Arminas Jasionis

Objective: Limited evidence supports the use of cognitive and psychosocial rehabilitation programs for people with epilepsy (PWE). We assessed the effects of a newly designed cognitive and psychological counseling intervention on patient‐reported and neuropsychological outcomes in a mixed sample of PWE. Methods: Seventy adult PWE (57.1% female, mean age = 35.9 ± 11.7 years, 57.1% with focal epilepsy) were randomized (1:1) to either an early intervention group (EIG) or a waiting list for a late intervention group (LIG). The intervention consisted of six individual and two group counseling sessions incorporating psychoeducation, cognitive training, coping strategies, and mindfulness. Both groups were assessed at baseline and 4 and 16 weeks. Primary endpoints were quality of life (Patient‐Weighted Quality of Life in Epilepsy 31‐item inventory [QOLIE‐31‐P]) and delayed verbal and visual recall at 4 weeks; secondary endpoints included symptoms of anxiety (Generalized Anxiety Disorder seven‐item scale), depression (Neurological Disorders Depression Inventory in Epilepsy), and stigma. Linear mixed models with maximum likelihood estimation were used for repeated measures analysis. Results: Follow‐up data were available for 66 participants (94.3%) at 4 weeks and 61 (87.1%) at 16 weeks. The EIG showed significant improvements on the QOLIE compared with the LIG (group by time interaction p = .006), which were maintained at both follow‐ups. Anxiety symptoms were also significantly reduced in the EIG (group by time interaction p = .006). These effects were observed in both focal and generalized epilepsy. No significant group differences were found for delayed verbal or visual recall over time. However, greater long‐term forgetting on the word list task was observed in the LIG at 4 weeks. No significant changes were detected for symptoms of depression or perceived stigma. Significance: An 8‐week cognitive and psychosocial rehabilitation program improved quality of life and reduced anxiety in PWE, with effects sustained for up to 16 weeks. Cognitive benefits were limited, with a possible transient effect on long‐term verbal recall. These findings support the use of rehabilitation interventions to enhance patient‐reported outcomes across epilepsy subtypes.

Background. Previous research has demonstrated the impairment of social cognition (SC) in people with epilepsy. It is associated with worse social functioning and quality of life; however, the influence on real-life outcomes is unknown. The purpose of this study was to investigate how SC is associated with epilepsy variables and real-life outcomes (education, employment and relationships) among patients with epilepsy (PWE). Methods. Eighty-one PWE completed tasks of theory of mind (ToM) (faux pas recognition (FPRT) and Happé Strange Stories test (HST)) and emotion recognition (ER) (Reading of the Mind in the Eyes (RMET)). Variables reflecting their education, employment and relationship status were treated as endpoints in search of association with SC. Data from a matched group (n = 30) of healthy controls (HCs) were used for comparison of ToM abilities. Results. ToM scores were lower among PWE as compared to HCs (U = 1816.0, p < 0.0001 (HST), U = 1564.5, p = 0.020 (FPRT)). All SC tests were associated with the level of education (OR = 1.22, 95% confidence interval (CI) = 1.09 to 1.36 (RMET), OR = 1.20, 95% CI = 1.02 to 1.40 (HST), OR = 0.93, 95% CI = 0.87 to 1.00 (FPRT)). The results of ToM and ER testing were not associated with employment (χ² = 33.423, p < 0.0001) if adjusted for the level of education (B = 0.804, OR = 2.23 (95% CI = 1.33 to 3.76), p = 0.002). SC abilities did not differ between PWE who were single and those in a relationship (U = 858.5, p = 0.541 (HST)), t= −1.236, p = 0.220 (RMET), U = 909.5, p = 0.271 (FPRT)). Conclusion. Better social cognition skills are linked to a higher level of education among PWE. SC probably has less influence on professional achievements and interpersonal relationships.

Accelerated long-term forgetting (ALF) is a memory disorder that manifests by a distinct pattern of normal memory for up to an hour after learning, but an increased rate of forgetting during the subsequent hours and days. The topic of ALF has gained much attention in group studies with epilepsy patients and the phenomenon has been shown to have contradictory associations with seizures, epileptiform activity, imaging data, sleep, and antiepileptic medication. The aim of this review was to explore how clinical and imaging data could help determine the topographic and physiological substrate of ALF, and what is the possible use of this information in the clinical setting. We have reviewed 51 group studies in English to provide a synthesis of the existing findings concerning ALF in epilepsy. Analysis of recently reported data among patients with temporal lobe epilepsy, transient epileptic amnesia, and generalized and extratemporal epilepsies provided further indication that ALF is likely a disorder of late memory consolidation. The spatial substrate of ALF might be located along the parts of the hippocampal–neocortical network and novel studies reveal the increasingly possible importance of damage in extrahippocampal sites. Further research is needed to explore the mechanisms of cellular impairment in ALF and to develop effective methods of care for patients with the disorder.