The phantom of progressive dementia in epilepsy

Helmstaedter, C.; Elger, C.E.

doi:10.1016/s0140-6736(99)03542-4

Cited by 65 publications

(41 citation statements)

References 5 publications

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“…In accordance with our previous findings in patients with left ammonshorn sclerosis, 7 performance in verbal learning declined with age at the same rate in patients before SAH (r ϭ Ϫ0.20) as in healthy controls (r ϭ Ϫ0.25; difference, p Ͼ 0.1) (see scatter plots for SAH in Fig 2 and correlations in Table 2). Both groups showed a loss in learning of approximately 1 SD over 4 decades.…”

Section: Age Regressions Of Memory In the Selective Amygdalohippocampsupporting

confidence: 92%

“…6 We recently showed that the rate of verbal memory decline is identical in patients with left mesial TLE and healthy controls, indicating that memory decline in chronic TLE is determined by an interaction of a predamaged brain and "physiologic" aging processes rather than progressive damage due to epilepsy. 7 To investigate the possible effects of surgery on cognitive prognosis, we evaluated age regressions of verbal memory performance before and 1 year after left temporal surgery. We postulated that, before surgery, progressive memory impairment due to chronic epilepsy should become evident as a deviation of the age regressions of patients and healthy control subjects.…”

Section: Discussionmentioning

confidence: 99%

“…6 We recently showed that in patients with mesial left hemisphere TLE, this lifetime memory decline is parallel to that observed in the general population, suggesting that the course of memory in pharmacologically treated TLE is better explained by the combined effects of underlying brain lesion and "normal" aging than by progressive brain damage due to chronic epilepsy. 7 We were concerned that there could be an interaction between the negative effects of TLE surgery and aging, that is, that surgery could accelerate age-related memory decline and increase the risk of cognitive decompensation as patients reach older age. …”

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confidence: 99%

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Interaction of cognitive aging and memory deficits related to epilepsy surgery

Helmstaedter

Reuber

Elger

2002

Annals of Neurology

109

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Temporal lobe epilepsy surgery can cause significant memory impairment. This study was intended to examine whether surgery also could affect prognosis of memory in older age. Age regression of verbal memory was examined in 187 patients (before and 1 year after left temporal lobe surgery) and 264 healthy controls. Eighty patients underwent selective amygdalohippocampectomy, and 107 patients underwent anterior two-thirds temporal lobectomy. Amygdalohippocampectomy patients had mesiotemporal epilepsy; anterior two-thirds temporal lobectomy patients had more extramesial or diffuse seizure onset zones. Memory was assessed by word list learning for its more mesial (consolidation/retrieval) and more neocortical (learning) aspects. Patients showed significant preoperative memory impairment. Independent of seizure outcome and surgical approach, surgery had significant negative effects on learning and consolidation/retrieval. In the amygdalohippocampectomy group, preoperative and postoperative age regressions of learning and consolidation/retrieval were not different from those of controls. In the anterior two-thirds temporal lobectomy group, age regression of verbal learning became steeper after surgery, and consolidation/retrieval was negatively correlated with older age and later onset of epilepsy even before surgery. The data confirm that age regression of verbal memory in left temporal lobe epilepsy is similar to that in healthy controls. Both left anterior two-thirds temporal lobectomy and amygdalohippocampectomy worsen verbal learning and memory and bring patients closer to cognitive disability. Particularly in anterior two-thirds temporal lobectomy patients, surgery and reduced capacities for compensation cause acceleration of lifetime memory decline. The results support earlier and tailored epilepsy surgery and suggest that memory prognosis in older age should be considered if more extensive temporal resections would be inevitable.

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Section: Age Regressions Of Memory In the Selective Amygdalohippocampsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Interaction of cognitive aging and memory deficits related to epilepsy surgery

Helmstaedter

Reuber

Elger

2002

Annals of Neurology

109

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“…Helmstaedter & Elger (1999) have described it as a phantom. A plethora of evidence from cross-sectional and longitudinal studies shows that the progress of cognitive decline in chronic epilepsy is very slow and that, in adult epilepsies, successful treatment can stop or partly reverse it.…”

Section: Prognosis Of Cognitive Impairmentmentioning

confidence: 99%

Neurocognitive problems in epilepsy

Lodhi¹,

Agrawal²

2012

Adv. psychiatr. treat

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SummaryCognitive dysfunction is one of the major contributors to the burden of epilepsy. It can significantly disrupt intellectual development in children and functional status and quality of life in adults. Epilepsy affects cognition through a number of mechanisms in complex interrelationship. Cognitive deficits in epilepsy may be treated indirectly through aggressive seizure control using anti-epileptic drugs or surgery, and by treating comorbid conditions such as depression. The beneficial effects of reducing seizures may offset the adverse cognitive side-effects of these therapies. Direct treatment of cognitive impairment in epilepsy mainly involves memory rehabilitation. Other direct treatments are mostly experimental and their evidence base is currently poor.

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“…Also seizures, especially secondarily generalized seizures, might have an effect on cognition. In patients with a high number of secondarily generalized tonic-clonic seizures (SGTCS), cognitive decline has been described (Dodrill, 2002;Dodrill and Batzel, 1986;Stefan and Pauli, 2002; Thompson and Duncan, 2005;Trimble, 1988), although data are sometimes contradictory (Helmstaedter and Elger, 1999;Kramer et al, 2006). In various preclinical and clinical studies, changes in cerebral metabolism (Bernasconi et al, 2002;Jokeit et al, 1997;Miller et al, 2000;Tasch et al, 1999) and neuronal loss (Kotloski et al, 2002) were observed shortly after SGTCS.…”

Section: Introductionmentioning

confidence: 99%

Multimodal MRI Reveals Secondarily Generalized Seizure Related Abnormalities at 1.5 T: Preliminary Findings

Jansen¹,

Vlooswijk²,

Reijs³

et al. 2015

JMED

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Patients with chronic epilepsy, who have suffered a high number of secondarily generalized tonicclonic seizures (SGTCS) frequently show cognitive comorbidity. It is yet unclear whether a higher number of SGTCS is associated with tissue changes in the brain. We have investigated in patients with chronic epilepsy whether a high number of SGTCS accumulated over life is associated with microstructural changes in brain tissue. Sixteen patients with localization-related epilepsy with SGTCS underwent a multimodal quantitative Magnetic Resonance (MR) examination at 1.5 T, comprising T2 relaxometry, and diffusion weighted imaging to study microstructural changes in the temporal and frontal lobes. Fourteen healthy volunteers were also included to assess the effect of age. Patients with more than 20 SGTCS (n=8) showed a significantly lower IQ (-20%, p<0.05) compared to those with less than 20 SGTCS (n=8). Furthermore, regional combined multimodal analysis revealed that significant quantitative MRI changes, related to the number of SGTCS, were present in the frontal lobe but not in the temporal lobe. Moreover, the left and right frontal lobe generally displayed lower T2 relaxation times, smaller pericortical cerebrospinal fluid fraction and lower apparent diffusion coefficients, in the patients with more than 20 SGTCS. These findings suggest that SGTCS are associated with substantial changes in microstructural brain tissue characteristics within the frontal lobes. These frontal changes possibly explain the cognitive problems which are often observed in patients with many SGTCS. This knowledge may help in the development of treatment aimed at preventing decline in cognitive abilities.

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The phantom of progressive dementia in epilepsy

Cited by 65 publications

References 5 publications

Interaction of cognitive aging and memory deficits related to epilepsy surgery

Interaction of cognitive aging and memory deficits related to epilepsy surgery

Neurocognitive problems in epilepsy

Multimodal MRI Reveals Secondarily Generalized Seizure Related Abnormalities at 1.5 T: Preliminary Findings

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