TOPLINE:

Executive dysfunction was highly prevalent in patients with drug-resistant epilepsy and associated with a high antiseizure medication (ASM) load/number of ASMs, symptoms of anxiety and depression, and increased likelihood of unemployment, a new retrospective study showed.

METHODOLOGY:

• A retrospective cross-sectional study included data for more than 500 patients hospitalized for epilepsy in Norway between 2017 and 2023. Work status categories included unemployed (including disability leave, sickness leave, or unemployment), students, and part- or full-time employed.
• Seizure frequency was classified as seizure-free (no seizures in the past year), yearly (less than one per month), monthly (one to three per month), weekly (one to five per week), and daily (more than six per week).
• Executive functions were assessed using EpiTrack, a brief neuropsychological screening tool administered to patients when changing ASM treatment was indicated and/or when executive dysfunction was reported. General cognitive ability was measured using the general ability index in a subgroup of 226 patients.
• Affective symptoms were evaluated using the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and the 7-item Generalized Anxiety Disorder (GAD-7) scale.

TAKEAWAY:

• Impaired executive function was observed in 51.5% of patients with epilepsy and was associated with a higher ASM load, with patients off drugs or on monotherapy having significantly better EpiTrack scores than those taking two or more ASMs (P < .001).
• About 36% of patients reported symptoms indicating major depression (NDDI-E scores ≥ 14), and 19% reported symptoms indicating GAD (GAD-7 scores ≥ 10). Women had higher depression (P = .002) and GAD (P = .003) scores than men.
• About 50% of patients were unemployed and had poorer executive functions than those engaged in employment or education (P < .001). There were no differences between employment status for seizure frequency or anxiety and depressive symptoms.
• Patients with unimpaired executive functions had 2.5-fold higher odds of participating in education or employment than those with impaired executive functions (odds ratio, 0.4; P < .001). Age was the only other significant predictor, with each additional year reducing these odds by about 7%.

IN PRACTICE:

“Our findings suggest that job retention may depend on more than the burden of epilepsy alone, with executive functioning playing a critical role,” the investigators wrote.

The results also support “minimizing total ASM load whenever possible to promote better functional outcomes,” they added.

SOURCE:

This study was led by Lisa E. Hauger, PhD, National Centre for Epilepsy, Oslo University Hospital, Oslo, Norway. It was published online on March 07 in Epilepsia.

LIMITATIONS:

Most participants had focal epilepsy, so the findings may not be fully generalizable to individuals with generalized epilepsy. The ASM load did not account for individual doses or medication class details, and some data on anxiety and depressive symptoms were missing. Additionally, data on general cognitive ability were available only for patients who completed the full neurophysiologic evaluation.

DISCLOSURES:

This study was funded by the Norwegian Epilepsy Association. One investigator reported receiving a licensing fee for EpiTrack from Eisai Co., Ltd. Another reported conducting lectures and being on expert panels for UCB, Eisai, and Arvelle. The other five investigators reported no relevant financial relationships.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.