Objective: Cognitive impairments are common complaints among people with epilepsy with its occurrence to emanate a great topic in the course of the illness, so our study aimed to examine the executive functions in adult patients with idiopathic epilepsy. Methods: Forty consecutive adult patients with idiopathic epilepsy (either generalized or focal) with age range from 18 - 45 years old, IQ > 85, treated with either monotherapy or polytherapy, matched with forty healthy adult volunteers by age, sex and educational level. They were examined in executive functions tests: cognitive flexibility and set shifting (Wisconsin Card sorting Test), Planning (Tower of London), response inhibition (Continuous Performance Test) and working memory (verbal and visuospatial). Results: Patients with epilepsy showed deficits in all executive functions tests, with no difference between patients with generalized and focal epilepsy except for correct response time mean in CPT. There was significant positive correlation between frequency of seizures and mean total time, mean number of extra movies in TOL, in verbal working memory (digit back word), and omission errors in CPT; at the same time there was significant negative correlation between target accuracy rate and frequency of seizures in CPT, and in visuo-spatial part of working memory (Corsi Block-Tapping Test). Conclusion: Adult patients with idiopathic epilepsy had executive dysfunctions than healthy control, with no difference between generalized and focal epilepsy except for correct response time mean in CPT; the increase of the frequency of seizure is associated with impairment in planning, attention and working memory (either verbal or viuso-spatial).
KeywordsExecutive FunctionsIdiopathic EpilepsySeizuresWorking Memory in Epilepsy
Lima, A.B., Moreira, F., Gomes Mda, M. and Maia-Filho, H. (2014) Clinical and Neuropsychological Assessment of Executive Function in a Sample of Children and Adolescents with Idiopathic Epilepsy. Arquivos de Neuro-Psiquiatria, 72, 954-959. https://doi.org/10.1590/0004-282X20140191
Granbichler, C.A., Zimmermann, G., Oberaigner, W., Kuchukhidze, G., Ndayisaba, J.P., Taylor, A., et al. (2017) Potential Years Lost and Life Expectancy in Adults with Newly Diagnosed Epilepsy. Epilepsia, 58, 1939-1945. https://doi.org/10.1111/epi.13902
World Health Organization. Epilepsy. Fact Sheet No. 999.
Gelziniene, G., Jurkeviciene, G., Marmiene, V., Adomaitiene, V. and Endziniene, M. (2011) Executive Functions in Adolescents with Idiopathic Generalized Epilepsy. Medicina (Kaunas), 47, 313-319. https://doi.org/10.3390/medicina47060044
Johanson, M., Revonsuo, A., et al. (2003) Level and Contents of Consciousness in Connection with Partial Epileptic Seizures. Epilepsy and Behaviour, 4, 279-285. https://doi.org/10.1016/S1525-5050(03)00106-9
Banerjee, P., et al. (2009) The Descriptive Epidemiology of Epilepsy: A Review. Epilepsy Research, 85, 31-45. https://doi.org/10.1016/j.eplepsyres.2009.03.003
Chowdhury, F.A., Elwes, R.D., Koutroumanidis, M., Morris, R.G., Nashef, L. and Richardson, M.P. (2014) Impaired Cognitive Function in Idiopathic Generalized Epilepsy and Unaffected Family Members: An Epilepsy Endophenotype. Epilepsia, 55, 835-840. https://doi.org/10.1111/epi.12604
Hermann, B., Seidenberg, M., Sager, M., et al. (2008) Growing Old with Epilepsy: The Neglected Issue of Cognitive and Brain Health in Aging and Elder Persons with Chronic Epilepsy. Epilepsia, 49, 731-740. https://doi.org/10.1111/j.1528-1167.2007.01435.x
Lima, E.M., Rzezak, P., Guimarães, C.A., Montenegro, M.A., Guerreiro, M.M. and Valente, K.D. (2017) The Executive Profile of Children with Benign Epilepsy of Childhood with Centrotemporal Spikes and Temporal Lobe Epilepsy. Epilepsy & Behavior, 72, 173-177. https://doi.org/10.1016/j.yebeh.2017.04.024
Lezak, A. and Anderson, P. (1995) Executive Functions after Frontal Lobe Injury. In: Stuss and Knight, Eds., Principles of Frontal Lobe Function, Springer, Berlin, 505.
Miyake, A., Friedman, N.P., Emerson, M.J., Witzki, A.H., et al. (2000) The Unity and Diversity of EFs and Their Contributions to Complex “Frontal Lobe” Tasks: A Latent Variable Analysis. Cognitive Psychology, 41, 49-100. https://doi.org/10.1006/cogp.1999.0734
Hofmann, W., Schmeichel, B.J. and Baddeley, A.D. (2012) Executive Functions and Self-Regulation. Trends in Cognitive Sciences, 16, 174-180. https://doi.org/10.1016/j.tics.2012.01.006
Bell, B., Lin, J.J., Seidenberg, M. and Hermann, B. (2011) The Neurobiology of Cognitive Disorders in Temporal Lobe Epilepsy. Nature Reviews Neurology, 7, 154-164. https://doi.org/10.1038/nrneurol.2011.3
Roswall, L.A., Engman, E., Samuelsson, H. and Malmgren, K. (2010) Cognitive Outcome 10 Years after Temporal Lobe Epilepsy Surgery: A Prospective Controlled Study. Neurology, 74, 1977-1985.
Meador, K.J. (2002) Cognitive Outcomes and Predictive Factors in Epilepsy. Neurology, 58, S21-S26. https://doi.org/10.1212/WNL.58.8_suppl_5.S21
Commission on Classification and Terminology of the International League against Epilepsy (1989) Proposal for Revised Classification of Epilepsies and Epileptic Syndromes. Epilepsia, 30, 389-399. https://doi.org/10.1111/j.1528-1157.1989.tb05316.x
Emad El Din, I. and Melika, L.K. (1999) Wechsler Intelligence Scale for Children. Arabic Version, 6th Edition.
Wechsler, D.I. (1991) WISC-III Wechsler Intelligence Scale for Children-Third Edition Manual. The Psychological Corporation of America, New York.
Mueller, S.T. (2012) The PEBL Manual, Version 0.13. Lulu Press, Morrisville.
Mueller, S.T. (2012) Developing Open Source Tests for Psychology and Neuroscience. http://opensource.com/life/12/12/developing-open-source-tests-psychology-and-neuroscience
Berg, E.A. (1948) A Simple Objective Technique for Measuring Flexibility in Thinking. The Journal of General Psychology, 39, 15-22. https://doi.org/10.1080/00221309.1948.9918159
Grant, D.A. and Berg, E. (1948) A Behavioral Analysis of Degree of Reinforcement and Ease of Shifting to New Responses in a Weigl-Type Card-Sorting Problem. Journal of Experimental Psychology, 38, 404-411. https://doi.org/10.1037/h0059831
Piper, B.J., Li, V., Eiwaz, M.A., Kobel, Y.V., Benice, T.S., Chu, A.M., et al. (2012) Executive Function on the Psychology Experiment Building Language Tests. Behavior Research Methods, 44, 110-123. https://doi.org/10.3758/s13428-011-0096-6
Knoblock, C.A. (1991) Automatically Generating Abstractions for Problem Solving. PhD Thesis, School of Computer Science, Carnegie Mellon University, Pittsburgh, Technical Report CMU-CS-91-120.
Conners, C.K. and MHS Staff (2000) Conners’ Continuous Performance Test II: Computer Program for Windows Technical Guide and Software Manual. Multi-Health Systems, North Tonawanda.
Kessels, R.P.C., van Zandvoort, M.J.E., Postma, A., Kappelle, L.J. and de Haan, E.H.F. (2000) The Corsi Block-Tapping Task: Standardization and Normative Data. Applied Neuropsychology, 7, 252-258. https://doi.org/10.1207/S15324826AN0704_8
Taylor, J., Kolamunnage-Dona, R., Marson, A.G., Smith, P.E., Aldenkamp, A.P. and Baker, G.A. (2010) Patients with Epilepsy: Cognitively Compromised before the Start of Antiepileptic Drug Treatment? Epilepsia, 51, 48-56. https://doi.org/10.1111/j.1528-1167.2009.02195.x
Berg, A.T., Langfitt, J.T., Testa, F.M., Levy, S.R., Di Mario, F. and Westerveld, M. (2008) Global Cognitive Function in Children with Epilepsy: A Community-Based Study. Epilepsia, 49, 608-614. https://doi.org/10.1111/j.1528-1167.2007.01461.x
Kanner, A.M., Barry, J.J., Gilliam, F., Hermann, B. and Meador, K.J. (2010) Anxiety Disorders, Subsyndromic Depressive Episodes, and Major Depressive Episodes: Do They Differ on Their Impact on the Quality of Life of Patients with Epilepsy? Epilepsia, 51, 1152-1158. https://doi.org/10.1111/j.1528-1167.2010.02582.x
Shehata, G.A. and Bateh, Ael-A. (2008) Cognitive Function, Mood, Behavioral Aspects, and Personality Traits of Adult Males with Idiopathic Epilepsy. Epilepsy & Behavior, 14, 121-124. https://doi.org/10.1016/j.yebeh.2008.08.014
Sonmez, F., Atakli, D., Sari, H., Atay, T. and Arpaci, B. (2004) Cognitive Function in Juvenile Myoclonic Epilepsy. Epilepsy & Behavior, 5, 329-336. https://doi.org/10.1016/j.yebeh.2004.01.007
Pascalicchio, T.F., ArafjoFilho, G.M., Noffs, M.H.S., et al. (2005) Neuropsychological Profile of Patients with Juvenile Myoclonic Epilepsy: A Controlled Study of 50 Patients. Epilepsy & Behavior, 10, 263-267. https://doi.org/10.1016/j.yebeh.2006.11.012
Moschetta, S.P. and Valente, K.D. (2012) Juvenile Myoclonic Epilepsy: The Impact of Clinical Variables and Psychiatric Disorders on Executive Profile Assessed with a Comprehensive Neuropsychological Battery. Epilepsy & Behavior, 25, 682-686. https://doi.org/10.1016/j.yebeh.2012.10.002
Piazzini, A., Turner, K., Vignoli, A., Canger, R. and Canevini, M.P. (2008) Frontal Cognitive Dysfunction in Juvenile Myoclonic Epilepsy. Epilepsia, 49, 657-662. https://doi.org/10.1111/j.1528-1167.2007.01482.x
Huang, C.W., Itsieh, Y.J., Tsai, J.J., et al. (2005) Cognitive Performance in Cryptogenic Epilepsy. Acta Neurologica Scandinavica, 112, 228-233. https://doi.org/10.1111/j.1600-0404.2005.00480.x
Lezak, M.D. (2004) Neuropsychological Assessment. 4th Edition, Oxford University Press, New York.
Riccio, C.A., Reynolds, C.R. and Lowe, P.A. (2001) Clinical Application of Continuous Performance Test. Wiley & Son, New York.
Borgatti, R., Piccinelli, P., Montirosso, R., Donati, G., Rampani, A., Molteni, L., et al. (2004) Study of Attentional Processes in Patients with Idiopathic Epilepsy by Conners’ Continuous Performance Test. Journal of Neurology, 19, 509-515. https://doi.org/10.1177/08830738040190070601
Austin, J.K., Dunn, D.W., Johnson, C.S. and Perkins, S.M. (2004) Behavioural Issues Involving Children and Adolescents with Epilepsy and the Impact of Their Families: Recent Research Data. Epilepsy & Behavior, 5, 33-41. https://doi.org/10.1016/j.yebeh.2004.06.014
Sanchez-Carpintero, R. and Neville, B.G.R. (2003) Attentional Ability in Patient with Epilepsy. Epilepsia, 44, 1340-1349. https://doi.org/10.1046/j.1528-1157.2003.16403.x
Martin, R.C., Griffith, H.R., Faught, E., Gilliam, F., Mackey, M. and Vogtle, L. (2005) Cognitive Functioning in Community Dwelling Older Adults with Chronic Partial Epilepsy. Epilepsia, 46, 298-303. https://doi.org/10.1111/j.0013-9580.2005.02104.x
Meador, K. and Motamedi, G. (2003) Epilepsy and Cognition. Epilepsy & Behavior, 4, 25-38. https://doi.org/10.1016/j.yebeh.2003.07.004
Parente, A., Manfredi, V., Villani, F., Franceschetti, S. and Giovagnoli, A.R. (2013) Investigating Higher-Order Cognitive Functions in Temporal Lobe Epilepsy: Cognitive Estimation.
Levin, H.S., Fletcher, J.M., Kufera, J.A., Haward, H., Lilly, M.A., Mendelsohn, D.B., Bruce, D. and Eisenberg, H.M. (1996) Dimension of Cognition Measured by the Tower of London and Other Cognitive Tasks in Adolescents. Developmental Neuropsychology, 12, 17-34. https://doi.org/10.1080/87565649609540638
Igarashi, K., Oguni, H., Osawa, M., et al. (2002) Wisconsin Card Sorting Test in Temporal Lobe Epilepsy. Brain & Development, 24, 174-178. https://doi.org/10.1016/S0387-7604(02)00024-4
Rzezak, P., Fuentes, D., Guimares, C.A., et al. (2009) Executive Dysfunction in Children and Adolescents with Temporal Lobe Epilepsy: Is the Wisconsin Card Sorting Test Enough? Epilepsy & Behavior, 15, 376-378. https://doi.org/10.1016/j.yebeh.2009.04.014
Hernandez, M.T., Sauerwein, H.C., Jambaqué, I., et al. (2002) Deficits in Executive Functions and Motor Coordination in Frontal Lobe Epilepsy. Neuropsy-chologia, 40, 384-400. https://doi.org/10.1016/S0028-3932(01)00130-0
McDonald, C.R., Delis, D.C., Norman, M.A., Wetter, S.R., Tecoma, E.S. and Iragui, V.J. (2005) Response Inhibition and Set Shifting in Patients with Frontal Lobe Epilepsy or Temporal Lobe Epilepsy. Epilepsy & Behavior, 7, 438-446. https://doi.org/10.1016/j.yebeh.2005.05.005
Luton, L.M., Burns, T.G. and De Filippis, N. (2010) Frontal Lobe Epilepsy in Children and Adolescents: A Preliminary Neuropsychological Assessment of Executive Function. Archives of Clinical Neuropsychology, 25, 762-770. https://doi.org/10.1093/arclin/acq066
Hommet, C., Sauerwein, H.C. and De Toffol, B. (2006) Idiopathic Epileptic Syndromes and Cognition. Neuroscience & Biobehavioral Reviews, 30, 85-96. https://doi.org/10.1016/j.neubiorev.2005.06.004
Smith, D.B., Craft, B.R., Collins, J., Mattson, R.H. and Cramer, J.A. (1998) Behavioral Characteristics of Epilepsy Patients Compared with Normal Controls. Epilepsia, 27, 760-768. https://doi.org/10.1111/j.1528-1157.1986.tb03607.x
D’Agati, E., Cerminara, C., Casarelli, L. and Pitzianti, M. (2012) Attention and Executive Functions Profile in Epilepsy. Brain & Development, 34, 812-817. https://doi.org/10.1016/j.braindev.2012.03.001
Mula, M. and Trimble, M.R. (2009) Antiepileptic Drug-Induced Cognitive Adverse Effects: Potential Mechanisms and Contributing Factors. CNS Drugs, 23, 121-137. https://doi.org/10.2165/00023210-200923020-00003