Cognitive Impairment and Personality Traits in Epilepsy: Characterization and Risk Factor Analysis

Mathematics Skills in Epilepsy: A Systematic Review and Meta-Analysis

Mathematics incorporates a broad range of skills, which includes basic early numeracy skills, such as subitizing and basic counting to more advanced secondary skills including mathematics calculation and reasoning. The aim of this review was to undertake a detailed investigation of the severity and pattern of early numeracy and secondary mathematics skills in people with epilepsy. Searches were guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Twenty adult studies and 67 child studies were included in this review. Overall, meta-analyses revealed significant moderate impairments across all mathematics outcomes in both adults (g= -0.676), and children (g= -0.593) with epilepsy. Deficits were also observed for specific mathematics outcomes. For adults, impairments were found for mathematics reasoning (g= -0.736). However, two studies found that mathematics calculation was not significantly impaired, and an insufficient number of studies examined early numeracy skills in adults. In children with epilepsy, significant impairments were observed for each mathematics outcome: early numeracy (g= -0.383), calculation (g= -0.762), and reasoning (g= -0.572). The gravity of impairments also differed according to the site of seizure focus for children and adults, suggesting that mathematics outcomes were differentially vulnerable to the location of seizure focus.

Big Five personality predict epilepsy diagnosis in 7 years

Objective

Recently, there is growing interest in investigating how personality traits could predict a subsequent diagnosis of various diseases. Regarding epilepsy, there is only preliminary evidence based on cross-sectional studies linking personality traits to epilepsy, hence, emphasizing the need for longitudinal studies. The aim of the current study is to assess if the Big Five personality traits can predict the risk of an epilepsy diagnosis.

Methods

The current study analyzed data from 17,789 participants who participated in Understanding Society: the UK Household Longitudinal Study (UKHLS) at Wave 3 (collected between 2011 and 2012) and Wave 10 (collected between 2018 and 2019). The mean age was 47.01 (SD = 16.31) years and were 42.62% male. Two binary logistic regressions were used by including age, monthly income, highest educational qualification, legal marital status, residence, and standardized personality traits scores at Wave 3 as predictors for a clinical diagnosis of epilepsy at Wave 10 for males and females, respectively.

Results

There were 175 participants (0.98%) with epilepsy and 17,614 participants (99.02%) without epilepsy at Wave 10. Results of the binary regression analyses revealed that Neuroticism is positively related to the risk of an epilepsy diagnosis in males (OR = 1.32, p = 0.04, 95% CI [1.01, 1.71]) but not in females 7  years after Wave 3 at Wave 10. However, other personality traits including Agreeableness, Openness, Conscientiousness, and Extraversion were not significant predictors of epilepsy diagnosis.

Conclusion

These findings suggested that personality traits might enhance our understanding of psychophysiological associations in epilepsy. Neuroticism might be a relevant factor that should be taken into account in epilepsy education and treatment. Moreover, sex differences must be taken into account.

Understanding the associations between personality traits and mental health in people with epilepsy and healthy controls

Objectives

The aim of the current study was to test how epilepsy could moderate the associations between Big Five personality traits and mental health.

Methods

This cross-sectional study analyzed data from Understanding Society: UK Household Longitudinal (UKHLS), which relies on a complex multi-stage stratified sampling design. Personality traits were measured by the Big Five inventory whereas mental health where measured by the GHQ-12. A hierarchical regression and two multiple regressions were performed on 334 people with epilepsy with a mean age of 45.14 ± 15.88 years old (41.32% males) and 26,484 healthy controls (42.5% males) with a mean age of 48.71 ± 17.04 years old.

Results

Neuroticism was positively related to worse mental health in both people with epilepsy and healthy controls with a stronger relationship in people with epilepsy, but Conscientiousness was negatively related to worse mental health in both people with epilepsy and healthy controls. Moreover, Openness and Extraversion were negatively related to worse mental health in healthy controls but not in people with epilepsy.

Conclusion

Personality traits are closely related to mental health in both people with epilepsy and healthy controls. Clinicians should use findings from this study to detect people with epilepsy who may be at high risk of poor mental health based on their personality traits.

Personality traits in patients with refractory versus non-refractory epilepsy

Background

Epilepsy has significant effects on the behavior of most people who suffer it. In some cases, the seizure activity itself is manifested as a brief change in behavior that might appear unusual to the casual observer. Evidence also suggests that epilepsy can affect behavior when seizures are not occurring. Descriptions of inter-ictal behavior in people with epilepsy have a long and controversial history. The study aims to assess the personality disorders among epileptic patients and impact of the severity of epilepsy on personality traits. Methods: This study is conducted upon 90 patients presented at outpatient clinic of epilepsy in Assiut University Hospital diagnosed as having epilepsy versus 40 cross-matched healthy controls. Patient group were classified into two groups (refractory versus controlled groups). All patients and control were subjected to (1) detailed medical interview. (2) Assessment of intelligence using The Arabic Version of Wechsler Adult Intelligence Scale. (3) Conventional EEG study. (4) The Arabic Version of The Structured interview for the five-factor model of personality.

Results

A relationship was found between personality traits and the severity of epilepsy. When patients have more severe epilepsy, they often have a high seizure frequency, they use more antiepileptic medications. It is likely that in those patients the need for control is usually high (because seizures mean a loss of control). Regarding the five-factor model of personality which we used to assess the personality traits of our selected studied samples, we found that the five main domains of the scale which are neuroticism, extraversion, openness to experience, agreeableness and conscientiousness differ markedly between the two groups of our patients. We found neuroticism was markedly increased at the refractory epileptic patients than the controlled epileptic ones, while extraversion, openness to experience, agreeableness, and conscientiousness increased at the controlled epileptic patients than the refractory epileptic ones.

Conclusion

Patients with epilepsy have raised scores for several personality traits also those personality traits are different in patients with refractory and controlled epilepsy. Also, those personality traits are different compared with a control group from the general population.

Mood variations and personality traits in patients with epilepsy over the course of their menstrual cycle

INTRODUCTION

The incidence of mood disorders and psychopathology is more frequent in patients with epilepsy (PWE) than in the general population. Also, it has been reported that PWE suffer more seizures during certain phases of their menstrual cycle (MC). Still, limited information exists regarding the relationship between the physical and emotional changes during the MC in PWE. Therefore, in this study, we aimed to evaluate the mood and personality traits of PWE during their MC and to compare them with controls.

METHODS

A cohort of 22 PWE and nine controls was gathered. All the participants underwent psychiatric, electroencephalographic, and gynecological evaluations.

RESULTS

Overall, PWE scored higher in depression compared with controls (p < 0.05), PWE also obtained higher scores for the personality traits of neuroticism and self-isolation (p < 0.05). During the evaluation of the symptoms of premenstrual syndrome (PMS), PWE were more symptomatic during the early follicular (EF) phase in comparison with the rest of the phases of their MC, whereas the control group showed the known premenstrual pattern of symptoms during the late luteal (LL) phase. The frequency of seizures (40.6%) and electroencephalographic abnormalities (34.8%) was also higher during the EF phase of the MC when compared with the other phases of the MC (p < 0.05).

CONCLUSIONS

The results of this study suggest that unlike the PMS present in women without epilepsy, PWE appear to show a "menstrual syndrome" that consists of similar mood changes and physical symptoms. This arrangement of symptoms seems to have an impact on the increase in seizure activity.

Cognition, Behavior, and Psychosocial Effects of Seizures in the Developing Brain

Epilepsy, a complex neurological disorder of recurrent seizures, is associated with significant impacts on the developing brain. Patients commonly face multiple comorbidities, including debilitating effects on cognition, behavior, and psychiatric outcomes. These conditions can be a source of great distress for patients that may even be greater than the burden of epilepsy itself. Here we investigate the relationship between seizures and the development of these comorbidities, specifically cognition, memory, learning, behavior, and psychiatric disorders. We first delineate the current research methodology in clinical and basic science that is employed to study the impact of epilepsy and seizures. We then explore neurobiological mechanisms underlying the development of seizures and cognitive and behavioral outcomes. Potential avenues of intervention to best support individuals and optimize their neurodevelopmental progress are also highlighted.

Personality functioning in adults with refractory epilepsy and community adults: Implications for health-related quality of life

INTRODUCTION

Prior research has shown that people with epilepsy are at risk for a poorer health-related quality of life (HRQOL). However, patients differ greatly in how well they adjust to their epilepsy. To better understand these differences, the present study examined the role of personality. More specifically, we examined mean-level differences in Big Five personality traits between adults with refractory epilepsy and a community sample and related these traits to patients' HRQOL.

METHODS

A total of 121 adults with refractory epilepsy (18-40 years old, 56% women) completed questionnaires on the Big Five personality traits, HRQOL, and seizure frequency and severity. Patients' Big Five scores were compared to those of a community sample matched on sex and age using paired samples t-tests. We conducted hierarchical regression analyses to examine associations between personality and HRQOL, while controlling for the effects of sex, age, age at diagnosis, seizure frequency, and seizure severity.

RESULTS

Patients reported higher levels of neuroticism and lower levels of openness as compared to controls. In patients, seizure severity was positively related to neuroticism and negatively related to agreeableness. Finally, patients high in neuroticism and low in conscientiousness generally reported a poorer HRQOL.

CONCLUSION

In the present study, small personality differences were observed between adults with refractory epilepsy and a community sample. Patients' personality was found to play an important role in adjusting to epilepsy, even after controlling for seizure frequency and severity. Personality assessment may help healthcare professionals in identifying patients at risk for poor HRQOL later in life.

Personality patterns of people with medically refractory epilepsy - Does the epileptogenic zone matter?

OBJECTIVES

The aims of this study were to determine the rate of dysfunctional personality patterns before and after epilepsy surgery, their types, and the importance of the epileptogenic zone in a sample of people with refractory epilepsy.

METHODS

We conducted an ambispective observational study, including refractory epilepsy surgery candidates. Demographic, psychiatric, and neurological data were recorded. Evaluation of personality was made using the Millon Clinical Multiaxial Inventory-II (MCMI-II). Presurgical predictors of personality patterns were determined using a linear regression model. The proportion of patients with dysfunctional personality patterns, before and after surgery, was compared using the Mcnemar's test. Then a generalized estimating equation model was performed to include predictors of changes in this rate.

RESULTS

One hundred and ninety-nine participants were included. Seventy percent had a dysfunctional personality pattern before surgery. After surgery, this percentage dropped to 58%. The difference was statistically significant after adjusting for potential confounders (p = 0.013). The most common types were Cluster C personality patterns. Temporal epileptogenic zone was a significant predictor of higher scores of the Avoidant (Coef. 11.8; Confidence Interval (CI) -0.59 23.7; p = 0.051) and Compulsive (Coef. 9.55; CI 2.48 16.6; p = 0.008) personality patterns and lower scores of Histrionic (Coef. -11.4; CI -21.2 -1.55; p = 0.024) and Antisocial (Coef. -8.4; CI -15.6 -1.25; p = 0.022) personality patterns, compared to extratemporal epileptogenic zone.

CONCLUSION

People with refractory epilepsy have high rates of dysfunctional personality patterns. These patterns differ according to the epileptogenic zone.