Department of Pharmacology and Therapeutics, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Sagamu, Nigeria.
Department of Medicine, University College Hospital, Ibadan, Nigeria.
Brain Behav. 2021 Apr;11(4):e02038. doi: 10.1002/brb3.2038. Epub 2021 Mar 5.
This study aims to identify the determinants of cognitive dysfunction and compare the effect of CPZ and LTC on cognition in WWE.
An observational study involving 87 consenting adult WWE aged between 16 and 40 years on LTC or CZP monotherapy. At enrollment, an interviewer-based questionnaire was used to obtain demographic and clinical information from participants. The diagnosis of epilepsy was mainly clinical and supported by electroencephalographic (EEG) features and classified based on recommendation by the 2017 International League Against Epilepsy (ILAE). Zung Self-Reporting Depression Scale (ZSRDS) was used to assess the mood of participants. The Community Screening Interview for Dementia (CSID) was used to assess various cognition domains. The National Hospital Seizure Severity Scale (NHS-3) was used to assess disease severity.
There were statistical differences between the CZP and LTC groups in all domains of cognition assessed except for orientation. The total CSID scores of the LTC group were 59.2 (4.9) as opposed to CZP group, 57.2 (5.0); p: .005. Those with focal onset seizures had lower median total CSID score (58; IQR: 54-62) when compared to those with generalized onset seizures (62; IQR: 58-62), p: .012. There was a significant correlation between ZSRD score and NHS-3 score; rho: 0.30, p: .007. Bivariate analysis shows statistically significant correlation between total CSID score and ZSRDS (rho: -0.65), BMI (rho: 0.22), and NHSS-3 score (rho: -0.36), respectively. However, the effect of AED on CSID scores was lost after multivariate quantile regression with only ZSRDS retaining significance.
Depression, seizure severity, type and structural etiology were associated with cognitive impairment among WWE. However, on regression model, only depression was statistically significant. The presence of more risks for cognitive impairment in the CZP group limits possible conclusion of LTC superiority.
本研究旨在确定认知功能障碍的决定因素，并比较 CPZ 和 LTC 对 WWE 认知的影响。
这是一项观察性研究，纳入了 87 名年龄在 16 至 40 岁之间、正在接受 LTC 或 CZP 单药治疗的成人 WWE 患者。在入组时，使用基于访谈的问卷从参与者那里获得人口统计学和临床信息。癫痫的诊断主要是临床诊断，并得到脑电图（EEG）特征的支持，并根据 2017 年国际抗癫痫联盟（ILAE）的建议进行分类。采用zung 自评抑郁量表（ZSRDS）评估参与者的情绪。采用社区痴呆筛查访谈（CSID）评估认知的各个领域。采用国家医院癫痫严重程度量表（NHS-3）评估疾病严重程度。
在认知评估的所有领域，除定向外，CPZ 组和 LTC 组之间均存在统计学差异。LTC 组的总 CSID 评分为 59.2（4.9），而 CZP 组为 57.2（5.0）；p：.005。与全面性发作相比，局灶性发作的患者 CSID 总分中位数较低（58；IQR：54-62），而全面性发作的患者 CSID 总分中位数较高（62；IQR：58-62），p：.012。ZSRD 评分与 NHS-3 评分呈显著正相关；rho：0.30，p：.007。二元分析显示，总 CSID 评分与 ZSRDS（rho：-0.65）、BMI（rho：0.22）和 NHS-3 评分（rho：-0.36）呈显著负相关。然而，在多变量分位数回归中，只有 ZSRDS 对 CSID 评分的影响具有统计学意义，而 AED 对 CSID 评分的影响则消失。
抑郁、癫痫严重程度、类型和结构病因与 WWE 认知障碍有关。然而，在回归模型中，只有抑郁具有统计学意义。CPZ 组存在更多认知障碍风险，限制了 LTC 优越性的可能结论。
