The impact of bilateral asynchronous discharges on cognitive functions in temporal lobe epilepsy patients
Objective To investigate the cognitive functions of temporal lobe epilepsy(TLE)patients with bilateral asynchronous interictal discharges.Methods A total of 162 TLE patients who were treated at Zhongshan Hospital,Fudan University,from June 2021 to December 2023 were collected.According to the interictal scalp electroencephalogram,TLE patients were classified to the TLE with bilateral temporal asynchronous interictal epileptiform discharges(n=51)and TLE with unilateral temporal epileptiform discharges(n=111).Unilateral TLE patients were divided into TLE with right(n=48)and left(n=63)temporal epileptiform discharges.The Mini-Mental State Examination(MMSE),Montreal Cognitive Assessment(MoCA),Digital Span(DS),Verbal Fluency Test(VFT),the third part of Color Word Test(CWT-C),Trail Making Test-B(TMT-B),Symbol Digit Modalities Test(SDMT),Auditory Verbal Learning Test(AVLT),Rey-Osterrieth Complex Figure(ROCF),and Similarity Comprehension Test were performed for the participants.The differences of cognitive functions between patients with bilateral and unilateral temporal discharges were compared.Univariate and multivariate Logistic regression models were used to analyze the risk factors for patients with bilateral temporal asynchronous discharges.Spearman analysis was used to explore the correlation between cognitive function and clinical indicators.Results In the group of TLE patients with bilateral asynchronous discharges compared to those with unilateral discharges,the completion time of CWT-C[67(55,103)s vs 59(50,71)s,Z=-2.904,P=0.004],TMT-B[159(108,219)s vs 129(95,180)s,Z=-2.361,P=0.018]was longer.Additionally,TLE patients with bilateral asynchronous discharges got lower scores of MMSE[28(26,29)vs 29(28,30),Z=3.098,P=0.002],MoCA[23(19,28)vs 27(23,28),Z=3.175,P=0.001],AVLT1+2+3[16.843±6.482 vs 19.162±5.526,t=-2.347,P=0.020],AVLT6[6(3,10)vs 8(5,10),Z=3.275,P=0.001],ROCF2[15(8,22)vs 20(12,25),Z=2.870,P=0.004],ROCF3[14(8,22)vs 20(11,25),Z=2.634,P=0.008],and Similarity Test[13(8,18)vs 16(12,20),Z=2.387,P=0.017]as well as lower VFT-vegetable and fruit count[15(13,19)vs 18(15,21),Z=2.402,P=0.016]and SDMT completion count[41(30,53)vs 51(40,60),Z=3.089,P=0.002].The multivariate Logistic regression analysis showed that the decrease in AVLT6 scores(OR=1.546,95％CI 1.150-2.078,P=0.004)and longer TMT-B time(OR=1.013,95％CI 1.001-1.025,P=0.035)were independent risk factors for TLE patients with bilateral asynchronous discharges.Conclusions Compared to the patients with TLE characterized by unilateral temporal lobe discharges,those with asynchronous discharges in bilateral temporal lobes show statistically significant declines in all domains of cognitive functions,including executive function,memory,and language abilities.Decreased cue recall ability in language memory and prolonged trail-making test in executive function are independent cognitive impairment risk factors for bilateral temporal asynchronous discharges.
Bilateral asynchronous interictal dischargesTemporal lobe epilepsyCognitive function
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