Abstracts

Rationale: Memory impairment, a common co-morbidity of epilepsy, significantly impacts quality of life, but treatment options are few. Subjective memory complaints do not necessarily correlate with objective neuropsychological impairment. We examined which factors influence subjective memory complaints in a large well documented patient cohort of women with epilepsy (WWE). Methods: The National Institute of Health Progesterone Trial randomized 294 women, ages 11-46 years, with focal, poorly controlled epilepsy. In 249 patients, baseline data about subjective memory impairment was available as part of the quality of life assessment (QOLIE-31). Seizure frequency, AED type and epilepsy characteristics were well documented for three months in the baseline phase of the trial. Depression and mood was repeatedly measured by the Beck Depression Inventory (BDI II) and Profile of Mood States (POMS) without treatment intervention over three months. Cognitive complaints were correlated to epilepsy characteristics, AEDs, seizure frequency, BDI II, POMS mood states, body mass index (BMI) using linear regression. Results: Cognitive complaints were highly correlated with depression (p<0.001) on BDI II and all mood state subscales (p<0.001) on the POMS (tension, vigor, depression, anger, fatigue, confusion). Overall 25.4% of patients showed mild depressive symptoms (BDI II >11) and 14.3 % showed clinically significant depression (BDI II>15). Memory complaints also correlated with seizure type and whether the patient was on mono- or polytherapy with AEDs. Patients with secondarily generalized seizures had more significant memory complaints than patients with focal seizures as their main seizure type (p<0.001). Polytherapy increased cognitive complaints (p<0.05). There was no difference in memory complaints whether patients received enzyme-inducing or non-enzyme inducing AEDs. Seizure type, type of AED therapy and depression were independently related to memory complaints in a multiple regression model. Memory complaints did not correlate with age, BMI, catamenial seizure pattern or average seizure frequency over three months (p>0.05). Side of seizure onset, unilateral or bilateral seizure onset and temporal or extratemporal seizure onset had no impact on subjective memory (p>0.05). Conclusions: Depression is a major determinant for cognitive complaints in WWE. Among epilepsy related factors, secondarily generalized seizures, as most severe seizure type, and type of AED polytherapy were independently associated with subjective cognitive dysfunction. Although the relationship is not proven to be causal, the management of depression may be important in the treatment of memory impairment, a frequent co-morbidity in WWE.