 10/24/2022] Open
|
11
|
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.
Collapse
|
12
|
Quon RJ, Mazanec MT, Schmidt SS, Andrew AS, Roth RM, MacKenzie TA, Sajatovic M, Spruill T, Jobst BC. Antiepileptic drug effects on subjective and objective cognition. Epilepsy Behav 2020; 104:106906. [PMID: 32006792 PMCID: PMC7064420 DOI: 10.1016/j.yebeh.2020.106906] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/07/2020] [Accepted: 01/07/2020] [Indexed: 11/29/2022]
Abstract
RATIONALE Cognitive impairment is one of the most common complaints for persons with epilepsy (PWE). These impairments are not only associated with seizures, but are also regularly reported as adverse effects of antiepileptic drugs (AEDs). Previous studies have examined cognitive effects of both AED monotherapy and polytherapy, yet there is limited research on these differences with respect to both subjective and objective cognition. The current study uses data from previous research conducted by the Centers for Disease Control and Prevention (CDC)-sponsored Managing Epilepsy Well (MEW) Network collaborative. We used three distinct archival datasets from the following: (1) the HOBSCOTCH efficacy trial at Dartmouth-Hitchcock Medical Center (HOB-1), (2) the multisite replication trial (HOB-2), and (3) epilepsy self-management research conducted at the NYU School of Medicine. METHODS This retrospective analysis combined baseline data from three datasets to determine how the number of AEDs and the type of AEDs were associated with subjective (patient-reported) and objective (examiner-assessed) cognition. Subjective cognition was captured using the cognitive subscale of the Quality of Life in Epilepsy Inventory (QOLIE-31) in all three datasets (n = 224), while objective cognition was measured using the Repeated Battery for the Assessment of Neuropsychological Status (RBANS) in the HOB-1 dataset (n = 65) and the Brief Test of Adult Cognition by Telephone (BTACT) in the HOB-2 dataset (n = 91). Multivariable linear regression was utilized for our initial assessments, followed by propensity score matching to provide stronger control of covariates. Matching was based on significantly different covariates, such as education, depression, and history of prior epilepsy surgery. Nonparametric statistical tests were utilized to compare these matched subjects. RESULTS Subjective cognitive impairment was significantly worse among individuals on polytherapy (2 + AEDs) compared with those on monotherapy (1 AED) (adjusted p = 0.041). These findings were consistent with our propensity score matched comparison of monotherapy and polytherapy, which indicated that polytherapy was associated with worse overall subjective cognition (adjusted p = 0.01), in addition to impairments on the RBANS (Total score p = 0.05) and specific subdomains of the BTACT (Episodic Verbal Memory p < 0.01, Working Memory p < 0.01, Processing Speed p < 0.01). Interestingly, older generation AEDs were associated with better language performance than newer generation and combined generation AED therapy (RBANS Language p = 0.03). These language-specific findings remained significant after controlling for the effects of topiramate and zonisamide (p = 0.04). CONCLUSIONS A greater number of AEDs is significantly and negatively associated with subjective and objective cognition in PWE, and is in line with previous research. Antiepileptic drug type did not, in itself, appear to be associated with subjective cognition. Our findings suggest that ineffective AEDs should be replaced, rather than introducing additional AEDs to a treatment regimen. Further, while subjective and objective cognition assessments were both sensitive at detecting differences based on AED status, the neuropsychological objective subdomains offer additional and specific insights into how cognition is impaired with AEDs.
Collapse
Affiliation(s)
- Robert J Quon
- Department of Neurology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
| | - Morgan T Mazanec
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Samantha S Schmidt
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Angeline S Andrew
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA; Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Robert M Roth
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Todd A MacKenzie
- Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, NH, USA; The Dartmouth Institute, Dartmouth College, Hanover, NH, USA
| | - Martha Sajatovic
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Tanya Spruill
- Department of Population Health, New York University Langone, New York, NY, USA; Department of Medicine, New York University Langone, New York, NY, USA
| | - Barbara C Jobst
- Department of Neurology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA; Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| |
Collapse
|
13
|
Foster E, Malpas CB, Ye K, Johnstone B, Carney PW, Velakoulis D, O'Brien TJ, Kwan P. Antiepileptic drugs are not independently associated with cognitive dysfunction. Neurology 2020; 94:e1051-e1061. [PMID: 32015172 DOI: 10.1212/wnl.0000000000009061] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 10/10/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To test the hypothesis that individual antiepileptic drugs (AEDs) are not associated with cognitive impairment beyond other clinically relevant factors, we performed a cross-sectional study of patients admitted to an inpatient video-EEG monitoring unit. METHODS We prospectively enrolled patients admitted to an inpatient specialist epilepsy program between 2009 and 2016. Assessments included objective cognitive function, quality of life subscales for subjective cognitive function, and questionnaires for anxiety and depressive symptoms. Bayesian model averaging identified predictors of cognitive function. Bayesian model selection approach investigated effect of individual AEDs on cognition. Conventional frequentist analyses were also performed. RESULTS A total of 331 patients met inclusion criteria. Mean age was 39.3 years and 61.9% of patients were women. A total of 45.0% of patients were prescribed AED polypharmacy, 25.1% AED monotherapy, and 29.9% no AED. Age, seizure frequency, and a diagnosis of concomitant epilepsy and psychogenic nonepileptic seizure were predictors of objective cognitive function. Depression, anxiety, and seizure frequency were predictors of subjective cognitive function. Individual AEDs were not independently associated with impaired cognitive function beyond other clinically relevant variables. CONCLUSIONS This study found that no AED was independently associated with cognitive dysfunction. Significant determinants of objective and subjective cognitive dysfunction included seizure frequency and depression, respectively. These findings suggest that optimizing therapy to prevent seizures is not likely to occur at the expense of cognitive function.
Collapse
Affiliation(s)
- Emma Foster
- From the Departments of Neurology (E.F., C.B.M., K.Y., B.J., T.J.O., P.K.) and Neuropsychiatry (D.V.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.F., C.B.M., T.J.O., P.K.), Alfred Health; Department of Neurosciences, Central Clinical School (E.F., T.J.O., P.K.), Monash University, Melbourne; Clinical Outcomes Research (CORe) Unit, Department of Medicine (RMH) (C.B.M.), The University of Melbourne, Parkville; Department of Medicine (P.W.C.), Monash University and Eastern Health; and Florey Institute of Neuroscience and Mental Health (P.W.C.), Melbourne, Australia.
| | - Charles B Malpas
- From the Departments of Neurology (E.F., C.B.M., K.Y., B.J., T.J.O., P.K.) and Neuropsychiatry (D.V.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.F., C.B.M., T.J.O., P.K.), Alfred Health; Department of Neurosciences, Central Clinical School (E.F., T.J.O., P.K.), Monash University, Melbourne; Clinical Outcomes Research (CORe) Unit, Department of Medicine (RMH) (C.B.M.), The University of Melbourne, Parkville; Department of Medicine (P.W.C.), Monash University and Eastern Health; and Florey Institute of Neuroscience and Mental Health (P.W.C.), Melbourne, Australia
| | - Karena Ye
- From the Departments of Neurology (E.F., C.B.M., K.Y., B.J., T.J.O., P.K.) and Neuropsychiatry (D.V.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.F., C.B.M., T.J.O., P.K.), Alfred Health; Department of Neurosciences, Central Clinical School (E.F., T.J.O., P.K.), Monash University, Melbourne; Clinical Outcomes Research (CORe) Unit, Department of Medicine (RMH) (C.B.M.), The University of Melbourne, Parkville; Department of Medicine (P.W.C.), Monash University and Eastern Health; and Florey Institute of Neuroscience and Mental Health (P.W.C.), Melbourne, Australia
| | - Benjamin Johnstone
- From the Departments of Neurology (E.F., C.B.M., K.Y., B.J., T.J.O., P.K.) and Neuropsychiatry (D.V.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.F., C.B.M., T.J.O., P.K.), Alfred Health; Department of Neurosciences, Central Clinical School (E.F., T.J.O., P.K.), Monash University, Melbourne; Clinical Outcomes Research (CORe) Unit, Department of Medicine (RMH) (C.B.M.), The University of Melbourne, Parkville; Department of Medicine (P.W.C.), Monash University and Eastern Health; and Florey Institute of Neuroscience and Mental Health (P.W.C.), Melbourne, Australia
| | - Patrick W Carney
- From the Departments of Neurology (E.F., C.B.M., K.Y., B.J., T.J.O., P.K.) and Neuropsychiatry (D.V.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.F., C.B.M., T.J.O., P.K.), Alfred Health; Department of Neurosciences, Central Clinical School (E.F., T.J.O., P.K.), Monash University, Melbourne; Clinical Outcomes Research (CORe) Unit, Department of Medicine (RMH) (C.B.M.), The University of Melbourne, Parkville; Department of Medicine (P.W.C.), Monash University and Eastern Health; and Florey Institute of Neuroscience and Mental Health (P.W.C.), Melbourne, Australia
| | - Dennis Velakoulis
- From the Departments of Neurology (E.F., C.B.M., K.Y., B.J., T.J.O., P.K.) and Neuropsychiatry (D.V.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.F., C.B.M., T.J.O., P.K.), Alfred Health; Department of Neurosciences, Central Clinical School (E.F., T.J.O., P.K.), Monash University, Melbourne; Clinical Outcomes Research (CORe) Unit, Department of Medicine (RMH) (C.B.M.), The University of Melbourne, Parkville; Department of Medicine (P.W.C.), Monash University and Eastern Health; and Florey Institute of Neuroscience and Mental Health (P.W.C.), Melbourne, Australia
| | - Terence J O'Brien
- From the Departments of Neurology (E.F., C.B.M., K.Y., B.J., T.J.O., P.K.) and Neuropsychiatry (D.V.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.F., C.B.M., T.J.O., P.K.), Alfred Health; Department of Neurosciences, Central Clinical School (E.F., T.J.O., P.K.), Monash University, Melbourne; Clinical Outcomes Research (CORe) Unit, Department of Medicine (RMH) (C.B.M.), The University of Melbourne, Parkville; Department of Medicine (P.W.C.), Monash University and Eastern Health; and Florey Institute of Neuroscience and Mental Health (P.W.C.), Melbourne, Australia
| | - Patrick Kwan
- From the Departments of Neurology (E.F., C.B.M., K.Y., B.J., T.J.O., P.K.) and Neuropsychiatry (D.V.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.F., C.B.M., T.J.O., P.K.), Alfred Health; Department of Neurosciences, Central Clinical School (E.F., T.J.O., P.K.), Monash University, Melbourne; Clinical Outcomes Research (CORe) Unit, Department of Medicine (RMH) (C.B.M.), The University of Melbourne, Parkville; Department of Medicine (P.W.C.), Monash University and Eastern Health; and Florey Institute of Neuroscience and Mental Health (P.W.C.), Melbourne, Australia
| |
Collapse
|
14
|
Hoppe C, Porębska I, Beeres K, Sassen R, Kuczaty S, Gleissner U, Lendt M, Elger CE, Helmstaedter C. Parents' view of the cognitive outcome one year after pediatric epilepsy surgery. Epilepsy Behav 2019; 101:106552. [PMID: 31698257 DOI: 10.1016/j.yebeh.2019.106552] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 09/06/2019] [Accepted: 09/08/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The cognitive outcome of pediatric epilepsy surgery has mainly been examined on the basis of standardized tests. Here, we analyzed the outcome in six cognitive domains from the parents' view. METHODS Included were consecutive surgical pediatric patients whose parents filled-in a comprehensive questionnaire on cognitive problems in children and adolescents (Kognitive Probleme bei Kindern und Jugendlichen (KOPKIJ); Gleissner et al. 2006) at the preoperative baseline (T1) as well as twelve months thereafter (T2). All children also underwent standard neuropsychological assessments at T1 and T2. RESULTS Parents of 96 patients provided pre- and postoperative KOPKIJ data. Overall, 80% of the children became seizure-free at the follow-up. Group means indicated a strong positive effect of time on KOPKIJ and neuropsychological performance. We found postoperative improvements in five out of six cognitive domains (language, memory, executive functions, attention, school; unchanged: visuospatial abilities). Individually, improvements were twice as likely as declines. However, 33 patients (35%) experienced significant decline in at least one cognitive domain. Later onset of epilepsy resulted in better performance but had no effect on change scores. Seizure-free status, lower antiseizure drug load, and stronger drug reduction after surgery contributed to postoperative cognitive improvements as perceived by the parents; no other effects of clinical factors were obtained (e.g., localization/lateralization). Despite their similar outcome patterns, change scores as derived from parental ratings and neuropsychological assessment were not correlated. CONCLUSIONS Parents acknowledged the overall positive neurocognitive development after pediatric epilepsy surgery as previously shown by standardized tests. Seizure freedom and lower antiseizure drug load contributed to the beneficial cognitive outcome. Even if cognitive improvements outweighed declines, a risk for cognitive decline with impact on everyday functioning does exist.
Collapse
Affiliation(s)
- Christian Hoppe
- Department of Epileptology, University of Bonn Medical Centre, Venusberg-Campus 1, FRG-53127 Bonn, Germany.
| | - Izabela Porębska
- Department of Epileptology, University of Bonn Medical Centre, Venusberg-Campus 1, FRG-53127 Bonn, Germany
| | - Kassandra Beeres
- Department of Epileptology, University of Bonn Medical Centre, Venusberg-Campus 1, FRG-53127 Bonn, Germany
| | - Robert Sassen
- Department of Epileptology, University of Bonn Medical Centre, Venusberg-Campus 1, FRG-53127 Bonn, Germany
| | - Stefan Kuczaty
- Department of Epileptology, University of Bonn Medical Centre, Venusberg-Campus 1, FRG-53127 Bonn, Germany
| | - Ulrike Gleissner
- LVR-Klinik Bonn, Kinderneurologisches Zentrum, Waldenburger Ring 46, FRG-53119 Bonn, Germany
| | - Michael Lendt
- St. Mauritius Therapieklinik, Strümper Str. 111, FRG-40670 Meerbusch, Germany
| | - Christian E Elger
- Department of Epileptology, University of Bonn Medical Centre, Venusberg-Campus 1, FRG-53127 Bonn, Germany
| | - Christoph Helmstaedter
- Department of Epileptology, University of Bonn Medical Centre, Venusberg-Campus 1, FRG-53127 Bonn, Germany; St. Mauritius Therapieklinik, Strümper Str. 111, FRG-40670 Meerbusch, Germany
| |
Collapse
|
15
|
Helmstaedter C, Durch P, Hoppe C, Witt JA. Is the computerized assessment of psychomotor speed more sensitive to cognitive effects of antiepileptic pharmacotherapy than tests with a focus on higher-order cognitive processing? Implications for the choice of sensitive test parameters. Eur Neuropsychopharmacol 2019; 29:1273-1281. [PMID: 31606304 DOI: 10.1016/j.euroneuro.2019.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/09/2019] [Accepted: 09/19/2019] [Indexed: 02/04/2023]
Abstract
The study evaluated whether it is psychomotor speed or higher-order cognitive processing which is primarily affected by antiepileptic drug (AED) treatment in epilepsy and whether computerized testing versus paper-pencil testing of executive functions is more sensitive. In this retrospective observational study, 55 patients with epilepsy underwent NeuroCog FXⓇ, a computerized battery assessing "psychomotor speed/alertness" and "cognitive processing" via 8 tasks, and EpiTrackⓇ, a paper-pencil screening of "executive functions and working memory" based on 6 subtests. Test performance was related to the number of drugs and the Defined Daily Dose and the presence/absence of AEDs with known adverse psychotropic effects. EpiTrackⓇ performance correlated with "cognitive processing" of the NeuroCog FXⓇ but not with "psychomotor speed/alertness". Significant correlations with drug load were mainly yielded for EpiTrackⓇ (number of AEDs: r = -0.551, total DDD: r = -0.452) and "cognitive processing" (number of AEDs: r = -0.433, total DDD: r = -0.415). "Psychomotor speed/alertness" was less related to drug load (number of AEDs: r = -0.285, total DDD: r = -0.232). Statistical control for "psychomotor speed/alertness" hardly changed the correlations of EpiTrackⓇ or "cognitive processing" with drug load indices. AEDs with known adverse profiles negatively affected EpiTrackⓇ and the "cognitive processing" but not the "psychomotor speed/alertness" domain of the computerized test. The results demonstrate that it is less basal psychomotor speed than higher-order cognitive processing which is negatively affected by antiepileptic pharmacotherapy. The results question the value of (computer-)tests with a major emphasis on psychomotor speed and alertness for cognitive drug monitoring.
Collapse
Affiliation(s)
- Christoph Helmstaedter
- Department of Epileptology, University of Bonn Medical Center (UKB), Venusberg-Campus 1, Bonn 53105, Germany.
| | - Philipp Durch
- Department of Epileptology, University of Bonn Medical Center (UKB), Venusberg-Campus 1, Bonn 53105, Germany
| | - Christian Hoppe
- Department of Epileptology, University of Bonn Medical Center (UKB), Venusberg-Campus 1, Bonn 53105, Germany
| | - Juri-Alexander Witt
- Department of Epileptology, University of Bonn Medical Center (UKB), Venusberg-Campus 1, Bonn 53105, Germany
| |
Collapse
|
16
|
Jacobs CS, Willment KC, Sarkis RA. Non-invasive Cognitive Enhancement in Epilepsy. Front Neurol 2019; 10:167. [PMID: 30890998 PMCID: PMC6413707 DOI: 10.3389/fneur.2019.00167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 02/08/2019] [Indexed: 12/02/2022] Open
Abstract
Epilepsy patients frequently experience cognitive difficulties, particularly in the domains of memory, attention, and executive function. Despite the frequency of these difficulties among epilepsy patients, current strategies to treat cognitive dysfunction are limited. We performed a systematic review of controlled trials of non-invasive cognitive enhancement in epilepsy. We identified studies examining the efficacy of pharmacological agents, namely the acetylcholinesterase inhibitors donepezil and galantamine, the NMDA non-competitive antagonist memantine, and the stimulant methylphenidate, as well as non-invasive non-pharmacological transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). We highlight the data currently available and the limitations of the current literature.
Collapse
Affiliation(s)
- Claire S Jacobs
- Division of Epilepsy, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Kim C Willment
- Department of Neurology, Edward B. Bromfield Epilepsy Program, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Rani A Sarkis
- Department of Neurology, Edward B. Bromfield Epilepsy Program, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| |
Collapse
|
17
|
Michaelis R, Tang V, Goldstein LH, Reuber M, LaFrance WC, Lundgren T, Modi AC, Wagner JL. Psychological treatments for adults and children with epilepsy: Evidence-based recommendations by the International League Against Epilepsy Psychology Task Force. Epilepsia 2018; 59:1282-1302. [PMID: 29917225 DOI: 10.1111/epi.14444] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2018] [Indexed: 12/12/2022]
Abstract
Given the significant impact that psychosocial factors and epilepsy treatments can have on the health-related quality of life (HRQOL) of individuals with epilepsy and their families, there is great clinical interest in the role of psychological evaluation and treatments to improve HRQOL and comorbidities. Therefore, the International League Against Epilepsy (ILAE) charged the Psychology Task Force with the development of recommendations for clinical care based on evaluation of the evidence from their recent Cochrane review of psychological treatments in individuals with epilepsy. The literature search for a recent Cochrane review of randomized controlled trials investigating psychological treatments for individuals with epilepsy constitutes the key source of evidence for this article. To provide practical guidance to service providers, we provide ratings on study research designs based on (1) the American Academy of Neurology's Level of Evidence system and (2) the Grading of Recommendations, Assessment, Development, and Evaluation system. This paper is the culmination of an international collaboration process involving pediatric and adult psychologists, neurologists, psychiatrists, and neuropsychiatrists. The process and conclusions were reviewed and approved by the ILAE Executive Committee. The strongest evidence for psychological interventions was identified for the most common mental health problems, including depression, neurocognitive disturbances, and medication adherence. Psychological interventions targeting the enhancement of HRQOL and adherence and a decrease in comorbidity symptoms (anxiety, depression) should be incorporated into comprehensive epilepsy care. There is a range of psychological strategies (ie, cognitive behavioral therapy and mindfulness-based therapies) that show promise for improving the lives of persons with epilepsy, and clinical recommendations are provided to assist epilepsy health care providers in treating the comorbidities and challenges associated with epilepsy and its treatments.
Collapse
Affiliation(s)
- Rosa Michaelis
- Department of Neurology, Herdecke Community Hospital, University of Witten/Herdecke, Herdecke, Germany.,Integrated Curriculum for Anthroposophical Medicine (ICURAM), Witten/Herdecke University, Herdecke, Germany.,Department of Neurology, Center for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria
| | - Venus Tang
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong.,Department of Clinical Psychology, Prince of Wales Hospital, Shatin, Hong Kong
| | - Laura H Goldstein
- Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Markus Reuber
- Academic Neurology Unit, Royal Hallamshire Hospital, University of Sheffield, Sheffield, UK
| | - William Curt LaFrance
- Departments of Psychiatry and Neurology, Rhode Island Hospital, Brown University, Providence, RI, USA
| | - Tobias Lundgren
- Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institute, Stockholm, Sweden
| | - Avani C Modi
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Janelle L Wagner
- College of Nursing and Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
18
|
Willems LM, Watermann N, Richter S, Kay L, Hermsen AM, Knake S, Rosenow F, Strzelczyk A. Incidence, Risk Factors and Consequences of Epilepsy-Related Injuries and Accidents: A Retrospective, Single Center Study. Front Neurol 2018; 9:414. [PMID: 29963000 PMCID: PMC6013746 DOI: 10.3389/fneur.2018.00414] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/18/2018] [Indexed: 12/23/2022] Open
Abstract
Introduction: This study was designed to evaluate risk factors and incidence of epilepsy-related injuries and accidents (ERIA) at an outpatient clinic of a German epilepsy center providing healthcare to a mixed urban and rural population of over one million inhabitants. Methods: Data acquisition was performed between 10/2013 and 09/2014 using a validated patient questionnaire on socioeconomic status, course of epilepsy, quality of life (QoL), depression, injuries and accidents associated with seizures or inadequate periictal patterns of behavior concerning a period of 3 months. Univariate analysis, multiple testing and regression analysis were performed to identify possible variables associated with ERIA. Results: A total of 292 patients (mean age 40.8 years, range 18-86; 55% female) were enrolled and analyzed. Focal epilepsy was diagnosed in 75% of the patients. The majority was on an antiepileptic drug (AEDs) polytherapy (mean number of AEDs: 1.65). Overall, 41 patients (14.0%) suffered from epilepsy-related injuries and accidents in a 3-month period. Besides lacerations (n = 18, 6.2%), abrasions and bruises (n = 9, 3.1%), fractures (n = 6, 2.2%) and burns (n = 3, 1.0%), 17 mild injuries (5.8%) were reported. In 20 (6.8% of the total cohort) cases, urgent medical treatment with hospitalization was necessary. Epilepsy-related injuries and accidents were related to active epilepsy, occurrence of generalized tonic-clonic seizures (GTCS) and drug-refractory course as well as reported ictal falls, ictal loss of consciousness and abnormal peri-ictal behavior in the medical history. In addition, patients with ERIA had significantly higher depression rates and lower QoL. Conclusion: ERIA and their consequences should be given more attention and standardized assessment for ERIA should be performed in every outpatient visit.
Collapse
Affiliation(s)
- Laurent M Willems
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt, Germany
| | - Nina Watermann
- Department of Neurology, Epilepsy Center Hessen, Philipps University of Marburg, Marburg, Germany
| | - Saskia Richter
- Department of Neurology, Epilepsy Center Hessen, Philipps University of Marburg, Marburg, Germany
| | - Lara Kay
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt, Germany
| | - Anke M Hermsen
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt, Germany
| | - Susanne Knake
- Department of Neurology, Epilepsy Center Hessen, Philipps University of Marburg, Marburg, Germany
| | - Felix Rosenow
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt, Germany.,Department of Neurology, Epilepsy Center Hessen, Philipps University of Marburg, Marburg, Germany
| | - Adam Strzelczyk
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt, Germany.,Department of Neurology, Epilepsy Center Hessen, Philipps University of Marburg, Marburg, Germany
| |
Collapse
|
19
|
Rawlings GH, Brown I, Stone B, Reuber M. A pilot randomised controlled trial of a home-based writing intervention for individuals with seizures. Psychol Health 2018; 33:1151-1171. [PMID: 29843528 DOI: 10.1080/08870446.2018.1478974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
OBJECTIVE We investigated the feasibility, acceptability and preliminary effectiveness of a writing intervention for individuals with epilepsy or psychogenic nonepileptic seizures. METHODS Individuals were randomised to write about potentially 'therapeutic' topics (n = 43) or about their daily events (n = 25). Participants were asked to write on four separate occasions for at least 20 min. Repeated-measures analysis of variance was used to investigate change in measures of health-related quality of life (NEWQoL-6D), depression (NDDI-E), anxiety (GAD-7) and illness perception (B-IPQ) from baseline to one and three-month follow-ups. Qualitative and quantitative data taken from a Writing Task Questionnaire was analysed between the two conditions. RESULTS Recruitment was acceptable with 52% of those randomised completing the full writing intervention. In both conditions, participants wrote for longer than 20 min suggesting those who completed the study engaged well with the procedure. Greater benefits were observed in the 'therapeutic' condition (p < 0.05), which was associated with an improvement in health-related quality of life at one-month follow-up (p = 0.02). No differences were found in the other measures. CONCLUSIONS A writing intervention is acceptable in this population. Self-reported benefits were modest, suggesting therapeutic writing may be more suitable as a supplement to other therapies rather than a stand-alone therapeutic intervention.
Collapse
Affiliation(s)
- Gregg H Rawlings
- a Academic Neurology Unit , University of Sheffield , Sheffield , UK
| | - Ian Brown
- b Department of Psychology , University of Sheffield , Sheffield , UK
| | - Brendan Stone
- c School of English , University of Sheffield , Sheffield , UK
| | - Markus Reuber
- a Academic Neurology Unit , University of Sheffield , Sheffield , UK
| |
Collapse
|
20
|
Meschede C, Witt JA, Rademacher M, von Wrede RD, Elger CE, Helmstaedter C. Evaluating the longer-term cognitive effects of adjunctive perampanel compared to lacosamide in a naturalistic outpatient setting. Seizure 2018; 58:141-146. [PMID: 29704679 DOI: 10.1016/j.seizure.2018.04.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/18/2018] [Accepted: 04/19/2018] [Indexed: 01/01/2023] Open
Abstract
PURPOSE This retrospective longitudinal study aims to compare the longer-term cognitive and behavioral side effects of adjunctive antiepileptic treatment with perampanel (PER) and lacosamide (LCM), two third generation antiepileptic drugs with suggested favorable cognitive profiles. The two drugs were monitored according to a previously established routine diagnostic protocol (Helmstaedter et al. E&B 2013;26:182-7) which facilitates the retrospective comparison of antiepileptic drug tolerability in a naturalistic outpatient setting. METHODS Records from 94 patients were evaluated who underwent neuropsychological assessment before and under adjunctive treatment with either PER (n = 57) or LCM (n = 37). Cognition was assessed using the EpiTrack screening for executive functions and a VLMT short form for verbal memory. Subjective assessments included a German QOLIE-10 adaptation (quality of life) and an extended Adverse Events Profile (AEP). The median follow-up interval was 36 weeks. RESULTS Multivariate repeated measures statistics revealed a non-significant trend towards an interaction effect "time - treatment arm" on both executive function and memory. When analyzed separately executive functions and memory scores significantly improved under LCM (t = -2.76 p < 0.01 and t = -2.44 p < 0.05 respectively). Subjectively, PER was associated with improvements in 2/18 physiological domains and in the LCM group 1/9 cognitive domains deteriorated. Seizure freedom was achieved for five patients treated with LCM (14%) and 15 treated with PER (26%, χ2 = 2.2, n.s.). CONCLUSION In a naturalistic outpatient setting, chronic adjunctive treatment with PER and LCM did not negatively affect cognition and LCM may even improve cognition. Neither drug increased self-reported irritability or aggression. This suggests favorable longer-term tolerability.
Collapse
Affiliation(s)
- Carolin Meschede
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany
| | - Juri-Alexander Witt
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany
| | - Michael Rademacher
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany
| | - Randi D von Wrede
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany
| | - Christian E Elger
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany
| | | |
Collapse
|
21
|
Feldman L, Lapin B, Busch RM, Bautista JF. Evaluating subjective cognitive impairment in the adult epilepsy clinic: Effects of depression, number of antiepileptic medications, and seizure frequency. Epilepsy Behav 2018; 81:18-24. [PMID: 29455082 DOI: 10.1016/j.yebeh.2017.10.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 09/22/2017] [Accepted: 10/07/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Subjective cognitive complaints are a frequent concern of patients with epilepsy. The Aldenkamp-Baker Neuropsychological Assessment Schedule (ABNAS) is a patient-reported scale validated to measure adverse cognitive effects of antiepileptic drugs (AEDs). The goals of this study were to identify predictors of patient-reported cognitive dysfunction and to assess the relationship between subjective and objective cognitive impairment. METHODS The Cleveland Clinic Knowledge Program Data Registry was used to identify adult patients seen in outpatient epilepsy clinic from January to May 2015 and who completed the following scales: ABNAS for subjective cognitive impairment, Patient Health Questionnaire (PHQ-9) for depression, Generalized Anxiety Disorder 7-item (GAD-7) scale, Quality of Life in Epilepsy (QOLIE-10), and EuroQOL five dimensions questionnaire (EQ-5D) for health-related quality of life. Topiramate (TPM) was considered a high-risk medication for cognitive impairment. Patients were categorized into groups based on total ABNAS score: subjective cognitive impairment (ABNAS>15; N=270) and no subjective cognitive impairment (ABNAS≤15; N=400). Multivariable logistic regression models were constructed to identify independent predictors of subjective cognitive impairment. In a subset of patients who had neuropsychological testing within 6months of completing the ABNAS (N=60), Pearson correlations and multivariable logistic regression models, controlling for number of AEDs, depression, and anxiety, assessed the relationship between subjective cognitive impairment and objective cognitive performance on measures of intelligence, attention/working memory, verbal fluency, naming, processing speed, manual dexterity, visuomotor processing, and verbal memory. RESULTS Forty percent of patients in the overall sample (N=270/670) reported cognitive impairment. The variables most strongly associated with subjective cognitive impairment were PHQ-9 score, number of AEDs, and seizure frequency. In the subset of patients with neuropsychological testing, ABNAS score was correlated with anxiety (r=0.44), depression (r=0.38), and attention/working memory (r=-0.31). After adjusting for depression and anxiety, patients who endorsed subjective cognitive impairment scored significantly lower on measures of nonverbal intelligence and attention/working memory, but not on other cognitive measures. CONCLUSIONS Subjective cognitive impairment as reported on the ABNAS is most strongly associated with depressive symptomatology, number of AEDs, and seizure frequency, but not with most objective cognitive measures. Identifying these three predictors provides a clear framework to understand and address subjective cognitive complaints in adult patients with epilepsy.
Collapse
Affiliation(s)
- Lauren Feldman
- Department of Neurology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Brittany Lapin
- Department of Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Robyn M Busch
- Department of Psychiatry and Psychology, Cleveland Clinic, 2070 East 90th Street, Cleveland, OH 44195, United States; Epilepsy Center, Cleveland Clinic, 9500 Euclid Avenue S51, Cleveland, OH 44195, United States
| | - Jocelyn F Bautista
- Department of Neurology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States; Epilepsy Center, Cleveland Clinic, 9500 Euclid Avenue S51, Cleveland, OH 44195, United States.
| |
Collapse
|
22
|
Lenoir D, De Pauw R, Ickmans K, Schumacher C, Timmers I, Kregel J, Coppieters I. Validity and Test-Retest Reliability of the Dutch Modified Perceived Deficits Questionnaire to Examine Cognitive Symptoms in Women with Chronic Whiplash, Chronic Idiopathic Neck Pain, and Fibromyalgia. Pain Pract 2018; 18:850-863. [PMID: 29383819 DOI: 10.1111/papr.12683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 01/23/2018] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Until now, only reliability and validity of the English version of the modified Perceived Deficits Questionnaire (mPDQ) have been investigated. OBJECTIVE The aim of this study was to translate the mPDQ into Dutch and evaluate its validity and reliability as an assessment tool for self-perceived cognitive problems in patients with chronic whiplash-associated disorders (CWAD), chronic idiopathic neck pain (CINP), and fibromyalgia (FM). METHODS A case-control study was performed with a volunteer sample of 13 women with CWAD, 18 with CINP, and 33 with FM, and 33 women who were healthy and free of pain. The mPDQ was first translated into Dutch, and its test-retest reliability, internal consistency, and discriminative power were examined. RESULTS The intraclass correlation coefficients were higher than 0.74. Cronbach's α values ranged between 0.71 and 0.95. Total mPDQ scores were significantly higher (P < 0.017) in FM and CWAD patients compared to healthy controls. Furthermore, participants performed the Stroop task and the psychomotor vigilance task (PVT), 2 neuropsychological computer-based cognitive performance tests. Correlations between the mPDQ total score and the cognitive performance tests were evaluated. Significant moderate to high correlations were found in all study samples between total mPDQ score and objective cognitive tests (Spearman correlation coefficient = 0.35 to 0.80; P < 0.05). CONCLUSION Therefore, the Dutch version of the mPDQ showed high test-retest reliability and high internal consistency, and was able to distinguish CWAD and FM patients from healthy controls. PERSPECTIVE This article presents the validity and test-retest reliability of the Dutch mPDQ. This measure could help clinicians who seek a reliable and user-friendly way to assess cognitive symptoms in chronic pain patients.
Collapse
Affiliation(s)
- D Lenoir
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion International Research Group
| | - R De Pauw
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - K Ickmans
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussels, Brussels, Belgium
| | - C Schumacher
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - I Timmers
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands.,Department of Rehabilitation Medicine, Maastricht University, Maastricht, The Netherlands
| | - J Kregel
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussels, Brussels, Belgium
| | - I Coppieters
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion International Research Group
| |
Collapse
|
23
|
Helmstaedter C, Pandolfo RV, Hoppe C, Witt JA. Cognitive-behavioral correlates of proxy reports on cognitive capabilities in pediatric patients with epilepsy. Seizure 2017; 51:193-199. [DOI: 10.1016/j.seizure.2017.08.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 08/22/2017] [Accepted: 08/24/2017] [Indexed: 10/18/2022] Open
|
24
|
van Veenendaal TM, IJff DM, Aldenkamp AP, Lazeron RHC, Hofman PAM, de Louw AJA, Backes WH, Jansen JFA. Chronic antiepileptic drug use and functional network efficiency: A functional magnetic resonance imaging study. World J Radiol 2017; 9:287-294. [PMID: 28717415 PMCID: PMC5491656 DOI: 10.4329/wjr.v9.i6.287] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 02/24/2017] [Accepted: 03/24/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To increase our insight in the neuronal mechanisms underlying cognitive side-effects of antiepileptic drug (AED) treatment.
METHODS The relation between functional magnetic resonance-acquired brain network measures, AED use, and cognitive function was investigated. Three groups of patients with epilepsy with a different risk profile for developing cognitive side effects were included: A “low risk” category (lamotrigine or levetiracetam, n = 16), an “intermediate risk” category (carbamazepine, oxcarbazepine, phenytoin, or valproate, n = 34) and a “high risk” category (topiramate, n = 5). Brain connectivity was assessed using resting state functional magnetic resonance imaging and graph theoretical network analysis. The Computerized Visual Searching Task was used to measure central information processing speed, a common cognitive side effect of AED treatment.
RESULTS Central information processing speed was lower in patients taking AEDs from the intermediate and high risk categories, compared with patients from the low risk category. The effect of risk category on global efficiency was significant (P < 0.05, ANCOVA), with a significantly higher global efficiency for patient from the low category compared with the high risk category (P < 0.05, post-hoc test). Risk category had no significant effect on the clustering coefficient (ANCOVA, P > 0.2). Also no significant associations between information processing speed and global efficiency or the clustering coefficient (linear regression analysis, P > 0.15) were observed.
CONCLUSION Only the four patients taking topiramate show aberrant network measures, suggesting that alterations in functional brain network organization may be only subtle and measureable in patients with more severe cognitive side effects.
Collapse
|
25
|
Sałat K, Podkowa A, Malikowska N, Trajer J. Effect of pregabalin on fear-based conditioned avoidance learning and spatial learning in a mouse model of scopolamine-induced amnesia. Toxicol Mech Methods 2017; 27:181-190. [PMID: 27996351 DOI: 10.1080/15376516.2016.1273426] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Cognitive deficits are one of the frequent symptoms accompanying epilepsy or its treatment. METHODS In this study, the effect on cognition of intraperitoneally administered antiepileptic drug, pregabalin (10 mg/kg), was investigated in scopolamine-induced memory-impaired mice in the passive avoidance task and Morris water maze task. The effect of scopolamine and pregabalin on animals' locomotor activity was also studied. RESULTS In the retention phase of the passive avoidance task, pregabalin reversed memory deficits induced by scopolamine (p < 0.05). During the acquisition phase of the Morris water maze pregabalin-treated memory-impaired mice performed the test with longer escape latencies than the vehicle-treated mice (significant at p < 0.05 on Day 5, and at p < 0.001 on Day 6). There were no differences in this parameter between the scopolamine-treated control group and pregabalin-treated memory-impaired mice, which indicated that pregabalin had no influence on spatial learning in this task. During the probe trial a significant difference (p < 0.05) was observed in terms of the mean number of target crossings between vehicle-treated mice and pregabalin-treated memory-impaired mice but there was no difference between the scopolamine-treated control group and mice treated with pregabalin + scopolamine. Pregabalin did not influence locomotor activity increased by scopolamine. DISCUSSION In passive avoidance task, pregabalin reversed learning deficits induced by scopolamine. In the Morris water maze, pregabalin did not influence spatial learning deficits induced by scopolamine. These results are relevant for epileptic patients treated with pregabalin and those who use it for other therapeutic indications (anxiety, pain).
Collapse
Affiliation(s)
- Kinga Sałat
- a Department of Pharmacodynamics, Faculty of Pharmacy , Jagiellonian University, Medical College , Krakow , Poland
| | - Adrian Podkowa
- a Department of Pharmacodynamics, Faculty of Pharmacy , Jagiellonian University, Medical College , Krakow , Poland
| | - Natalia Malikowska
- a Department of Pharmacodynamics, Faculty of Pharmacy , Jagiellonian University, Medical College , Krakow , Poland
| | - Jędrzej Trajer
- b Department of Fundamental Engineering, Faculty of Production Engineering , Warsaw University of Life Sciences , Warsaw , Poland
| |
Collapse
|
26
|
van Veenendaal TM, IJff DM, Aldenkamp AP, Lazeron RHC, Puts NAJ, Edden RAE, Hofman PAM, de Louw AJA, Backes WH, Jansen JFA. Glutamate concentrations vary with antiepileptic drug use and mental slowing. Epilepsy Behav 2016; 64:200-205. [PMID: 27744245 DOI: 10.1016/j.yebeh.2016.08.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 08/26/2016] [Accepted: 08/30/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Although antiepileptic drugs (AEDs) are effective in suppressing epileptic seizures, they also induce (cognitive) side effects, with mental slowing as a general effect. This study aimed to assess whether concentrations of MR detectable neurotransmitters, glutamate and GABA, are associated with mental slowing in patients with epilepsy taking AEDs. METHODS Cross-sectional data were collected from patients with localization-related epilepsy using a variety of AEDs from three risk categories, i.e., AEDs with low, intermediate, and high risks of developing cognitive problems. Patients underwent 3T MR spectroscopy, including a PRESS (n=55) and MEGA-PRESS (n=43) sequence, to estimate occipital glutamate and GABA concentrations, respectively. The association was calculated between neurotransmitter concentrations and central information processing speed, which was measured using the Computerized Visual Searching Task (CVST) and compared between the different risk categories. RESULTS Combining all groups, patients with lower processing speeds had lower glutamate concentrations. Patients in the high-risk category had a lower glutamate concentration and lower processing speed compared with patients taking low-risk AEDs. Patients taking intermediate-risk AEDs also had a lower glutamate concentration compared with patients taking low-risk AEDs, but processing speed did not differ significantly between those groups. No associations were found between the GABA concentration and risk category or processing speed. CONCLUSIONS For the first time, a relation is shown between glutamate concentration and both mental slowing and AED use. It is suggested that the reduced excitatory action, reflected by lowered glutamate concentrations, may have contributed to the slowing of information processing in patients using AEDs with higher risks of cognitive side effects.
Collapse
Affiliation(s)
- Tamar M van Veenendaal
- Departments of Radiology and Nuclear Medicine, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; School for Mental Health and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | - Dominique M IJff
- School for Mental Health and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Departments of Neurology and Neuropsychology, Epilepsy Center Kempenhaeghe, P.O. Box 61, 5590 AB Heeze, The Netherlands and Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, The Netherlands.
| | - Albert P Aldenkamp
- School for Mental Health and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Departments of Neurology and Neuropsychology, Epilepsy Center Kempenhaeghe, P.O. Box 61, 5590 AB Heeze, The Netherlands and Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, The Netherlands; Department of Neurology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; Department of Neurology, Gent University Hospital, De Pintelaan 185, 9000 Gent, Belgium; Faculty of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands.
| | - Richard H C Lazeron
- Departments of Neurology and Neuropsychology, Epilepsy Center Kempenhaeghe, P.O. Box 61, 5590 AB Heeze, The Netherlands and Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, The Netherlands.
| | - Nicolaas A J Puts
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, 601 N Caroline St., Baltimore 21287, MD, USA; F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, 707 North Broadway, Baltimore 21205, MD, USA.
| | - Richard A E Edden
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, 601 N Caroline St., Baltimore 21287, MD, USA; F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, 707 North Broadway, Baltimore 21205, MD, USA.
| | - Paul A M Hofman
- Departments of Radiology and Nuclear Medicine, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; School for Mental Health and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Departments of Neurology and Neuropsychology, Epilepsy Center Kempenhaeghe, P.O. Box 61, 5590 AB Heeze, The Netherlands and Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, The Netherlands.
| | - Anton J A de Louw
- Departments of Neurology and Neuropsychology, Epilepsy Center Kempenhaeghe, P.O. Box 61, 5590 AB Heeze, The Netherlands and Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, The Netherlands; Department of Neurology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; Faculty of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands.
| | - Walter H Backes
- Departments of Radiology and Nuclear Medicine, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; School for Mental Health and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | - Jacobus F A Jansen
- Departments of Radiology and Nuclear Medicine, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; School for Mental Health and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| |
Collapse
|
27
|
Do We Know What We Think We Know? Reconciling Subjective Complaints and Objective Cognitive Testing in Older Adults With Epilepsy. Epilepsy Curr 2016; 16:230-1. [PMID: 27582656 DOI: 10.5698/1535-7511-16.4.230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
28
|
|