1st Department of Neurosurgery, National & Kapodistrian University of Athens, Greece; Laboratory of Cognitive Neuroscience, Department of Psychology, Aristotle University of Thessaloniki, Greece.
Laboratory of Cognitive Behavioral Neurology, Neurology and Neuropathology Unit, Department of Diagnostics and Technology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy.
Epilepsy Behav. 2022 Sep;134:108850. doi: 10.1016/j.yebeh.2022.108850. Epub 2022 Aug 4.
To compare neuropsychological function in juvenile myoclonic epilepsy (JME) and frontal lobe epilepsy (FLE) since frontal circuitry is involved in both conditions. By drawing on previously theory-guided hypotheses and findings, a particular emphasis is placed on the way different cognitive-pathophysiological mechanisms act upon to produce frontal dysfunction in JME (frontal-executive and attention-related problems: vigilance, reaction times, processing speed, and response inhibition) and in FLE (reflecting the coproduct of the functional deficit zone), respectively.
A total of 16 patients with JME, 34 patients with FLE, and 48 normal controls, all matched for age and education, were administered a comprehensive battery of tests to assess frontal-executive functions, as well as attention, memory, and learning domains. Participants did not take medications other than antiepileptics or have a psychiatric history.
Patients with FLE overall showed worse neuropsychological performance compared to both JME and HCs. With respect to JME, patients with FLE did significantly worse in measures of verbal and nonverbal executive function, short-term-, and long-term- auditory-verbal memory and learning, immediate and delayed episodic recall, visual attention and motor function, visuo-motor coordination and psychomotor speed, speed of visual information processing, and vocabulary. Patients with JME performed significantly worse compared to FLE only in associative semantic processing, while the former outperformed all groups in vocabulary, visuomotor coordination, and psychomotor speed.
We suggest that selective impairments of visual- and mostly auditory-speed of information processing, vigilance, and response inhibition may represent a salient neuropsychological feature in JME. These findings suggest the existence of an aberrantly working executive-attention system, secondary to pathological reticulo-thalamo-cortical dynamics. Contrariwise, cortically (frontal and extra-frontal) and subcortically induced malfunction in FLE is determined by the functional deficit zone i.e., the ensemble of cortical and subcortical areas that are functionally abnormal between seizures.
比较青少年肌阵挛癫痫（JME）和额叶癫痫（FLE）的神经心理学功能，因为额叶回路涉及这两种情况。通过借鉴先前基于理论的假设和发现，特别强调了不同认知病理生理机制在 JME（额叶执行和与注意力相关的问题：警觉、反应时间、处理速度和反应抑制）和 FLE（反映功能缺陷区的副产品）中产生额叶功能障碍的方式。
共纳入 16 例 JME 患者、34 例 FLE 患者和 48 名正常对照者，所有患者均匹配年龄和教育程度，采用综合成套测验评估额叶执行功能以及注意力、记忆和学习领域。参与者除抗癫痫药外未服用其他药物，也无精神病史。
FLE 患者的神经心理学表现总体上较 JME 和 HC 患者差。与 JME 相比，FLE 患者在言语和非言语执行功能、短期和长期听觉言语记忆和学习、即刻和延迟情节回忆、视觉注意力和运动功能、视动协调和运动速度、视觉信息处理速度以及词汇方面的表现明显更差。与 FLE 相比，JME 患者仅在联想语义处理方面表现更差，而前者在词汇、视动协调和运动速度方面优于所有组。
我们认为，视觉和主要是听觉信息处理速度、警觉性和反应抑制的选择性损伤可能是 JME 的一个显著神经心理学特征。这些发现表明存在执行注意系统的异常，这是继发于病理网状丘脑皮质动力学的。相反，FLE 中的皮质（额叶和额状外）和皮质下功能障碍是由功能缺陷区决定的，即发作间功能异常的皮质和皮质下区域的集合。
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