Faculty of Medical Sciences, Department of Neurology, University of Kragujevac, Serbia, 69 Svetozara Markovica St., 34000, Kragujevac, Serbia.
Clinic of Neurology, Clinical Center Kragujevac, 30 Zmaj Jovina St., 34000, Kragujevac, Serbia.
Acta Neurol Belg. 2019 Sep;119(3):403-410. doi: 10.1007/s13760-019-01090-x. Epub 2019 Feb 8.
Cognitive impairment frequently occurs in epilepsy patients. Patients with drug-resistant epilepsy (DRE) have poor drug responsivity and higher seizure frequency which consequently lead to brain damage and may have implications on cognitive status. In the present study, we assessed a frequency and degree of cognitive impairment in 52 patients with drug-sensitive epilepsy (DSE) and 103 DRE patients at three time points (baseline, after 12 and 18 months). Degree of cognitive decline was assessed with Montreal Cognitive Assessment (MoCA) scale. We examined the possible correlation between demographic and clinical characteristics and cognitive deterioration in epilepsy patients. Patients in the DRE group had significantly lower MoCA score than patients in the DSE group at baseline (28.83 ± 2.05 vs. 29.69 ± 0.61, p = 0.003), after 12 months (27.36 ± 2.40 vs. 29.58 ± 1.22, p = 0.000) and 18 months (26.86 ± 2.73 vs. 29.33 ± 1.47, p = 0.000). Patients with DRF epilepsy had significantly lower MoCA score than patients with DSF epilepsy at three time points (28.71 ± 2.48 vs. 29.86 ± 0.35, p = 0.015; 27.22 ± 2.72 vs. 29.52 ± 1.37, p = 0.000; 26.80 ± 2.99 vs. 29.31 ± 1.56, p = 0.000). After 12 and 18 months of follow-up, patients with DRG epilepsy had significantly lower MoCA score than patients with DSG epilepsy (27.52 ± 2.01 vs. 29.65 ± 1.02, p = 0.000; 26.94 ± 2.43 vs. 29.35 ± 1.40, p = 0.000). Illness duration negatively correlated with cognitive status (p = 0.005); seizure control and EEG findings positively correlated with MoCA score (p = 0.000). Illness duration, seizure control, drug responsivity, and EEG findings are significant predictors of MoCA score (p < 0.05). Clinicians have to pay attention to patients with drug-resistant epilepsy and concepts of aggressive treatment to minimize the adverse effects of epilepsy on cognition.
认知障碍在癫痫患者中经常发生。耐药性癫痫（DRE）患者药物反应差，发作频率较高，导致脑损伤，可能对认知状态产生影响。在本研究中，我们在三个时间点（基线、12 个月和 18 个月）评估了 52 例药物敏感型癫痫（DSE）患者和 103 例 DRE 患者的频率和认知障碍程度。使用蒙特利尔认知评估量表（MoCA）评估认知下降程度。我们研究了癫痫患者的人口统计学和临床特征与认知恶化之间的可能相关性。DRE 组患者的 MoCA 评分明显低于 DSE 组患者的 MoCA 评分，在基线时（28.83±2.05 与 29.69±0.61，p=0.003）、12 个月后（27.36±2.40 与 29.58±1.22，p=0.000）和 18 个月后（26.86±2.73 与 29.33±1.47，p=0.000）。DRF 癫痫患者的 MoCA 评分明显低于 DSF 癫痫患者的 MoCA 评分，在三个时间点均如此（28.71±2.48 与 29.86±0.35，p=0.015；27.22±2.72 与 29.52±1.37，p=0.000；26.80±2.99 与 29.31±1.56，p=0.000）。在 12 个月和 18 个月的随访后，DRG 癫痫患者的 MoCA 评分明显低于 DSG 癫痫患者（27.52±2.01 与 29.65±1.02，p=0.000；26.94±2.43 与 29.35±1.40，p=0.000）。病程与认知状态呈负相关（p=0.005）；癫痫控制和脑电图结果与 MoCA 评分呈正相关（p=0.000）。病程、癫痫控制、药物反应性和脑电图结果是 MoCA 评分的显著预测因素（p<0.05）。临床医生必须关注耐药性癫痫患者，并采取积极治疗的理念，以最大限度地减少癫痫对认知的不利影响。
