Cognitive prognosis in chronic temporal lobe epilepsy

Hermann, Bruce P.; Seidenberg, Michael; Dow, Christian; Jones, Jana E.; Rutecki, Paul; Bhattacharya, Abhik; Bell, Brian

doi:10.1002/ana.20872

Cited by 270 publications

(197 citation statements)

References 35 publications

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“…In contrast, in adults, the impact of seizures seems be largely on measures of fluid intelligence (attention and processing speed) and other functions not sampled by the WISC (visual and verbal memory and fine motor function). 15,22,23 The traumatic brain injury literature provides similar patterns of findings. Insults during early brain developmental may be partially correctable through mechanisms of plasticity; however, the burden of deficit is then spread across a large range of cognitive functions.…”

Section: Discussionmentioning

confidence: 75%

Age at onset of epilepsy, pharmacoresistance, and cognitive outcomes

et al. 2012

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Objectives: Increasing evidence suggests that uncontrolled seizures have deleterious effects on cognition and behavior, particularly in the developing brain. Methods:In a community-based cohort, 198 children, aged Ͻ8 years with new-onset epilepsy were followed prospectively and reassessed with the Wechsler Intelligence Scales for Children, Third Edition (WISC-III) 8-9 years later. Linear regression analyses with interactions between age at onset (age) and pharmacoresistance (PR) were used to test whether earlier onset conveyed greater vulnerability to the effects of uncontrolled seizures. Full-scale IQ (FSIQ) and the 4 subdomain scores were examined. Adjustment for adaptive behavior scores in a subset was performed. A dichotomous indicator for IQ Ͻ80 or Ն80 was used to permit inclusion of children who were not tested, particularly those who were untestable.Results: FSIQ was not correlated with age. PR was associated with an 11.4 point lower FSIQ (p ϭ 0.002) and similar decrements in each WISC-III domain. There were substantial age-PR interactions for FSIQ (p ϭ 0.003) and 3 domain scores, indicating a lessening impact of PR with increasing age. The dichotomous IQ indicator was strongly correlated with age at onset in the pharmacoresistant group (p Ͻ 0.0001) and not in the non-pharmacoresistant group (p ϭ 0.61). Adjustment for adaptive behavior measured near onset did not alter the conclusions. Conclusions:Uncontrolled seizures impair cognitive function with effects being most severe in infancy and lessening with increasing age at onset. These findings further emphasize the need for early aggressive treatment and seizure control in infants and young children. Seizures and epilepsy are increasingly being recognized to have moderate to profound effects on cognitive function. There is an increasing body of literature demonstrating that, in children with refractory epilepsy who are evaluated for epilepsy surgery, earlier age at onset is associated with lower IQ or developmental scores, 1-5 and longer duration of epilepsy before surgery is negatively correlated with IQ and ability to rebound after surgery 2,4,6 . A drug treatment trial for infantile spasms reported a striking correlation between both age at onset and delay to treatment with developmental scores assessed later at age 4 years.7 These studies focused on severe epilepsy (spasms) or pharmacoresistant surgical epilepsy and by design do not allow comparisons with cognitive outcomes in well-controlled epilepsy. Consequently, they cannot directly address the separate roles of onset age vs seizures in the developing brain.In a prospective community-based study of children with epilepsy, we examined the association of cognitive scores assessed 8 -9 years after initial diagnosis and age at onset of epilepsy, pharmacoresistance, and the interaction between the two. We specifically hypothesized that the

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Section: Discussionmentioning

confidence: 75%

Age at onset of epilepsy, pharmacoresistance, and cognitive outcomes

et al. 2012

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“…As in our rat model, MTLE is often precipitated by SE (Cossart et al, 2001). Although cognitive impairment may be progressive in some patients with MTLE that have poorly controlled epilepsy (Hermann et al, 2006), much of the cognitive impairment is a result of the initial insult (Elger et al, 2004;Helmstaedter and Kockelmann, 2006). Similar to the impairment found in the rats in spatial memory in the water maze, humans with medial temporal lobe epilepsy demonstrate impairment in navigation in a virtual reality maze (Weniger and Irle, 2006).…”

Section: Discussionmentioning

confidence: 89%

Altered Phase Precession and Compression of Temporal Sequences by Place Cells in Epileptic Rats

Lenck-Santini¹,

Holmes²

2008

J. Neurosci.

100

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In the hippocampus, pyramidal cells encode information in two major ways: rate coding and temporal coding. Rate coding, in which information is coded through firing frequency, is exemplarily illustrated by place cells, characterized by their location-specific firing. In addition, the precise temporal organization of firing of multiple place cells provides information, in a compressed time window, about the temporal sequence of the locations visited by the animal. This encoding is accomplished through phase precession, a phenomenon whereby unit firing is linked to theta rhythm, one of the major hippocampal EEG oscillations. Although it is likely that this type of processing is critical for normal brain function, its involvement in pathologies associated with cognitive disorders is unknown. In this experiment, we determined whether the temporal organization of place cell firing is affected in an animal model of mesial temporal lobe epilepsy (MTLE), a disease accompanied with cognitive impairment. We investigated hippocampal coding and its relationship to theta rhythm in rats after status epilepticus (SE), a condition that leads to MTLE. We found a great proportion of SE place cells had aberrant phase/precession pattern and temporal organization of firing among pairs of neurons, which constitutes the compression of temporal sequences, was altered in SE rats. The same animals were also markedly impaired in the water maze task, a measure of spatial memory. We propose that the synaptic and cellular alterations observed in MTLE induce aberrant temporal coding in the hippocampus, contributing in turn to cognitive dysfunction.

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“…The mean "memory age" shift of left TLE patients as compared to healthy subjects of same chronological age was about 20 years. However, other groups revealed an acceleration of cognitive decline with ageing in a subset of severely affected patients (Hermann et al, 2006). In any case, TLE patients are at a higher risk to show dementialike deficits at an earlier age than healthy subjects.…”

Section: What Do Memory Problems Look Like?mentioning

confidence: 84%

Long‐term memory impairment in patients with focal epilepsy

2007

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SUMMARYIn temporal lobe epilepsy, long-term memory disturbance starts early in life mainly affecting declarative memory. Primary impairment of episodic memory often results in reduced semantic and autobiographic memory. Neuropsychological performance predicts academic achievement and everyday life functioning while subjective memory complaints are highly correlated with depression. Memory impairment is also influenced by initial brain damage, developmental retardation and dynamic factors (e.g., seizure frequency, medication). Damage of functional tissue, low mental reserve capacity, and poor seizure outcome increase the risk for postsurgical memory impairment whereas functional release due to seizure freedom counteracts negative impact. Preliminary findings indicate that postsurgical training improves memory deficits and encourage further research. KEY WORDS: Temporal lobe epilepsy, Cognitive Decline, Antiepileptic drugs, Surgery, Impact and consequences.Epilepsy is a complex condition, which may affect cognitive performance, learning and long-term memory by several factors (Elger et al., 2004). Neuropsychological performance is correlated with invariant clinical factors, such as side and site of a structural lesion or age at epilepsy-onset (together with duration of epilepsy). In addition, more dynamic variables, such as seizure frequency, interictal spike discharge, or cognitive side effects of pharmacological or surgical therapies strongly affect cognition and memory. A retrospective analysis of neuropsychological data from 3,193 patients with focal epilepsies at the Bonn centre (1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006) showed that memory functions (besides the higher order speech functions) are particularly susceptible to epilepsy related neuropsychological disturbances (Table 1). The majority of these patients (>70%) suffered from temporal lobe epilepsy (TLE).

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Cognitive prognosis in chronic temporal lobe epilepsy

Abstract: Cognitive prognosis is poor for a subset of patients characterized by chronicity of epilepsy, older age, lower intellectual ability, and more baseline abnormalities in quantitative magnetic resonance volumetrics.

Cited by 270 publications

References 35 publications

Age at onset of epilepsy, pharmacoresistance, and cognitive outcomes

Age at onset of epilepsy, pharmacoresistance, and cognitive outcomes

Altered Phase Precession and Compression of Temporal Sequences by Place Cells in Epileptic Rats

Long‐term memory impairment in patients with focal epilepsy

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