Naiem, Norazila
(2017)
Cognitive dysfunction among epilepsy patients and its associated factors.
Masters thesis, Universiti Sains Malaysia.
Abstract
Background
Epilepsy and cognition has an interchangeable relationship. The after-effect of seizure
may cause disturbances or damages to one’s cognitive function. Multiple factors may
adversely affect cognition in epilepsy, which can be grouped into sociodemographic,
seizure-related, psychosocial and treatment factors. The objective of this study is to
evaluate cognitive function (intelligence (IQ), memory and language) and factors
associated with poor cognition among epilepsy patients in local setting. The knowledge
of cognitive profile in epileptic patient will assist in improving quality of care and
treatment of epilepsy patients.
Methodology
This was a cross-sectional study from November 2015 to November 2016 in Hospital
USM. Epilepsy patients aged 16 to 65 years old who attended follow up at Neurology
clinic, willing to participate with informed consent and fulfilled the inclusion criteria
were selected. The largest sample size required for analysis was 111 subjects.
Demographic data, seizure-related history and treatment were recorded. Patients
underwent a set of neuropsychological assessment conducted by a trained personnel.
The components tested were IQ, verbal memory and language. Wechsler Abbreviated
Scale of Intelligence (WASI) was used to measure IQ level, while verbal memory was
assessed using the Wechsler Memory Scale (WMS) and Verbal Fluency Test was used
for language assessment. Variables obtained were analyzed using multiple logistic
regression to determine the factors associated with cognitive dysfunction among
epilepsy patients.
Result
135 subjects were analyzed. The mean age of subject in this study was 30 ± 10.57 years
old. The mean age of onset of epilepsy was 14 ± 4.82 years old. The mean duration of
illness was 15 ± 7.51 years with mean attack of 3 ± 1.41 times per month and mean
numbers of anti epileptic drug (AED) was 2 ± 0.85 drugs. Majority of subjects were
Malay (71.9%). There were 70 female (51.9%) and 65 male (48.1%). 58.2% received
higher education level and 60.7% were either not working or still studying. 72.6% had
not experience status epilepticus (SE) of more than 30 minutes. No family history of
epilepsy in 92.6% and absent of medical co morbidity in 85.9% of patients. The mean
value of full scale of intelligence quotient (FSIQ) was 85.18 ± 14.27, total memory of
84.65 ± 12.91 and verbal fluency of 38.43 ± 8.57. Multivariate analysis revealed certain
factors such as patient’s age, educational level, smoking status, duration of illness,
number of AED and history of SE of more than 30 minutes were associated with
impaired cognitive function among subjects studied.
Conclusion
There was significant association between cognitive dysfunction and sociodemographic
factors such as current age, level of education and smoking status. There was also
significant association with epilepsy characteristics such as age of onset, duration of
illness, seizure frequency, history of SE of more than 30 minutes and number of AED
used. We recommend an early recognition of patient’s cognitive profile via routine
screening and neuropsychological assessment at the time of diagnosis. This would help
to provide a baseline cognitive function. Any subsequent change in cognition among
epilepsy patients either due to progression of the disease or the effect of treatmentshould also be measured. Early seizure control combined with cognitive rehabilitation
may help to improve quality of life of the patients.
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