Epilepsy in low-grade gliomas: the impact on cognitive function and quality of life.

Low-grade gliomas frequently are associated with epilepsy. The purpose of this study is to determine the impact of epilepsy and antiepileptic drug (AED) treatment on cognitive functioning and health-related quality of life (HRQOL) in these patients. One hundred fifty-six patients without clinical or radiological signs of tumor recurrence for at least 1 year after histological diagnosis and with an epilepsy burden (based on seizure frequency and AED use) ranging from none to severe were compared with healthy controls. The association between epilepsy burden and cognition/HRQOL was also investigated. Eighty-six percent of the patients had epilepsy and 50% of those using AEDs actually were seizure-free. Compared with healthy controls, glioma patients had significant reductions in information processing speed, psychomotor function, attentional functioning, verbal and working memory, executive functioning, and HRQOL. The increase in epilepsy burden that was associated with significant reductions in all cognitive domains except for attentional and memory functioning could primarily be attributed to the use of AEDs, whereas the decline in HRQOL could be ascribed to the lack of complete seizure control. In conclusion, low-grade glioma patients suffer from a number of neuropsychological and psychological problems that are aggravated by the severity of epilepsy and by the intensity of the treatment.

The effectiveness of cognitive rehabilitation for attention deficits in focal seizures: a randomized controlled study.

PURPOSE: Cognitive deficits are one of the major limiting factors in the everyday life functioning of patients with focal seizures. Although cognitive rehabilitation methods have been successfully applied to patients with other central nervous system (CNS) lesions, these methods have not yet been evaluated in cognitively impaired patients with epilepsy. The present study evaluated the effectiveness of two commonly used methods for attention deficits: (a) the Retraining Method, aimed at retraining impaired cognitive functions; and (b) the Compensation Method, aimed at teaching compensatory strategies while taking neuronal loss for granted. METHODS: Fifty adult outpatients with focal seizures and attention impairments receiving carbamazepine (CBZ) monotherapy were randomly assigned to the Retraining Method, the Compensation Method, or to a waiting-list control group. Established and self-reported neuropsychological outcomes and self-reported quality of life of these groups were evaluated at pretraining, posttraining, and at a 6-month follow-up measurement point and were completed by 44 patients. RESULTS: Neuropsychological outcomes related to training, self-reported neuropsychological outcomes, and quality of life at the 6-month follow-up measurement point improved both in the Retraining Method group (n = 19) and the Compensation Method group (n = 17) relative to the waiting-list control group (n = 8). The Compensation Method was more effective in improving self-reported neuropsychological outcomes and quality of life, especially for patients with less education. The patients with active epilepsy benefited more from both methods than did the seizure-free patients. CONCLUSIONS: These data show that cognitive rehabilitation programs are effective for patients with focal seizures and attention deficits and should, therefore, be incorporated into comprehensive care programs.

Cognition and health-related quality of life in a well-defined subgroup of patients with partial epilepsy.

To investigate the extent and nature of the objective and subjective cognitive deficits and health-related quality of life (HRQOL) in adult outpatients with relatively well-controlled partial epilepsy without symptomatic aetiology, who were on carbamazepine (CBZ) monotherapy. Furthermore, we studied the influence of the epilepsy history and medication on various cognitive functions and the HRQOL. 56 outpatients (29 male, 27 female, mean age 41.3 years) with partial epilepsy were compared with 56 age-, gender-, and education-matched healthy controls. Patients were tested on attention, memory, speed of information processing, and executive functioning. Questionnaires aimed at measuring self-perceived cognitive functioning (CFQ) and HRQOL (SF-36) were administered. Mann Whitney-U tests were used to compare the two groups. Linear regression analysis was performed to identify the epilepsy and medication-related factors that are associated with cognitive functioning and HRQOL. Patients scored lower on measures of attention (P = 0.03), learning (P = 0.02) and speed of information processing (P = 0.00). Mental aspects of HRQOL such as fatigue were lower (P = 0.00), whereas physical functioning was unaffected. These patients also expressed reductions in mental functioning as indicated by a low self-perceived cognitive functioning (P = 0.01). Age at onset, duration of epilepsy, seizure type, seizure frequency, localisation, years on CBZ, and CBZ dosage were not related to cognitive functioning or HRQOL. Patients with partial epilepsy, even when able to maintain regular jobs, have impaired cognition and HRQOL that cannot be attributed to their epilepsy history or CBZ dosage or years of CBZ intake. Therefore, physicians should be more aware of their cognition and HRQOL, in addition to the antiepileptic drug regime.

The effectiveness of psychological interventions for patients with relatively well-controlled epilepsy.

Previous reviews about psychological interventions focused on refractory epilepsy patients and were inconclusive; this review investigates what the contribution of the psychologist can be for the large group of patients with relatively well-controlled epilepsy. This review was restricted to the literature reporting on adult patients with relatively well-controlled epilepsy. A literature search on the effect of psychological interventions was conducted using Medline and PsychInfo, including those studies published through March 2002. Applying strict inclusion criteria, a total of seven studies were identified. Four studies incorporated a waiting-list control group. Of these, one study addressing cognitive rehabilitation reported positive results on psychological outcome and one intervention based on comprehensive care led to seizure reduction, whereas all other studies were plagued too much by methodological inadequacies to allow firm conclusions to be drawn. Recommendations for future intervention studies, such as standardized interventions, controlling for positive attention, outcome measures without overlap with the intervention, and a follow-up measurement, are given. It is concluded that a concerted effort to assemble larger patient groups in randomized-controlled studies is a prerequisite to acquiring well-founded knowledge about psychological interventions in patients with relatively well-controlled epilepsy.

Cognition and health-related quality of life in chronic well-controlled patients with partial epilepsy on carbamazepine monotherapy.

As a group, patients with epilepsy have reduced neuropsychological functioning and health-related quality of life (HRQOL), but the status of these factors is uncertain in seizure-free patients with seizure onset in adulthood on monotherapy. Nevertheless, some of these patients report neuropsychological problems. We hypothesized that subtle impairments in neuropsychological functioning and HRQOL may be underdiagnosed and related to these problems. Sixteen patients with localization-related epilepsy on monotherapy carbamazepine were compared with 16 age-, gender-, and education-matched healthy controls by means of a standardized neuropsychological screening battery, questionnaires about HRQOL (Short-Form Health Survey, SF-36), self-perceived neuropsychological functioning (Cognitive Failure Questionnaire), and mood (Profile of Mood States). No objective impairments in selective attention, memory, and executive functioning were found. However, a lower speed of information processing affecting everyday life functioning was found. Lower levels of self-perceived neuropsychological functioning were reported, whereas HRQOL was unimpaired relative to healthy controls. Physicians should not be reassured when patients receive adequate medication that prevents seizures; careful follow-up of speed of information processing and self-perceived neuropsychological functioning is needed.