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Fang S, Zhu C, Zhang J, Wu L, Zhang Y, Huang H, Lin W. EEG microstates in epilepsy with and without cognitive dysfunction: Alteration in intrinsic brain activity. Epilepsy Behav 2024; 154:109729. [PMID: 38513568 DOI: 10.1016/j.yebeh.2024.109729] [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: 10/24/2023] [Revised: 02/27/2024] [Accepted: 02/27/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE This study aims to investigate the difference between epilepsy comorbid with and without cognitive dysfunction. METHOD Participants were classified into patients with epilepsy comorbid cognitive dysfunction (PCCD) and patients with epilepsy without comorbid cognitive dysfunction (nPCCD). Microstate analysis was applied based on 20-channel electroencephalography (EEG) to detect the dynamic changes in the whole brain. The coverage, occurrence per second, duration, and transition probability were calculated. RESULT The occurrence per second and the coverage of microstate B in the PCCD group were higher than that of the nPCCD group. Coverage in microstate D was lower in the PCCD group than in the nPCCD group. In addition, the PCCD group has a higher probability of A to B and B to A transitions and a lower probability of A to D and D to A transitions. CONCLUSION Our research scrutinizes the disparities observed within EEG microstates among epilepsy patients both with and without comorbid cognitive dysfunction. SIGNIFICANCE EEG microstate analysis offers a novel metric for assessing neuropsychiatric disorders and supplies evidence for investigating the mechanisms and the dynamic change of epilepsy comorbid cognitive dysfunction.
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Affiliation(s)
- Shenzhi Fang
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, PR China
| | - Chaofeng Zhu
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, PR China
| | - Jinying Zhang
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, PR China
| | - Luyan Wu
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, PR China
| | - Yuying Zhang
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, PR China
| | - Huapin Huang
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, PR China; Fujian Key Laboratory of Molecular Neurology, Fuzhou, PR China; Department of Geriatrics, Fujian Medical University Union Hospital, Fuzhou, PR China.
| | - Wanhui Lin
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, PR China; Fujian Key Laboratory of Molecular Neurology, Fuzhou, PR China.
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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.
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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
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Ochoa-Morales A, Fresan-Orellana A, Ramírez-García MÁ, Márquez-González H, Martínez-Juárez IE, López-Uribe M, Zuniga-García C, Jara-Prado A, Luis Guerrero-Camacho J, Dávila-Ortiz de Montellano DJ. Low quality of life, increased number of anti-seizure drugs, and the lack of caregiver support are associated with internalized stigma in adult Mexican patients with epilepsy. Epilepsy Behav 2023; 144:109268. [PMID: 37245482 DOI: 10.1016/j.yebeh.2023.109268] [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: 02/23/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND People with epilepsy (PWE) have been subject to stigma throughout history, a factor that could compromise their performance in daily life. In Mexico, little is known about the factors that may be affecting internalized stigma. OBJECTIVE To evaluate the internalized stigma in adult PWE, its relationship with the quality of life, cognitive and depressive symptomatology, and clinical-demographic characteristics. MATERIAL AND METHODS We conducted a cross-sectional study with a consecutive sampling approach in patients with epilepsy treated at the National Institute of Neurology and Neurosurgery Manuel Velasco Suárez (NINNMVS). Sociodemographic and clinical data, depressive symptomatology (Beck's depression inventory, DBI), cognition (MoCA test), quality of life (QOLIE-31 scale), and internalized stigma (King's internalized stigma scale, ISS) were evaluated. Correlations were made between the continuous variables and the ISS to select those with statistical significance and include them in a multiple linear regression model, along with the dummy variables, to explain internalized stigma. RESULTS Of 128 patients, 74 (58%) were women; 38% of the patients had more than 20 years of epilepsy evolution. In addition, 39% presented depressive symptoms, and around 60% manifested a possible cognitive impairment. The variables that showed statistical significance concerning the ISS were selected along with dummy variables for multiple linear regression analysis. The resultant model considers the QOLIE-31 total score (β = -0.489), the number of anti-seizure drugs (ASD, β = 0.253), and those patients without caregiver support (β = -0.166) with an adjusted R2 value of 0.316. CONCLUSIONS A diminishing quality of life, an increased number of ASD, and patients without caregiver support influence a slight to moderate variation of internalized stigma in Mexican PWE. Therefore, it is necessary to continue studying other possible factors that influence internalized stigma to generate effective strategies to reduce its negative effects on PWE.
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Affiliation(s)
- Adriana Ochoa-Morales
- Genetics Department. National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez, Mexico City, Mexico
| | - Ana Fresan-Orellana
- Clinical Epidemiology Laboratory, Clinical Research Directorate. National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Miguel Ángel Ramírez-García
- Genetics Department. National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez, Mexico City, Mexico
| | - Horacio Márquez-González
- Clinical Research Department. Children's Hospital of Mexico, Federico Gómez, Mexico City, Mexico
| | - Iris E Martínez-Juárez
- Epilepsy Clinic. National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez, Mexico City, Mexico
| | - Mayra López-Uribe
- Social Work Department. National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez, Mexico City, Mexico
| | - Carol Zuniga-García
- Genetics Department. National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez, Mexico City, Mexico
| | - Aurelio Jara-Prado
- Genetics Department. National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez, Mexico City, Mexico
| | - Jorge Luis Guerrero-Camacho
- Genetics Department. National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez, Mexico City, Mexico
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Ren Z, Zhao Y, Han X, Yue M, Wang B, Zhao Z, Wen B, Hong Y, Wang Q, Hong Y, Zhao T, Wang N, Zhao P. An objective model for diagnosing comorbid cognitive impairment in patients with epilepsy based on the clinical-EEG functional connectivity features. Front Neurosci 2023; 16:1060814. [PMID: 36711136 PMCID: PMC9878185 DOI: 10.3389/fnins.2022.1060814] [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] [Received: 10/15/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023] Open
Abstract
Objective Cognitive impairment (CI) is a common disorder in patients with epilepsy (PWEs). Objective assessment method for diagnosing CI in PWEs would be beneficial in reality. This study proposed to construct a diagnostic model for CI in PWEs using the clinical and the phase locking value (PLV) functional connectivity features of the electroencephalogram (EEG). Methods PWEs who met the inclusion and exclusion criteria were divided into a cognitively normal (CON) group (n = 55) and a CI group (n = 76). The 23 clinical features and 684 PLV EEG features at the time of patient visit were screened and ranked using the Fisher score. Adaptive Boosting (AdaBoost) and Gradient Boosting Decision Tree (GBDT) were used as algorithms to construct diagnostic models of CI in PWEs either with pure clinical features, pure PLV EEG features, or combined clinical and PLV EEG features. The performance of these models was assessed using a five-fold cross-validation method. Results GBDT-built model with combined clinical and PLV EEG features performed the best with accuracy, precision, recall, F1-score, and an area under the curve (AUC) of 90.11, 93.40, 89.50, 91.39, and 0.95%. The top 5 features found to influence the model performance based on the Fisher scores were the magnetic resonance imaging (MRI) findings of the head for abnormalities, educational attainment, PLV EEG in the beta (β)-band C3-F4, seizure frequency, and PLV EEG in theta (θ)-band Fp1-Fz. A total of 12 of the top 5% of features exhibited statistically different PLV EEG features, while eight of which were PLV EEG features in the θ band. Conclusion The model constructed from the combined clinical and PLV EEG features could effectively identify CI in PWEs and possess the potential as a useful objective evaluation method. The PLV EEG in the θ band could be a potential biomarker for the complementary diagnosis of CI comorbid with epilepsy.
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Affiliation(s)
- Zhe Ren
- Department of Neurology, Zhengzhou University People’s Hospital, Zhengzhou, Henan, China
| | - Yibo Zhao
- Department of Neurology, Zhengzhou University People’s Hospital, Zhengzhou, Henan, China
| | - Xiong Han
- Department of Neurology, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China,*Correspondence: Xiong Han,
| | - Mengyan Yue
- Department of Rehabilitation, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Bin Wang
- Department of Neurology, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Zongya Zhao
- School of Medical Engineering, Xinxiang Medical University, Xinxiang, Henan, China
| | - Bin Wen
- School of Life Sciences and Technology, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Yang Hong
- Department of Neurology, People’s Hospital of Henan University, Zhengzhou, Henan, China
| | - Qi Wang
- Department of Neurology, Zhengzhou University People’s Hospital, Zhengzhou, Henan, China
| | - Yingxing Hong
- Department of Neurology, People’s Hospital of Henan University, Zhengzhou, Henan, China
| | - Ting Zhao
- Department of Neurology, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Na Wang
- Department of Neurology, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Pan Zhao
- Department of Neurology, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Novak A, Vizjak K, Gacnik A, Rakusa M. Cognitive impairment in people with epilepsy: Montreal Cognitive Assessment (MoCA) as a screening tool. Acta Neurol Belg 2022; 123:451-456. [PMID: 35925540 DOI: 10.1007/s13760-022-02046-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 07/19/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Although cognitive impairment is common in people with epilepsy, it is often neglected in outpatient clinics. MoCA is a simple and reliable test, which was validated for the cognitive screening of Alzheimer's and vascular dementia. The aim of our study was to evaluate MoCA as a tool for a cognitive screening of people with epilepsy. METHODS Our study included 50 people with epilepsy and 46 healthy individuals. All participants took the Slovenian version of the MoCA. Mean age, education and MoCA scores were compared between the two groups. RESULTS There was no significant difference between people with epilepsy and the controls in age (47.6, SD 18.1 vs 50.9, SD 14.0 years) or education (12.8, SD 2.8 vs 13.4, SD 2.8 years). People with epilepsy had significantly lower total MoCA scores than did the controls (23.3, SD 4.5 vs 27.5, SD 1.9 points; p < 0.001). CONCLUSIONS People with epilepsy achieved a lower score in several cognitive domains compared to the control group. MoCA can be used as an appropriate screening tool for cognitive impairment in people with epilepsy in the outpatient clinic. For a more accurate evaluation, neuropsychological assessments should be used.
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Affiliation(s)
- Ajda Novak
- Divison of Neurology, University Medical Centre Maribor, Maribor, Slovenia
| | - Karmen Vizjak
- Divison of Neurology, University Medical Centre Maribor, Maribor, Slovenia
| | - Albin Gacnik
- Divison of Neurology, University Medical Centre Maribor, Maribor, Slovenia
| | - Martin Rakusa
- Divison of Neurology, University Medical Centre Maribor, Maribor, Slovenia.
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