Is self-report sleepiness associated with cognitive performance in temporal lobe epilepsy?

Vascouto, Helena Dresch; Thais, Maria Emília Rodrigues de Oliveira; Osório, Camila Moreira; Ben, Juliana; Claudino, Lucia Sukys; Hoeller, Alexandre Ademar; Markowitsch, Hans J.; Wolf, Peter; Lin, Katia; Walz, Roger

doi:10.1590/0004-282X20180089

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Article • Arq. Neuro-Psiquiatr. 76 (9) • Sept 2018 • https://doi.org/10.1590/0004-282X20180089 copy

Is self-report sleepiness associated with cognitive performance in temporal lobe epilepsy?

A sonolência auto-relatada está associada ao desempenho cognitivo na epilepsia do lobo temporal?

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Sleepiness and cognitive impairment are common symptoms observed in patients with epilepsy. We investigate whether self-reported sleepiness is associated with cognitive performance in patients with refractory mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS). Seventy-one consecutive patients with MTLE-HS were evaluated with the Stanford Sleepiness Scale (SSS) before neuropsychological evaluation. Their mean SSS scores were compared with controls. Each cognitive test was compared between patients with (SSS ≥ 3) or without sleepiness (SSS < 3). Imbalances were controlled by regression analysis. Patients reported a significantly higher degree of sleepiness than controls (p < 0.0001). After multiple linear regression analysis, only one test (RAVLT total) remained associated with self-reported sleepiness.

Conclusion:

Self-reported sleepiness was significantly higher in MTLE-HS patients than controls, but did not affect their cognitive performance. If confirmed in other populations, our results may have implications for decision making about sleepiness screening in neuropsychological settings.

Keywords:
neuropsychological tests; drug resistant epilepsy; clinical decision-making

Variables		Patients	Controls	p-value
		n = 71 (%)	n = 71 (%)
		n = 71 (%)	n = 36 (%)
Gender
	Female	37 (52.1)	23 (63.9)
	Male	34 (47.9)	13 (36.1)	0.25
Hand dominance
	Right	66 (93.0)	32 (89)
	Left	5 (7.0)	4 (11)	0.47
Age (years)		36 (11.5)	35.6 (12.3)	0.85
Education (years)		7.3 (3.2)	8.2 (2.8)	0.18
Hours of sleep overnight		6 (2.0)	6.56 (1.7)	0.18
Stanford sleepiness scale
	Overall score	3.38 (1.8)	1.56 (0.8)	< 0.0001
	Score ≥ 3 (%)	33 (46.5)	3 (8.3)	< 0.0001

Variables		All patients	Sleepiness ^a a Sleepiness: Yes: SSS score ≥ 3; No: SSS score < 3;		p-value
			No	Yes
			n=71(%)	n=45(%)
			n=26(%)	n=45(%)
Gender
	Female	37 (52.1)	13 (35.1)	24 (64.9)
	Male	34 (47.9)	13 (38.2)	21 (61.8)	0.79
Marital status
	Single	34 (47.9)	16 (47.1)	18 (52.9)
	Married	26 (36.6)	9 (34.6)	17 (65.4)
	Divorced or widower	7 (9.9)	1 (14.3)	6 (85.7)	0.23
Work activity
	Working	22 (31.0)	07 (31.8)	15 (68.2)
	Housewife	13 (18.3)	5 (38.5)	8 (61.5)
	Unemployed	14 (19.7)	4 (28.6)	10 (71.4)
	Health insurance	22 (31.0)	10 (45.5)	12 (54.5)	0.71
History of initial precipitating injury
	No	26 (36.6)	8 (30.8)	18 (69.2)
	Yes	38 (53.5)	16 (42.1)	22 (57.9)
	Unknown	7 (9.9)	2 (7.7)	5 (71.4)	0.58
Side of hippocampal sclerosis on MRI
	Right	30 (42.3)	9 (30.0)	21 (70.0)
	Left	38 (53.5)	17 (44.7)	21 (55.3)
	Bilateral ^b b Bilateral asymmetric hippocampal sclerosis in two patients (right hippocampus worse) and bilateral symmetric in one patient;	3 (4.2)	0 (0)	3 (100.0)	0.18
AEDs Treatment
	Monotherapy	30 (42.3)	12 (40.0)	18 (60.0)
	Polytherapy	41 (57.8)	14 (34.1)	27 (65.8)	0.32
Benzodiazepines
	No	32 (45.1)	15 (46.9)	17 (53.1)
	Yes	39 (54.0)	11 (28.2)	28 (71.8)	0.10
AEDs in use
	Carbamazepine	53 (74.6)	17 (32.1)	36 (67.9)	0.17
	Phenytoin	11 (15.5)	7 (63.6)	4 (36.4)	0.04
	Phenobarbital	19 (26.8)	5 (26.3)	14 (73.7)	0.28
	Valproic acid	13 (18.3)	3 (23.1)	10 (76.9)	0.26
	Topiramate	5 (7.0)	3 (60.0)	2 (40.0)	0.26
	Lamotrigine	10 (14.1)	1 (10.0)	9 (90.0)	0.06
	Oxcarbazepine	7 (9.9)	4 (57.1)	3 (42.9)	0.23
Hand Dominance
	Right	66 (93.0)	24 (36.4)	42 (63.6)
	Left	5 (7.0)	2 (40.0)	3 (60.0)	0.87
Age (years)		36 (11.5)	35.5 (10)	36.3 (12.3)	0.80
Education (years)		7.3 (3.2)	6.35 (3.3)	7.8 (3.1)	0.06
Disease duration (years)		22.7 (10.6)	22.7 (8.2)	22.7 (11.9)	0.98
Epilepsy onset age (years)		9.6 (9.15)	9.1 (8.5)	9.9 (9.6)	0.73
Hours of sleep overnight^c c Hours of overnight sleep on the night before the SSS was evaluated; p: significance level; AEDs: antiepileptic drugs.		6 (2.0)	6.9 (1.8)	5.5 (1.96)	0.02

Cognitive Tests		Sleepiness		p-value
		No	Yes
		(n = 26)	(n = 45)
Verbal memory
	Logical Memory 1^st	18.4 (7.2)	18.5 (7.5)	0.95
	Logical Memory I	29.3 (11.2)	29.9 (11.1)	0.83
	Logical Memory II	15.2 (9.9)	15.2 (9.0)	0.99
	Paired Associates I	10.2 (6.7)	11.0 (7.3)	0.69
	Paired Associates II	2.8 (2.5)	3.5 (2.6)	0.30
	RAVLT Total	33 (8.5)	38.4 (8.9)	0.01
	RAVLT Retention	5.3 (3.0)	6.6 (2.7)	0.08
	RAVLT Delayed	4.7 (3.2)	5.7 (3.0)	0.19
	RAVLT Recognition	8.9 (3.9)	10.1 (6.3)	0.37
Nonverbal memory
	ROCF Immediate	10.8 (4.7)	13.0 (6.7)	0.15
	ROCF Delayed	11.6 (5.1)	14.3 (8.2)	0.13
	Visual Reproduction I	61.2 (19.5)	60.7 (21.8)	0.93
	Visual Reproduction II	21.9 (19.7)	26 (23.8)	0.46
Attention and working memory
	Digit Span	11.6 (2.7)	11 (3.0)	0.37
Executive Function
	Five-Points Test	19.1 (11.0)	18.6 (9.5)	0.85
Language
	Boston Naming Test	34.1 (9.3)	34.3 (10.1)	0.93
	Letters Fluency	20.6 (6.5)	19.5 (8.8)	0.58
	Category Fluency	10.4 (3.4)	10.8 (4.4)	0.68
	Vocabulary	21.7 (7.9)	22.1 (7.0)	0.83
	Similarities	14.1 (5.8)	15.2 (4.5)	0.39
	Information	6 (2.8)	6.8 (4.5)	0.32
Visuospatial, visuoperceptual and motor skills
	Block Design	21.1 (11.9)	22.8 (12.6)	0.58
	Matrix Reasoning	7.8 (4.5)	7.7 (5.1)	0.91
	Picture Completion	14.3 (5.0)	14.22 (7.2)	0.94
	ROCF Copy	25.4 (6.1)	26.7 (6.5)	0.43

Cognitive tests and predictors		Linear regression coefficients			p-value
Cognitive tests and predictors		r	r²	B (CI 95%)	p-value
RAVLT Total		0.46	0.21		0.001
	Side of hippocampal sclerosis on MRI^a a For the linear regression analysis the side of hippocampal sclerosis on MRI were classified as: 1 = right hippocampal sclerosis; 2 = left hippocampal sclerosis; 3 = bilateral hippocampal sclerosis;			0.7 (0.1 to 1.4)	0.03
	Education			-2.9 (-6.5 to 0.6)	0.10
	SSS score			1.2 (0.004 to 2.2)	0.05
	SSS score alone^b b SSS score alone predicted 9% (r2 = 0.09) of the RAVLT total score variation; p: significance level. RAVLT: Rey Auditory Verbal Learning Test, ROCF: Rey-Osterrieth Complex Figure.	0.29	0.09	1.4 (0.3 to 2.6)	0.01
RAVLT Retention		0.46	0.21		0.001
	Side of hippocampal sclerosis on MRI^a a For the linear regression analysis the side of hippocampal sclerosis on MRI were classified as: 1 = right hippocampal sclerosis; 2 = left hippocampal sclerosis; 3 = bilateral hippocampal sclerosis;			- 1.5 (-2.6 to −0.36)	0.01
	Education			0.2 (- 0.02 to 0.04)	0.07
	SSS score			0.25 (-0.1 to 0.6)	0.16
ROCF Delayed		0.42	0.18		0.004
	Education			0.3 (0.1 to 0.5)	0.005
	SSS			0.28 (-0.6 a 1.2)	0.86
ROCF Immediate		0.39	0.16		0.004
	Education			0.8 (0.3 to 1.2)	0.001
	SSS score			- 0.2 (-1.0 to 0.6)	0.63

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[1] Correspondence: Roger Walz; Departamento de Clínica Médica, HU-UFSC; R. Eng. Agronômico Andrei Cristian Ferreira, s/n; 88040-970 Florianópolis SC, Brasil. Email: rogerwalz@hotmail.com