First Seizure Effects on Cognition in Adults
Overview
Investigating cognitive and psychological functioning in adults after their first seizure, prior to epilepsy diagnosis and treatment, is crucial for understanding the early manifestations of neuropsychological comorbidities associated with chronic epilepsy.
In this study, conducted through a telehealth-based prospective design, cognition, mood, and anxiety symptoms were screened in adult patients referred to a First Seizure Clinic (FSC).
The participants, over 18 years old, English-speaking, and not taking antiseizure medication, underwent screening via telephone for cognition and online questionnaires for psychological symptoms before their diagnostic evaluation.
Data from 32 individuals subsequently diagnosed with epilepsy at the FSC were compared with 30 healthy controls matched for age, gender, and education.
Results revealed significant differences between the groups in combined cognitive measures, with the epilepsy group exhibiting notably poorer performances in verbal memory, working memory, and executive functions compared to controls.
Additionally, the epilepsy group demonstrated higher rates of clinically significant depressive and anxiety symptoms. This study sheds light on the early cognitive and psychological challenges faced by individuals following their first seizure, providing valuable insights for early intervention and management strategies in epilepsy care.
Introduction
Cognitive and psychological comorbidities are common in epilepsy, encompassing deficits in memory, attention, language, executive function, and mood and anxiety disorders.
However, understanding these comorbidities in chronic epilepsy cohorts is challenging due to the presence of multiple confounding factors such as antiseizure medication (ASM) use, recurrent seizures, and adjustment to the chronic diagnosis.
To address these complexities, researchers have turned to studying individuals with new-onset epilepsy, aiming to elucidate the natural progression of neuropsychological deficits from the earliest stages of the disease.
By capturing patients as close to the onset of epilepsy as possible, researchers can minimize the influence of confounding factors and gain insights into the primary features of the disorder.
In a recent study employing a telehealth-based prospective design, cognition, mood, and anxiety symptoms were screened in adult patients referred to a First Seizure Clinic (FSC) before undergoing diagnostic evaluation.
This approach allowed researchers to assess cognitive and psychological functioning in individuals with new-onset epilepsy prior to the initiation of ASM treatment.
Results from the study revealed significant differences in cognitive measures between individuals subsequently diagnosed with epilepsy at the FSC and healthy controls.
Specifically, the epilepsy group exhibited poorer performances in memory, processing speed, attention, and executive functions compared to controls. Additionally, high rates of depressive and anxiety symptoms were observed in the epilepsy group.
These findings underscore the early onset of cognitive and psychological dysfunction in individuals with new-onset epilepsy, highlighting the importance of early detection and intervention. Telehealth screening offers a practical and efficient means of identifying these issues, facilitating timely management to improve patient outcomes.
Methods
Patients were recruited from referrals to the Austin Health First Seizure Clinic (FSC), a diagnostic neurology clinic in Melbourne, Australia, specialized in assessing and treating individuals presenting with a first suspected seizure.
Ethical approval for the study was obtained from the Austin Health Human Research Ethics Committee.
Potential participants, aged 18 years and older, who were English-speaking and not taking antiseizure medication (ASM), were contacted via phone and informed about the study.
Individuals with hearing impairment or moderate to severe intellectual/neurocognitive disability were excluded due to their inability to complete telephone-based assessments independently.
Those providing informed consent were invited to undergo psychological screening questionnaires online and cognitive screening measures via phone, all before their initial FSC visit.
Cognitive screening was conducted by trained neuropsychologists using a standardized approach, focusing on memory, attention, working memory, and executive functions.
Psychological functioning was assessed through self-reported depressive symptoms using the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and anxiety symptoms using the Brief Epilepsy Anxiety Survey Instrument (brEASI), administered via online surveys.
The clinical diagnosis of epilepsy was made by a qualified neurologist within the FSC, following the International League Against Epilepsy (ILAE) criteria, based on thorough clinical history, eyewitness accounts, outpatient EEG, and epilepsy-directed MRI-brain investigations.
Prospective data were collected on individuals diagnosed with epilepsy at the FSC between February 2021 and July 2023.
Control participants were healthy volunteers recruited from local community centers and social media, with exclusion criteria including past or current neurological or psychiatric conditions, and current use of psychotropics or ASM.
A subset of controls matched to the epilepsy group in terms of age, gender, and education was selected for the analysis.
Cognitive and psychological measures were chosen to reflect domains commonly affected in epilepsy, with a tailored cognitive screening battery administered via telephone to maximize accessibility.
Verbal learning and memory, attention, working memory, and executive functions were assessed through various tests, while depressive and anxiety symptoms were evaluated using standardized questionnaires administered online.
All data were collected prior to the FSC visit to minimize the influence of subsequent diagnostic and treatment interventions.
Statistical Analysis
In this study, participants were recruited from the Austin Health First Seizure Clinic (FSC) in Melbourne, Australia, which specializes in evaluating and treating individuals presenting with their first suspected seizure.
The research was conducted following approval from the Austin Health Human Research Ethics Committee (HREC: 59148).
The inclusion criteria comprised individuals aged 18 years and above, proficient in English, and not currently taking antiseizure medications (ASM).
Exclusion criteria included conditions that might impede independent completion of telephone-based assessments, such as hearing impairment or moderate to severe intellectual/neurocognitive disability.
Prospective participants were contacted via telephone and provided with information about the study. Those who consented were invited to undergo cognitive screening over the phone and complete psychological screening questionnaires online before their initial visit to the FSC.
Trained neuropsychologists administered the telephone-based cognitive screening in a standardized manner. Patient medical records were subsequently monitored to track diagnostic outcomes, with epilepsy diagnoses made by qualified neurologists at the FSC based on International League Against Epilepsy (ILAE) criteria.
The study included 32 individuals diagnosed with epilepsy between February 2021 and July 2023. Controls were recruited from the local community and matched to the epilepsy group based on age, gender, and education level. A total of 30 controls were selected for analysis.
Cognitive and psychological measures were chosen to reflect domains commonly affected in epilepsy and sensitive to impairments. Telephone-based cognitive assessments included tasks assessing verbal learning and memory, attention, working memory, and executive functions. Psychological functioning was evaluated using self-report measures for depressive and anxiety symptoms administered via online surveys.
Statistical analyses involved independent samples t-tests, chi-squared tests, and a multivariate analysis of variance (MANOVA) to assess group differences in cognitive variables. Imputation techniques were applied to handle missing data, and outliers were addressed through winsorization.
Rates of impairment in psychological variables were compared using clinical cut-scores, with significance levels determined through statistical tests in R/RStudio software.
The study also provided a comprehensive overview of sample characteristics for both the epilepsy and control groups.
Result
The study found no statistically significant differences in age, gender, or level of education between the epilepsy and control groups.
In the epilepsy group, most cases were diagnosed with focal epilepsy, with a smaller portion diagnosed with generalized epilepsy, and some cases where the type was unknown.
The majority had no history of seizures prior to the index event, which was typically a tonic–clonic seizure. Epilepsy diagnoses were made more than 48 hours after the most recent seizure, with only a few participants screened within 5 days of the index seizure.
An epileptogenic lesion was identified on MRI in only a small subset of cases.
Regarding cognitive functioning, a between-subjects multivariate analysis of variance (MANOVA) revealed significant differences between the epilepsy and control groups across multiple cognitive outcome variables, including verbal learning and memory, attention, working memory, and executive functions.
These differences remained significant even after adjusting for potential mood and anxiety effects. Rates of cognitive impairment were notably higher in the epilepsy group compared to controls, particularly in verbal memory and executive functions.
In terms of psychological functioning, a considerable proportion of epilepsy participants were at high risk for major depressive disorder (MDD) and any anxiety disorder compared to controls.
However, the severity of symptoms did not significantly differ between groups.
Overall, the study highlighted significant cognitive impairments and increased psychological risk in individuals with epilepsy compared to controls, underscoring the importance of comprehensive assessment and management strategies in epilepsy care.
Conclusion
The primary objective of this study was to comprehensively assess the cognitive and psychological functioning of individuals experiencing new-onset epilepsy after their first seizure, prior to receiving a formal diagnosis and treatment.
To achieve this, the researchers utilized a methodological approach involving telephone-based cognitive testing and online questionnaires.
This methodology enabled the investigation of neuropsychological functioning soon after seizure onset, thereby minimizing the influence of typical confounding factors encountered in previous studies, such as recurrent seizures and the psychological impact of an epilepsy diagnosis.
The study provided valuable insights into the cognitive and psychological challenges faced by individuals with new-onset epilepsy, emphasizing the need for early intervention and support to mitigate the impact of these impairments on daily functioning and overall quality of life.
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