EpiTrack is a feasible tool for assessing attention and executive functions in patients with refractory epilepsy

Lähde, Niina; Basnyat, Pabitra; Lehtinen, Hanna; Rainesalo, Sirpa; Rosti-Otajärvi, Eija; Peltola, Jukka

doi:10.1016/j.yebeh.2020.107691

Cited by 8 publications

(18 citation statements)

References 28 publications

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“…Our current results are in line with previous studies suggesting that treatment with more than two ASMs is associated with impaired cognitive performance. 16,17 First, patients taking 1-2 ASMs exhibited significant increases in their EpiTrack scores during follow-up. Second, the predicted improvement in the EpiTrack total score of patients taking 1-2 ASMs during the 5-year follow-up period was almost quadruple that of patients taking 3-4 ASMs.…”

Section: Discussionmentioning

confidence: 99%

“…15 In our previous study, we utilized EpiTrack to assess attention and executive functions in patients with DRE in consideration for treatment interventions (ASM changes and/or neuromodulation therapies), identifying several clinical features such as the number of ASMs, seizure count, and psychiatric comorbidities, which can have an impact on executive functions in patients with DRE. 16 Furthermore, we discovered that more than 75% of the patients treated with VNS exhibited deficits in that specific domain prompting us to…”

Section: Introductionmentioning

confidence: 99%

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Longitudinal EpiTrack assessment of executive functions following vagus nerve stimulation therapy in patients with drug‐resistant epilepsy

Lähde,

Basnyat,

Raitanen

et al. 2023

Epilepsia Open

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ObjectiveTo investigate executive functions and attention with repeated EpiTrack evaluations in a group of drug‐resistant epilepsy (DRE) patients receiving vagus nerve stimulation (VNS) during a follow‐up duration of up to five years.MethodsThe study involved 33 DRE patients who were assessed with EpiTrack as a part of the clinical VNS protocol. Evaluations were scheduled prior to VNS implantation and then at 6 months, 12 months and yearly thereafter. However, the COVID‐19 pandemic disrupted follow‐up. Therefore, changes in EpiTrack total scores over time were analysed using a linear mixed‐effects (LME) model to compensate for the variation in follow‐up duration when predicting EpiTrack total score changes over five years.ResultsThe median follow‐up time was 29 months. During each month, the EpiTrack total score was predicted to increase by 0.07 units (95% confidence interval (CI): 0.01 to 0.12, p = 0.02), corresponding to a change from a baseline score of 27.3 (severe impairment) to a score of 28.9 (mild impairment) at two years and to a score of 31.5 (almost normal) at five years. In the group of patients with psychiatric comorbidities, the EpiTrack total score increased by 0.14 units per month (p = 0.003), which was 3.5‐fold higher than the increase of patients without psychiatric comorbidities. For the patients taking 1–2 antiseizure medications (ASMs), the EpiTrack total score increased by 0.11 units per month (p = 0.005), which was almost quadruple the rate of patients taking 3–4 ASMs.SignificanceBased on EpiTrack total scores, the LME model predicted a four‐point improvement in executive functions among DRE patients at five years after the initiation of VNS, representing a clinically meaningful change. DRE patients with comorbid depression seemed to experience the most cognitive benefits. Additionally, better cognitive outcomes were achieved if the patient took less than three ASMs.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Longitudinal EpiTrack assessment of executive functions following vagus nerve stimulation therapy in patients with drug‐resistant epilepsy

Lähde,

Basnyat,

Raitanen

et al. 2023

Epilepsia Open

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“…43,44 Thus, we administered supplemental behavioral screening tools to ensure that group disparities were not driven solely by neurobehavioral differences in other domains. Specifically, we used the EpiTrack and MoCA, [34][35][36] which are designed to track deficits in executive function and attention as well as mild cognitive impairment and dementia, respectively. While performances on the EpiTrack and MoCA correlated with PLS-derived iREP composite scores, group differences in episodic memory persisted even after controlling for these screening tests, suggesting that these differences were not uniquely mediated by non-relational cognitive domains.…”

Section: Discussionmentioning

confidence: 99%

“…Both tools are behavioral screening protocols for cognitive impairment. The EpiTrack is commonly used in patients with epilepsy to identify and monitor impairments in attention, processing speed, and executive function, 34,35 while the MoCA is used to detect mild cognitive impairment and dementia. 36…”

Section: Methodsmentioning

confidence: 99%

Differential Memory Impairment Across Relational Domains in Temporal Lobe Epilepsy

Tavakol

Kebets

Royer

et al. 2022

Preprint

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BACKGROUND. Temporal lobe epilepsy (TLE) is typically associated with pathology of the hippocampus, a key structure involved in relational memory processes, including episodic, semantic, and spatial memory. While it is widely accepted that TLE-associated hippocampal alterations may underlie global deficits in memory, it remains poorly understood whether TLE may present with shared or unique impairment across distinct relational memory domains. METHODS. We administered a recently validated behavioral paradigm to evaluate episodic, semantic, and spatial memory in 20 pharmacoresistant TLE patients and 53 age- and sex-matched healthy controls. We implemented linear mixed effects models to identify memory deficits in individuals with TLE relative to controls, and used partial least squares analysis to identify factors contributing to overall variations in relational memory performance across both cohorts. RESULTS. TLE patients showed marked impairment in episodic memory compared to controls, while spatial and semantic memory remained relatively intact. Findings were robust, with slight decreases in effect sizes after controlling for performance on executive function tests. Via partial least squares analysis, we identified group, age, and bilateral hippocampal volumes as important variables relating to relational memory impairment. CONCLUSION. Our behavioral framework provides a granular approach for assessing relational memory deficits in people with TLE and may inform future prognostic strategies in patients with hippocampal pathology. Our work warrants further investigations into the underlying neural substrates of relational memory.

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“…In general, treatments with ASMs such as topiramate and zonisamide should be avoided. [57][58][59][60] In addition, treatment with more than two ASMs should be avoided as the risk for deficits in executive function increases with each additional ASM in combination therapy. 61 An EpiTrack evaluation is recommended in the context of therapeutic interventions.…”

Section: Of Asms On Cognitionmentioning

confidence: 99%

Expert opinion on diagnosis and management of epilepsy‐associated comorbidities

Peltola,

Surges,

Voges

et al. 2023

Epilepsia Open

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Apart from seizure freedom, the presence of comorbidities related to neurological, cardiovascular, or psychiatric disorders is the largest determinant of a reduced health‐related quality of life in people with epilepsy (PwE). However, comorbidities are often underrecognized and undertreated, and clinical management of comorbid conditions can be challenging. The focus of a comprehensive treatment regimen should maximize seizure control while optimizing clinical management of treatable comorbidities to improve a person's quality of life and overall health.A panel of four European epileptologists with expertise in their respective fields of epilepsy‐related comorbidities combined the latest available scientific evidence with clinical expertise and collaborated to provide consensus practical advice to improve the identification and management of comorbidities in PwE. This review provides a critical evaluation for the diagnosis and management of sleep‐wake disorders, cardiovascular diseases, cognitive dysfunction, and depression in PwE. Whenever possible, clinical data have been provided. The PubMed database was the main search source for the literature review.The deleterious pathophysiological processes underlying neurological, cardiovascular, or psychiatric comorbidities in PwE interact with the processes responsible for generating seizures to increase cerebral and physiological dysfunction. This can increase the likelihood of developing drug‐resistant epilepsy; therefore, early identification of comorbidities and intervention is imperative. The practical evidence‐based advice presented in this article may help clinical neurologists and other specialist physicians responsible for the care and management of PwE.

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EpiTrack is a feasible tool for assessing attention and executive functions in patients with refractory epilepsy

Cited by 8 publications

References 28 publications

Longitudinal EpiTrack assessment of executive functions following vagus nerve stimulation therapy in patients with drug‐resistant epilepsy

Longitudinal EpiTrack assessment of executive functions following vagus nerve stimulation therapy in patients with drug‐resistant epilepsy

Differential Memory Impairment Across Relational Domains in Temporal Lobe Epilepsy

Expert opinion on diagnosis and management of epilepsy‐associated comorbidities

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