Abarrategui Belén, Parejo-Carbonell Beatriz, García García Maria Eugenia, Di Capua Daniela, García-Morales Irene
Unidad de Epilepsia, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain.
Unidad de Epilepsia, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain.
Epilepsy Behav. 2018 Dec;89:99-104. doi: 10.1016/j.yebeh.2018.10.007. Epub 2018 Nov 6.
Dysexecutive traits have been described in idiopathic generalized epilepsy (IGE), but studies mainly focused on juvenile myoclonic epilepsy (JME). To better understand the neuropsychology of IGE, more research is needed on syndromes other than JME, controlling potential confounding factors as the cognitive effects of valproate and epileptic discharges (ED). We describe the neuropsychological profile of a group of patients with different syndromes of IGE including simultaneous video electroencephalography (EEG).
We performed a comprehensive cognitive and neuropsychiatric evaluation with video-EEG on 61 adults with IGE (JME 19; IGE with generalized tonic-clonic seizures [GTCS] alone [IGE-GTCS] 22; childhood absence epilepsy [CAE] or juvenile absences epilepsy [JAE] persisting in adulthood 20). We compared results between patients (globally and by syndrome) and a control group of 21 individuals (similar age, educational level); p-values were adjusted for multiple testing according to a 0.05 false discovery rate.
Patients obtained significantly lower results than controls on visuospatial working memory, processing speed, cognitive flexibility and strategy, abstract visuospatial reasoning, arithmetic, and acquired knowledge. While CAE/JAE showed the lowest scores on cognitive assessment and highest anxiety index, IGE-GTCS showed the most favorable scores. Most tests were not influenced by valproate intake, and the dose did not correlate with cognitive performance in the test that yielded differences between patients and controls. Epileptic discharges during assessment were not frequent (10 patients, 1-4 tests).
Our findings suggest that patients with IGE have significantly lower abilities in various executive functions and acquired knowledge, compared to population of same age and education. The low frequency of ED on simultaneous video-EEG and absence of correlation of scores with valproate dose reinforce that the obtained results are due to a cognitive phenotype in IGE. This phenotype may be influenced by syndrome, and patients with CAE/JAE persisting in the adult may have a wider neuropsychiatric impairment.
在特发性全身性癫痫（IGE）中已描述了执行功能障碍特征，但研究主要集中在青少年肌阵挛癫痫（JME）。为了更好地理解IGE的神经心理学，需要对JME以外的综合征进行更多研究，控制丙戊酸盐和癫痫放电（ED）的认知效应等潜在混杂因素。我们描述了一组患有不同IGE综合征患者的神经心理学概况，包括同步视频脑电图（EEG）。
我们对61例成年IGE患者（19例JME；22例仅伴有全面强直阵挛发作[GTCS]的IGE[IGE-GTCS]；20例成年期仍持续存在的儿童失神癫痫[CAE]或青少年失神癫痫[JAE]）进行了同步视频脑电图的全面认知和神经精神评估。我们比较了患者（总体及按综合征）与21名个体组成的对照组（年龄、教育水平相似）的结果；根据0.05的错误发现率对p值进行多重检验校正。
患者在视觉空间工作记忆、处理速度、认知灵活性和策略、抽象视觉空间推理、算术和知识获取方面的得分显著低于对照组。虽然CAE/JAE在认知评估中得分最低且焦虑指数最高，但IGE-GTCS得分最理想。大多数测试不受丙戊酸盐摄入影响，且在患者与对照组存在差异的测试中，剂量与认知表现无关。评估期间癫痫放电不频繁（10例患者，1-4次测试）。
我们的研究结果表明，与同年龄和教育水平的人群相比，IGE患者在各种执行功能和知识获取方面的能力显著较低。同步视频脑电图上ED的低频率以及得分与丙戊酸盐剂量无相关性，进一步证明所获得的结果是由于IGE中的一种认知表型。这种表型可能受综合征影响，成年期仍持续存在的CAE/JAE患者可能有更广泛的神经精神损害。
