Cognitive dysfunction in patients with epilepsy: focus on clinical variables

Abstract

A variety of factors can affect cognitive functions in patients with epilepsy, with the majority of cognitive problems having a multifactorial origin. In routine clinical practice, it can be difficult to dissect out the contribution of all of the different variables, because they are often interlinked together. In this article, all of the major variables implicated in cognitive dysfunction in epilepsy are discussed. In general terms, it is widely accepted that cognitive dysfunction in epilepsy can be trait dependent or state dependent. The former is a permanent condition due to the underlying brain damage or disorder, while the latter is a potentially reversible condition due to modifiable factors, such as antiepileptic drugs, seizure frequency and pattern and psychiatric comorbidity. Neuropsychological deficits also represent an important sequela in epilepsy surgery. Visual naming and visual memory loss have been clearly associated with temporal lobe surgery. It seems that the laterality of resection is not a major determinant, while the extension of resection is relevant for visual naming. Medscape: Continuing Medical Education OnlineThis activity has been planned and implemented in accordance with the Essential Areas andpolicies of the Accreditation Council for Continuing Medical Education through the joint providership of Medscape, LLC and Future Medicine Ltd. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians. Medscape, LLC designates this Journal-based CME activity for a maximum of 1.0 AMAPRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test with a 75% minimum passing score and complete the evaluation at www.medscape.org/journal/fnl; (4) view/print certificate.

Characteristics of Cognitive Status of Epilepsy Patients Treated With Monotherapy of First-Generation Antiepileptic Drugs

“…In contrast, the characteristics of age, years of education, age at epilepsy onset, type of seizure, and etiology of epilepsy did not associate significantly with the prevalence of cognitive decline among these epilepsy subjects in multiple logistic regression model (Table 3). This findings was on the contrary to the results of several reviews showing that interaction of these variables will affect the cognitive decline in epilepsy patients 11,30 .…”

“…The lower scores of cognitive domains which construct MoCA-Ina instrument among epilepsy patients in this study, namely visuospatial and executive, naming, attention, language, delayed memory, and orientation functions represent the dysfunction of brain areas carrying these cognitive functions 28 . Generally, the results of this study were in accordance with the findings from previous studies 6, [29][30][31] .…”

The frequency and management of seizures during psychological treatment among patients with psychogenic nonepileptic seizures and epilepsy

“…3,4 Neither epilepsy nor PNES is characterized by seizures alone. Cognitive dysfunction and psychiatric comorbidities are more common in patients with both of these seizure disorders than in the general population, [5][6][7][8] and the complex and intimate nature of the links between seizures and psychiatric and cognitive morbidity is recognized in the International League Against Epilepsy (ILAE) definition of epilepsy. 9 Indeed, when epileptic seizures or PNES is not fully controlled by treatment, neuropsychological and psychiatric problems have greater adverse effects on patients' quality of life than seizure-related variables do.…”

“…9 Indeed, when epileptic seizures or PNES is not fully controlled by treatment, neuropsychological and psychiatric problems have greater adverse effects on patients' quality of life than seizure-related variables do. [5][6][7][8]10,11 There is accumulating evidence of the effectiveness of psychological therapy in patients with both types of seizure disorders: such treatments can improve health-related quality of life (HRQoL) in patients with epilepsy, 12 and seizure control, HRQoL, and functioning in patients with PNES. [13][14][15] Consequently, in clinical practice, a proportion of people with PNES and epilepsy may be referred for psychological therapy.…”

“…Cognitive dysfunction and psychiatric comorbidities are more common in patients with both of these seizure disorders than in the general population, and the complex and intimate nature of the links between seizures and psychiatric and cognitive morbidity is recognized in the International League Against Epilepsy (ILAE) definition of epilepsy . Indeed, when epileptic seizures or PNES is not fully controlled by treatment, neuropsychological and psychiatric problems have greater adverse effects on patients' quality of life than seizure‐related variables do . There is accumulating evidence of the effectiveness of psychological therapy in patients with both types of seizure disorders: such treatments can improve health‐related quality of life (HRQoL) in patients with epilepsy, and seizure control, HRQoL, and functioning in patients with PNES .…”