Growing older with drug-resistant epilepsy: cognitive and psychosocial outcomes

Abstract

We aimed to investigate the cognitive and psychosocial outcomes of patients older than 50 with drug-resistant temporal lobe epilepsy as compared to a younger cohort. One hundred and thirty-one patients with temporal lobe epilepsy (47% age ≥ 50) who underwent comprehensive neuropsychological testing were retrospectively identified. A comparison of percentage of Z scores < - 1.5 between the older and younger cohort on Trail Making Tests A and B, Boston Naming Test, Rey Auditory Verbal Learning Test (RAVLT) delayed recall, and Rey-Osterrieth complex figure test delayed recall was performed as well as the presence of disability due to epilepsy and depression scores. Grading of white matter hyperintensities on MRI was also performed. Older patients with epilepsy were more likely to score Z < - 1.5 on the RAVLT (54.1 vs 32.8%) and were more likely to be on disability due to their seizures (23.0 vs 5.7%). A higher grade of white matter hyperintensities correlated with worse performance on Trail Making Test A, while a higher number of anti-epileptic drugs (AEDs) correlated with worse performance on Trail Making Test B regardless of age. The results of this study reveal that older patients with drug-resistant epilepsy are a vulnerable population with an impaired cognitive profile. In addition, limiting the number of AEDs and addressing markers of small vessel disease should also be prioritized by clinicians.

Comparison of screening tests in the evaluation of cognitive status of patients with epilepsy

“…There are several factors that directly or indirectly interfere with the cognitive performance of epilepsy patients, such as the frequency of seizures, the antiepileptic medication in use, age, and location of the epileptogenic focus. [21][22][23] In this sense, a screening for cognitive impairment is very important. It remains unknown if the cause is the early onset of epilepsy, the accumulation of brain damage due to seizures or the interaction of an initial precipitating lesion with physiological or senile processes.…”

Best care for older people with epilepsy: A scoping review

“…Consistently throughout the literature, older people did not receive enough information about epilepsy [9,25,30,53]. As older people score lower on cognitive tests than peers without epilepsy [42][43][44][76][77][78][79], information should be provided in writing, and repeated periodically.…”

Epilepsy outcome following resection of low-grade brain tumors in children

“…Patients who are maintained on unsuccessful drug regimens show worse recall skills and are at higher risk for cognitive and psychiatric problems. 15 Even in infants, untreated epilepsy can lead to long-term cognitive decline. 20 Therefore, in pediatric patients, it becomes uniquely important to identify good candidates for epilepsy surgery and treat them appropriately.…”