Provocative and inhibitory effects of a video‐EEG neuropsychologic protocol in juvenile myoclonic epilepsy

Abstract

SUMMARYPurpose: Studies suggest that higher cognitive functions could precipitate seizures in juvenile myoclonic epilepsy (JME). The present study aimed to analyze the effects of higher mental activity on epileptiform discharges and seizures in patients with JME and compare them to those of habitual methods of activation. Methods: Seventy-six patients with JME (41 female) underwent a video-EEG (electroencephalography) neuropsychologic protocol (VNPP) and habitual methods of activation for 4-6 h. Results: Twenty-nine of the 76 (38.2%) presented provocative effect, and inhibition was seen in 28 of 31 (90.3%). A mixed effect was observed in 11 (35.5%), and 30 patients (39.5%) suffered no effect of VNPP. Action-programming tasks were more effective than thinking in provoking epileptiform discharges (23.7% and 11.0% of patients, respectively, p = 0.03). Inhibitory effect was observed equally in the various categories of tasks, except in mental calculation, which had a higher inhibitory rate. Habitual methods of activation were more effective than VNPP in provoking discharges. Anxiety disorders were diagnosed in 24 of 58 patients (41.4%); anxious patients had greater discharge indexes and no significant inhibitory effect on VNPP. Discussion: Praxis exerted the most remarkable provocative effect, in accordance with the motor circuitry hyperexcitability hypothesis in JME. Inhibitory effect, which had no such task specificity, might be mediated by a widespread corticalthalamic pathway, possibly involving the parietal cortex. The frequent inhibitory effect found under cortical activation conditions, influenced by the presence of anxiety, supports nonpharmacologic therapeutic interventions in JME.

The Effect of Cognitive Functions on EEG in Patients with Juvenile Myoclonic Epilepsy

“…Matsuoka et al [11] found that mental acitivities mainly associated with the use of hands such as writing, written calculation, and spatial construction provoked discharges in 46.7% of their JME patients.Similarly, Guaranha et al [14] showed that the action programming tasks were more effective than thinking in provoking epileptiform discharges and suggested that the more tissue Global attention -…”

“…In another study of patients with JME, Karachriastianou et al [12] reported that 23 of 30 patients (76.6%) showed EEG activation in response to at least one neuropsychological task. In a more recent paper, Guaranha et al [14] showed that 29 of the 76 patients with JME (38.2%) were affected by at least one cognitive task of video-EEG neuropsychological protocol. A distinguishing feature from the similar studies in the literature, is that patients with any previous perception of mental activity precipitating or inhibiting their seizures were not included in the present study.…”

“…The NPA battery of other similar studies did not include the global attention test, however the other three activatory tests were all manual activities in accordance with the previous reports. [11][12][13][14] Matsouka et al [11] reported that the provocative effect of NPA tasks was observed in 6.6% of the patients without paroxysms and 9.6% of the patients with paroxysms on the standard EEG. In our study however, although the NPA tasks induced provocative effect in a similar percentage of patients (6.7) without discharges on standard EEG; affinity to provocation was present in 40% of the patients with discharge.…”

“…[1][2][3][4] The relation between spontaneous epileptiform activity and cognitive functions has been studied with an increasing interest since present. [7][8][9][10][11][12][13][14] Seizures induced by higher mental activities have encouraged studies which were designed with special EEG activation methods to show any effect of mental tasks on the EEG of epileptic patients. [11][12][13][14] Matsuoka et al [11] used a neuropsychological method testing for various mental activities as a part of routine EEG examination for patients with epilepsy.…”

“…[1][2][3][4] It has been also demonstrated that spesific or nonspecific complex cognitive activities such as calculations, constructive activities, drawing, playing strategic board games are able to precipitate seizures. [7][8][9][10][11][12][13][14][15] In the treatment of JME not only antiepileptic drug therapy but also identification and regulation of seizure precipitant factors are important.…”