The cognitive burden of epilepsy: Assessing executive dysfunction in adult patients

Executive functions are frequently impaired in individuals with epilepsy. Understanding the patterns of these dysfunctions is essential for effective management of epileptic patients. To comprehend these patterns, we aimed to investigate executive function performance in adult epileptic patients. Thirty adults with epilepsy, along with fifty healthy controls matched for age, gender, and education were administered standard performance-based executive tasks, including Digit Span Forward and Backward, Trail Making Test A and B, Design Fluency Regular and Irregular, and Semantic Verbal Fluency. Results indicated that Digit Span Forward and Backward tests were the most frequently impaired, with 80% and 90% of patients showing impairments, respectively. The Semantic Verbal Fluency task had the lowest frequency of impairment, with a 30% prevalence among patients. Additionally, a higher frequency of seizures significantly predicted longer completion times for Trail Making Test A (beta = 0.281, p = 0.030) and Trail Making Test B (beta = 0.586, p = 0.001), as well as lower total executive function scores (beta = -0.429, p = 0.000). No significant associations were found between executive function and age of onset or number of antiepileptic drugs. Our results indicate that adult epileptic patients display substantial executive dysfunction, particularly in working memory and cognitive flexibility and highlight the detrimental effect of inadequately controlled epilepsy and high seizure frequency on exacerbating these impairments. This underscores the importance of regular executive function assessments in the management of epileptic patients, tailored to individual needs and performance levels, to optimize care and improve quality of life.