Application of the International Classification of Cognitive Disorders in Epilepsy (IC-CoDE) to Adults with Frontal Lobe Epilepsy
Abstract number :
1.353
Submission category :
11. Behavior/Neuropsychology/Language / 11A. Adult
Year :
2022
Submission ID :
2204017
Source :
www.aesnet.org
Presentation date :
12/3/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:23 AM
Authors :
Kayela Arrotta, PhD – Cleveland Clinic; Sallie Baxendale, PhD – University College London; Robyn Busch, PhD – Cleveland Clinic; Bruce Hermann, PhD – University of Wisconsin, Madison; Carrie McDonald, PhD – San Diego State University/ University of California-San Diego; Anny Reyes, MS – San Diego State University/ University of California-San Diego
Rationale: The International Classification of Cognitive Disorders in Epilepsy (IC-CoDE) was recently introduced as a consensus based, empirically driven taxonomy of cognitive disorders in epilepsy and has been effectively applied to patients with temporal lobe epilepsy (TLE; McDonald et al., 2022). The purpose of this study was to apply the IC-CoDE to patients with frontal lobe epilepsy (FLE) for the first time.
Methods: A total of 138 patients (aged 16-67; 44% female) with pharmocoresitant FLE completed comprehensive neuropsychological testing as part of their pre-surgical workup. Following the proposed IC-CoDE guidelines, patterns of impairment were determined based on commonly used tests within five cognitive domains (language, memory, executive functioning, attention/processing speed, and visuospatial ability) using two impairment thresholds (>1.0 and >1.5 standard deviations (SD) below the normative mean). Distributions across phenotypes were then compared to those found in patients with TLE for which the IC-CoDE classification was validated.
Results: The following cognitive phenotypes were identified using the IC-CoDE classification scheme: cognitively intact (1 SD: 24%; 1.5 SD: 41%), single domain impairment (1 SD:32; 1.5 SD: 38%), bi-domain impairment (1 SD: 19%; 1.5SD: 7%), and generalized impairment (1 SD: 25%; 1.5 SD: 14%). Compared to the previously reported IC-CoDE phenotypes found in TLE (McDonald et al., 2022), patients with FLE were less likely to have intact cognition and those with cognitive impairment most commonly fell into either the single domain or generalized impairment phenotypes. Interestingly, language was the most common single domain impairment in both TLE and FLE. For those with bi-domain impairment, patients with FLE were most commonly impaired in the language and attention/processing speed domains, while language and memory were most commonly impaired in patients with TLE.
Conclusions: The application of the IC-CoDE to patients with FLE demonstrates a unique distribution of cognitive phenotypes compared to TLE. These results suggest that patients with FLE may have a higher rate of cognitive impairment compared to patients with TLE, and tend to fall into the extremes of either having single domain or generalized impairment. This study also highlights the utility of the IC-CoDE not only as a way to improve our understanding about how cognition is impacted across epilepsy syndromes, but also as a harmonized cognitive taxonomy that will benefit future research and clinical care.
Funding: Charles Shor Epilepsy Center, Cleveland Clinic
Behavior