Cognitive adverse effects of epilepsy and its predictors attending outpatient department of South Gondar zone hospitals, Amhara Region, Ethiopia 2020 /2021

Association between cognitive impairment and antiseizure medication adherence among people with epilepsy in Addis Ababa, Ethiopia

BACKGROUND

Cognitive impairment is one of the most common and most troublesome comorbidities among people with epilepsy (PWE). Adherent use of antiseizure medications (ASM) can control seizure episodes in 70% of the cases. However, the relationship between adherent use of ASMs and cognitive impairment in epilepsy is complex.

OBJECTIVE

To assess the association between adherence to ASMs and cognitive status among PWE.

METHODS

We performed a cross-sectional observational study with prospective data collection from PWE using translated and content-validated Amharic versions of the Montreal cognitive assessment tool (MOCA-B) and a four-item Morisky Medication Adherence Scale (Morski-4). Ordinal logistic regression analysis was performed to evaluate the potential risk factors for cognitive impairment, including ASM adherence, physical exercise, and level of education.

RESULTS

A total of 214 individuals with epilepsy were included in this study; 53.7 % were female, and the mean age was 34 years ± 12. The mean age at seizure occurrence was 19 years ± 9. The most common epilepsy type among participants was generalized epilepsy (69 %). The prevalence of poor medication adherence to ASM was 54.2 %. The prevalence of mild cognitive impairment was 65.4 %, and 18.2 % had moderate cognitive impairment, particularly affecting verbal fluency (60.8 %) and memory (43.9 %). Cognitive impairment was significantly associated with poor ASM adherence (AOR = 12.0, 95 %CI, (1.53, 93.75), lower level of physical exercise (AOR = 16.30, 95 %CI (1.24, 214.99), and poor educational attainment with both no formal education (AOR = 0.04, 95 %CI (0.02, 0.14)) and primary or secondary level education (AOR = 0.32, 95 %CI, (0.15, 0.70).

CONCLUSIONS

There is a high rate of cognitive impairment and non-adherence to ASMs in PWE living in Addis Ababa, Ethiopia. Poor ASM adherence is a possible risk factor for cognitive impairment. PWE can benefit from interventions to improve ASM adherence, physical exercise, and better educational attainment.

Advances in understanding the pathogenesis of epilepsy: Unraveling the molecular mechanisms: A cross-sectional study

Introduction

Epilepsy is characterized by having two or more unprovoked seizures. Understanding the pathogenesis of epilepsy, requires deep investigation into the molecular mechanisms. This helps develop diagnostic techniques, treatments, and pharmacotherapy. It also enhances precision medicine and individualized treatment processes. This article reviews all the molecular mechanisms predisposing to epileptogenesis, presents the current diagnostic techniques and drug therapy, and suggests future perspectives in treating Epilepsy in a more comprehensive and holistic approach.

Methodology

Four authors searched keywords concerning epilepsy at a molecular level, Epilepsy diagnostic techniques and technologies, and antiepileptic drug therapy and precision medicine. Separate search strategies were conducted for each concern and retrieved articles were reviewed for relevant results.

Results

The traditional diagnostic techniques for Epilepsy and its pathogenesis are insufficient in highlighting dynamic brain changes. For this, emerging technologies including genetic sequencing and profiling, and functional neuroimaging techniques are prevailing. Concerning treatment, the current approach focuses on managing symptoms and stopping seizures using antiseizure medications. However, their usage is limited by developing resistance to such drugs. Some therapies show promise, although most antiseizure drugs do not prevent epilepsy.

Discussion

Understanding epileptogenesis at a molecular and genetic level aids in developing new antiepileptic pharmacotherapy. The aim is to develop therapies that could prevent seizures or modify disease course, decreasing the severity and avoiding drug resistance. Gene therapy and precision medicine are promising but applications are limited due to the heterogeneity in studying the Epileptic brain, dynamically. The dynamic investigation of the epileptic brain with its comorbidities works hand-in-hand with precision medicine, in developing personalized treatment plans.