Page 76 - JCBP-2-4

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

These results suggest that while there were no with changes in alertness levels in response to external,
significant differences between the groups in terms of non-emotional stimuli. This could explain why the alerting
executive control and orienting; differences were observed network in the PNES group is less efficient or sensitive
in alerting. Specifically, patients in the ES group displayed compared to the ES group, according to the integrative
significantly slower RTs in the non-tone conditions cognitive model.
compared to the tone conditions. In contrast, for the PNES Contrary to our hypothesis, the executive score from
group, no significant difference in RTs between the tone the ANT revealed no significant difference in executive
and non-tone conditions was found. control between the ES and PNES groups. Similarly, the
3.4. Effect of antiepileptic drug on cognitive orienting score showed no notable difference between
assessment the two groups. It is possible that these effects were not
significant because of the small sample size and the
To examine the effect of ASM usage on cognitive mixture of PNES + ES in the PNES group, which could
processing, data were analyzed using analysis of covariance. have increased variability in the sample and interfered with
The interaction between ASM usage and Stroop task the detection of these effects.
congruency, F(4, 54) = 1.48, P = 0.221, was not statistically
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significant, indicating that ASM usage did not significantly Regarding the Stroop task, a significant Stroop effect
affect cognitive interference as measured by the Stroop was observed in both seizure groups. However, there was
task. Furthermore, there were no significant interactions no difference in the interference effect among patients
between ASM usage and the attentional network indices of in the ES group compared to those in the PNES group,
executive control, alerting, and orienting: F(2, 25) = 1.89, meaning that deficits in selective attention and cognitive
P = 0.172, F(2, 25) = 1.95, P = 0.164, and F(4, 50) = 0.62, control in the ES group may not differ significantly from
P = 0.653, respectively. This suggests that ASM load – those in the PNES group.
whether participants were on none, one, or multiple In addition, the cognitive performance observed in
ASM – did not significantly influence RT variability across the ANT and the Stroop task is not differentially affected
different cognitive task conditions. by the quantity of ASM consumed by the patients. This
finding is inconsistent with previous studies that found
4. Discussion cognitive deterioration in children with epilepsy after
The current preliminary cross-sectional study aims to using carbamazepine. 48,49 This may be due to the fact
evaluate the cognitive deficit profiles in ES and PNES that in the current study, participants were adults, part
patients as assessed by the ANT and the Stroop task. with comorbid PNES, and that we analyzed all kinds of
ASMs together and used different cognitive assessment
Our results primarily show a more pronounced alerting
effect in the ES group compared to the PNES group, methods. However, this issue should be explored in
further studies.
indicating marked differences in attentional processing
between the groups. This was a significant observation we Given the small number of participants and other
did not initially hypothesize. ES patients seem to be more potential confounding factors that could influence the
responsive to warning cues, allowing them to achieve outcomes, we present these findings with considerable
and maintain heightened alertness more efficiently than caution. Overall, our findings may indicate more severe
patients with PNES. This may imply that the alerting cognitive deficits, especially in alertness, among patients
network in the PNES group is less efficient or sensitive with ES, compared to those with PNES and comorbid cases.
compared to the ES group. However, drawing from prior However, this does not negate the presence of attentional
research in this domain, the difference in the alerting effect cognitive impairments in PNES patients, which have been
might indicate a state of hyper-alertness to the presence of documented in previous studies. 28,50
tones in the task among the ES group and not necessarily In our research, we identified a significantly higher
a deficit in the capacity of the PNES group to initiate and rate of comorbid psychiatric diagnoses and greater seizure
maintain an alert state in response to warning cues. 46,47 severity among patients in the PNES group compared to

According to the integrative cognitive model mentioned those in the ES group. This is notable, considering that
above, the first stage of PNES is marked by a sharp rise in previous studies in this field have consistently established
sympathetic arousal. However, following a seizure event, a positive correlation between these factors and attention
there is a change in the patient’s experience as the initial deficits, which may be significant confounding factors. 44,51
sympathetic response is interrupted, resulting in decreased Given the high percentage of comorbid psychiatric
arousal. This alteration in arousal state may be associated diagnoses and the establishment of attentional control
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Volume 2 Issue 4 (2024) 8 doi: 10.36922/jcbp.3847