Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain.
Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain; School of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.
Epilepsy Behav. 2020 Mar;104(Pt B):106443. doi: 10.1016/j.yebeh.2019.106443. Epub 2019 Aug 6.
Late-onset epilepsy is often accompanied by underlying cerebrovascular disease and has been associated with neurocognitive deficits even dementia, but the interrelation between them remains unknown. In this study, we aimed to explore the contribution of vascular-related and epilepsy-related factors on neurocognitive outcomes in a sample of late-onset epilepsy with history of cerebral small vessel disease.
In this retrospective cross-sectional study, a comprehensive neurocognitive assessment was performed in 25 patients aged >60 years with one or more unprovoked seizures and history of small-vessel disease. Raw scores of cognitive tests were transformed in T-scores and were grouped in 6 cognitive domains. Regression models were performed to explore the contribution of vascular risk factors (diabetes mellitus, arterial hypertension, dyslipidemia, and smoking habit) and epilepsy-related factors (drug-resistance, number of antiepileptic drugs, age at epilepsy onset, and epileptic focus localization).
Diabetes (p = 0.03) and smoking habit (p = 0.05) were the best independent factors to predict attention performance; diabetes also predicted visual memory function (p = 0.02); gender was related to verbal memory performance (p = 0.04) and speed processing (p = 0.02). Age at onset predicted that executive function (p = 0.05); age (p = 0.01) and gender (p = 0.03) were the major contributors to language performance. Epilepsy-related variables did not predict any cognitive outcomes.
Vascular risk factors and sociodemographic characteristics were the best predictors of cognitive outcomes in a sample of late-onset epilepsy with cerebral small-vessel disease. Epilepsy did not show influence on cognitive function. Longitudinal studies are necessary to clarify the relationship between vascular risk factors and epilepsy on progression of cognitive deterioration in patients with late-onset epilepsy. This article is part of the Special Issue "Seizures & Stroke".
迟发性癫痫常伴有潜在的脑血管疾病，并与神经认知缺陷甚至痴呆有关，但它们之间的关系尚不清楚。在这项研究中，我们旨在探讨血管相关因素和癫痫相关因素对伴有脑小血管疾病病史的迟发性癫痫患者的认知结局的影响。
在这项回顾性的横断面研究中，对 25 名年龄>60 岁、有一次或多次无诱因发作和小血管疾病史的患者进行了全面的认知评估。认知测试的原始分数转换为 T 分数，并分为 6 个认知域。进行回归模型以探讨血管危险因素（糖尿病、动脉高血压、血脂异常和吸烟习惯）和癫痫相关因素（耐药性、抗癫痫药物数量、癫痫发作年龄和癫痫灶定位）的贡献。
糖尿病（p=0.03）和吸烟习惯（p=0.05）是预测注意力表现的最佳独立因素；糖尿病也预测了视觉记忆功能（p=0.02）；性别与言语记忆表现（p=0.04）和速度处理（p=0.02）有关。发病年龄预测了执行功能（p=0.05）；年龄（p=0.01）和性别（p=0.03）是语言表现的主要决定因素。癫痫相关变量不能预测任何认知结局。
在伴有脑小血管疾病的迟发性癫痫患者中，血管危险因素和社会人口学特征是认知结局的最佳预测因素。癫痫对认知功能没有影响。需要进行纵向研究以阐明血管危险因素和癫痫对迟发性癫痫患者认知功能恶化的关系。本文是“癫痫发作与中风”特刊的一部分。
