OBJECTIVE The purpose of this cross-sectional retrospective study was to utilize EpiTrack to assess cognitive performance within the domain of attention and executive functions in patients with refractory epilepsy in consideration for treatment interventions either with antiepileptic drug (AED) changes and/or neuromodulation therapies. We also aimed to identify the relevant clinical and treatment factors possibly affecting EpiTrack performance. METHODS The patient group consisted of 95 consecutive refractory epilepsy patients who were evaluated with EpiTrack. Based on their EpiTrack performance, the patients could be categorized as cognitively unimpaired, mildly, or severely impaired. The patients were also divided into three groups based on the planned treatment modification: AED group (n = 38) with only AED treatment, vagal nerve stimulation (VNS) group (n = 40) and deep-brain stimulation (DBS) group (n = 17). However, the effect of planned interventions was not the subject of this study. We retrospectively reviewed the medical records for detailed clinical characterization. RESULTS EpiTrack performance was severely impaired in 48 (50.5%), mildly impaired in 22 (23.2%) and unimpaired in 25 (26.3%) of the patients. The DBS group had significantly lower EpiTrack scores (mean (SD) and median, 25.5 (4.81) and 27.0, respectively) compared to the AED group (28.6 (6.2) and 30.0, respectively, p = 0.049). Sixty-three (66.3%) of the whole study population had more than 2 AEDs. When comparing EpiTrack scores between patient groups based on the number of AEDs administered, there was a trend toward better performance in EpiTrack with 2 AEDs as compared to 3-4 AEDs. CONCLUSIONS Deficits in attention and executive functions were frequent among patients with refractory epilepsy. Deficits were evident in all three treatment groups being most severe in the DBS group reflecting the patient selection. Furthermore, the effect of AED burden on executive functions was remarkable since two thirds of the patients had more than two AEDs and the deficits were more prominent among those with a higher AED burden. These results highlight the benefits of a feasible screening tool such as EpiTrack for assessing attention and executive functions when optimizing the treatment effects of neurostimulation therapies on cognition, and when evaluating the impacts of the AED burden.

中文翻译：

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EpiTrack 是评估难治性癫痫患者注意力和执行功能的可行工具

目的 本横断面回顾性研究的目的是利用 EpiTrack 评估难治性癫痫患者在注意力和执行功能领域内的认知表现，以考虑进行抗癫痫药物 (AED) 改变和/或神经调节疗法的治疗干预。我们还旨在确定可能影响 EpiTrack 性能的相关临床和治疗因素。方法 患者组由 95 名接受 EpiTrack 评估的连续难治性癫痫患者组成。根据他们的 EpiTrack 表现，患者可以分为认知未受损、轻度或严重受损。还根据计划的治疗修改将患者分为三组：AED 组（n = 38）仅接受 AED 治疗，迷走神经刺激 (VNS) 组 (n = 40) 和深部脑刺激 (DBS) 组 (n = 17)。然而，计划干预的效果不是本研究的主题。我们回顾性地审查了详细的临床特征的医疗记录。结果 48 名（50.5%）患者的 EpiTrack 性能严重受损，22 名（23.2%）轻度受损，25 名（26.3%）未受损。与 AED 组（分别为 28.6 (6.2) 和 30.0，p = 0.049）相比，DBS 组的 EpiTrack 评分（平均 (SD) 和中位数，分别为 25.5 (4.81) 和 27.0）显着降低。整个研究人群中有 63 人 (66.3%) 有超过 2 种 AED。当根据施用的 A​​ED 数量比较患者组之间的 EpiTrack 评分时，与 3-4 个 AED 相比，使用 2 个 AED 的 EpiTrack 有更好的性能趋势。结论 在难治性癫痫患者中，注意力和执行功能的缺陷是常见的。缺陷在所有三个治疗组中都很明显，在 DBS 组中最严重，反映了患者的选择。此外，AED 负担对执行功能的影响是显着的，因为三分之二的患者有两个以上的 AED，并且在 AED 负担较高的患者中缺陷更为突出。这些结果强调了一种可行的筛选工具（如 EpiTrack）在优化神经刺激疗法对认知的治疗效果以及评估 AED 负担的影响时评估注意力和执行功能的好处。缺陷在所有三个治疗组中都很明显，在 DBS 组中最为严重，反映了患者的选择。此外，AED 负担对执行功能的影响是显着的，因为三分之二的患者有两个以上的 AED，并且在 AED 负担较高的患者中缺陷更为突出。这些结果强调了一种可行的筛选工具（如 EpiTrack）在优化神经刺激疗法对认知的治疗效果以及评估 AED 负担的影响时评估注意力和执行功能的好处。缺陷在所有三个治疗组中都很明显，在 DBS 组中最严重，反映了患者的选择。此外，AED 负担对执行功能的影响是显着的，因为三分之二的患者有两个以上的 AED，并且在 AED 负担较高的患者中缺陷更为突出。这些结果强调了一种可行的筛选工具（如 EpiTrack）在优化神经刺激疗法对认知的治疗效果以及评估 AED 负担的影响时评估注意力和执行功能的好处。AED 负担对执行功能的影响显着，三分之二的患者有 2 个以上的 AED，且 AED 负担较高的患者缺陷更为突出。这些结果强调了一种可行的筛选工具（如 EpiTrack）在优化神经刺激疗法对认知的治疗效果以及评估 AED 负担的影响时评估注意力和执行功能的好处。AED 负担对执行功能的影响显着，三分之二的患者有 2 个以上的 AED，且 AED 负担较高的患者缺陷更为突出。这些结果强调了一种可行的筛选工具（如 EpiTrack）在优化神经刺激疗法对认知的治疗效果以及评估 AED 负担的影响时评估注意力和执行功能的好处。