Wismeth Sophia, Badr Mostafa, Helmstaedter Christoph, Witt Juri-Alexander, Surges Rainer
Department of Epileptology, University Hospital Bonn, Bonn, Germany.
Epilepsia. 2025 Aug;66(8):2930-2940. doi: 10.1111/epi.18429. Epub 2025 Apr 28.
Previous studies have suggested that stress precipitates seizures and that cognitive exertion may increase brain excitability, thereby possibly contributing to seizure occurrence during neuropsychological examinations. The present study investigates whether specific, standardized cognitive activities are linked to seizure occurrence.
Two thousand neuropsychological examinations including the Verbal Learning and Memory Test (VLMT) and Diagnosticum für Cerebralschädigung-Revised (DCS-R) were retrospectively evaluated, and occurrence of seizures during neuropsychological testing was assessed. In addition, patient characteristics and epilepsy features were collected from electronic patient charts. Statistical analysis was performed using chi-squared test and linear mixed regression models.
Data of 1444 patients (age = 46 ± 17 years, 48% female) were included in the study, of whom 95% displayed focal epilepsy. Seizures occurred in 36 (1.8%) of 2000 neuropsychological examinations in 34 (2.4%) of the 1444 patients. Test-related seizures were observed only in patients with focal epilepsy, predominantly during memory tests (58%) and most frequently during VLMT (33.3%) and DCS-R (19.4%). A significant association was found between seizure occurrence during VLMT and a seizure onset zone in the right and left temporal lobe, whereas no such association was identified with seizures occurring during DCS-R. No other features were linked with seizure occurrence during testing.
The occurrence of seizures during neuropsychological examinations is very rare. Our data do not support the notion that specific cognitive activities favor acute onset of seizures but rather suggest a coincidental relationship.
以往研究表明，压力会诱发癫痫发作，认知活动可能会增加大脑兴奋性，从而可能导致在神经心理学检查期间癫痫发作。本研究调查特定的、标准化的认知活动是否与癫痫发作有关。
回顾性评估了包括言语学习和记忆测试（VLMT）和修订版脑损伤诊断量表（DCS-R）在内的2000次神经心理学检查，并评估了神经心理学测试期间癫痫发作的情况。此外，还从电子病历中收集了患者特征和癫痫特征。使用卡方检验和线性混合回归模型进行统计分析。
1444例患者（年龄=46±17岁，48%为女性）的数据纳入研究，其中95%表现为局灶性癫痫。在2000次神经心理学检查中，36次（1.8%）出现癫痫发作，1444例患者中有34例（2.4%）出现癫痫发作。仅在局灶性癫痫患者中观察到与测试相关的癫痫发作，主要发生在记忆测试期间（58%），最常见于VLMT（33.3%）和DCS-R（19.4%）期间。发现VLMT期间癫痫发作与左右颞叶癫痫发作起始区之间存在显著关联，而DCS-R期间癫痫发作未发现此类关联。测试期间癫痫发作与其他特征无关。
神经心理学检查期间癫痫发作的情况非常罕见。我们的数据不支持特定认知活动有利于癫痫急性发作的观点，而是表明两者之间是一种偶然关系。
