Academic journal article Iranian Journal of Psychiatry

Juvenile Myoclonic Epilepsy (JME): Neuropsychological Profile and Related Factors with Cognitive Dysfunction

Academic journal article Iranian Journal of Psychiatry

Juvenile Myoclonic Epilepsy (JME): Neuropsychological Profile and Related Factors with Cognitive Dysfunction

Article excerpt

Epilepsy is often associated with reduced general intellectual functioning and specific cognitive impairments, such as general mental slowness, memory impairment and attention deficits (1, 2). Even though understanding of neuropsychological impairment in epilepsy has implications for the treatment and rehabilitation of this common disorder (3, 4), most of the earlier studies have carried out on determining the localization and lateralization of the epileptogenic abnormality in adult patients with focal epilepsy (5) and researchers have recently concentrated on the neuropsychological deficits in non-lesional, so-called idiopathic epilepsies (3). This aspect may provide clues concerning the underlying pathogenic process and the potential compensatory mechanisms that come into play (3). While the cognitive function of patients with Idiopathic Generalized Epilepsy (IGE) is usually within the normal range, they tend to be somewhat lower than in the general population (6-8). However we should always consider the negative impact of antiepileptic drugs on cognitive function of these patients who receive medications.

Juvenile Myoclonic Epilepsy (JME) is the most common form of IGE (9). Previous studies have shown neuropsychological deficits in patients with JME, affecting mainly frontal lobe functions, such as visual working memory, mental flexibility, concept formation, cognitive speed, executive functions mainly planning, perseveration, task switching, verbal fluency, and response inhibition (10-15). However, the presence of cognitive impairments and related factors in JME patients has not yet been thoroughly investigated despite the extensive literature on cognition in other types of epilepsy. Moreover, most studies on patients with epilepsy have not considered confounding factors such as depression in the neuropsychological evaluation.

The aim of this study was 1) to compare cognitive function in JME patients with sex, age and education-matched healthy controls using several neuropsychological tests and 2) to evaluate changes in cognitive function due to epilepsy and mentioned demographic variables in a sample of patients with JME in Iran.

Material and Methods

Thirty two consecutive patients with JME admitted at the epilepsy clinic of Sina Hospital, and 32 healthy controls in Tehran, Iran were enrolled in the study. JME was diagnosed using International League Against Epilepsy (ILAE) classification (6). Entry criteria for patients included normal brain MRI, age between 16-60 years, completion of primary school as the minimum level of education, juvenile onset of myoclonic jerks with or without generalized tonic- clonic seizure, generalized discharges of an irregular mixture of 3-6 Hz spike/polyspikes-slow waves on Electroencephalography (EEG). The exclusion criteria were the presence of an illness other than JME that may affect cognitive functions including neurological or psychiatric disorders, occurrence of a generalized seizure within the previous month or myoclonic jerks or absence seizures within the previous 24 hours, mental retardation (IQ score below 85 based on Raven's Progressive Matrices test), progressive psychiatric and neurological disorders, alcohol or drug abuse, ongoing use of any medications affecting central nervous system. Age-, sex- and education-matched healthy control subjects collected from patient's accompanies or other healthy subjects who were admitted to Sina hospital and had no medical, neurological or psychiatric illnesses , neither had family history of seizures and history of medication use which may affect cognitive function. Subjects in both groups signed their written informed consents prior to being included in this study.

JME diagnosis and EEG recording were done by an expert neurologist in the field of Epilepsy. Subjects completed a questionnaire including clinical and socio- demographic information as gender, age, level of education, duration of epilepsy, type and frequency of seizures, and drug treatment. …

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