Page 72 - JCBP-2-4

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

The study was approved by the Helsinki committee of These three different scores represent three distinct
Hadassah Hebrew University Medical Center (application attention networks: alertness, orientation, and executive
HMO-0651-19), where all data were collected and stored. control. The alertness network primes the brain for
sensory input and sustains this heightened state of
2.2. Measures readiness. As such, it is essential for ongoing information
2.2.1. Demographic clinical questionnaire processing. Moreover, alertness is significantly important
in diagnosing, managing, and predicting ES. 44
A self-report questionnaire, in Hebrew or Arabic,
was administered to gather information on various This task was translated into Arabic and Hebrew using
demographic and clinical factors, including age (18 – a validated method and version.
65 years), gender (male, female, or other), religion, native
language (Arabic and Hebrew), psychiatric diagnosis, 2.2.4. The Stroop task
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seizure severity, and seizure frequency. The severity scale The Stroop task is considered the gold standard of
section comprises levels of seizure severity (S-severity), selective attention measurement. In this task, lexical-
where the severity level is influenced by the type of seizures, colored stimuli were presented on the screen one at a
their impact on functioning, and the state of consciousness, time in blue, green, red, and yellow. Participants were
among other factors. The score ranges from 1 to 6, with asked to respond to the color of the stimulus and to ignore
6 indicating higher seizure severity. The frequency scale the meaning of the word. The text color and meaning
section includes four levels of seizure frequency, ranging of the word could be either congruent (e.g., the word
from 0 to 4, with 4 being the highest score. Participants RED appeared in red), incongruent (e.g., the word RED
were needed to choose from each scale the option that best appeared in yellow), or neutral (e.g., a letter string XXXX
matched both the severity and frequency of the seizures appeared in red).
experienced. The interference effect, measured by the RT difference

2.2.2. Psychiatric assessment: Diagnostic interview for between incongruent and neutral stimuli, is large and
anxiety, mood, and OCD and related neuropsychiatric reliable. In contrast, the facilitation effect, gauged by the
disorders (DIAMOND) RT difference between neutral and congruent stimuli, is
small and less stable. 45
The DIAMOND is a semi-structured psychiatric interview
adjusted and aimed at providing psychiatric diagnosis This task was translated into Arabic and Hebrew using
according to the criteria outlined in The DSM-5. In this a validated method and version.
study, DIAMOND was administered by certified clinicians, 2.3. Procedure
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using the validated Arabic and Hebrew versions.
Patients who met our inclusion criteria were approached
2.2.3. ANT when they arrived for their routine appointments at

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The ANT is a computerized test that combines a flanker Hadassah Medical Center.
task (with arrows) and a cued RT task that measures Each subject signed an informed consent form,
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participants’ performance in three separate components of followed by a computerized demographic questionnaire
attention: alert, orientation, and executive control. and a short survey regarding his or her seizures. Then, a
In this task, participants reacted to target arrows by computerized cognitive battery task was administered.
quickly pressing the keyboard to indicate the target’s The order of the cognitive tasks was randomized to rule
direction. Participants fixated on a cross until the target out confounders. In addition, each patient without a
appeared. Occasionally, participants received a cue (valid prior psychiatric evaluation underwent a comprehensive
or invalid) hinting at the target, while in some trials, a assessment conducted by trained psychologists or master’s
tone sounded before the target, aiding in preparation. The degree psychology students, using a semi-structured
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target, a central arrow among five, pointed in congruent interview.
or incongruent directions. Participants quickly pressed “C” At the end of the session, patients exhibiting
for left or “M” for right, indicating the target’s direction. psychological distress were given the option to receive
Dependent variables were overall RTs and three difference psychological treatment at the neuropsychiatric clinic.
scores: Orientation (“invalid” RTs minus “valid” RTs), In addition, those diagnosed with a psychiatric disorder
alertness (“no tone” RTs minus “tone” RTs), and executive following their evaluation were informed about their
control (“incongruent” RTs minus “congruent” RTs). The diagnosis and were invited to follow up with the clinic’s
task’s sequence of events is illustrated in Figure 1. psychiatrist.

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