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Struck AF, Garcia-Ramos C, Nair VA, Prabhakaran V, Dabbs K, Conant LL, Binder JR, Loring D, Meyerand M, Hermann BP. The relevance of Spearman's g for epilepsy. Brain Commun 2024; 6:fcae176. [PMID: 38883806 PMCID: PMC11179110 DOI: 10.1093/braincomms/fcae176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 04/18/2024] [Accepted: 06/10/2024] [Indexed: 06/18/2024] Open
Abstract
Whilst the concept of a general mental factor known as 'g' has been of longstanding interest, for unknown reasons, it has never been interrogated in epilepsy despite the 100+ year empirical history of the neuropsychology of epilepsy. This investigation seeks to identify g within a comprehensive neuropsychological data set and compare participants with temporal lobe epilepsy to controls, characterize the discriminatory power of g compared with domain-specific cognitive metrics, explore the association of g with clinical epilepsy and sociodemographic variables and identify the structural and network properties associated with g in epilepsy. Participants included 110 temporal lobe epilepsy patients and 79 healthy controls between the ages of 19 and 60. Participants underwent neuropsychological assessment, clinical interview and structural and functional imaging. Cognitive data were subjected to factor analysis to identify g and compare the group of patients with control participants. The relative power of g compared with domain-specific tests was interrogated, clinical and sociodemographic variables were examined for their relationship with g, and structural and functional images were assessed using traditional regional volumetrics, cortical surface features and network analytics. Findings indicate (i) significantly (P < 0.005) lower g in patients compared with controls; (ii) g is at least as powerful as individual cognitive domain-specific metrics and other analytic approaches to discriminating patients from control participants; (iii) lower g was associated with earlier age of onset and medication use, greater number of antiseizure medications and longer epilepsy duration (Ps < 0.04); and lower parental and personal education and greater neighbourhood deprivation (Ps < 0.012); and (iv) amongst patients, lower g was linked to decreased total intracranial volume (P = 0.019), age and intracranial volume adjusted total tissue volume (P = 0.019) and age and intracranial volume adjusted total corpus callosum volume (P = 0.012)-particularly posterior, mid-posterior and anterior (Ps < 0.022) regions. Cortical vertex analyses showed lower g to be associated specifically with decreased gyrification in bilateral medial orbitofrontal regions. Network analysis of resting-state data with focus on the participation coefficient showed g to be associated with the superior parietal network. Spearman's g is reduced in patients, has considerable discriminatory power compared with domain-specific metrics and is linked to a multiplex of factors related to brain (size, connectivity and frontoparietal networks), environment (familial and personal education and neighbourhood disadvantage) and disease (epilepsy onset, treatment and duration). Greater attention to contemporary models of human cognition is warranted in order to advance the neuropsychology of epilepsy.
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Affiliation(s)
- Aaron F Struck
- Department of Neurology, University of Wisconsin–Madison, Madison, WI 53726, USA
- Department of Neurology, William S. Middleton Veterans Administration Hospital, Madison, WI 53705, USA
| | - Camille Garcia-Ramos
- Department of Neurology, University of Wisconsin–Madison, Madison, WI 53726, USA
| | - Veena A Nair
- Department of Radiology, University of Wisconsin–Madison, Madison, WI 53726, USA
| | - Vivek Prabhakaran
- Department of Radiology, University of Wisconsin–Madison, Madison, WI 53726, USA
| | - Kevin Dabbs
- Department of Neurology, University of Wisconsin–Madison, Madison, WI 53726, USA
| | - Lisa L Conant
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Jeffrey R Binder
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - David Loring
- Department of Neurology and Pediatrics, Emory University, Atlanta, GA 30322, USA
| | - Mary Meyerand
- Department of Medical Physics, Wisconsin-Madison, Madison, WI 53726, USA
| | - Bruce P Hermann
- Department of Neurology, University of Wisconsin–Madison, Madison, WI 53726, USA
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2
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Azuma H, Akechi T. EEG
correlates of quality of life and associations with seizure without awareness and depression in patients with epilepsy. Neuropsychopharmacol Rep 2022; 42:333-342. [PMID: 35724977 PMCID: PMC9515718 DOI: 10.1002/npr2.12276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 11/24/2022] Open
Abstract
Aims Quality of life (QOL) is an important issue for not only patients with epilepsy but also physicians. Depression has a large impact on QOL. Nonlinear electroencephalogram (EEG) analysis using machine learning (ML) has the potential to improve the accuracy of the diagnosis of epilepsy. Therefore, in this study, we examined EEG nonlinearity, EEG correlates of QOL in patients with epilepsy, and the accuracy of EEG for the interval from seizure without awareness (SA–) and for depression, using ML. Methods The Side Effects and Life Satisfaction (SEALS) inventory was used to assess QOL, and the Neurological Disorders Depression Inventory for Epilepsy (NDDI‐E) was used as a screening tool for depression on the date of the EEG recording. EEG with wavelet denoising (WD), the Savitzky–Golay filter, and non‐denoising were created in combination with low‐ and high‐pass filters. These EEG sets were adopted for phase space reconstruction methods. Using a generalized linear mixed‐effects model for SEALS, sample entropy as a measurement of regularity, SA–, seizure with awareness, and depression were examined. Results WD and non‐denoising EEG sets in the bilateral posterior temporal‐occipital, centro‐parietal, parieto‐occipital, and Fz–Cz of the 10–20 method were associated with SEALS and demonstrated nonlinearity, and the moderate effects of classification for the interval elapsed from SA– and for depression. When the intervals from SA– were added, the effects of the EEG classification for depression increased. Conclusion These findings suggest that EEG regions associated with QOL showing nonlinearity are useful for classifying SA– and depression. Wavelet denoising and non‐denoising EEG sets in the bilateral posterior temporal‐occipital, centro‐parietal, parieto‐occipital, and Fz‐Cz of the 10‐20 method were associated with the Side Effects and Life Satisfaction inventory and demonstrated nonlinearity, and the moderate effects of classification for the interval elapsed from seizure without awareness and for depression. When the intervals from seizure without awareness were added, the effects of the EEG classification for depression increased.![]()
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Affiliation(s)
- Hideki Azuma
- Department of Psychiatry and Cognitive‐Behavioral Medicine Nagoya City University Graduate School of Medical Sciences Nagoya Japan
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive‐Behavioral Medicine Nagoya City University Graduate School of Medical Sciences Nagoya Japan
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3
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Fan B, Pang L, Li S, Zhou X, Lv Z, Chen Z, Zheng J. Correlation Between the Functional Connectivity of Basal Forebrain Subregions and Vigilance Dysfunction in Temporal Lobe Epilepsy With and Without Focal to Bilateral Tonic-Clonic Seizure. Front Psychiatry 2022; 13:888150. [PMID: 35722568 PMCID: PMC9201520 DOI: 10.3389/fpsyt.2022.888150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/12/2022] [Indexed: 12/02/2022] Open
Abstract
PURPOSE Previous research has shown that subcortical brain regions are related to vigilance in temporal lobe epilepsy (TLE). However, it is unknown whether alterations in the function and structure of basal forebrain (BF) subregions are associated with vigilance impairment in distinct kinds of TLE. We aimed to investigate changes in the structure and function BF subregions in TLE patients with and without focal to bilateral tonic-clonic seizures (FBTCS) and associated clinical features. METHODS A total of 50 TLE patients (25 without and 25 with FBTCS) and 25 healthy controls (HCs) were enrolled in this study. The structural and functional alterations of BF subregions in TLE were investigated using voxel-based morphometry (VBM) and resting-state functional connectivity (rsFC) analysis. Correlation analyses were utilized to investigate correlations between substantially altered imaging characteristics and clinical data from patients. RESULTS FBTCS patients had a lower rsFC between Ch1-3 and the bilateral striatum as well as the left cerebellum posterior lobe than non-FBTCS patients. In comparison to non-FBTCS patients, the rsFC between Ch4 and the bilateral amygdala was also lower in FBTCS patients. Compared to HCs, the TLE patients had reduced rsFC between the BF subregions and the cerebellum, striatum, default mode network, frontal lobe, and occipital lobes. In the FBTCS group, the rsFC between the left Ch1-3 and striatum was positive correlated with the vigilance measures. In the non-FBTCS group, the rsFC between the left Ch4 and striatum was significantly negative correlated with the alertness measure. CONCLUSION These results extend current understanding of the pathophysiology of impaired vigilance in TLE and imply that the BF subregions may serve as critical nodes for developing and categorizing TLE biomarkers.
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Affiliation(s)
- Binglin Fan
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Linlin Pang
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Siyi Li
- Department of Neurology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Xia Zhou
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zongxia Lv
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zexiang Chen
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jinou Zheng
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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McMillan TM, Mason CA, Seidenberg M, Jones J, Hermann B. The impact of processing speed on cognition in temporal lobe epilepsy. Epilepsy Behav 2021; 122:108203. [PMID: 34274747 PMCID: PMC8565181 DOI: 10.1016/j.yebeh.2021.108203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/27/2021] [Accepted: 06/29/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To characterize the impact of slowed processing speed on the efficiency of broader cognitive function in temporal lobe epilepsy (TLE). METHODS Participants included 100 patients with TLE and 89 healthy controls (mean ages 36.8 and 33.6, respectively) administered a neuropsychological battery consisting of 15 cognitive metrics. Confirmatory factor analysis using structural equation modeling (SEM) latent variable modeling demonstrated a cognitive structure representing the domains of verbal intelligence, immediate memory, delayed memory, executive function, working memory, and processing speed. Furthermore, the latent variable measurement model determined the direct and indirect relationships of verbal intelligence and processing speed with immediate memory, delayed memory, executive function, and working memory. RESULTS Following SEM of hypothesized structural models, the results demonstrated that, among controls, intelligence had a direct and unmediated (by processing speed) relationship with all identified cognitive domains. In contrast, among participants with TLE, processing speed mediated the relationship between verbal intelligence and performance across all cognitive domains. CONCLUSION Slowing of cognitive/psychomotor processing speed appears to play a critical mediating role in the broader cognitive status of participants with TLE and may serve as a target through which to attempt to exert a broad positive impact on neuropsychological status.
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Affiliation(s)
- Taylor M. McMillan
- Department of Psychology, University of Maine, 301 Little Hall, Orono, ME 04469, USA,Corresponding author at: Department of Psychology, University of Maine-Orono, 301 Little Hall, Orono, ME 04469, USA., (T.M. McMillan)
| | - Craig A. Mason
- School of Learning and Teaching, University of Maine, 5766 Shibles Hall, Orono, ME 04469, USA
| | - Michael Seidenberg
- Department of Psychology, Rosalind Franklin University of Science and Medicine, 3333 N. Green Bay Road, North Chicago, IL 60064, USA
| | - Jana Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI 53705, USA
| | - Bruce Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI 53705, USA
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Leek NJ, Neason M, Kreilkamp BAK, de Bezenac C, Ziso B, Elkommos S, Das K, Marson AG, Keller SS. Thalamohippocampal atrophy in focal epilepsy of unknown cause at the time of diagnosis. Eur J Neurol 2020; 28:367-376. [PMID: 33012040 DOI: 10.1111/ene.14565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 09/24/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND PURPOSE Patients with chronic focal epilepsy may have atrophy of brain structures important for the generation and maintenance of seizures. However, little research has been conducted in patients with newly diagnosed focal epilepsy (NDfE), despite it being a crucial point in time for understanding the underlying biology of the disorder. We aimed to determine whether patients with NDfE show evidence of volumetric abnormalities of subcortical structures. METHODS Eighty-two patients with NDfE and 40 healthy controls underwent magnetic resonance imaging scanning using a standard clinical protocol. Volume estimation of the left and right hippocampus, thalamus, caudate nucleus, putamen and cerebral hemisphere was performed for all participants and normalised to whole brain volume. Volumes lower than two standard deviations below the control mean were considered abnormal. Volumes were analysed with respect to patient clinical characteristics, including treatment outcome 12 months after diagnosis. RESULTS Volume of the left hippocampus (p(FDR-corr) = 0.04) and left (p(FDR-corr) = 0.002) and right (p(FDR-corr) = 0.04) thalamus was significantly smaller in patients relative to controls. Relative to the normal volume limits in controls, 11% patients had left hippocampal atrophy, 17% had left thalamic atrophy and 9% had right thalamic atrophy. We did not find evidence of a relationship between volumes and future seizure control or with other clinical characteristics of epilepsy. CONCLUSIONS Volumetric abnormalities of structures known to be important for the generation and maintenance of focal seizures are established at the time of epilepsy diagnosis and are not necessarily a result of the chronicity of the disorder.
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Affiliation(s)
- N J Leek
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - M Neason
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - B A K Kreilkamp
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - C de Bezenac
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - B Ziso
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - S Elkommos
- St. George's University Hospitals NHS Foundation Trust, London, UK
| | - K Das
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - A G Marson
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - S S Keller
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,The Walton Centre NHS Foundation Trust, Liverpool, UK
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Disrupted alertness and related functional connectivity in patients with focal impaired awareness seizures in temporal lobe epilepsy. Epilepsy Behav 2020; 112:107369. [PMID: 32858367 DOI: 10.1016/j.yebeh.2020.107369] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Focal impaired awareness seizures are common in temporal lobe epilepsy (TLE). The cognitive impairment associated with this type of seizure is unclear. Alertness is a fundamental aspect of cognition. The locus coeruleus (LC) is closely related to alertness. We aimed to assess the impairment in alertness and LC-related alertness network in patients with focal impaired awareness seizures. METHODS Patients with unilateral TLE were grouped into the only focal impaired awareness seizure group (focal group, n = 19) and the focal impaired awareness seizure with focal to bilateral tonic-clonic seizure (FBTCS) group (FBTCS group, n = 19) and compared with matched healthy controls (HC, n = 19). Alertness was assessed with the attention network test. Functional magnetic resonance imaging (fMRI) was used to construct an alertness-related LC-based functional connectivity (FC) network. RESULTS The focal group exhibited impaired tonic and phasic alertness and exhibited a decreased trend of LC-based FC to the left superior frontal gyrus (SFG). The FBTCS group exhibited impaired tonic alertness, phasic alertness, and alertness efficiency. No significant difference or trend in LC-based FC was found in the FBTCS group. SIGNIFICANCE This study reveals disrupted alertness and alertness-related LC-based FC in patients with focal impaired awareness seizures. Our results further demonstrate that the patterns of impaired alertness and of changed LC-based FC were not significantly different between focal impaired awareness seizures and FBTCS.
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7
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Attention/Working Memory, Learning and Memory in Adult Cameroonians: Normative Data, Effects of HIV Infection and Viral Genotype. J Int Neuropsychol Soc 2020; 26:607-623. [PMID: 32066518 PMCID: PMC8582275 DOI: 10.1017/s1355617720000120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE There is lack of Cameroonian adult neuropsychological (NP) norms, limited knowledge concerning HIV-associated neurocognitive disorders in Sub-Saharan Africa, and evidence of differential inflammation and disease progression based on viral subtypes. In this study, we developed demographically corrected norms and assessed HIV and viral genotypes effects on attention/working memory (WM), learning, and memory. METHOD We administered two tests of attention/WM [Paced Auditory Serial Addition Test (PASAT)-50, Wechsler Memory Scale (WMS)-III Spatial Span] and two tests of learning and memory [Brief Visuospatial Memory Test-Revised (BVMT-R), Hopkins Verbal Learning Test-Revised (HVLT-R)] to 347 HIV+ and 395 seronegative adult Cameroonians. We assessed the effects of viral factors on neurocognitive performance. RESULTS Compared to controls, people living with HIV (PLWH) had significantly lower T-scores on PASAT-50 and attention/WM summary scores, on HVLT-R total learning and learning summary scores, on HVLT-R delayed recall, BVMT-R delayed recall and memory summary scores. More PLWH had impairment in attention/WM, learning, and memory. Antiretroviral therapy (ART) and current immune status had no effect on T-scores. Compared to untreated cases with detectable viremia, untreated cases with undetectable viremia had significantly lower (worse) T-scores on BVMT-R total learning, BVMT-R delayed recall, and memory composite scores. Compared to PLWH infected with other subtypes (41.83%), those infected with HIV-1 CRF02_AG (58.17%) had higher (better) attention/WM T-scores. CONCLUSIONS PLWH in Cameroon have impaired attention/WM, learning, and memory and those infected with CRF02_AG viruses showed reduced deficits in attention/WM. The first adult normative standards for assessing attention/WM, learning, and memory described, with equations for computing demographically adjusted T-scores, will facilitate future studies of diseases affecting cognitive function in Cameroonians.
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Alonazi BK, Keller SS, Fallon N, Adams V, Das K, Marson AG, Sluming V. Resting-state functional brain networks in adults with a new diagnosis of focal epilepsy. Brain Behav 2019; 9:e01168. [PMID: 30488645 PMCID: PMC6346674 DOI: 10.1002/brb3.1168] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/19/2018] [Accepted: 10/24/2018] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Newly diagnosed focal epilepsy (NDfE) is rarely studied, particularly using advanced neuroimaging techniques. Many patients with NDfE experience cognitive impairments, particularly with respect to memory, sustained attention, mental flexibility, and executive functioning. Cognitive impairments have been related to alterations in resting-state functional brain networks in patients with neurological disorders. In the present study, we investigated whether patients with NDfE had altered connectivity in large-scale functional networks using resting-state functional MRI. METHODS We recruited 27 adults with NDfE and 36 age- and sex-matched healthy controls. Resting-state functional MRI was analyzed using the Functional Connectivity Toolbox (CONN). We investigate reproducibly determined large-scale functional networks, including the default mode, salience, fronto-parietal attention, sensorimotor, and language networks using a seed-based approach. Network comparisons between patients and controls were thresholded using a FDR cluster-level correction approach. RESULTS We found no significant differences in functional connectivity between seeds within the default mode, salience, sensorimotor, and language networks and other regions of the brain between patients and controls. However, patients with NDfE had significantly reduced connectivity between intraparietal seeds within the fronto-parietal attention network and predominantly frontal and temporal cortical regions relative to controls; this finding was demonstrated including and excluding the patients with brain lesions. No common alteration in brain structure was observed in patients using voxel-based morphometry. Findings were not influenced by treatment outcome at 1 year. CONCLUSIONS Patients with focal epilepsy have brain functional connectivity alterations at diagnosis. Functional brain abnormalities are not necessarily a consequence of the chronicity of epilepsy and are present when seizures first emerge.
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Affiliation(s)
- Batil K Alonazi
- Department of Psychological Sciences, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK.,Department of Radiology and Medical Imaging, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Simon S Keller
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.,The Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Nicholas Fallon
- Department of Psychological Sciences, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Valerie Adams
- Liverpool Magnetic Resonance Imaging Centre (LiMRIC), University of Liverpool, Liverpool, UK
| | - Kumar Das
- The Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Anthony G Marson
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Vanessa Sluming
- Department of Psychological Sciences, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
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Garcia-Ramos C, Dabbs K, Meyerand E, Prabhakaran V, Hsu D, Jones J, Seidenberg M, Hermann B. Psychomotor slowing is associated with anomalies in baseline and prospective large scale neural networks in youth with epilepsy. NEUROIMAGE-CLINICAL 2018; 19:222-231. [PMID: 30035016 PMCID: PMC6051771 DOI: 10.1016/j.nicl.2018.04.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 04/14/2018] [Accepted: 04/17/2018] [Indexed: 12/18/2022]
Abstract
Purpose Psychomotor slowing is a common but understudied cognitive impairment in epilepsy. Here we test the hypothesis that psychomotor slowing is associated with alterations in brain status reflected through analysis of large scale structural networks. We test the hypothesis that children with epilepsy with cognitive slowing at diagnosis will exhibit a cross-sectional and prospective pattern of altered brain development. Methods A total of 78 children (age 8–18) with new/recent onset idiopathic epilepsies underwent 1.5 T MRI with network analysis of cortical, subcortical and cerebellar volumes. Children with epilepsy were divided into slow and fast psychomotor speed groups (adjusted for age, intelligence and epilepsy syndrome). Results At baseline, slow-speed performers (SSP) presented lower modularity, lower global efficiency, higher transitivity, and lower number of hubs than fast-speed performers (FSP). Community structure in SSP exhibited poor association between cortical regions and both subcortical structures and the cerebellum while FSP presented well-defined communities. Prospectively, SSP displayed lower modularity but higher global efficiency and transitivity compared to FSP. Modules in FSP showed higher integration between and within themselves compared to SSP. SSP showed hubs mainly from frontal and temporal regions while in FSP were spread among frontal, temporal, parietal, subcortical areas and the left cerebellum. Implications Results suggest the presence of widespread alterations in large scale networks between fast- and slow-speed children with recent onset epilepsies both at baseline and 2 years later. Slower processing speed appears to be a marker of abnormal brain development antecedent to epilepsy onset as well as brain development over the 2 years following diagnosis. Baseline: slow-speed performers (SSP) showed lower modularity and global efficiency They also showed higher transitivity but fewer hubs than fast-speed performers (FSP) Prospective: SSP showed lower modularity, harmonic mean and higher transitivity Regional volume changes seem to be occurring as one in SSP, but more modular in FSP SSP showed hubs mainly from frontal and temporal while FSP showed them widespread
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Affiliation(s)
- Camille Garcia-Ramos
- Medical Physics, University of Wisconsin School of Medicine and Public Health Madison WI, USA.
| | - Kevin Dabbs
- Departments of Neurology, University of Wisconsin School of Medicine and Public Health Madison WI, USA
| | - Elizabeth Meyerand
- Medical Physics, University of Wisconsin School of Medicine and Public Health Madison WI, USA; Radiology, University of Wisconsin School of Medicine and Public Health Madison WI, USA; Biomedical Engineering, University of Wisconsin School of Medicine and Public Health Madison WI, USA
| | - Vivek Prabhakaran
- Medical Physics, University of Wisconsin School of Medicine and Public Health Madison WI, USA; Radiology, University of Wisconsin School of Medicine and Public Health Madison WI, USA; Psychiatry, University of Wisconsin School of Medicine and Public Health Madison WI, USA
| | - David Hsu
- Departments of Neurology, University of Wisconsin School of Medicine and Public Health Madison WI, USA
| | - Jana Jones
- Departments of Neurology, University of Wisconsin School of Medicine and Public Health Madison WI, USA
| | - Michael Seidenberg
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Bruce Hermann
- Departments of Neurology, University of Wisconsin School of Medicine and Public Health Madison WI, USA
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Witt JA, Helmstaedter C. Cognition in the early stages of adult epilepsy. Seizure 2015; 26:65-8. [DOI: 10.1016/j.seizure.2015.01.018] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 01/30/2015] [Accepted: 01/31/2015] [Indexed: 11/16/2022] Open
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Farina E, Raglio A, Giovagnoli AR. Cognitive rehabilitation in epilepsy: An evidence-based review. Epilepsy Res 2015; 109:210-8. [DOI: 10.1016/j.eplepsyres.2014.10.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 10/19/2014] [Accepted: 10/26/2014] [Indexed: 11/29/2022]
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Witt JA, Werhahn KJ, Krämer G, Ruckes C, Trinka E, Helmstaedter C. Cognitive-behavioral screening in elderly patients with new-onset epilepsy before treatment. Acta Neurol Scand 2014; 130:172-7. [PMID: 24796793 DOI: 10.1111/ane.12260] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Cognitive comorbidity at epilepsy onset reflects disease severity and provides a baseline estimate of reserve capacities with regard to the effects of epilepsy and its treatment. Given the high incidence of epilepsy at an older age, this study analyzed objective and subjective cognition as well as quality of life in elderly patients with new-onset focal epilepsy before initiation of anti-epileptic treatment. MATERIALS AND METHODS A total of 257 untreated patients (60-95 years of age) with new-onset epilepsy underwent objective assessment of executive function (EpiTrack) and performed subjective ratings of cognition (Portland Neurotoxicity Scale) and quality of life (QoL; QOLIE-31). RESULTS According to age-corrected norms, 58% of patients (N=257) demonstrated deficits in executive function; major determinants were cerebrovascular etiology, neurological comorbidity, and higher body mass index. Subjective ratings indicated deficits in up to 27% of patients. Self-perceived deficits were associated with neurological, cardiovascular, and/or psychiatric comorbidity, whereas poorer QoL was related to neurological comorbidity and female gender. Objectively assessed executive functions correlated with subjective social functioning, energy, motor function, and vigilance. CONCLUSIONS We found a relatively high QoL, a low rate of subjective impairment, but a high incidence of objective executive deficits in untreated elderly patients with new-onset epilepsy. Neurological status and body mass index, rather than seizure frequency or severity, were risk factors for cognitive impairment. Given the relevance of cognition in the course of epilepsy and its treatment, routine screening before treatment initiation is highly recommended.
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Affiliation(s)
- J.-A. Witt
- Department of Epileptology; University of Bonn; Bonn Germany
| | - K. J. Werhahn
- Department of Neurology; University Medical Center of the Johannes Gutenberg University; Mainz Germany
- Since 2012 UCB Pharma; Monheim Germany
| | - G. Krämer
- Neurocenter Bellevue; Zurich Switzerland
| | - C. Ruckes
- Interdisciplinary Center of Clinical Studies; Johannes Gutenberg University; Mainz Germany
| | - E. Trinka
- Department of Neurology; University Salzburg; Salzburg Austria
| | - C. Helmstaedter
- Department of Epileptology; University of Bonn; Bonn Germany
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An initial validation of the Virtual Reality Paced Auditory Serial Addition Test in a college sample. J Neurosci Methods 2014; 222:15-23. [DOI: 10.1016/j.jneumeth.2013.10.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 10/06/2013] [Accepted: 10/09/2013] [Indexed: 01/22/2023]
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14
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Giovagnoli AR. Awareness, overestimation, and underestimation of cognitive functions in epilepsy. Epilepsy Behav 2013; 26:75-80. [PMID: 23220464 DOI: 10.1016/j.yebeh.2012.11.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 11/02/2012] [Accepted: 11/04/2012] [Indexed: 10/27/2022]
Abstract
This study estimated cognitive awareness and the predictors of self-rating in patients with epilepsy (PWE). The Multiple Ability Self-Report Questionnaire (MASQ), State-Trait Anxiety Inventory, and Beck Depression Inventory were used for self-evaluation. Neuropsychological assessment yielded five single-domain scores (Long-Term Memory, Mental Speed, Working Memory, Set Shifting, and Visuospatial Matching) and a total composite score. Awareness was computed as the concordance between the neuropsychological and MASQ scores. In 37 patients with full awareness, self-ratings were predicted by Long-Term Memory, Working Memory, and Mental Speed. In 58 patients with incomplete or no awareness, self-ratings related to depression and seizure frequency. Compared with overestimation, underestimation was associated with higher test scores, better education, and younger age. Brain lesion and the type of epilepsy showed no effect. Therefore, PWE may appear unaware of their cognitive abilities due to negative affect and clinical burden. Understanding patients' awareness of their cognitive deficits can help clarify the clinical pattern provoked by epilepsy, as well as patients' compliance with treatment for seizures or cognitive difficulties.
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Affiliation(s)
- Anna Rita Giovagnoli
- Laboratory of Cognitive Neurology and Rehabilitation, Neurology and Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milano, Italy.
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Age-accelerated psychomotor slowing in temporal lobe epilepsy. Epilepsy Res 2012; 103:231-6. [PMID: 22989854 DOI: 10.1016/j.eplepsyres.2012.08.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 08/22/2012] [Accepted: 08/26/2012] [Indexed: 11/20/2022]
Abstract
Cognitive and psychomotor slowing is a complication of epilepsy and is less often a focus of investigation relative to other cognitive domains (e.g., memory). A diversity of tasks has been used to examine psychomotor slowing in epilepsy, but it remains unknown whether the degree of epilepsy-related slowing is fixed or is exacerbated with increasing task demand. Also unknown is to what degree age related slowing is accelerated in epilepsy. Participants with temporal lobe epilepsy (n=50) were compared to healthy controls (n=69) across three tasks of psychomotor speed with varied complexity. Performance was examined as a function of group (epilepsy, controls), task complexity (simple, intermediate, complex), and chronological age. The results showed that speed of performance declined across the epilepsy and control participants as a function of task complexity. Epilepsy participants were significantly slower than controls across the three tasks, and there was a significant three-way interaction (group by task complexity by age). These results demonstrate that psychomotor slowing is related to task complexity in both epilepsy and healthy control participants, always greater in epilepsy participants, and there is a significant age acceleration of psychomotor slowing in the epilepsy group that is magnified by complex tasks.
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Abstract
PURPOSE Cognitive impairment is a common comorbidity of epilepsy; however, relatively little research has been undertaken to investigate how cognitive problems develop in adults who are newly diagnosed. This study aimed to investigate changes in cognitive performance in adults with new-onset epilepsy 12 months after diagnosis compared with healthy volunteers. METHODS One hundred forty-seven people with epilepsy (PWE) were assessed using a comprehensive neuropsychological test battery before they started treatment and after 12 months. Cognitive change scores were compared with 69 healthy volunteers who were also assessed at baseline and after 12 months. KEY FINDINGS At 12 month follow-up, PWE had significantly poorer change scores for 9 of the 16 variables. For the majority of these measures, PWE had subtle declines in performance, whereas healthy volunteers improved. Poorer performance on some measures was associated with treatment with topiramate, generalized seizures and, interestingly, achieving an immediate 12-month seizure remission. SIGNIFICANCE After controlling for statistically confounding factors, people with newly diagnosed epilepsy had a different cognitive trajectory compared with healthy volunteers from the general population. Memory, psychomotor speed, and higher executive functioning were the domains most vulnerable to change over a 12-month period.
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Affiliation(s)
- Gus A Baker
- Neuroscience Research Unit, University of Liverpool, Liverpool, UK.
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Pal SK, Sharma K, Prabhakar S, Pathak A. Neuroepidemiology of epilepsy in northwest India. Ann Neurosci 2010; 17:160-6. [PMID: 25205899 PMCID: PMC4117013 DOI: 10.5214/ans.0972.7531.1017404] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 09/23/2010] [Accepted: 10/07/2010] [Indexed: 11/17/2022] Open
Abstract
BACKROUND Epilepsy has a complex etiology characterised by recurring seizures. PURPOSE To study clinical profile of epilepsy patients with reference to type of epilepsy in northwest India. No previous Indian study has reported relative incidence of various types of seizures with reference to type of epilepsy. METHODS Data of 400 epilepsy patients (200 idiopathic and 200 symptomatic) was collected for their clinical characteristics. The classification of epilepsy into idiopathic and symptomatic types was done on the basis of findings of EEG, CT scan and MRI tests. RESULTS The age of onset of seizures was less than 15 years in only one third of the total patients. The number of non-vegetarians was higher in SE (68.5%) than IE (58%). The male to female ratio was significantly higher (1.33:1 in IE and 1.47:1 in SE). No difference was seen for place of residence (urban vs rural) patients with epilepsy (PWE). The majority of patients (58.5% of symptomatic and 52.8% idiopathic) though reported no triggering factors, yet many of them, when questioned, had held supernatural powers to be the cause of the disease. Sleep deprivation was reported as a major triggering factor by 28.5% of idiopathic epilepsy (IE) and 25% of symptomatic epilepsy (SE) patients. The incidence of mental retardation (1.25%) and behavioral disorders (7%) was found to be relatively low. Loss of memory was reported in 46% of IE and 43.5% of SE and poor scholastic performance in 23% of IE and 16.5% of SE. A positive history was recorded in 11% first-degree relatives and 4% second-degree relatives. Generalized seizures were more common in IE patients (67.5%), while partial seizures with and without secondary generalization (50.5%), and generalized seizures (49.5%) were equally common in SE. CONCLUSIONS The study demonstrates differences in the type of seizures between idiopathic and symptomatic epilepsies and not other demographic, clinical and psycho-social traits. The males were found to have higher risk of epilepsy than females. The epidemiological characteristics of epileptics show variations across populations and also within population.
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Affiliation(s)
- Surender Kumar Pal
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Krishan Sharma
- Department of Anthropology, Panjab University Chandigarh, INDIA
| | - Sudesh Prabhakar
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Ashish Pathak
- Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh
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Taylor J, Kolamunnage-Dona R, Marson AG, Smith PEM, Aldenkamp AP, Baker GA. Patients with epilepsy: Cognitively compromised before the start of antiepileptic drug treatment? Epilepsia 2010; 51:48-56. [DOI: 10.1111/j.1528-1167.2009.02195.x] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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19
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Velissaris SL, Wilson SJ, Newton MR, Berkovic SF, Saling MM. Cognitive complaints after a first seizure in adulthood: Influence of psychological adjustment. Epilepsia 2009; 50:1012-21. [DOI: 10.1111/j.1528-1167.2008.01893.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Giustizieri M, Armogida M, Berretta N, Federici M, Piccirilli S, Mercuri NB, Nistico R. Differential effect of carbamazepine and oxcarbazepine on excitatory synaptic transmission in rat hippocampus. Synapse 2009; 62:783-9. [PMID: 18655118 DOI: 10.1002/syn.20556] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
In this study, we have compared the effects of two structurally related compounds carbamazepine (CBZ) and oxcarbazepine (OXC), both in current use for the treatment of epilepsy and bipolar disorder, on fast excitatory transmission in rat hippocampal slices. Using electrophysiological recordings, we have investigated the effects of CBZ and OXC on repetitive action potential discharge of CA1 pyramidal neurons demonstrating that both compounds produced firing inhibition with similar IC(50) values. Moreover, we show that bath applied CBZ (0.01-1 mM) exerted a concentration-dependent decrease in the amplitude of the field excitatory postsynaptic potentials with an IC(50) of approximately 194.3 microM. When OXC was used at the same concentrations, the concentration-response curve was shifted to the right (IC(50) of approximately 711.07 microM). In addition, we demonstrated that CBZ and OXC reduced, to a different extent, both evoked excitatory postsynaptic currents and NMDA-, AMPA-, and KA-mediated inward currents, CBZ being more potent than OXC. These data highlight distinct presynaptic and postsynaptic sites of action for both compounds and suggest that CBZ, by markedly depressing postsynaptic ionotropic glutamate receptors-mediated responses, may produce more severe cognitive and memory impairment. Thus, we assume that relatively high doses of OXC could be better tolerated than therapeutically equivalent doses of CBZ, justifying the preferential use of OXC as first-line treatment in the therapy of neurological and psychiatric disorders, particularly when compared with CBZ.
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Affiliation(s)
- Michela Giustizieri
- Laboratory of Experimental Neurology, Fondazione Santa Lucia IRCCS, Rome, Italy
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21
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Ortiz KZ, Pereira LD, Borges ACLDC, Vilanova LCP. Nonverbal dichotic test in patients with epilepsy. Dement Neuropsychol 2009; 3:108-113. [PMID: 29213620 PMCID: PMC5619227 DOI: 10.1590/s1980-57642009dn30200007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Auditory processing during childhood may be altered if there is any predisposing factor during the course of development. Neurological disorders are among the risk factors for auditory processing disorders. Some studies have shown verbal auditory processing disorder in children with epilepsy. Objective To verify the performance of children with epilepsy on a nonverbal dichotic test. Methods Thirty-eight subjects, 23 female and 15 male, ranging from 7 to 16 years of age with neurological diagnosis of idiopathic epilepsy, without clinical or imaging evidence of cerebral lesion were evaluated. Patients were divided into two groups: 23 patients diagnosed with partial seizures and 15 patients with generalized seizures. Illiterate children, children with hearing thresholds exceeding the normal range and with brain lesions confirmed either clinically or by imaging tests were excluded from the study group. Results Analysis of the performance of epileptic patients with partial and generalized seizures on the Nonverbal Dichotic Test revealed that the majority of patients with epilepsy showed impairments in the test, with no significant differences related to seizure type, generalized or partial. Although patients with partial and generalized seizures performed similarly, all the epileptic patients showed different performance to a normal population. Conclusions This study revealed a high prevalence of impairments among epileptic patients in relation to nonverbal processing in a dichotic paradigm.
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Affiliation(s)
- Karin Zazo Ortiz
- PhD in Neuroscience from UNIFESP, Professor at the Department of Speech Pathology and Audiology. Department of Speech Pathology and Audiology, UNIFESP, São Paulo, SP, Brazil
| | - Liliane Desgualdo Pereira
- PhD in Human Communication Disorders, Professor at the Department of Speech Pathology and Audiology, UNIFESP, Department of Speech Pathology and Audiology, UNIFESP, São Paulo, SP, Brazil
| | - Alda Christina Lopes de Carvalho Borges
- PhD in Human Communication Disorders, Professor at the Department of Speech Pathology and Audiology, UNIFESP, Department of Speech Pathology and Audiology, UNIFESP, São Paulo, SP, Brazil
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22
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Ferlazzo E, Gagliano A, Calarese T, Magaudda A, Striano P, Cortese L, Cedro C, Laguitton V, Bramanti P, Carbonaro M, Albachiara A, Fragassi N, Italiano D, Sessa E, Coppola A, Genton P. Neuropsychological findings in patients with Unverricht-Lundborg disease. Epilepsy Behav 2009; 14:545-9. [PMID: 19185615 DOI: 10.1016/j.yebeh.2009.01.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Accepted: 01/10/2009] [Indexed: 11/16/2022]
Abstract
The aims of this study were to clarify if patients with Unverricht-Lundborg disease (ULD) have adequate cognitive functioning and to delineate their neuropsychological profile. We evaluated 20 patients with ULD and 20 healthy, matched controls. Mean age of the patients was 35 years, and mean duration of disease, 22 years. Patients underwent a neuropsychological battery exploring intelligence, executive functions, visuospatial and verbal memory, depression, and anxiety. Eleven of 20 subjects with ULD had mild to moderate cognitive impairment. Compared with controls, patients with ULD had lower scores on all short-term memory and executive function tasks. Linear regression analysis disclosed significant associations between impaired performance on some memory tests and duration of disease and between severity of myoclonus and performance on most executive function tests. In conclusion, most patients with ULD seem to be impaired with respect to cognitive abilities. Longitudinal prospective studies are needed to confirm and further expand our findings.
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Hamed SA. The aspects and mechanisms of cognitive alterations in epilepsy: the role of antiepileptic medications. CNS Neurosci Ther 2009; 15:134-56. [PMID: 19254331 PMCID: PMC6494068 DOI: 10.1111/j.1755-5949.2008.00062.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Epilepsy is a major health problem. Several studies suggest a significant influence of epilepsy and its treatment on dynamic and functional properties of brain activity. Epilepsy can adversely affect mental development, cognition, and behavior. Epileptic patients may experience reduced intelligence, attention, and problems in memory, language, and frontal executive functions. Neuropsychological, functional, and quantitative neuroimaging studies revealed that epilepsy affect the brain as a whole. Mechanisms of epilepsy-related cognitive dysfunction are poorly delineated. Cognitive deficits with epilepsy may be transient, persistent, or progressive. Transient disruption of cognitive encoding processes may occur with paroxysmal focal or generalized epileptic discharges, whereas epileptogenesis-related neuronal plasticity, reorganization, sprouting, and impairment of cellular metabolism are fundamental determinants for progressive cognitive deterioration. Also antiepileptic drugs (AEDs) have differential, reversible, and sometimes cumulative cognitive adverse consequences. AEDs not only reduce neuronal irritability but also may impair neuronal excitability, neurotransmitter release, enzymes, and factors critical for information processing and memory. The present article serves as an overview of recent studies in adult and childhood epilepsy literatures present in PubMed that highlighted cognitive evaluation in epilepsy field (publications till 2008 were checked). We also checked the reference lists of the retrieved studies for additional reports of relevant studies, in addition to our experience in this field. Our search revealed that although the aspects of cognitive dysfunction, risk factors, and consequences have been explored in many studies; however, the mechanisms of contribution of epilepsy-related variables, including AEDs, to patients' cognition are largely unexplored. In this review, we discussed the differential effect of AEDs in mature and immature brains and the known mechanisms underlying epilepsy and AEDs adverse effects on cognition. The nature, timing, course, and mechanisms of cognitive alteration with epilepsy and its medications are of considerable clinical and research implications.
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Affiliation(s)
- Sherifa A Hamed
- Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt.
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Schouten D, Hendriksen JGM, Aldenkamp AP. Performance of children with epilepsy on the Rey-Osterrieth complex figure test: is there an effect of localization or lateralization? Epilepsy Res 2008; 83:184-9. [PMID: 19091512 DOI: 10.1016/j.eplepsyres.2008.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Revised: 10/26/2008] [Accepted: 11/02/2008] [Indexed: 11/17/2022]
Abstract
SUMMARY The effects of lateralization and localization of the epileptic focus, drug load of antiepileptic drug treatment and seizure frequency were examined on the performance of children with epilepsy on the Rey-Osterrieth complex figure test. Two scoring systems were used, a quantitative and a qualitative system. Sixty-two children with cryptogenic localization-related epilepsy between 6 and 13 years completed the test. No effects were found for lateralization of the epileptic focus, drug load and seizure frequency on test performance. Localization of the epileptic focus appeared to have a significant effect: an epileptic focus in the temporal lobe caused a poorer performance on the copy of the test.
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Affiliation(s)
- Diana Schouten
- Faculty of Psychology, Tilburg University, The Netherlands
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25
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Nekrassov V, Sitges M. Comparison of acute, chronic and post-treatment effects of carbamazepine and vinpocetine on hearing loss and seizures induced by 4-aminopyridine. Clin Neurophysiol 2008; 119:2608-14. [PMID: 18829385 DOI: 10.1016/j.clinph.2008.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Revised: 08/17/2008] [Accepted: 08/20/2008] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the acute, chronic and post-treatment effects of the classic antiepileptic drug carbamazepine (CBZ) and the potential antiepileptic vinpocetine (VPC), successfully used in the treatment of brain vascular origin disorders, on 4-aminopyridine (4-AP)-induced increase in auditory threshold, brain-auditory-evoked-potentials (BAEPs) later waves alterations and epileptiform activity. METHODS BAEP and EEG recordings before and following 4-AP (3mg/kg, i.p.) were obtained in guinea pigs. One week after, the animals received a daily injection (i.p.) of vehicle, 3mg/kg VPC or 17 mg/kg CBZ for 13 days. The acute and chronic effects before and following 4-AP were tested at the 1st and last days, respectively, and the post-treatment effect 1 month after the end of treatment. RESULTS CBZ and 4-AP increased BAEPs threshold and BAEPs P4 wave latency. Chronic CBZ inhibited 4-AP-induced increase in P3 amplitude. In the VPC-treated group, all the 4-AP-induced BAEPs changes were prevented. Seizures were prevented in 50% and 75% of the animals by chronic CBZ and VPC, respectively. After acute VPC and after the end of VPC-treatment 4-AP failed to induce seizures in 50% of the animals. CONCLUSION VPC inhibits 4-AP-induced seizures and hearing loss, even after post-treatment, at a concentration about 10 times lower than CBZ. SIGNIFICANCE The complications in hearing that can accompany epilepsy can be prevented by VPC, indicating its advantage as an alternative antiepileptic.
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26
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Lui S, Ouyang L, Chen Q, Huang X, Tang H, Chen H, Zhou D, Kemp GJ, Gong Q. Differential interictal activity of the precuneus/posterior cingulate cortex revealed by resting state functional MRI at 3T in generalized vs. partial seizure. J Magn Reson Imaging 2008; 27:1214-20. [PMID: 18504738 DOI: 10.1002/jmri.21370] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To characterize, using functional MRI (fMRI), the pattern of active brain regions in the resting state in patients with epilepsy. MATERIALS AND METHODS We studied 28 patients with epilepsy, divided into a partial seizure (PS; N = 9) and a generalized seizure group (GS; N = 19), and 34 control subjects. Resting state fMRI was performed using a GE 3T scanner by collecting 200 volumes of echo-planar imaging (EPI) images with subjects relaxed, eyes closed. Data were processed using a modification of the method of Fransson (Hum Brain Mapp 2005;26:15-29), which reveals information on regional low-frequency Blood Oxygenation Level Dependent (BOLD) signal oscillations in the resting state without any a priori hypothesis. The significant active areas in brain were identified with both individual and group analysis. RESULTS Controls showed active regions in the precuneus/posterior cingulate cortex (PCC) and medial prefrontal cortex (MPFC)/ventral anterior cingulate cortex (vACC), theregions associated with the brain "default mode." Similar active regions were observed in PS, whereas GS showed no significant activation of precuneus/PCC. CONCLUSION In GS, the lack of activation in precuneus/PCC may partly account for their more severe interictal deficits, compared to PS, in cognitive functions such as concentration and memory.
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Affiliation(s)
- Su Lui
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, West China School of Medicine, Chengdu, China
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Andersson-Roswall L, Engman E, Malmgren K, Samuelsson H. Verbal cognition and attention deficits do not explain the verbal memory decline associated with pharmacoresistant partial epilepsy. Epilepsy Behav 2007; 11:413-20. [PMID: 17905667 DOI: 10.1016/j.yebeh.2007.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2007] [Revised: 07/07/2007] [Accepted: 07/14/2007] [Indexed: 11/19/2022]
Abstract
The aim of this study was to explore whether change in verbal memory with time in patients with epilepsy is influenced by performance on tasks assessing verbal cognition or attention/processing speed. Thirty-six patients and twenty-five healthy controls were tested twice with median retest intervals of 4.8 and 3.1 years, respectively. Aspects of verbal memory, verbal cognition, and attention/processing speed were assessed. Decline in one verbal memory variable (Cronholm-Molander Memory Test Paired Associates -- Delayed Recall) was the strongest correlate of epilepsy. The second strongest correlate was a decrease in one attention/processing speed variable (Digit Symbol). The relationship between decline in verbal memory and epilepsy was not influenced by the decline in attention/processing speed, and the results did not support the notion that limited mental reserves as reflected in impaired verbal cognition or attention/processing speed can explain the relationship between verbal memory and epilepsy.
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Affiliation(s)
- Lena Andersson-Roswall
- Epilepsy Research Group, Institute of Neuroscience and Physiology, University of Göteborg, Göteborg, Sweden.
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28
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Sitges M, Chiu LM, Guarneros A, Nekrassov V. Effects of carbamazepine, phenytoin, lamotrigine, oxcarbazepine, topiramate and vinpocetine on Na+ channel-mediated release of [3H]glutamate in hippocampal nerve endings. Neuropharmacology 2006; 52:598-605. [PMID: 17070874 DOI: 10.1016/j.neuropharm.2006.09.002] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2006] [Revised: 08/14/2006] [Accepted: 09/05/2006] [Indexed: 11/22/2022]
Abstract
Several of the most effective antiepileptic drugs are believed to stop the paroxysmal neuronal activity acting as Na(+) channel blockers. However, no single study comparing in parallel the potency and efficacy of the most commonly used antiepileptic drugs on brain Na(+) channel-mediated responses is available. In the present study the effects of increasing concentrations of carbamazepine, phenytoin, lamotrigine, oxcarbazepine and topiramate, which are among the most frequently used antiepileptic drugs, and of the new putative antiepileptic drug, vinpocetine, on the release of glutamate (Glu) elicited by the Na(+) channel opener, veratridine were investigated in hippocampal isolated nerve endings preloaded with the labeled excitatory amino acid neurotransmitter. The present results show that carbamazepine, phenytoin, lamotrigine and oxcarbazepine, in the range from 150 to 1500 microM, progressively inhibit [(3)H]Glu release induced by veratridine. Also vinpocetine progressively inhibits the veratridine-induced response, but in a much lower range of concentrations (from 1.5 to 15 microM), whereas topiramate only exerts a modest inhibition (20%) of Glu release to veratridine at the highest dose tested (1500 microM). These results indicate that the mechanism of action of several of the most widely used antiepileptic drugs involves reduction in cerebral presynaptic voltage sensitive Na(+) channels permeability. Considering that the high doses of antiepileptic drugs required to control seizures are frequently accompanied by adverse secondary effects, the higher potency of vinpocetine to reduce Na(+) channels permeability might be advantageous.
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Affiliation(s)
- María Sitges
- Departamento de Biología Celular y Fisiología, Instituto de Investigaciones Biomédicas, UNAM, Apartado Postal 70228, Ciudad Universitaria 04510, México D.F., Mexico.
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Nekrassov V, Sitges M. Additive effects of antiepileptic drugs and pentylenetetrazole on hearing. Neurosci Lett 2006; 406:276-80. [PMID: 16930834 DOI: 10.1016/j.neulet.2006.07.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2006] [Revised: 07/04/2006] [Accepted: 07/21/2006] [Indexed: 11/26/2022]
Abstract
The long-term effect of three of the most widely used antiepileptic drugs at relevant doses on the hearing decline that accompanies pentylenetetrazole (PTZ)-induced experimental epilepsy was investigated here, and compared with the effect of vinpocetine (VPC), which is a drug with antiepileptic potential. For this purpose, cortical activity (monitored by the EEG) and auditory sensitivity, as indicated by brainstem auditory evoked potential (BAEP) threshold at 4 and 8 kHz tone frequencies, were determined in guinea pigs daily injected for 28 days with vehicle (control), 20 mg/kg carbamazepine (CBZ), 6 mg/kg phenytoin (PHT), 30 mg/kg valproate (VPA) or 2 mg/kg vinpocetine (VPC) before and after the administration of PTZ at a convulsing dose (100 mg/kg). Results show that all the antiepileptic drugs tested were more or less effective in preventing PTZ-induced seizures. The long-term treatment with VPC decreased the auditory threshold, whereas the long-term treatment with CBZ, PHT or VPA increased the auditory threshold to a similar extent as the convulsing agent, PTZ. The combined effects of the antiepileptic drugs and PTZ on auditory threshold were additive. Therefore, only VPC prevented the increase in the auditory threshold induced by PTZ. It is concluded that the hearing loss produced by the long-term treatment with the most commonly used antiepileptic drugs could be aggravated by the illness. The prevention exerted by VPC on the hearing decline that accompanies experimental epilepsy, along with its capacity to control seizures at low doses in this and other animal models of epilepsy, would make VPC a valid candidate for the treatment of epilepsy.
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Affiliation(s)
- Vladimir Nekrassov
- División de Investigación Básica y Aplicada, Instituto Nacional de Rehabilitación, SSA, México
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Sitges M, Chiu LM, Nekrassov V. Single and combined effects of carbamazepine and vinpocetine on depolarization-induced changes in Na+, Ca2+ and glutamate release in hippocampal isolated nerve endings. Neurochem Int 2006; 49:55-61. [PMID: 16621162 DOI: 10.1016/j.neuint.2005.12.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2005] [Accepted: 12/21/2005] [Indexed: 11/22/2022]
Abstract
The single and combined effects of carbamazepine and vinpocetine on the release of the excitatory amino acid neurotransmitter glutamate, on the rise in internal Na+ (Na(i), as determined with SBFI), and on the rise in internal Ca2+ (Ca(i), as determined with fura-2) induced by an increased permeability of presynaptic Na+ channels, with veratridine, or by an increased permeability of presynaptic Ca2+ channels with high K+, were investigated in isolated hippocampal nerve endings. The present study shows that carbamazepine and vinpocetine, both inhibit dose dependently the release of preloaded [3H]Glu induced by veratridine. However, carbamazepine is two orders of magnitude less potent than vinpocetine. The calculated IC(50)'s for carbamazepine and vinpocetine to inhibit veratridine-induced [3H]Glu release are 200 and 2 microM, respectively. Consistently 150 microM carbamazepine and 1.5 microM vinpocetine reduce the veratridine-induced rise in Na(i) in a similar extent. The single effects of carbamazepine and of vinpocetine on the presynaptic Na+ channel mediated responses, namely the rise in Na(i) and the release of Glu induced by veratridine, are additive. Responses that depend on the entrance of external Ca2+ via presynaptic Ca2+ channels, such as the release of [3H]Glu and the rise in Ca(i) induced by high K+, are insensitive to 300 microM carbamazepine and slightly reduced by 5 microM vinpocetine. It is concluded that the additive effects of carbamazepine, which is one of the most common antiepileptic drugs, and vinpocetine that besides its known neuroprotective action and antiepileptic potential is a memory enhancer, may perhaps be advantageous in the treatment of epileptic patients.
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Affiliation(s)
- María Sitges
- Depto. de Biología Celular y Fisiología, Instituto de Investigaciones Biomédicas, UNAM, Apartado Postal 70228, Ciudad Univeresitaria, 04510 México D.F., Mexico.
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Hommet C, Sauerwein HC, De Toffol B, Lassonde M. Idiopathic epileptic syndromes and cognition. Neurosci Biobehav Rev 2005; 30:85-96. [PMID: 16120462 DOI: 10.1016/j.neubiorev.2005.06.004] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2005] [Revised: 06/26/2005] [Accepted: 06/29/2005] [Indexed: 11/19/2022]
Abstract
Epilepsy is frequently associated with cognitive impairments which result from various interacting factors. The present paper deals with the contribution of neuropsychology to the characterization of the type of epilepsy and the possible mechanisms underlying idiopathic epileptic syndromes. The non-lesional, so-called idiopathic epilepsies, constitute an interesting model for assessing the relationship between epileptiform EEG discharges and cognition. Among the idiopathic generalized epilepsies, disorders of social integration and personality have been frequently reported in juvenile myoclonic epilepsy (JME). Since similar disturbances are observed in frontal-lobe-lesioned patients, impairments in other frontal lobe functions (e.g. executive functions) might be expected in JME. This gives rise to speculation about the possible underlying pathophysiological mechanisms in JME. With regard to partial idiopathic epilepsies, benign childhood epilepsy with centrotemporal spikes (BCECTS) may provide a useful model for the study of the relationship between epileptiform EEG discharges in the peri-sylvian region and language functions. Furthermore, the description of mild cognitive dysfunctions in BCECTS, and their persistence into adulthood, can provide information about compensatory mechanisms and may allow for the generation of remedial strategies. Thus, 'lesional' neuropsychology has given way to 'dynamic' neuropsychology based on specific postulates. By using the cognitive profile to specify the mechanism underlying the behavioral disturbances observed in different types of epilepsy, neuropsychology may eventually contribute to a revision of the present classification of epileptic syndromes. In addition, the neuropsychological data may help predict the extent and limits of functional recovery and cerebral plasticity.
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Affiliation(s)
- Caroline Hommet
- Service de Neurologie Hôpital Bretonneau, 37044 Tours, cedex, France.
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Sitges M, Nekrassov V. Vinpocetine prevents 4-aminopyridine-induced changes in the EEG, the auditory brainstem responses and hearing. Clin Neurophysiol 2004; 115:2711-7. [PMID: 15546779 DOI: 10.1016/j.clinph.2004.06.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The purpose of the present study was to investigate if the sodium channel blocker and memory enhancer, vinpocetine, was capable to overcome the epileptic cortical activity, the abnormalities in the later waves of the auditory brainstem responses (ABRs) and the hearing loss induced by 4-AP at a convulsing dose in the guinea pig in vivo. METHODS EEG and ABR recordings before and at specific times within 2h after the injection of 4-AP (2 mg/kg, i.p.) were taken in animals pre-injected i.p. with vehicle or with vinpocetine (2 mg/kg) 1 h before 4-AP. The amplitude and latency of the ABR waves induced by a monoaural stimulus of high intensity (100 dB nHL) at 4 and 8 kHz pure tone frequencies and the ABR threshold were determined in the animals exposed to the different experimental conditions. RESULTS Vinpocetine inhibited the EEG changes induced by 4-AP for the ictal and post-ictal periods as well as the alterations in amplitude and latency of P3 and P4 and the increase in the ABR threshold induced by 4-AP. CONCLUSIONS Vinpocetine prevents the retro-cochlear alterations and the hearing decline that accompany the epileptic cortical activity. SIGNIFICANCE Vinpocetine could be a promising alternative for the treatment of epilepsy.
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Affiliation(s)
- Maria Sitges
- Depto. de Biología Celular y Fisiología, Instituto de Investigaciones Biomédicas, UNAM, Apartado Postal 70228, Ciudad Universitaria 04510, Mexico City, DF, Mexico.
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Andersson-Roswall L, Engman E, Samuelsson H, Sjöberg-Larsson C, Malmgren K. Verbal memory decline and adverse effects on cognition in adult patients with pharmacoresistant partial epilepsy: a longitudinal controlled study of 36 patients. Epilepsy Behav 2004; 5:677-86. [PMID: 15380119 DOI: 10.1016/j.yebeh.2004.05.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2003] [Revised: 05/26/2004] [Accepted: 05/27/2004] [Indexed: 11/16/2022]
Abstract
The aim of this study was to delineate possible longitudinal cognitive changes in adult patients with a long history of pharmacoresistant partial epilepsy. Thirty-six patients and thirty healthy controls were investigated at baseline. A reassessment was conducted, with median test intervals of 4.8 years for the patients and 3.1 years for controls. A standardized battery was used for assessment of general cognitive level and memory. At baseline, patients performed at a significantly lower level on general cognition, immediate recall of pairs of associated words, and retention of learned words and visuospatial stimuli, compared with controls. Analyses of change over time in the patients disclosed significant verbal memory decline in retention of pairs of associated words. Group comparisons of change over time revealed adverse effects in the performance aspect of general cognition on the patients. Also, group comparisons indicated impaired performance across time for the patients in retention of pairs of associated words and retention of visuospatial stimuli. The adverse effect on memory and general cognition in this patient group over the period was clear-cut when compared with the longitudinal changes in an adequate control group.
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Affiliation(s)
- Lena Andersson-Roswall
- Institute of Clinical Neuroscience, Epilepsy Research Group, University of Göteborg, Göteborg, Sweden
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Valton L, Mascott CR. Quelle est la place du bilan neuropsychologique dans la prise en charge des patients souffrant d’une épilepsie partielle pharmaco-résistante ? Rev Neurol (Paris) 2004. [DOI: 10.1016/s0035-3787(04)71194-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nekrassov V, Sitges M. Vinpocetine inhibits the epileptic cortical activity and auditory alterations induced by pentylenetetrazole in the guinea pig in vivo. Epilepsy Res 2004; 60:63-71. [PMID: 15279871 DOI: 10.1016/j.eplepsyres.2004.05.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2004] [Revised: 04/16/2004] [Accepted: 05/15/2004] [Indexed: 11/16/2022]
Abstract
Here we investigate the effect of the neuroprotective drug, vinpocetine on the epileptic cortical activity, on the alterations of the later waves of brainstem auditory evoked potentials (BAEPs) and on the hearing decline induced by the convulsing agent, pentylenetetrazole (PTZ). Vinpocetine at doses from 2 to 10 mg/kg inhibits the tonic-clonic convulsions induced by PTZ (100 mg/kg). Vinpocetine injected at a dose of 2 mg/kg 4 h before PTZ completely prevents the characteristic electroencephalogram (EEG) changes induced by PTZ for the ictal and post-ictal periods. Vinpocetine also abolished the PTZ-induced changes in the amplitude and latency of the later waves of the BAEPs in response to pure tone burst monoaural stimuli (frequency 8 or 4 kHz intensity 100 dB), and the PTZ-induced increase in the BAEP threshold. These results show the antiepileptic potential of vinpocetine and indicate the capability of vinpocetine to prevent the changes in the BAEP waves associated with the hearing loss observed during generalized epilepsy.
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Affiliation(s)
- Vladimir Nekrassov
- Instituto de la Comunicación Humana, Centro Nacional de Rehabilitación, SSA, Mexico
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Abstract
The consequences of epilepsy can be quite severe and include shortened lifespan, excessive bodily injury, neuropsychological and psychiatric impairment, and social disability. There is evidence that seizures cause brain injury, including neuronal death and physiological dysfunction. Mortality rates are 4-7 times higher in people with medically refractory seizures, and injury rates are substantial, ranging from one per 20 person-years to as much as one per 3 person-years. Quality of life is impaired in epilepsy, and relates to seizure control. Psychosocial disabilities, including lower social interaction with reduced marriage rates and reduced employment levels, are more common in people with refractory seizures. Complete seizure control is desirable, since seizures potentially constitute a serious threat to health and well-being. Therefore, satisfactory seizure control should be defined as having no seizures. Treatment should be directed to preventing seizures whenever possible and achieving control early in the course of illness. The risks of uncontrolled seizures outweigh the risks of aggressive medical or surgical therapy.
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Affiliation(s)
- Michael R Sperling
- Department of Neurology, Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
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Affiliation(s)
- Albert P Aldenkamp
- Department of Behavioral Sciences, Epilepsy Center Kempenhaeghe, PO Box 61, NL-5590 A.B. Heeze, The Netherlands.
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McLntyre DC, McLeod WS, Anisman H. Working and Reference Memory in Seizure-Prone and Seizure-Resistant Rats: Impact of Amygdala Kindling. Behav Neurosci 2004; 118:314-23. [PMID: 15113257 DOI: 10.1037/0735-7044.118.2.314] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In rat selectively bred for different amygdala kindling rates (Fast vs. Slow), comorbid differences in learning were detected. Here, performance was tested in a delayed alternation task before, during, and after kindling. Although similar reference memory was evident, Fast rats showed working memory deficits with increasing delays between information and choice trials. Further, seizures shortly before learning disrupted both reference and working memory in Fast, but not Slow, rats. Weeks after kindling, progressive delays further disrupted Fast rats, but only longer delays disrupted Slow rats. Clearly relevant to individual differences in human epilepsy, a temporal lobe, seizure-prone genetic background in rats provides poorer original learning and easier disruption of new learning by recent and past seizures than a seizure-resistant background.
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Affiliation(s)
- Dan C McLntyre
- Department of Psychology, Institute for Neuroscience, Carleton University, Ottawa, ON, Canada.
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Fisher RS, Bortz JJ, Blum DE, Duncan B, Burke H. A pilot study of donepezil for memory problems in epilepsy. Epilepsy Behav 2001; 2:330-4. [PMID: 12609209 DOI: 10.1006/ebeh.2001.0221] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2001] [Accepted: 05/25/2001] [Indexed: 11/22/2022]
Abstract
We performed a pilot 3-month, open-label study of 5-10 mg donepezil, an anticholinesterase inhibitor, as treatment for memory problems in people with epilepsy. The Buschke Selective Reminding Test was administered at baseline and after 3 months of donepezil. In 18 completing patients, the total number of words recalled across learning trials was greater on donepezil (P = 0.4). No change was noted in attention, visual sequencing, mental flexibility, psychomotor speed, or reported quality-of-life scores. Mean 3-month seizure frequency at baseline was 2.70 ± 4.60, and during treatment, 3.06 ± 4.52 (P = 0.19, not significant). Two patients experienced increased tonic-clonic seizures. Side effects included diarrhea, stomach cramps, insomnia, depression, and blurred vision. Cholinergic medication is worthy of investigation as treatment for memory problems in people with epilepsy, but attention must be paid to possible exacerbation of seizures.
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Affiliation(s)
- R S Fisher
- Stanford Comprehensive Epilepsy Center, Stanford, California
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Gonzalez EA, Dieter JN, Natale RA, Tanner SL. Neuropsychological evaluation of higher functioning homeless persons: a comparison of an abbreviated test battery to the mini-mental state exam. J Nerv Ment Dis 2001; 189:176-81. [PMID: 11277354 DOI: 10.1097/00005053-200103000-00006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study examined neuropsychological functioning in a heterogeneous population of persons who were homeless (N = 60) and compared the value of the Abbreviated Halstead-Reitan Test Battery with the Mini-Mental State Exam (MMSE). A high incidence of neuropsychological dysfunction was evident with 80% of patients showing impaired test battery performance and 35% showing an impaired MMSE. Performance on the Trail Making Test, Part B was especially impaired. Patients impaired on Trails B more often showed impaired test battery performance, suggesting it may be a better screening tool than the MMSE. Neuropsychological performance was not significantly affected by the patients' gender, age, diagnosis, or past psychiatric and medical history. Regression analysis suggested that 29% of the variance in test battery performance was accounted for by the patients' education. Results support previous findings that large numbers of people who are homeless are neuropsychologically impaired; this should be considered when planning treatment and rehabilitation.
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Affiliation(s)
- E A Gonzalez
- Division of Psychology, University of Miami School of Medicine/Jackson Memorial Hospital, UM/JMH, Mental Health Hospital Center, Florida 33136, USA
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Aikiä M, Salmenperä T, Partanen K, Kälviäinen R. Verbal Memory in Newly Diagnosed Patients and Patients with Chronic Left Temporal Lobe Epilepsy. Epilepsy Behav 2001; 2:20-27. [PMID: 12609178 DOI: 10.1006/ebeh.2000.0140] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The objective of this study was to evaluate verbal memory in newly diagnosed and chronic left temporal lobe epilepsy (LTLE). Verbal memory performance of 39 newly diagnosed, previously untreated adult patients with LTLE and 16 patients with chronic LTLE, as well as 46 healthy controls, was analyzed. The patients with newly diagnosed and chronic LTLE had impaired verbal memory performance compared with normal controls. Memory performance was more affected in chronic LTLE. However, preliminary data from 5-year follow-up of 20 newly diagnosed LTLE patients did not show any deterioration in verbal memory performance. The memory impairment was not associated with the etiology of epilepsy or the hippocampal volumes, but was associated with early onset of epilepsy in LTLE and with secondarily generalized seizure type in newly diagnosed LTLE. The results of this study show that verbal memory is impaired not only in chronic LTLE but also in newly diagnosed, untreated LTLE. This suggests that the memory problems observed in patients with chronic LTLE cannot be attributed solely to medication effects or the chronic effects of recurrent seizures.
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Affiliation(s)
- Marja Aikiä
- Department of Neurology, Kuopio University Hospital, Kuopio, Finland
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Pulliainen V, Kuikka P, Kalska H. Are negative mood states associated with cognitive function in newly diagnosed patients with epilepsy? Epilepsia 2000; 41:421-5. [PMID: 10756407 DOI: 10.1111/j.1528-1157.2000.tb00183.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE The association of self-reported subclinical depressive symptoms and negative mood states with cognitive functioning was evaluated in 51 consecutive newly diagnosed adult persons with epilepsy. METHODS Emotional state was assessed with Profile of Mood States (POMS) and Brief Depression Scale (BDS) and was correlated with a battery of neuropsychological tests. RESULTS Patients with epilepsy reported more depressive symptoms in BDS than in controls. They also had more feeling of bewilderment and less vigor on POMS. Higher scores in BDS and in POMS inefficiency scale were associated with slower nondominant hand tapping, but emotional state did not correlate with cognitive measures within the epilepsy group. CONCLUSIONS Self-reported symptoms of depression and negative mood states were not extensively or significantly associated with cognitive function, and they do not explain the cognitive impairments observed in cognition in newly diagnosed patients with epilepsy.
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Affiliation(s)
- V Pulliainen
- Department of Neurology, Central Hospital of Päijät-Häme, Lahti, Finland.
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Abstract
PURPOSE There is now a considerable amount of research relating to memory functioning in epilepsy. The majority of studies have focused on the retention of new information, and few reports have measured memory for past events. This study aims to redress this and measure the efficiency of remote memory in epilepsy. METHODS A remote memory questionnaire was prepared and administered to three groups of patients with epilepsy and a control group without epilepsy. The questionnaire assessed knowledge of public events that occurred between 1980 and 1991, inclusive. The epilepsy groups comprised 33 patients with temporal lobe epilepsy (TLE), 33 with extratemporal epilepsy (ExTE), and 10 with primary generalized epilepsy (PGE). Thirty control subjects were tested. RESULTS Patients with TLE performed significantly less well on the questionnaire than all other groups (p = 0.001), but no effect of laterality was recorded; patients with extratemporal or primary generalised epilepsy did not differ from controls. Performance on the questionnaire was not determined by verbal IQ, educational achievement, social class, or drug treatment, but was related to the number of generalised convulsions that had occurred since 1980. The strongest neuropsychological predictors of performance on this questionnaire were measures of verbal memory. CONCLUSIONS The study demonstrated weak memory for past events in patients with TLE, thereby providing evidence of a broader memory disturbance in this group than has been previously highlighted. A test of remote memory, such as the one designed for this study, is easy to administer and provides clinically important information not available from conventional neuropsychological tests.
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Affiliation(s)
- P S Bergin
- Epilepsy Research Group, Institute of Neurology, London, England
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