Cognitive complaints after a first seizure in adulthood: Influence of psychological adjustment

Abstract

SUMMARYPurpose: To examine the nature and determinants (biologic and psychological) of cognitive complaints in first-seizure patients. We analyzed this in the context of our previous findings that a sense of loss of control after a newly diagnosed seizure (limited or pervasive) predicts subsequent psychological adjustment trajectories. Methods: Eighty-five consecutive First Seizure Clinic patients were assessed at 1 and 3 months. Cognitive complaints were evaluated qualitatively, with a semistructured interview, and quantitatively, with the A-B Neuropsychological Assessment Schedule (ABNAS). Objective attentional processing was assessed with reaction time tasks and the Wechsler Adult Intelligence Scale3rd edition (WAIS-III) Processing Speed Index. Mood was assessed with the Hospital Anxiety and Depression Scale (HADS). Psychological adjustment trajectories were represented by previous classification of patients into limited and pervasive groups, as derived from semistructured interview. Results: Cognitive complaints at 1 and 3 months were strongly associated with mood, and unrelated to objective attentional processing. Psychological adjustment trajectories influenced the longitudinal course of cognitive complaints, and these effects were partially mediated by mood differences between the limited and pervasive groups. The course of cognitive complaints was also altered by commencing antiepileptic drugs. Patients experiencing seizure recurrence reported greater cognitive complaints, even before their seizure recurred. Mediation analyses showed this effect was likely attributable to increased mood disturbance in the seizure recurrence group, and was unrelated to objective attentional processing. Discussion: Understanding cognitive complaints in first-seizure patients requires a longitudinal perspective that takes into account the patients' changing psychological and medical contexts. Patients presenting with extensive cognitive complaints may warrant assessment for mood and adjustment issues.

Psychosocial difficulties in people with epilepsy: A systematic review of literature from 2005 until 2010

“…A mediation effect is played by the use of appropriate coping strategies that have been found to be associated, with limited evidence, with good control over epilepsy-related PSDs [49]. Finally, one study reported limited evidence of a correlation between locus of control, cognitive functions, and depressive symptoms: cognitive problems and high levels of depressive symptoms interfere with the sense of control of the health condition [41]. Studies were rated with good quality, even if evidence of the reported results was limited.…”

“…Specifically, limited evidence was found in the determination of the severity of cognitive problems by the subtype of epilepsy [43]. Two studies reported strong evidence for the positive effects of levetiracetam on seizure control and reduction of cognitive problems [41,45] and the limited evidence of the connection to improvement in emotional functions [41]. Studies suggested that cognitive problems increase in patients who have high frequency of seizures and are perceived as more severe in [42]; [37] patients with emotional difficulties.…”

“…Severity of depressive symptoms was also associated with cognitive complaints [41], low quality of life [35], and lack of adherence to treatment [39].…”

Cognitive impairment in adults with epilepsy: The relationship between subjective and objective assessments of cognition

“…It has been validated as a measure of patient-perceived cognitive function against the computerised Fepsy neuropsychological battery (Aldenkamp et al 2002), although not against a clinician administered tool such as EpiTrack. The ABNAS has previously been used to assess the scope of cognitive complaints in a number of PWE, including in those following a first seizure (Velissaris et al 2009). In its original form, the…”

Single Seizure and Cognition: Clinical and Translational Implications

“…Velissaris et al examined the presence of cognitive impairment and mood disorders in 90 patients with the first convulsion at the age of 18 to 65 years one and three months after the seizure [42]. For subjective assessment of cognitive function by the patients a qualitative questionnaire Austin First Seizure Impact Interview (AFSII) and a semi-quantitative scale AB Neuropsychological Assessment Schedule (ABNAS) was used, while to assess the scale of emotional changes Hospital Anxiety and Depression Scale (HADS) was applied.…”