Cognitive Implications in Epilepsy.

Abstract

Cognitive disability is a major contributor to the comorbidities of epilepsy. There is major evidence that confirms that cognitive impairment can appear or worsen with early and chronic progressive neurologic changes in epilepsy. It has been increasingly accepted that comorbidity does not indicate causality. Certainly, cognitive impairment in epileptic patients warrants crucial evaluation and mitigation from the onset of diagnosis and treatment of epilepsy. The concept of a bidirectional nature of cognitive impairment in epilepsy represents a change in the paradigm of the neuropsychology of epilepsy. It has been suggested that both behavioral and cognitive dysfunction associated with epilepsy are not necessarily the consequence of active epilepsy but in fact, can dominate and be associated with factors before the emergence of epilepsy. This review discusses different relations of behavioral and cognitive comorbidities in epilepsy and tries to clarify the nature of the relationship between epilepsy and cognition.

Cognitive functions and epilepsy-related characteristics in patients with generalized tonic–clonic epilepsy: a cross-sectional study

“…In a study assessing cognition in a sample of patients with newly diagnosed, untreated epilepsy, there was nearly 75% having deficits in attention, executive functions, and memory [13]. This indicates that comorbidity does not always indicate causality and that a bidirectional concept of cognitive impairment in patients with epilepsy should rather be adopted [14].…”

Perbedaan Fungsi Kognitif pada Pasien Anak dengan Epilepsi yang Mendapatkan Monoterapi dan Politerapi di Rumah Sakit Umum Daerah Moewardi Surakarta

“…Namun, risikonya lebih tinggi pada obat-obatan yang meningkatkan GABA yang dapat menyebabkan perlambatan mental dan gangguan produksi bahasa. 14 Hasil penelitian Besag dkk 15 menunjukkan bahwa fenobarbital, fenitoin, dan topiramate merusak fungsi neurokognitif. Ada bukti bahwa Levetiracetam, dan Lamotrigin dapat dikaitkan dengan perbaikan di beberapa bidang kognisi.…”

“…Namun, epilepsi umum memiliki defisit kognitif yang lebih tinggi daripada epilepsi fokal dan bahaya terbesar pada pasien dengan status epileptikus. 14 Hasil penelitian ini sesuai dengan penelitian Wishwadewa dkk, 17 yakni semakin jarang pasien mengalami serangan kejang dalam enam bulan terakhir semakin baik fungsi kognitif, karena semakin sering pasien kejang akan mengakibatkan semakin banyak kerusakan sel-sel neuron di otak sehingga fungsi kognitif menurun. Hasil serupa dilaporkan oleh Seidenberg dkk, 18 bahwa frekuensi kejang mempunyai korelasi negatif signifikan dengan fungsi kognitif anak.…”