Journal of Neurology

, Volume 259, Issue 8, pp 1727–1731 | Cite as

Should cognition be screened in new-onset epilepsies? A study in 247 untreated patients

Original Article


The aim of our study was to assess cognition in newly diagnosed and untreated patients with epilepsy in order to determine the prevalence and the determinants of cognitive deficits at this early stage of the disease. A total of 247 untreated patients with newly diagnosed epilepsy underwent a brief test battery focusing on attention and executive functions (EpiTrack®) and memory (short form of the VLMT). In addition, the assessment included ratings of self-perceived deficits in attention and memory. Impairments in attention and executive functions were seen in 49.4 % of the patients and memory deficits in 47.8 %. Unimpaired performance in both domains was observed in 27.9 % of the cases. Self-perceived deficits in attention were only reported by 28.7 % of the patients, and 25.1 % of the patients complained of memory impairments. Lower education and a symptomatic, i.e., lesional, cause of epilepsy were associated with worse performance in attention and executive functions, whereas worse memory performance was related to generalized tonic–clonic seizures. Results indicate a high prevalence of cognitive deficits at an early stage of epilepsy, which calls for consideration in the daily clinical care. Patients appear to underreport cognitive deficits. Thus, a routine application of a brief standardized neuropsychological screening before the initiation of a pharmacological treatment would be appreciated to provide a baseline to evaluate subsequent treatment success, to eventually initiate countermeasures, and to monitor the course of the disease.


Untreated patients Newly diagnosed epilepsy Cognition Neuropsychology Screening 


Conflicts of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Elger CE, Helmstaedter C, Kurthen M (2004) Chronic epilepsy and cognition. Lancet Neurol 3(11):663–672. doi: 10.1016/s1474-4422(04)00906-8 PubMedCrossRefGoogle Scholar
  2. 2.
    Kwan P, Brodie M (2001) Neuropsychological effects of epilepsy and antiepileptic drugs. Lancet 357(9251):216–222. doi: 10.1016/s0140-6736(00)03600-x PubMedCrossRefGoogle Scholar
  3. 3.
    McDonald CR, Taylor J, Hamberger M, Helmstaedter C, Hermann BP, Schefft B (2011) Future directions in the neuropsychology of epilepsy. Epilepsy Behav 22(1):69–76. doi: 10.1016/j.yebeh.2011.06.004 PubMedCrossRefGoogle Scholar
  4. 4.
    Helmstaedter C, Hermann B, Lassonde M, Kahane P, Arzimanoglou A (eds) (2011) Neuropsychology in the care of people with epilepsy. Progress in Epileptic Disorders, vol 11. John Libbey Eurotext, MontrougeGoogle Scholar
  5. 5.
    Jokeit H, Ebner A (2002) Effects of chronic epilepsy on intellectual functions. Prog Brain Res 135:455–463. doi: 10.1016/S0079-6123(02)35042-8 PubMedCrossRefGoogle Scholar
  6. 6.
    Äikiä M, Salmenperä T, Partanen K, Kälviäinen R (2001) Verbal memory in newly diagnosed patients and patients with chronic left temporal lobe epilepsy. Epilepsy Behav 2(1):20–27. doi: 10.1006/ebeh.2000.0140 PubMedCrossRefGoogle Scholar
  7. 7.
    Helmstaedter C, Wagner G, Elger CE (1993) Differential effects of first antiepileptic drug application on cognition in lesional and non-lesional patients with epilepsy. Seizure 2(2):125–130PubMedCrossRefGoogle Scholar
  8. 8.
    Kälviäinen R, Aikiä M, Helkala EL, Mervaala E, Riekkinen PJ (1992) Memory and attention in newly diagnosed epileptic seizure disorder. Seizure 1(4):255–262PubMedCrossRefGoogle Scholar
  9. 9.
    Ogunrin O, Adamolekun B, Ogunniyi AO, Aldenkamp AP (2000) Cognitive function in Nigerians with newly diagnosed epilepsy. Can J Neurol Sci 27(2):148–151PubMedGoogle Scholar
  10. 10.
    Pulliainen V, Kuikka P, Jokelainen M (2000) Motor and cognitive functions in newly diagnosed adult seizure patients before antiepileptic medication. Acta Neurol Scand 101(2):73–78PubMedCrossRefGoogle Scholar
  11. 11.
    Taylor J, Kolamunnage-Dona R, Marson AG, Smith PE, Aldenkamp AP, Baker GA (2010) Patients with epilepsy: cognitively compromised before the start of antiepileptic drug treatment? Epilepsia 51(1):48–56. doi: 10.1111/j.1528-1167.2009.02195.x PubMedCrossRefGoogle Scholar
  12. 12.
    Oostrom KJ, van Teeseling H, Smeets-Schouten A, Peters AC, Jennekens-Schinkel A (2005) Three to four years after diagnosis: cognition and behaviour in children with ‘epilepsy only’. A prospective, controlled study. Brain 128 (Pt 7):1546–1555. doi: 10.1093/brain/awh494
  13. 13.
    Austin JK, Harezlak J, Dunn DW, Huster GA, Rose DF, Ambrosius WT (2001) Behavior problems in children before first recognized seizures. Pediatrics 107(1):115–122PubMedCrossRefGoogle Scholar
  14. 14.
    Lutz MT, Helmstaedter C (2005) EpiTrack: tracking cognitive side effects of medication on attention and executive functions in patients with epilepsy. Epilepsy Behav 7(4):708–714. doi: 10.1016/j.yebeh.2005.08.015 PubMedCrossRefGoogle Scholar
  15. 15.
    Helmstaedter C, Lutz M (2005) EpiTrack. Veränderungssensitives kognitives Screening zur Qualitäts- und Outcomekontrolle der Epilepsiebehandlung, UCB GmbHGoogle Scholar
  16. 16.
    Helmstaedter C, Witt JA (2008) The effects of levetiracetam on cognition: a non-interventional surveillance study. Epilepsy Behav 13(4):642–649. doi: 10.1016/j.yebeh.2008.07.012 PubMedCrossRefGoogle Scholar
  17. 17.
    Helmstaedter C, Witt JA (2010) Cognitive outcome of antiepileptic treatment with levetiracetam versus carbamazepine monotherapy: a non-interventional surveillance trial. Epilepsy Behav 18(1–2):74–80. doi: 10.1016/j.yebeh.2010.02.011 PubMedCrossRefGoogle Scholar
  18. 18.
    Helmstaedter C, Lendt M, Lux S (2001) VLMT Verbaler Lern- und Merkfähigkeitstest. Beltz Test GmbH, GöttingenGoogle Scholar
  19. 19.
    Witt JA, Helmstaedter C (2009) Neuropsychology in Epilepsy—Part II: towards an establishment of diagnostic guidelines. Fortschr Neurol Psychiatr 77(12):691–698. doi: 10.1055/s-0028-1109799 PubMedCrossRefGoogle Scholar
  20. 20.
    Muslimovic D, Post B, Speelman JD, Schmand B (2005) Cognitive profile of patients with newly diagnosed Parkinson disease. Neurology 65(8):1239–1245. doi: 10.1212/01.wnl.0000180516.69442.95 PubMedCrossRefGoogle Scholar
  21. 21.
    Glanz BI, Holland CM, Gauthier SA, Amunwa EL, Liptak Z, Houtchens MK, Sperling RA, Khoury SJ, Guttmann CR, Weiner HL (2007) Cognitive dysfunction in patients with clinically isolated syndromes or newly diagnosed multiple sclerosis. Mult Scler 13(8):1004–1010. doi: 10.1177/1352458507077943 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Department of EpileptologyUniversity of BonnBonnGermany

Personalised recommendations