Selective Cognitive Impairment During Focal and Generalized Epileptiform Eeg Activity

It is well established that generalized epileptiform EEG discharges unaccompanied by overt clinical change may nevertheless be associated with transitory cognitive impairment (TCI) detectable by appropriate psychological testing. However, the tests employed in most research studies of this phenomenon are of little use for routine clinical application. They are suitable for administration only over short periods of time and are therefore applicable only to patients with a high discharge rate, a serious limitation, as the discharges are generally depressed by the tests themselves. We have developed two short-term memory tasks, one using verbal, the other nonverbal material presented in the form of television games which patients are generally prepared to perform for up to an hour or longer. Forty-six patients with subclinical EEG discharges have been studied. They were screened by video monitoring before and during testing to exclude any with overt clinical changes during the discharges. Despite this rigorous selection, in 50 per cent TCI was demonstrable with a confidence level (within the individual patient) of 10 per cent. Discharges during stimulus presentation were most disruptive of performance and those confined to the period when the patient was responding were without demonstrable effect. A significant association was found between the laterality of focal or asymmetrical generalized discharges and impairment of one or other task, left-sided discharges being associated with errors in the verbal task and right-sided with impairment of the nonverbal test. Two case histories are cited illustrating patients who were clearly handicapped by TCI and whose functioning improved when the subclinical discharges were suppressed by medication. To determine how many patients suffer such disabilities or can be helped by appropriate medication, further prospective studies are required.