Abstracts

Rationale: Many features prevent juvenile myoclonic epilepsy (JME) from being defined as a benign epilepsy syndrome: in particular, although associated with normal IQ, people with JME identify complaints with memory. Detailed neuropsychometry is time consuming and costly if used indiscriminately. We set out to identify whether the self administered cognitive screening test - Test Your Memory (TYM) designed as a screening tool for dementia - may help identify people with epilepsy with cognitive difficulties. The TYM tasks include orientation, verbal fluency, semantic knowledge, visuospatial abilities and calculation. A score of ?42/50 has a sensitivity of 93% and specificity of 86% in the diagnosis of Alzheimer s disease (Brown et al. BMJ 2009;338:b2030). Methods: Nineteen people with a clinical and EEG diagnosis of JME attending detailed phenotyping interviews for genetic research, were asked to complete a TYM scale before attending their interview (seventeen remembered to do so). Participants also undertook a full Wechsler Adult Intelligence Scale (WAIS III), Wechsler Memory Scale (WMS III), three sub-tests of the Delis-Kaplan Executive Function System (D-KEFS), three sub-tests of the BADS (Behavioural Assessment of Dysexecutive Syndrome), and a semi-structured clinical interview. Results were analysed using the Student s t-test. Results: Mean full scale IQ was 100 (SE /-4) and the TYM scores ranged from 38 to 50 (mean score 46 (SE /-1), median 48). A score of ?42/50 identified those people with the lowest full scale IQ scores (p>0.0005): all scoring ?42/50 struggled with naming and semantic knowledge tasks. Memory deficits and executive function difficulties were similarly identified by a TYM score of 42 or under, including: all WMS-III subscales (p>0.001); the FAS test (p>0.0005), inhibition on the D-KEFS colour word test (p>0.03), trail making task (p>0.0006) and elements of BADS - such as Key search (p>0.0003) and Zoo map (p>0.02). All of those with a score of ?42/50 in this study were in employment and only one had a pre-existing diagnosis of mild learning disability. There was no significant difference between those taking sodium valproate (n=9) and those who were not. Conclusions: TYM is not specific for Alzheimer s dementia and may help identify people with epilepsy who have significant cognitive difficulties across a broad range of sub tests. JME may be more heterogeneous than previously thought, with certain subgroups demonstrating cognitive difficulties despite good seizure control. Low test scores across a range of scales may be due to attentional deficits. Educational achievement may also be lower due to delayed diagnosis and recurrent absence seizures during schooling (resulting in lower semantic knowledge scores). Because TYM tests a wide range of abilities including sequencing it is capable of identifying difficulties with concentration and attention. This freely available (www.tymtest.com) and patient friendly test may help clinicians identify people with idiopathic epilepsy who have significant cognitive difficulties.