Discrepancy between subjective and objective memory change after epilepsy surgery: Relation with seizure outcome and depressive symptoms

Mücke, Florian Johannes; Hendriks, Marc Petrus; Bien, Christian G.; Grewe, Philip

doi:10.3389/fneur.2022.855664

Cited by 7 publications

(6 citation statements)

References 42 publications

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“…As we focused on subjective psychological data, we did not include objective measures of cognition. Subjective and objective cognition may differ, 48 so that it would be intriguing to investigate the differential impact of both on patients' decisions in future studies.…”

Section: Discussionmentioning

confidence: 99%

How patients' psycho‐social profiles contribute to decision‐making in epilepsy surgery: A prospective study

et al. 2023

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Objective Identifying factors associated with surgical decision‐making is important to understand reasons for underutilization of epilepsy surgery. Neurologists' recommendations for surgery and patients' acceptance of these recommendations depend on clinical epilepsy variables, for example, lateralization and localization of seizure onset zones. Moreover, previous research shows associations with demographic factors, for example, age and sex. Here, we investigate the relevance of patients' psycho‐social profile for surgical decision‐making. Methods We prospectively studied 296 patients from two large German epilepsy centers. Multiple logistic regression analyses were used to investigate variables linked to neurologists' recommendations for and patients' acceptance of surgery or intracranial video‐electroencephalographic monitoring. Patients' psycho‐social profiles were assessed via self‐reports and controlled for various clinical–demographic variables. Model selection was performed using the Akaike information criterion. Results As expected, models for neurologists' surgery recommendations primarily revealed clinical factors such as lateralization and localization of the seizure onset zone, load with antiseizure medication (ASM), and site of the epilepsy‐center. For this outcome, employment was the only relevant psycho‐social aspect (odds ratio [OR] = .38, 95% confidence interval [CI] = .13–1.11). In contrast, three of the five relevant predictors for patients' acceptance were psycho‐social. Higher odds were found for those with more subjective ASM adverse events (OR = 1.04, 95% CI = .99–1.00), more subjective seizure severity (OR = 1.12, 95% CI = 1.01–1.24), and lower subjective cognitive impairment (OR = .98, 95% CI = .96–1.00). Significance We demonstrated the relevance of the patients' psycho‐social profile for decision‐making in epilepsy surgery, particularly for patients' decisions. Thus, in addition to clinical–demographic variables, patients' individual psycho‐social characteristics add to the understanding of surgical decision‐making. From a clinical perspective, this calls for individually tailored counseling to assist patients in finding the optimal treatment option.

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Section: Discussionmentioning

confidence: 99%

How patients' psycho‐social profiles contribute to decision‐making in epilepsy surgery: A prospective study

et al. 2023

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“…Interestingly, in our study, depressive symptoms were only linked to executive functions, whereas based on the aforementioned rationales, attentional and memory impairment may also be expected. However, in PWE, some studies found correlations between depressive symptoms and different cognitive functions, 15,19,30 whereas other did not 22,59–61 . Thus, it seems necessary to differentiate between groups of PWE (e.g., presurgical vs. outpatient samples, localization of the brain lesion 60 ).…”

Section: Discussionmentioning

confidence: 99%

“…We examined concordance of SCI and OCI by comparing subjective reports and objective performance 16,30 . SCI scores were classified based on the same recommendations as the objective performance 34 .…”

Section: Methodsmentioning

confidence: 99%

“…Therefore, we investigate whether SCI in memory, attention, and executive functions is correlated with corresponding objective measures. We selected parameters that are often impaired in PWE and that showed associations with SCI previously 11,22,28,30 . Extending previous work, which often solely considered univariate correlations, 11,24,28 we control for various possible epilepsy‐related, pharmacological, social, and psychological confounders.…”

Section: Introductionmentioning

confidence: 99%

“…We selected parameters that are often impaired in PWE and that showed associations with SCI previously. 11,22,28,30 Extending previous work, which often solely considered univariate correlations, 11,24,28 we control for various possible epilepsy-related, pharmacological, social, and psychological confounders. We assume that memory SCI is linked to self-ratings and objective measures, tailored counseling and treatment should be offered.…”

Section: Introductionmentioning

confidence: 99%

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Domain‐specific relationships of subjective and objective cognition in epilepsy

et al. 2023

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Objective: Many people with epilepsy report subjective cognitive impairment (SCI), i.e., problems with memory, attention, or executive functions, reducing quality of life. Nevertheless, overlap with objective cognitive impairment (OCI) is often weak. One reason may be a domain-specific mismatch between subjective reports and objective tests. We aimed to evaluate relations between SCI and OCI of corresponding domains and to assess whether these differ between persons who over-or underestimate their performance. Methods:In this prospective, cross-sectional sample of 104 adult inpatients with epilepsy, we performed multiple regression analyses predicting SCI in the domains attention, memory, and executive functions. We tested relationships with measures of psychomotor speed, short-term memory, verbal learning, verbal delayed recall, and word fluency while controlling for age, sex, seizure frequency, structural lesions, mono-versus polytherapy and adverse events of antiseizure medication (ASM), depressive and anxiety symptoms, level of education, and employment status. Furthermore, we tested whether these relationships differed between realistic raters and over-and underestimators. Results:We found domain-specific relations for attention and executive functions for the full sample, explaining a small proportion of variance of SCI (general dominance index = .03 and .004), whereas ASM adverse events and psychological variables were more important predictors. When dividing the sample according to the concordance of SCI and OCI, we found high frequencies of both over-(23%-46%) and underestimation (31%-35%) depending on the domain. The explanatory power of OCI for SCI was stronger within the subgroups compared to the full sample, suggesting nonlinear relationships and different underlying mechanisms for realistic raters, underestimators, and overestimators.Significance: Domain-specific SCI and OCI are related, and both should be assessed with standardized instruments. These relationships differ between overand underestimators as well as realistic raters. Based on the concordance of

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Determinants of health‐related quality of life of patients with focal epilepsy: A systematic literature review

Engelhart,

Marcin,

Lerner

et al. 2024

Epileptic Disorders

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ObjectiveFocal epilepsy can have significant negative impacts on a person's health‐related quality of life (HRQoL). Although studies have been published on HRQoL in persons with focal epilepsy (PWFE), determinants of HRQoL have not been comprehensively examined. This systematic literature review (SLR) queried existing literature to identify aspects associated with HRQoL in PWFE without focus on resective epilepsy surgery, with an interest in identifying modifiable determinants for medical/nonmedical interventions.MethodsThis SLR was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Searches were conducted in PubMed and Google Scholar for articles published from January 1, 1900, to February 19, 2023, reporting on the association between HRQoL or employability and a range of demographic, psychosocial, or epilepsy‐related factors and comorbidities in PWFE.ResultsA total of 879 abstracts were identified, with 126 manuscripts reviewed and 37 studies selected for inclusion that quantified the relationship between HRQoL and the variable of interest by multivariate (N = 21) or univariate only (N = 15) methods; 10 multivariate models also included univariate data. In adjusted models, the most commonly examined determinants of HRQoL included depression (n = 15/21), number of antiseizure medications (ASMs; n = 13/21), seizure frequency (continuous seizure count, n = 11/21; seizure freedom, n = 5/21), anxiety (n = 10/21), duration of disease (n = 9/21), and cognition (n = 9/21). Depression, anxiety, and cognition were frequently seen as significant contributors to HRQoL when studied (14/15 [93%], 9/10 [90%], and 7/9 [78%], respectively). Among concepts studied less frequently, ASM severity/adverse event burden was significant each time examined (in 5/19 studies). Attainment of seizure freedom and employability was significant 75% (n = 3/4) and 72% (n = 5/7) of the time, respectively.SignificancePoor HRQoL in PWFE can be attributed to a multitude of factors, including depression, anxiety, factors in disease management, and employability. An unmet need remains in addressing elements associated with poor HRQoL in this population.

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Discrepancy between subjective and objective memory change after epilepsy surgery: Relation with seizure outcome and depressive symptoms

Cited by 7 publications

References 42 publications

How patients' psycho‐social profiles contribute to decision‐making in epilepsy surgery: A prospective study

How patients' psycho‐social profiles contribute to decision‐making in epilepsy surgery: A prospective study

Domain‐specific relationships of subjective and objective cognition in epilepsy

Determinants of health‐related quality of life of patients with focal epilepsy: A systematic literature review

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