Cognitive features of adult focal epilepsy with unknown etiology revealed by the trail making test

Hasegawa, Naoya; Annaka, Hiroki

doi:10.1016/j.yebeh.2022.108625

Cited by 3 publications

(5 citation statements)

References 25 publications

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“…To objectively evaluate which clinical features influenced the first TMT performance, we listed as many candidate explanatory factors as we could produce and selected the most important using a stepwise method. These analyses replicate those of our previous study 4 except for the inclusion of ASMs and the exclusion of EEG findings. The reason for this repetition is that some of the patients had changed, and it was necessary to confirm the reproducibility of the results of our previous study.…”

Section: Methodssupporting

confidence: 79%

“…3 In a previous study, we found that the active seizure period and the number of antiseizure medications (ASMs) were associated with TMT performance. 4 However, we also found a positive correlation between the active seizure period and the number of ASMs in that study. Therefore, we could not clarify the causality in terms of whether unknown factors that make epilepsy intractable adversely affect TMT performance, prolong the active seizure period, and increase the number of ASMs, or whether an increasing number of ASMs and the cumulative effects of repeated seizures cause worse TMT performance.…”

Section: Introductionmentioning

confidence: 46%

“…To evaluate these dynamic aspects of cognitive function in adult patients with focal epilepsy, we adopted the Trail Making Test (TMT), one of the most widely used screening tests in clinical neuropsychology practice and one of the few tests recommended by both the National Institutes of Health and the European Union survey to assess executive dysfunction in patients with epilepsy 3 . In a previous study, we found that the active seizure period and the number of antiseizure medications (ASMs) were associated with TMT performance 4 . However, we also found a positive correlation between the active seizure period and the number of ASMs in that study.…”

Section: Introductionmentioning

confidence: 99%

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Long‐term effect associated with seizures and dynamic effect associated with treatment on cognitive dysfunction of adult patients with focal epilepsy as evaluated by the Trail Making Test

Hasegawa

Annaka

2023

Epileptic Disorders

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ObjectiveThis study was performed to clarify the utility of the Trail Making Test (TMT) in evaluating the effects of the course of epilepsy on cognitive function by evaluating the course of epileptic seizures and the results of the TMT over time.MethodsWe performed the TMT twice at a 1‐year interval for each patient with focal epilepsy. We performed multiple regression analyses with the first TMT scores as dependent variables and clinical features as independent variables. Next, we performed a multivariate analysis of covariance (MANCOVA) to evaluate the difference between the first and second TMT scores for patients in each seizure prognosis group.ResultsWe enrolled 132 adult patients in this study. Multiple regression analyses showed that longer active seizure periods were associated with worse first TMT‐B performance (β = .318, p < .001) and B–A (β = .377, p < .001) and that the number of antiseizure medicines was associated with worse first TMT‐A performance (β = .186, p = .025). In addition, topiramate and zonisamide adversely affected TMT performance. MANCOVA showed an interaction between the prognosis of TMT‐B performance and the seizure prognosis [F(2, 120) = 3.68, p = .028]. Subeffect tests revealed that the second TMT‐B performance improved only in the seizure improvement group [F(1, 10) = 10.07, p = .01].SignificanceEpileptic seizures were shown to be associated with both long‐term and dynamic adverse effects on cognitive function evaluated with the TMT in adult patients with focal epilepsy. Seizure control is important for improving the cognitive function of patients with epilepsy; however, the potential adverse effects of polypharmacy and some antiseizure medicines such as zonisamide and topiramate on cognitive function should be considered.

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Section: Methodssupporting

confidence: 79%

Section: Introductionmentioning

confidence: 46%

Section: Introductionmentioning

confidence: 99%

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Long‐term effect associated with seizures and dynamic effect associated with treatment on cognitive dysfunction of adult patients with focal epilepsy as evaluated by the Trail Making Test

Hasegawa

Annaka

2023

Epileptic Disorders

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“…In individual analysis, the correlation between seizure responders and clinically significant improvement was more evident in TMT-A/B than in DB. In previous studies, a longer duration of active epilepsy has been associated with worse TMT-B performance ( 19 ), and in a follow-up study, only patients with improved seizure control due to ASM changes also improved in TMT-B but not in TMT-A ( 20 ). However, in our study, the decrease in seizure frequency was not always concordant with clinically significant improvement in any of the tests highlighting the involvement of other factors in addition to seizure reduction.…”

Section: Discussionmentioning

confidence: 88%

“…The Trail-Making Test (TMT) is one of the most common tests for evaluating executive functions and has been demonstrated to be useful in assessing executive functions of epilepsy patients in previous studies (19,20). The TMT consists of two parts; the TMT-A provides a baseline measure of psychomotor speed, visuospatial search, and target-directed motor tracking (21), while the TMT-B is similar to the TMT-A in assessing low-level processes, but it additionally measures other more advanced components of executive functions, such as inhibition control and set-switching (22)(23)(24).…”

Section: Introductionmentioning

confidence: 99%

Complex executive functions assessed by the trail making test (TMT) part B improve more than those assessed by the TMT part A or digit span backward task during vagus nerve stimulation in patients with drug-resistant epilepsy

Lähde,

Basnyat,

Raitanen

et al. 2024

Front. Psychiatry

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IntroductionThere is a paucity of clinical studies examining the long-term effects of vagus nerve stimulation (VNS) on cognition, although a recent study of patients with drug-resistant epilepsy (DRE) treated with VNS therapy demonstrated significant improvement in executive functions as measured by the EpiTrack composite score. The present study aimed to investigate performance variability in three cognitive tests assessing executive functions and working memory in a cohort of DRE patients receiving VNS therapy during a follow-up duration of up to 5 years.MethodsThe study included 46 DRE patients who were assessed with the Trail Making Test (TMT) (Parts A and B) and Digit Span Backward (DB) task prior to VNS implantation, 6 months and 12 months after implantation, and yearly thereafter as a part of the clinical VNS protocol. A linear mixed-effects (LME) model was used to analyze changes in test z scores over time, accounting for variations in follow-up duration when predicting changes over 5 years. Additionally, we conducted descriptive analyses to illustrate individual changes.ResultsOn average, TMT-A z scores improved by 0.024 units (95% confidence interval (CI): 0.006 to 0.042, p = 0.009), TMT-B z scores by 0.034 units (95% CI: 0.012 to 0.057, p = 0.003), and DB z scores by 0.019 units per month (95% CI: 0.011 to 0.028, p < 0.001). Patients with psychiatric comorbidities achieved the greatest improvements in TMT-B and DB z scores among all groups (0.0058 units/month, p = 0.036 and 0.028 units/month, p = 0.003, respectively). TMT-A z scores improved the most in patients taking 1–2 ASMs as well as in patients with psychiatric comorbidities (0.042 units/month, p = 0.002 and p = 0.003, respectively).ConclusionPerformance in all three tests improved at the group level during the follow-up period, with the most robust improvement observed in TMT-B, which requires inhibition control and set-switching in addition to the visuoperceptual processing speed that is crucial in TMT-A and working-memory performance that is essential in DB. Moreover, the improvement in TMT-B was further enhanced if the patient had psychiatric comorbidities.

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Structural and functional abnormalities and cognitive profiles in older adults with early-onset and late-onset focal epilepsy

Wan,

Zeng,

Wang

et al. 2024

Cerebral Cortex

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This study aimed to determine the patterns of changes in structure, function, and cognitive ability in early-onset and late-onset older adults with focal epilepsy (OFE). This study first utilized the deformation-based morphometry analysis to identify structural abnormalities, which were used as the seed region to investigate the functional connectivity with the whole brain. Next, a correlation analysis was performed between the altered imaging findings and neuropsychiatry assessments. Finally, the potential role of structural-functional abnormalities in the diagnosis of epilepsy was further explored by using mediation analysis. Compared with healthy controls (n = 28), the area of reduced structural volume was concentrated in the bilateral cerebellum, right thalamus, and right middle cingulate cortex, with frontal, temporal, and occipital lobes also affected in early-onset focal epilepsy (n = 26), while late-onset patients (n = 31) displayed cerebellar, thalamic, and cingulate atrophy. Furthermore, correlation analyses suggest an association between structural abnormalities and cognitive assessments. Dysfunctional connectivity in the cerebellum, cingulate cortex, and frontal gyrus partially mediates the relationship between structural abnormalities and the diagnosis of early-onset focal epilepsy. This study identified structural and functional abnormalities in early-onset and late-onset focal epilepsy and explored characters in cognitive performance. Structural-functional coupling may play a potential role in the diagnosis of epilepsy.

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Cognitive features of adult focal epilepsy with unknown etiology revealed by the trail making test

Cited by 3 publications

References 25 publications

Long‐term effect associated with seizures and dynamic effect associated with treatment on cognitive dysfunction of adult patients with focal epilepsy as evaluated by the Trail Making Test

Long‐term effect associated with seizures and dynamic effect associated with treatment on cognitive dysfunction of adult patients with focal epilepsy as evaluated by the Trail Making Test

Complex executive functions assessed by the trail making test (TMT) part B improve more than those assessed by the TMT part A or digit span backward task during vagus nerve stimulation in patients with drug-resistant epilepsy

Structural and functional abnormalities and cognitive profiles in older adults with early-onset and late-onset focal epilepsy

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