Page 71 - JCBP-2-4

Journal of Clinical and
Basic Psychosomatics Profiles of attention and executive function in epilepsy versus psychogenic seizures

between the two groups. Reported similarities include understand and address the cognitive vulnerabilities in
deficits in working memory, cognitive flexibility, and tasks this population.
requiring response inhibition and visuomotor coordination, In this current preliminary cross-sectional study, we
suggesting that cognitive impairments in PNES patients aimed to evaluate performance in two crucial frontal
can be as severe as in those with ES. In addition, cognitive functions, attention, and executive control,
12
neuropsychological research often finds PNES individuals which are considered essential for effective and adaptive
performing below normal levels, 11,29 especially in attention behaviors. We focused on patients with PNES, with or
and executive functions, when compared to ES patients. without comorbid ES (categorized as PNES group), in
6,30
These variations in findings may stem from the diverse comparison to patients with only ES (categorized as
psychological and neurological profiles of PNES patients. 31 ES group). Smith and Jonides identified five executive
According to the integrated cognitive-emotional functions: inhibition, coding, monitoring, planning,
approach, cognitive impairments in PNES are influenced by and task management. 37,38 We employed the attentional
28
41
a complex mix of factors due to the condition’s heterogeneous network test (ANT) 39,40 and the Stroop task to measure
nature. Dissociation, somatization, and post-traumatic stress these cognitive performances.
disorder, which are common in PNES, negatively influence As reviewed, findings regarding attention and executive
cognitive functioning. Studies comparing the prevalence control in PNES patients compared to ES patients are
of somatoform dissociation and compartmentalization in heterogeneous and inconsistent. We hypothesize that
PNES and epilepsy patients show mixed results but generally adopting an integrated cognitive-emotional approach and
indicate a higher prevalence of somatoform dissociation the integrative cognitive model, which examines seizures
10
32
in PNES. These psychopathological mechanisms affect through a comprehensive, multidisciplinary lens – including
cognition differently through their differential impacts on biological, pathophysiological, neuropsychological, and
brain regions associated with memory, alertness, perception, cognitive-emotional aspects – will more effectively identify
and motor functions, illustrating the complex interplay discrepancies in attention deficits and executive control
between psychopathology and cognitive impairments between the two groups. Accordingly, we posit:
in PNES. In addition, patients with PNES exhibit
28
mood disorders and other psychiatric diagnoses which Patients in the PNES group will exhibit slower reaction
negatively affect their cognitive profiles. 28,33 These patients times (RTs) on the Stroop index compared to those in the
frequently report significant cognitive concerns and tend ES group.
to overestimate their cognitive impairments compared to (1) Patients in the PNES group will demonstrate slower
those with epilepsy. 34 RTs on the executive index of the ANT compared to
those in the ES group.
Neurologically, some studies have found that PNES
patients demonstrate prefrontal cortex atrophy and 2. Methods
neurochemical changes, impacting cognitive function.
4,28
Specifically, there is evidence of substantial atrophy in 2.1. Patients
their prefrontal cortex affecting their executive functions We recruited 38 patients admitted to the neuropsychiatry
and emotional behavior. In addition, neurochemical unit and the epilepsy center at Hadassah Hebrew University
35
changes in the prefrontal cortex, anterior cingulate cortex, Medical Center, Jerusalem, Israel, between January
and thalamus are linked to attention deficits, inhibitory 2021 and June 2023. Inclusion criteria were age 18 – 65,
control problems, and general intelligence issues in these confirmed diagnosis of ES/PNES both diagnoses and the
patients. By “general intelligence,” we mean evaluating ability to sign informed consent. Patients’ diagnoses were
broad cognitive functions through the Wechsler Adult verified through a neurological assessment performed by
Intelligence Scale, encompassing verbal comprehension, a qualified epileptologist and through ambulatory EEG or
perceptual reasoning, working memory, and processing gold-standard vEEG monitoring as needed. All patients in
speed. It has been hypothesized that these structural the ES and PNES groups had stable or well-controlled ES.
36
changes are caused by a history of unnecessary antiepileptic Exclusion criteria included individuals outside the
drug treatments as well as high emotional stress. 28,35 18 – 65 age range, current psychotic state, active suicidality,
In summary, cognitive difficulties in both ES and current substance abuse, or any cognitive impairment
PNES patients are multidimensional, stemming from that prevented them from giving informed consent. All
psychological, emotional, neurological, and subjective medical information was obtained from the electronic
factors. 18,28 This complexity necessitates a comprehensive medical records, which were then thoroughly reviewed
approach in both research and clinical evaluation to fully and validated by a physician.

Volume 2 Issue 4 (2024) 3 doi: 10.36922/jcbp.3847