Cross sectional study to determine the cognitive impairment among epilepsy patients

Vinodh Kumar J., Vatsala M.


Background: The study was aimed to screen cognitive impairment and assess its levels among epilepsy patients, also study the prevalence and the relationships between specific seizure subtype and determine the correlation between seizure frequency, seizure duration and abnormal EEG finding with cognitive impairment among epilepsy patients.

Methods: The study was conducted in a tertiary care hospital over a period of 1yr after taking informed consent from 100 patients by random sampling after fulfilling the inclusion criteria.

Results: Out of 100 patients 64% did not have cognitive impairment, 36% had cognitive impairment. Among 36%, 7% had definitive cognitive impairment and 29% had mild cognitive impairment. It was observed that the other group of seizure subtypes which included atonic, myoclonic, focal sensory, focal motor, absence seizure with secondary generalization had low mean cognitive scores signifying cognitive impairment, where as those with complex partial seizure with secondary generalization group had high mean cognitive scores signifying no cognitive dysfunction. However, the observed difference is statistically significant (p<0.05). Patients who had higher seizure frequency had low mean cognitive scores indicating cognitive decline and those with very low seizure frequency had high mean cognitive scores indicating no cognitive decline. However, the observed difference is statistically significant. It was observed that the mean cognitive score for abnormal EEG patients was 24.68 indicating mild cognitive decline whereas for normal EEG patients the mean cognitive score was 26.27 indicating no cognitive decline however the observed difference is statistically significant since P<0.05.

Conclusions: The high prevalence of cognitive impairment among epilepsy patients calls for early neuropsychological assessment soon after the diagnosis of epilepsy beyond that, the baseline screening may also guide treatment plan and serve as an early indicator for rehabilitative care.


Cognitive impairment, Cognition, Complex partial seizure, Epilepsy, Seizures

Full Text:



Epilepsy world Health organization. Accessed at:

Nouha F, Sawsan D, Salma S, Olfa H, Hanen H, Mariem D et al. Cognitive impairment in patients with temporal lobe epilepsy. J Neuropsychia. 2018;2(2):5.

Singh P, Pandey AK. Psychiatric morbidity in epilepsy. Int J Res Med Sci. 2017;5:4267-70.

Wieser HG. ILAE commission on neurosurgery of Epilepsy. ILAE commission report. Mesial temporal lobe epilepsy with hippocampal sclerosis. Epilepsia. 2004;45(6):695-714.

Hermann B, Seidenberg M, Jones J. The neurobehavioural comorbidities of epilepsy: can a natural history be developed? Lancet Neurol. 2008;7:151-60.

Tailby C, Kowalczyk MA, Jackson GD. Cognitive impairment in epilepsy: the role of reduced network flexibility. Annals Clinic Translational Neurol. 2018;5(1):29-40.

Helmstaedter C. Effects of chronic epilepsy on declarative memory systems. Prog Brain Res. 2002;135:439-53.

Butler C, Zeman AZJ. Neurological syndromes which can be mistaken for psychiatric conditions. J Neurol Neurosurg Psychiat. 2005;76(I)i31-8.

Petersen RC. Mild cognitive impairment as a diagnostic entity. J Intern Med. 2004;256:183-94.

Portet F, Ousset PJ, Visser PJ, Frisoni GB, Nobili F, Scheltens P, et al. Mild cognitive impairment (MCI) in medical practice: A critical review of the concept and new diagnostic procedure. Report of the MCI working group of the European Consortium on Alzheimer's Disease. J Neurol Neurosurg Psychiat. 2006;77:714-8.

Nadkarni S, Devinsky O. Current review in clinical science. Epilepsy Curr. 2005;5(5):176-81.

Besag FM. Behavioural effects of the new anticonvulsants. Drug Saf. 2001;24:513-36.

Hermann B, Meador BJ, Gaillard WD, Cramer JA. Cognition across the lifespan: antiepileptic drugs, epilepsy, or both? Epilepsy Behav. 2010;17:1-5.

Taylor J, Kolamunnage-Dona R, Marson AG, Smith PEM, Aldenkamp AP, Baker GA. Patients with epilepsy: Cognitively compromised before start of antiepileptic drug treatment? Epilepsia. 2009;51:48-56.

Almkvist O, Brane G, Johanson A. Neuropsychological assessment of dementia: state of the art. Acta Neurol Scand. 1996;168:45-9.

Albert M, Cohen C. The test for severe impairment: an instrument for the assessment of patients with severe cognitive dysfunction. J Am Geriat Society. 1992;40(5):449-53.

Carlesimo GA, Caltagirone C, Gainotti G. The mental deterioration battery: normative data, diagnostic reliability and qualitative analyses of cognitive impairment. The group for the standardization of the mental deterioration battery. Eur Neurol. 1996;36(6):378-84.

Gottfries CG, Brane G, Steen G: A new rating scale for dementia syndromes. Gerontol. 1982;28(2):20-31.

Rosen WG, Mohs RC, Davis KL. A new rating scale for Alzheimer's disease. Am J Psychiat. 1984; 141(11):1356-64.

Roth M, Tym E, Mountjoy CQ, Huppert FA, Hendrie H, Verma S, Goddard R. CAMDEX: a standardised instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia. British J Psychiat. 1986;149(6):698-709.

Bracco L, Amaducci L, Pedone D, Bino G, Lazzaro MP, Carella F, et al. Italian multicentre study on dementia (SMID): a neuropsychological test battery for assessing Alzheimer's disease. J Psychiatr Res. 1990;24(3):213-26.

Berg A.T. Epilepsy, Cognition, and behavior: The clinical picture. Epilepsia. 2011;52(1):7-12.

Helmstaedter C. Effects of chronic temporal lobe epilepsy on memory functions. Prog Brain Res. 2002;135:439-53.

Jones R, Rickards H, Cavanna AE. The prevalence of psychiatric disorders in epilepsy: a critical review of the evidence. Funct Neurol. 2010;25(4):191-4.

Thompson, Duncan JS. Cognitive decline in severe intractable epilepsy. Epilepsia. 2005;46(11):1780-7.

Ozmenek OA, Nazliel B, leventoglu A, Bilir E. The role of event related potentials in evaluation of subclinical cognitive dysfunction in epileptic patients. Acta neurol Belg. 2008;108:58-63.

Albert P, Aldenkamp. Effect of seizures and epleptiform discharges on cognitive function. Epilepsis. 1997;38(1):S52-S55.

Kimford J. Meador. Cognitive and memory effects of the new antiepileptic drugs. Epilepsy Res. 2006;68(1):63-7.

Schouten A, Oostrom KJ, Pestman WR, Peters AC, Jennekens-Schinkel A. Learning and memory of school children with epilepsy: a prospective controlled longitudinal study. Developmental medicine and child neurology. 2002;44(12):803-11.

Seidenberg M, Pulsipher DT, Hermann B. Cognitive progression in epilepsy. Neuropsychol Rev. 2007;17(4):445-54.

Cynthia L Harden, MD. New evidence supports cognitive decline in temporal lobe epilepsy. Epilepsy Curr. 2007;7(1):12-14.

Jokeit H, Ebner A. Long term effects of refractory temporal lobe epilepsy on cognitive abilities: A cross sectional study J Neurol Neurosurg Psychiat. 1999;67(1):44-50.

Helmstaedter C, Kurthen M, Lux S, Reuber M, Elger CE. Chronic epilepsy and cognition: a longitudinal study in temporal lobe epilepsy. Ann Neurol. 2003;54(4):425-32.

Rausch R, Kraemer S, Pietras CJ, Le M, Vickrey BG, Passaro EA. Early and late cognitive changes following temporal lobe surgery for epilepsy. Neurology. 2003;60(6):951-9.