Objective To investigate the changes of cognitive function of epileptic patients after antiepileptic drugs (AEDs) therapy. Methods Twenty eight cases of epileptic patients with new diagnosis and untreatment from March 2015 to February 2016 were collected. According to the seizure type, degree of attack and drug efficacy, patients were divided into three groups and treated with one of three AEDs, including Lamotrigine (LTG), Oxcarbazepine (OXC), and Sodium valproate (VPA). Among them, 11 were LTG group, 12 were OXC group and 5 were VPA group.Then the patients were followed up for 1 year. The clinical memory scale was used to analyze cognitive function of epileptic patients before and after therapy. Results Compared to 30 cases of healthy volunteers, the scores of memory quotient (P<0.01), directed memory (P<0.05), associative learning (P<0.05) and image free recall (P<0.01) of epileptic patients were obviously decreased before AEDs therapy.AEDs therapy reduced or controlled seizures in new diagnostic epileptic patients, and the total effective rate was 85.7%. In the clinical memory scale tests, the scores of memory quotient (P<0.01), directed memory (P<0.05), associative learning (P<0.05), portrait characteristics contact memory (P<0.05) were improved after therapy. The scores of image free recall and meaningless graphics recognition were also improved, but there was no statistical significance. Besides, there was a statistically significant improvement in the score of portrait characteristics contact memory after LTG treatment (P<0.05), and directed memory after VPA treatment (P<0.05). Conclusions Epileptic patients accompanied with cognitive deficits before drug intervention. Through standard AEDs treatment, seizures could be better controlled. The cognitive function of epileptic patients was not declined after short-term（within 1 year） intervention of LTG, OCX or VPA. Moreover some parts of the cognitive domain could be improved.
Epilepsy is defined as a disorder of brain neural function, characterized by the persistent possibility of seizures, which are usually sudden, brief, and recurrent. Cognition is a process of receiving information from the external world and analyzing and processing it, such as memory, language, visual-spatial, executive, calculation, comprehension, and judgement. With the increasing awareness of health, more and more scholars have begun to pay attention to the relationship between cognitive dysfunction and epilepsy. Data shows that over 80% of epilepsy patients have lower cognitive abilities than healthy people, and over 50% of patients have significant cognitive problems, which have a negative impact on their quality of life even greater than the seizures themselves. Cognitive impairment in epilepsy patients not only hinders their own treatment progress, but also has a negative impact on their daily life, academic and job performance, which brings huge care and economic pressure to their families and a heavy economic burden to the whole society. This review aimed to assess cognitive modules and provide key information for early diagnosis and treatment of patients.
ObjectivesTo explore the characteristics of cognitive deficits of Benign epilepsy of childhood with centrotemporal spikes (BECTS).MethodsA total of 61 BECTS patients who visited Neurology Clinic of Xuanwu Hospital Capital Medical University between September 2010 to December 2019 and 60 healthy controls were enrolled in our study. All patients and healthy controls performed a series of neuropsychological tests to assess their cognitive function in the "Multi-dimensional psychology" of Beijing Normal University, including attention; memory; arithmetic calculation; language processing; executive function; visuospatial processing; visual perception; psychomotor speed. Lastly, independent sample t-test and friedman test were performed on the scores of BECTS group and controls using SPSS 20.0 and we conducted a multi-factor comprehensive analysis of correlation between clinical criteria and cognitive dysfunction in BECTS.ResultsCompared with 60 healthy controls, the as group got an average score of 19.56±2.91 in Paired Association Learning Test (P<0.001), (23.67±9.50) in Word Discrimination Test (P=0.017), (61.45±13.14) in Object Quantity Perception Task (P=0.040), (6.54±1.47) in Digit Span Test (P<0.001), (5.79±5.90) in Vocal Perception Test (P<0.001), (35.10±2.33) in Taylor Complex Figure Test (P<0.001) and (700.34±493.053) (P=0.008) in Choice Reaction Time Test. The results of these tests are inferior to the control group and the remaining 10 tests are of no statistical significance. There were 36 children with onset of seizure before 8 years of age. Compared with the patients experienced onset of illness at a later age, the 36 patients exhibited lower scores in most of the neuropsychological tests including Visual Tracking Task, Spatial Memory Task, Simple Subtraction Task, Number Comparison Test, Language Rhyme Test, Word Discrimination Testand Visual Perception Task (P<0.05). 34 patients received monotherapy, and 27 received a combination of 2 or 3 anti-epileptic drugs. The scores of attention, memory, visual perception and reaction tests in the multi drug treatment group were lower than those in the single drug treatment group (P<0.05).ConclusionsChildren with BECTS have impairment in attention, vocal perception, visual perception, memory and psychomotor speed. The younger the age of onset, the more severe the cognitive impairments. The degree of cognitive deficitsinchildren treated with multi drugs was more serious than that of children treated with single drugs.
ObjectiveTo investigate the impact of deep hypothermic circulatory arrest (DHCA) with antegrade cerebral perfusion (ACP) on cognitive function of patients undergoing surgical therapy for acute Stanford type A aortic dissection (AD). MethodsBetween January 2009 and March 2012, 48 patients with acute Stanford type A AD underwent Sun's procedure (aortic arch replacement combined with stented elephant trunk implantation) under DHCA with ACP in Nanjing Hospital affiliated to Nanjing Medical University. There were 40 males and 8 females with their age of 51.3±13.6 years. Circulatory arrest time and time for postoperative consciousness recovery were recorded. Preoperative and postoperative cognitive functions of each patient were evaluated by mini-mental status examination (MMSE). ResultsMean cardiopulmonary bypass time of the 48 patients was 237.3±58.5 minutes, and mean circulatory arrest time was 37.3 ±6.9 minutes. Four patients died postoperatively with the causes of death including lung infection, multiple organ dysfunction syndrome, myocardial infarction and acute respiratory distress syndrome. Forty-one patients recovered their consciousness within 24 hours postoperatively, and the mean time for postoperative consciousness recovery was 15.3±6.5 hours. Preoperative MMSE score was 28.6±1.1 points, and MMSE score at 1 week postoperatively was 23.6±4.5 points. Thirty-one patients were followed up for 6 months with the follow-up rate of 70.45%. The average MMSE score of the 31 patients at 6 months after surgery was 27.6±2.1 points which was significantly higher than postoperative average MMSE score (P < 0.05), but not statistically different from preoperative average MMSE score (P > 0.05). ConclusionsDHCA with ACP can provide satisfactory cerebral protection for patients undergoing surgical therapy for acute Stanford type A AD, but patients' cognitive function may be adversely affected in the short term. As long as cerebral infarction or hemorrhage is excluded in CT scan of the brain, such adverse impact may generally disappear automatically within 6 months after surgery.
ObjectiveTo explore the correlation between cognitive function and diffusion tensor imaging (DTI) in children with self-limited epilepsy with centrotemporal spikes (SelECTS). Methods A total of 28 children with SelECTS who visited our hospital from June 2020 to December 2022 were selected as the SelECTS group. An additional 28 healthy children of similar age and gender were selected as the control group. Cognitive function was assessed using the Wechsler Intelligence Scale for Children (WISC). The SelECTS group also underwent cranial DTI. The results of the WISC were then combined with DTI values for correlation analysis. Results Children in the SelECTS group exhibited varying degrees of cognitive deficits. Their full-scale IQ and verbal IQ were significantly lower than those of the control group (P<0.05). Specific cognitive domains, including classification, verbal comprehension, block design, knowledge, and comprehension, also showed significantly lower scores compared to the control group (P<0.05). DTI revealed significant microstructural changes in multiple regions of interest in the SelECTS group (P<0.05), and these changes were correlated with the results of several cognitive function tests. Conclusion Children with SelECTS have certain cognitive deficits. There is evidence of occult damage in brain white matter, and cognitive function is correlated with damage in specific brain regions.
ObjectiveTo investigate the status of newly diagnosed adult epilepsy in the General Hospital of Jilin Province, in order to improve the prevention and treatment of epilepsy. MethodsTo collect the clinical data of newly diagnosed adult epilepsy from October 2016 to February 2017, and to follow up 6 months. ResultsA total of 81 patients were included. At the last clinic visit, 73 cases origined from focal, 74 cases were positive in EEG examination, 56 cases were unknown etiology, 12 cases had hippocampal sclerosis, 48 cases were mildly declined cognitive function, and 30 cases were poor compliance. ConclusionThe newly diagnosed epilepsy were focal origin, delayed treatment, mildly declined cognitive function and poor compliance.
Objective To explore the characteristics of cognitive impairment in patients with alcohol dependence, and analyze the related influencing factors. Methods The Montreal Cognitive Assessment Scale (MoCA) was used to evaluate the cognitive function of 65 alcohol dependent patients hospitalized between January 1st and December 31st, 2014. The features of cognitive impairment and related influencing factors were analyzed. Results The differences of MoCA attention and delayed recall between different drinking year groups had statistical significance (P<0.05). The correlations of drinking year with MoCA attention (r=–0.250,P=0.044), and with delayed recall (r=–0.326,P=0.008) were both negative. MoCA scores, naming, attention and delayed recall were different statistically among different age groups (P<0.05). The correlations of ages with MoCA scores (r=–0.429,P<0.001), naming (r=–0.261,P=0.035), attention (r=–0.391,P=0.001) and delayed recall (r=–0.461,P<0.001) were all negative. MoCA scores, the visuoconstructional skills, language, abstraction and delayed recall were significantly different among different education level groups (P<0.05). The correlations of education level with MoCA scores (rs=0.650,P<0.001), the visuoconstructional skills (rs=0.540,P<0.001), language (rs=0.486,P<0.001), abstraction (r=0.602,P<0.001) and delayed recall (rs=0.593,P<0.001) were all positive. Ages had an effect on MoCA scores by multiple linear regression analysis (P<0.01). Conclusions For alcohol dependent patients with cognitive impairment, cognitive function is correlated with drinking year, age and education level. The cognitive function is much serious in patients with older age and longer drinking years. This kind of patients should be focused on and intervened early.
ObjectiveTo investigate the correlation and clinical significance of 8-hydroxydeoxyguanosine (8-OHdG) and endothelin-1 (ET-1) levels with cognitive dysfunction in patients with chronic obstructive pulmonary disease (COPD), and provide new idea for the prevention and treatment for cognitive dysfunction in COPD patients.MethodsA total of 103 COPD patients, according to the Montreal cognitive assessment scale standard for evaluation, were divided into a cognitive dysfunction group and a cognitive normal group. Serum 8-OHdG and ET-1 levels were compared between the two groups and their correlations with cognitive function were analyzed with the receiver operating characteristic (ROC) curve.ResultsThe levels of serum 8-OHdG and ET-1 in the COPD patients with cognitive impairment were significantly higher than those in the cognitive normal group ［8-OHdG: (13.91±9.04) ng/ml vs. (7.28±3.00) ng/ml; ET-1: (95.64±57.66)pg/ml vs. (69.20±7.89)pg/ml］ (both P<0.05). The levels of 8-OHdG (OR=22.94, 95%CI 7.06-74.53) and ET-1 (OR=19.76, 95%CI 6.59-59.31) were associated with cognitive impairment in the COPD patients. The areas under ROC curve of serum 8-OHdG and ET-1 levels to predict cognitive dysfunction in the COPD patients were 0.786 (95%CI 0.691-0.881) and 0.790(95%CI 0.695-0.885).ConclusionsThe serum levels of 8-OHdG and ET-1 are associated with cognitive impairment in COPD patients. The levels of 8-OHdG and ET-1 in serum can predict cognitive impairment with high specificity.
ObjectiveAnalyzing the seizure and cognitive outcome after different treatment by observation of a large group of intractable child epilepsy patients under 15 years old. MethodsCollecting data of children with Intractable epilepsy from Apirl 2008 to December 2013 in Sanbo Brain Hospital, Capital Medical University. Three historical cohorts of intractable child epilepsy defined by the final treatment including medication, curative operation and palliative operation depending on the surgical assessment and the families intension was retrospectively observed. 1 year and 3 years follow-up postoperatively were conducted including seizure outcome and cognitive outcome. ResultsThe curative operation group had significant better seizure free rate, and cognitive statement than medication group. And, the seizure free and cognitive outcome were better in palliative operation group than the medication group. ConclusionsEarly surgical intervention is highly recommended for intractable epilepsy chilelren in order to improve both the seizure and cognitive prognosis.
Objective This study aimed to observe the protective effects of 17β-estradiol (17β-E2) to the damage of phenobarbital (PB) upon the cognition of the newly-born rats. Methods Thirty healthy 3-day-old Sprague Dawley (SD) rats were randomly divided into 3 groups: control group (10 rats), PB group (10 rats) and PB+17β-E2 group (10 rats). The control group were injected saline water with a dose of 10 mL/(kg·d); the PB group were injected with PB of 10 mg/(kg·d); the PB+17β-E2 group were injected with PB 10 mg/(kg·d) and 17β-E2 300 ug/(kg·d). All the rats were intraperitoneal injected once a day after weighing, for three continuous days. They were normally raised to one month old and then 8 rats were selected out of each group respectively for water maze test. Results The PB group was reported to have increasing latent periods in finding the underwater stage compared with control group (P<0.05). In comparison with the PB group, the PB+17β-E2 group has a shorter latent period in finding the underwater stage, and furthermore statistically significantly fewer times in finding validation areas (P<0.05). During the 120s test, the stage quadrant journey to total journey ratio of PB+17β-E2 group was lower than the ratio of PB groups, but no statistics significance had been detected. The PB+17β-E2 group exhibits no significance difference from the control group in the above-mentioned indexes. Conclusions Even a short-term injection of PB with an usual clinical dose will bring a long-term damage to an immature brain in terms of the learning ability and memory, whereas the 17β-E2 may play a protective role in this course.