Cognitive dysfunction after generalized tonic‐clonic status epilepticus in adults

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Generalized tonic‐clonic status epilepticus (GTC‐SE) is considered to have a high risk of causing poor functional outcome in survivors, including cognitive impairment.1 Previous studies indicate that memory is the cognitive function most prone to decay in patients with epilepsy.3 The association is strongest for generalized tonic‐clonic seizures and correlates with seizure load.4 Experimental studies have demonstrated that the neocortex, thalamus, cerebellum and hippocampus are vulnerable to damage from GTC‐SE.5 The hippocampus, essential for memory formation and retrieval, seems particularly sensitive to prolonged seizures.5 MRI studies in humans have shown hippocampal oedema, sometimes followed by sclerosis.7 Neuropathology studies in patients dying after SE have found distinct hippocampal neuronal damage.8
It has been argued that intellectual prognosis in otherwise normal children with focal epilepsies is little influenced by an unprovoked GTC‐SE.9 However, 1 year after febrile SE, children had significantly smaller hippocampi than controls with simple febrile seizures.10 They also tended to have delayed motor and language development.11 Impaired cognitive function after GTC‐SE has been detected in children without previous developmental delay.12
Impaired cognitive function after GTC‐SE has been reported in adults.4 Dysfunctions may partially subside during weeks or months following GTC‐SE,14 which also has been suggested after focal SE.15 There are few systematic and standardized studies on cognitive function after GTC‐SE. Results have been non‐conclusive regarding permanent SE‐induced cognitive impairment.4 Preexisting cerebral dysfunction and underlying aetiology remain possible explanations for the findings.
Our main hypothesis was that patients after GTC‐SE would show a cognitive profile reflecting dysfunction in the hippocampus and secondarily the frontal lobe.18 To explore this, we prospectively examined patients with the Cambridge Neuropsychological Test Automated Battery (CANTAB) on memory and executive function tasks shortly after GTC‐SE and repeated the assessment 1 year later.
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