Behaviour, cognition and epilepsy

Abstract

Cognitive and behavioural impairments have been observed as a consequence even of single seizures. In individuals with high seizure frequency, such impairments may accumulate and have a much greater impact on daily life than hitherto suspected. In addition, the risk of behavioural impairments is increased for some seizure types, such as secondary generalized seizures. Moreover, for all epilepsy types, increased risk is associated with persistent or poorly controlled seizures. Clinical studies show that cognitive impairments induced by seizures are reversible for most seizure types when seizures are controlled adequately. Additionally, for some seizure types there may be a kind of time window within which impairments are reversible. Exceeding the time window may result in irreversible impairment. These studies suggest that antiepileptic drug treatment can thus protect against such secondary behavioural impairments or at least correct these when seizures are controlled. This emphasizes the need to achieve complete and early seizure control. On the contrary, all antiepileptic drugs have a detrimental effect on the central nervous system and may affect cognitive function, behaviour and mood to some extent. Some treatments may undo the beneficial effects of antiepileptic drug treatment by inducing new or other cognitive impairments. This once more illustrates the need for the emphasis of clinical practice to evolve from mere seizure control to a more comprehensive approach, in which the prevention of central cognitive effects and effects on daily life of both seizures and drugs is given due attention. Optimal management requires a careful balance between, on the one hand, the desire to reach early and maximal seizure control and, on the other, the need to avoid tolerability problems related to cognitive and behavioural impairments. This article reviews how this balance can be achieved for older and newer antiepileptic drugs.

Neurocognitive problems in epilepsy

“…A negative correlation between frequency of generalised tonic-clonic seizures and performance on neuropsychological and IQ tests has been observed ( Fig. 2) (Aldenkamp 2005).…”

“…the dorsolateral frontal cortex, anterior cingulate cortex (executive function) and posterior parietal cortex (attention). Participants with a lifetime seizure frequency of over 50, however, revealed a disseminated pattern of brain activation, rather than the focused pattern of the other two groups (Aldenkamp 2005).…”

“…They were divided into two groups according to lifetime seizure frequency: over 50 seizures and under 10 seizures. Those who had experienced fewer than 10 seizures had a normal IQ, whereas those who had had more than 50 seizures showed a lower IQ than agematched population norms (Aldenkamp 2005).…”

“…The onset of seizures before 5 years of age appears to be a particular risk factor for low IQ (Aldenkamp 2005). Acquired epileptic aphasia presents between the ages of 3 and 8, the period in which the phase of accelerated cerebral maturation occurs.…”

Long-term follow-up after comprehensive rehabilitation of persons with epilepsy, with emphasis on participation in employment or education

“…Adding to the burden, comorbidities including depression as well as cognitive deficits and memory dysfunction are common [2][3][4][5][6][7][8][9]. All this can affect self-esteem and self-efficacy, which may contribute to the higher unemployment rate among people with epilepsy [10][11].…”