Abstracts

Rationale: Many people with epilepsy report their impairments in cognitive functioning. However, the relationship between epilepsy and cognitive function is still not well understood at present. It is important to understand how much the epileptic process itself and therapeutic intervention affect cognitive function, to improve the quality of life of patients with epilepsy in clinical practice. This study focused on the relationship between seizure prognosis and cognitive function in adult patients with focal epilepsy receiving anti-seizure medicine therapy. We adopted the Trail Making Test (TMT) which is considered to be suitable for evaluating the executive function, attention, and working memory of patients with epilepsy. The purpose of this study was to clarify clinical course of cognitive function using TMT in adult patients with focal epilepsy.

Methods: TMT data were obtained from patients with focal epilepsy without coexistence of acute central nerve system diseases, intellectual disability, psychiatric disorders and taking medications which might interfere with cognitive function. We performed TMT two times with one year interval for each patient. We performed multiple regression analyses with first TMT scores as dependent variables and clinical features as independent variables. Next, we divided patients into originally seizure free group, seizure persistence group, and seizure improvement group depending their seizure prognosis between the first and second TMT tests. We performed a multivariate analysis of covariance (MANCOVA) to evaluate the difference between the first and second TMT scores for each seizure prognosis group.

Results: We enrolled 132 patients in the study. All patients were under medication with anti-seizure medicines. The multiple regression analyses showed that a longer active seizure period was associated with worse the first TMT-B performance (β=0.323, P< 0.001) (Figure 1). On the other hand, seizure frequency when the TMT-B test was performed was not associated with TMT-B performance (FAS: β = 0.011, P = 0.878, FIAS: β = 0.131, P = 0.087, FBTCS: β=0.012, P=0.874). The MANCOVA showed an interaction between the prognosis of TMT-B performance and the seizure prognoses [F (2, 120) =3.69, P=0.028]. Sub effect tests revealed that the second TMT-B performance improved only in the seizure improvement group [F (1, 10) =7.43, P=0.021] (Figure 2).