SYNOPSIS

Rajiv Gandhi University of Health Sciences, Karnataka,

Bangalore

“COGNITIVE IMPAIRMENT IN EPILEPSY A

CLINICAL STUDY

Name of the candidate : Dr. Siddharth Shetty .A

Guide : Dr. P. John Mathai

Co-Guide :

Course and Subject : M.D. (Psychiatry)

Department of Psychiatry

Father Muller Medical College,

Kankanady, Mangalore – 575002.

AUGUST – 2007

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

1. Name of the Candidate

and Address

[in block letters]

DR. SIDDHARTH SHETTY A.

DEPARTMENT OF PSYCHIATRY

FATHER MULLER MEDICAL COLLEGE

KANKANADY

MANGALORE – 575002.

2. Name of the Institution FR. MULLER MEDICAL COLLEGE

KANKANADY

MANGALORE – 575002.

3. Course of study and M.D. PSYCHIATRY

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subject

4. Date of admission to

Course

18 t h APRIL 2007

5. TITLE OF THE TOPIC:

“COGNITIVE IMPAIRMENT IN EPILEPSY

A CLINICAL STUDY”

6.

BRIEF RESUME OF THE INTENDED WORK:

6.1 NEED FOR THE STUDY:

Patients with epilepsy have relatively higher risk for

psychopathology and cognitive impairment. There are several reports

about the cognitive impairment and cognitive deterioration in patients

with epilepsy. In recent years some of the factors underlying the

cognitive deficits l ike attention impairment, intellectual deterioration

and memory deficits have been investigated. There are reports about

cognitive deterioration to suggest possible ‘dementia of epilepsy’. The

research data indicate that the cognitive impairment and deterioration

are due to associated brain damage and not attributable to epilepsy.

There are only a limited number of studies investigating the cognitive

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impairment in patients with uncomplicated epilepsy, with good

seizures control and without obvious structural brain damage. There

have been only a few research reports on cognitive impairment in

patients with uncomplicated epilepsy, with good seizure control and

without obvious structural brain damage. There have been only a few

research reports on cognitive impairment in epilepsy in India.

6.2 REVIEW OF LITERATURE:

Cognitive impairment and cognitive deterioration have been

described as a complication of epilepsy for many years. According to

Trimble and Coworkers 1 there have been accumulating research data

indicating comorbid psychopathology and cognitive impairment in

patients with epilepsy. Other investigators report that preexisting brain

damage while being an important variable, does not entirely explain

the neuropsychological deficits. There appears to be some ‘epileptic

factor’ that contributes to the cognitive impairment in addition to the

brain damage, Perrine and Kiolbasa 2 , reported that a substantial

minority of patients with epilepsy develop cognitive impairment in the

domains of attention concentration, memory, word finding, executive

function and visuo spatial abilit ies.

Lishman 3 observed that patients with symptomatic epilepsy and

those with preexisting brain damage are more l ikely to have cognitive

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and intellectual impairment. There are evidences to indicate that the

intellectual decline is not progressive like in degenerative diseases, it

is st ill uncertain whether epilepsy as such could be responsible for

dementia.

6.3 OBJECTIVES OF THE STUDY:

1. To evaluate the frequency and nature of the cognitive impairment

in patients with epilepsy.

2. To evaluate the relationship between sociodemographic and

clinical variables and cognitive impairment in patients with

epilepsy.

3. To evaluate the quality of life in patients with epilepsy.

7.

MATERIALS AND METHODS:

7.1 SOURCE OF DATA:

The clinical study will be conducted in Father Muller Medical

College, Kankanady, Mangalore. All patients attending the out patient and

in patient facil ities of the department of neurology and psychiatry with a

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clinical diagnosis of epilepsy will constitute the population for the study.

7.2 METHOD OF COLLECTION OF DATA:

The sample for the study will consist of thirty consecutive patients

with epilepsy who satisfy the inclusion and exclusion criteria.

Inclusion Criteria

Male and female patients between the ages of 18 and 50yrs.

Patients with atleast primary school education

Patients with primary generalized tonic clonic epilepsy and complex

partial epilepsy (frontal and temporal lobe epilepsy)

Patients with epilepsy of less than 10 year duration

Exclusion Criteria

Patients with comorbid neuro psychiatric disorders.

Patients with epilepsy secondary to other causes, intractable epilepsy

or with poor seizure control and patients with epilepsy who have

undergone neuro surgical interventions.

Patients with epilepsy having medical disorders like diabetes melli tus,

thyroid and other endocrine disorders and other chronic debilitating

medical conditions known to cause cognitive impairment and patients

on long term regular treatment other than anti epileptic drugs.

Thirty first degree male and female non affected relatives of the

patients between the ages of 18-50yrs without comorbid psychopathology

will constitute the control for the study.

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Type of study – Clinical Analytical study

A written informed consent will be obtained from all patients and the

first degree relatives recruited for the study. The socio demographic and

clinical variables will be recorded in a specific proforma prepared for this

clinical study. All the patients and control will undergo a through clinical

examination to rule out psychopathology and medical disorders if any.

The cognitive functions of all the patients in the clinical sample and all

the subjects in the control group and their quality of life will be assessed

using the following instruments.

Standardized mini mental status examination

Digit symbol substi tution test

Trail making test B

Brief cognitive rating sale.

Short form health survey- 36

The patients with epilepsy will be evaluated during the interictal

period at least six weeks after the last seizure.

Statistics

The results obtained will be analyzed using the following statist ical

methods.

T –test

Chi-square test

Analysis of variable (ANOVA)

7.3 Does the study require any investigations or interventions to be

conducted on patients or other humans or animals? If so, please

describe briefly. – No -

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7.4 Has ethical clearance been obtained from your institution in case

of 7.3 - Yes -

8. LIST OF REFERENCES:

1. Trimble MR, Ring H.A and Schmitz B. Neuro psychiatric aspects

of epilepsy, Baltimore: Williams and Wilkins, 1996, 771-803.

2. Perrine K and Kiolbasa. T. “Cognitive deficits in epilepsy and

contribution to psychopathlogy”. Neurology [Supp 2] 1995; 53:

539-548.

3. Lishman W.A. Organic psychiatry. Ed -3. Oxford: Blackwell

Science Limited, 1998; 237-314.

4. Molloy DW et al. “Reliabili ty of Standardized mini mental status

examination compared with the traditional mini mental status

examination”. American journal of psychiatry 1991;148:102-105.

5. Reisberg B, Ferris SH. “Brief cognitive rating scale BCRS”.

Psychopharmacology bulletin, 1988; 24: 629-636.

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9. SIGNATURE OF THE CANDIDATE:

10. REMARK OF THE GUIDE:

11. NAME AND DESIGNATION OF (in block letters)

11.1 GUIDE DR. P. JOHN MATHAI

PROFESSOR

DEPARTMENT OF PSYCHIATRY

FATHER MULLER MEDICAL

COLLEGE- KANKANADY

MANGALORE-575002

11.2 SIGNATURE

11.3 HEAD OF THE DEPARTMENT

DR. K. KRISHNA MURTHY

PROFESSOR AND HOD

DEPARTMENT OF PSYCHIATRY

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FATHER MULLER MEDICAL

COLLEGE

KANKANADY

MANGALORE-575002

11.4 SIGNATURE

12. 12.1 REMARKS OF THE CHAIRMAN AND DEAN

12.2 SIGNATURE

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