THE FORMATION OF COGNITIVE AND MENTAL DISORDERS IN EPILEPSY: THE ROLE OF VARIOUS FACTORS ASSOCIATED WITH DISEASE AND TREATMENT (A REVIEW OF LITERATURE AND CASE REPORTS)
Cognitive and mental disorders often occur in patients with epilepsy and significantly reduce the quality of life of patients and their families. Approximately in 35 % of patients, despite treatment, various violations of intelligence, behavior, affective sphere of different degree of seve rity are preserved. In general, mental (affective, anxious and psychotic) disorders occur in epilepsy 2–3 times more often than in the general population. The most common is depression: the occurrence of depression and anxiety in epilepsy varies from 20 to 55 % (and more than 50 % of patients with refractory focal epilepsy, especially epilepsy of the temporal lobe of the brain). Children are a particularly vulnerable category of patients: in addition to persistent intellectual disabilities (mental retardation), they may have specific impairments in the form of mental and speech development delay, learning difficulties, attention deficit hyperactivity disorder.Causes of cognitive and mental disorders in epilepsy can directly be the factor underlying epilepsy (genetic disease, structural brain defect, etc.), epileptic seizures, interictal epileptiform activity, side effects of antiepileptic drugs (AED). In many cases, a patient with epilepsy combines several of these causes, and it is often difficult to determine which one cause is leading. The contribution of specific factors is difficult to estimate, because different factors can have an independent different effect on cognitive impairment. Some of causes underlying cognitive and mental disorders in epilepsy can be influenced and thus reduce the existing risk. Such measures include early diagnosis and effective adequate treatment of epileptic encephalopathy, as early as possible control of seizures, justified appointment of AED in children with cognitive impairment of unknown etiology and frequent epileptiform discharges on the electroencephalogram, careful monitoring of cognitive side effects of AED and assessment of benefit–risk ratio, early surgical treatment of patients with resistance to therapy. Of course, the use of AED with the most favorable profile of influence on cognitive functions plays an important role in the treatment of epilepsy. In the treatment of epilepsy in children, it’s especially important to give preference to AED, which doesn’t negatively influence on the cognitive sphere.