Similar Profile and Magnitude of Cognitive Impairments in Focal and Generalized Epilepsy: A Pilot Study

Abstract

Introduction: Cognitive impairments in epilepsy are not well-understood. In addition, long-term emotional, interpersonal, and social consequences of the underlying disturbances are important to evaluate.Purpose: To compare cognitive function including language in young adults with focal or generalized epilepsy. In addition, quality of life and self-esteem were investigated.Patients and Methods: Young adults with no primary intellectual disability, 17 with focal epilepsy and 11 with generalized epilepsy participated and were compared to 28 healthy controls. Groups were matched on age (mean = 26 years), sex, and education. Participants were administered a battery of neuropsychological tasks and carried out self-ratings of quality of life, self-esteem, and psychological problems.Results: Similar impairments regarding cognitive function were noted in focal and generalized epilepsy. The cognitive domains tested were episodic long-term memory, executive functions, attention, working memory, visuospatial functions, and language. Both epilepsy groups had lower results compared to controls (effect sizes 0.24–1.07). The total number of convulsive seizures was predictive of episodic long-term memory function. Participants with focal epilepsy reported lower quality of life than participants with generalized epilepsy. Lowered self-esteem values were seen in both epilepsy groups and particularly in those with focal epilepsy. Along with measures of cognitive speed and depression, the total number of seizures explained more than 50% of variation in quality of life.Conclusion: Interestingly, similarities rather than differences characterized the widespread cognitive deficits that were seen in focal and generalized epilepsy, ranging from mild to moderate. These similarities were modified by quality of life and self-esteem. This study confirms the notion that epilepsy is a network disorder.

Mechanisms for Cognitive Impairment in Epilepsy: Moving Beyond Seizures

“…Cognitive impairments in people with epilepsy are extremely common and have a major negative influence on quality of life. Patients with focal epilepsy have shown to have a significant decrease in their quality of life compared to patients with generalized epilepsy and healthy controls, however, both focal and generalized epilepsy patients have a decreased self-esteem and increased anxiety compared to healthy controls ( 9 ). Identification of mechanisms of cognitive impairment is important as this will help to guide development of novel therapeutic strategies to improve outcomes.…”

“…Researchers have focused on the time of onset and frequency of seizures, however, there are few clear correlations between seizure characteristics and cognitive outcomes. Taken into consideration that cognitive functions are dependent on complex brain networks and both focal and generalized epilepsy groups share the same cognitive impairments ( 9 ), we can say that seizure location is less of a determinant of the cognitive impairments than an altered or dysfunctional network in the brain. This suggests that there must be other factors influencing cognitive outcomes in epilepsy.…”

“…The cognitive deficits are seen in both focal and generalized seizures. Focal seizures occur in a lateralized network in contrast to generalized seizures occurring in a widespread network encompassing both hemispheres ( 8 ), however similar cognitive impairments are seen in both epilepsies ( 9 ). Patients with focal epilepsy experience various cognitive impairments such as language abnormalities, executive dysfunction, attention deficit and long-term episodic and semantic memory deficits ( 9 – 11 ).…”

“…Focal seizures occur in a lateralized network in contrast to generalized seizures occurring in a widespread network encompassing both hemispheres ( 8 ), however similar cognitive impairments are seen in both epilepsies ( 9 ). Patients with focal epilepsy experience various cognitive impairments such as language abnormalities, executive dysfunction, attention deficit and long-term episodic and semantic memory deficits ( 9 – 11 ). Patients with generalized epilepsy experience the same cognitive impairments in addition to acquired knowledge deficits and long-term information processing and retrieval impairment ( 9 , 12 , 13 ).…”

“…Patients with focal epilepsy experience various cognitive impairments such as language abnormalities, executive dysfunction, attention deficit and long-term episodic and semantic memory deficits ( 9 – 11 ). Patients with generalized epilepsy experience the same cognitive impairments in addition to acquired knowledge deficits and long-term information processing and retrieval impairment ( 9 , 12 , 13 ).…”