A study by Ajda Novak, Karmen Vizjak and Martin Rakusa with the Department of Neurologic Diseases, University Medical Centre Maribor in Slovenia

People with epilepsy (PWE) frequently have cognitive impairment. The majority of cognitive problems is influenced by a variety of interlinked factors, including the early onset of epilepsy and the frequency, intensity and duration of seizures, along with the anti-epileptic drug treatment. With a systematic review, we investigate significant factors about the cognitive impairment in epilepsy. Most cognitive problems in adult people with epilepsy include memory, attention and executive function deficits. However, which cognitive area is mainly affected highly depends on the location of epileptic activity. Moreover, modifications in signaling pathways and neuronal networks have an essential role in both the pathophysiology of epilepsy and in the mechanism responsible for cognitive impairment. Additionally, studies have shown that the use of polytherapy (EpilepsyU – meaning two or my drugs) in the treatment of epilepsy with anti-epileptic drugs (AEDs) heightens the risk for cognitive impairment. It can be challenging to distinguish the contribution of each factor, because they are often closely intertwined.

People with epilepsy (PWE) are also exposed to many other health problems that occur often. For many people, co-morbidity (EpilepsyU – more than one medical condition related) is more burdensome than the seizures themselves. Epileptic seizures can cause both morphological (EpilepsyU – a branch of biology that deals with the form and structure of animals and plants) and functional changes in the brain, manifesting as cognitive and neuropsychological disorders. Frequent seizures, especially status epilepticus, repeatedly cause oxidative stress; neuronal loss, mainly in hippocampus or entorhinal cortex, which is another area closely associated to cognitive processing; neurogenesis; changes in growth factors such as BDNF (EpilepsyU – Brain-derived neurotrophic, it plays an important role in neuronal survival and growth and serves as a neurotransmitter modulator.  It is essential for learning and memory); and inflammation in the brain. If the epileptic seizures are not properly treated and controlled, they can lead to permanent cognitive dysfunction. The difficulty with cognition is one of the most common problems in PWE; however, it is often overlooked. Some studies suggest that between 60% and 70% of people with chronic epilepsy have cognitive impairment.

Cognitive impairment in PWE is a consequence of several factors, such as the early onset of epilepsy, frequent seizures, frequent interictal discharges (EpilepsyU – meaning spikes, sharp waves, etc. in brain waves), a low level of education and polytherapy. Recurrent seizures have a strong effect, primarily on the hippocampus, and can cause deficits in brain plasticity.

Nevertheless, almost all confirm the negative impact of polytherapy on cognition in PWE. These are mainly AEDs of older generations and topiramate. However, it is crucial to take the prescribed therapy consistently to achieve the best seizure control possible. Given that, in many studies, levetiracetam was found to be a drug that had improved the area of attention in patients, it would also make sense to investigate whether some AEDs can even slow the development of cognitive decline in specific areas and in what concentrations.”

Link to full study abstract: https://www.mdpi.com/2077-0383/11/1/267/htm

SOURCE: MDPI.com Journal of Clinical Medicine