Abstracts

Rationale:
Cognitive impairments in patients with newly diagnosed epilepsy (NDE) are recognized but their prevalence ranges between studies and goes up to 70%. Cognitive impairments were shown in attention, executive functions and memory. These results should be taken with caution as there are important methodological differences between studies: use of a control group, heterogeneity of samples (brain tumor, stroke, etc.), and heterogenous neuropsychological assessment. The main objective of this study is to define the prevalence and the nature of cognitive impairment in French NDE. The second objective is to assess the impact of syndromic and etiological diagnosis on the types of the recorded cognitive impairments. This requires a systematic and complete neuropsychological assessment prior to the introduction of an antiepileptic drug (AED) at the time of diagnosis, which is scarce.
Method:
Immediately following the diagnosis of epilepsy, assessment of verbal and nonverbal memory, working memory (WM), executive function, language and processing speed was performed in NDE patients prior to initiation of AED. We employed available normative data of tests used. The cut-off for cognitive impairment is 1.65 standard deviation below the normative data. Depression and anxiety are also assessed. The patients included must have no history of epilepsy, or other known neurological and psychiatric conditions, or misuse of psychoactive substances (alcohol, cannabis, etc.).
Results:
Eighty NDE patients were included: 58 focal (FE) and 22 generalized epilepsy (GE). Patients with FE are significantly older and are diagnosed later after the first seizure than EG’s patients. Eighty-nine percent of patients have at least one impaired cognitive function. We find an impaired score in 60% of patients in oral denomination, 55% in WM, 40% in episodic memory, 35% in executive function and 9% in treatment speed. Twenty-one percent of patients have symptoms of depression and 15% of anxiety. In this sample, we did not identify a specific cognitive profile of epilepsy of presumed genetic origin or focal epilepsy. Nevertheless, a trend appears with a higher proportion of oral naming and processing speed impairments in GE compared to FE. The non-significance can be related to the size of our sample (low number of GE patients).
Conclusion:
These results confirm the presence of cognitive impairment from the onset of epilepsy with a very high prevalence in France. A more marked impairment in oral naming, memory and executive functions is recorded. This is in line with the results of previous studies in other countries. This implies that cognitive impairments may have been developing underhandedly before the first epileptic seizures occurred. In order to define the impact of the frequency of seizures and/or treatments and the risk factors for developing cognitive disorders in epilepsy, it is relevant to assess patients at an early stage. It is necessary to follow these patients over the long term as well.
Funding:
:This work was supported by UCB Pharma.