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Cognitive problems in young adults with epilepsy: Language deficits correlate to brain activation and self-esteem
Linköping University, Department of Clinical and Experimental Medicine, Neurology. Linköping University, Faculty of Health Sciences.
Linköping University, Center for Medical Image Science and Visualization, CMIV. Linköping University, Department of Medical and Health Sciences, Radiation Physics. Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0003-3587-3568
Linköping University, Center for Medical Image Science and Visualization, CMIV. Linköping University, Department of Clinical and Experimental Medicine, Neurobiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Neurology.
Linköping University, Department of Clinical and Experimental Medicine, Neurology. Linköping University, Faculty of Health Sciences.
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

People with epilepsy often display cognitive decline. Language function in epilepsy has been most thoroughly studied in temporal lobe epilepsy, but the impact of language deficits in epilepsy is not fully understood. The aim of this study was to evaluate the effect of epilepsy on language function with functional magnetic resonance imaging of brain activation, with behavioral methods and to relate language performance to demographic data, self-esteem and Quality of life. We specifically aimed to investigate if variation in epilepsy origin would relate to differences in language performance and if these differences could be associated with specific language activation patterns in the brain. We recruited people with epilepsy (29 in total), with focal onset seizures in either the left or right hemispheres or with generalized epilepsy; and 27 matching healthy controls. The participants’ language skills were measured with a phonemic word fluency test and a broader test measuring higher language functions. Functional magnetic resonance images of the brain were obtained during a word fluency and a sentence reading paradigm. Questionnaires on self-esteem and quality of life were collected. People with epilepsy of both focal and generalized origin had impaired function in semantic and verbal fluency tasks compared to the controls. The causes of language impairment were multifactorial; the most important determinants were education and onset age of epilepsy. Impaired language function was correlated to low self-esteem for participants with focal onset seizures; however Quality of life did not seem to be affected by language impairment. The functional magnetic resonance imaging investigation demonstrated altered functional activity during language tasks for participants with epilepsy compared to healthy controls. In epilepsy with focal seizures originating in the left hemisphere we found increased bilateral  activation of supporting areas in the anterior mid-cingulate cortex and the left anterior ventral insula, indicating a compensational functional reorganization. In generalized epilepsy, the functional language network showed an imbalance expressed as an inadequate  suppression of activation in the left anterior temporal lobe during semantic processing. Our study shows not only that reduced language functioning is present in people with epilepsy other than in the temporal lobe, but also that frequency of convulsive seizures correlates to language impairment. For patients with focalized seizures, low self esteem correlated also to language impairment. Our results highlight the importance of addressing the negative consequences of language decline in people with epilepsy of both focal and generalized origin.

National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-80385OAI: oai:DiVA.org:liu-80385DiVA: diva2:546681
Available from: 2012-08-24 Created: 2012-08-24 Last updated: 2015-09-22Bibliographically approved
In thesis
1. Epilepsy in young adulthood: medical, psychosocial and functional aspects
Open this publication in new window or tab >>Epilepsy in young adulthood: medical, psychosocial and functional aspects
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis was to describe the medical, cognitive and psychosocial consequences of epilepsy in young adulthood. Four studies were carried out with this patient group. The first two papers were based on a follow-up study regarding young adults with epilepsy that investigated medical and psychosocial aspects and compared the present results with those five years earlier. We then conducted focus group interviews with young adults with epilepsy and subjective cognitive decline to assess the deeper meaning of living with epilepsy accompanied by cognitive difficulties. In the fourth study we studied cognitive dysfunction further, choosing the language function in young adults with epilepsy. We firstly examined whether language impairments were associated to functional brain alterations and secondly related the language performance to demographics, clinical data, Quality of Life (QoL) and self-esteem.

The five-year follow up of 97 young adults with uncomplicated epilepsy revealed no improvement regarding seizure frequency or side effects from anti-epileptic drugs (AEDs) over time, even though many new-generation AEDs had been established during this period. During the study period 21% had recovered from epilepsy, Seizure frequency among those who still had epilepsy had not improved, and 42% had experienced seizures during the past year. New-generation anti-epileptic drugs (AEDs) had been introduced to PWE, especially to women. There is still need for new and more effective treatment options for this group in the future. It is essential to find alternative approaches to develop better treatment options for this group in the future. However QoL was normal compared to the general population, indicating that new options regarding treatment can have made an impact. Lower QoL was correlated to high seizure frequency and to cognitive side effects. Self-esteem and Sence of Coherence were impaired compared to the situation at adolescence. Self-esteem was correlated to seizure frequency and to side-effects of antiepileptic drugs. Sence of Coherence was not correlated to epilepsy-related factors in the same way as QoL, but mirrored the phenomenon of epilepsy.

The qualitative study showed that the consequences of epilepsy are not only restricted to the consequences of seizures, but also concerns many other aspects of life. The interviews revealed four themes: “affecting the whole person“, “influencing daily life”, ”affecting relations” and ”meeting ignorance in society”. Another important factor was language function; when one loses some language ability, this gives a feeling of losing one’s capability.

The fourth study examined language by neuropsychological methods and correlated this function to brain activation measured by fMRI. Language functions measured in verbal fluency and abstract language comprehension were impaired in participants with both generalized epilepsy and epilepsy of focal onset. Age at onset of epilepsy and education are the most important factors correlating to language function. An additional factor that impacts abstract language comprehension is the frequency of convulsive seizures, while use of topiramate /zonisamide affect verbal fluency negatively. QoL was not correlated to language impairments, but for patients with focal onset seizures there was a correlation between self-esteem and abstract language comprehension. The fMRI investigation revealed altered activity during language tasks in participants with epilepsy compared to controls. In epilepsy with focal seizures originating in the left hemisphere, we found increased bilateral activation of supporting areas, in the anterior mid-cingulate cortex and the anterior ventral insulae, indicating a compensational functional reorganization. In generalized epilepsy, the functional language network showed an imbalance, as this group expressed an inadequate suppression of activation in the anterior temporal lobe during semantic processing. Subtle language impairment can, even if it does not occur in everyday dialogue, be of importance and have consequences for the person affected. The negative consequences of language decline must be addressed in people with epilepsy of different etiology. Young adults with epilepsy are still substantially affected by the condition. The consequences are not only restricted to the seizures, but concern many aspects of life and there is a great need for new treatment options for this group in the future.

Place, publisher, year, edition, pages
Lin: Linköping University Electronic Press, 2012. 66 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1309
Keyword
Epilepsy, young adult, Quality of Life, self-esteem, daily life, antiepileptic drugs, cognition, language, fMRI, Sence of Coherence
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-80388 (URN)978-91-7519-893-4 (ISBN)
Public defence
2012-09-13, Linden, Hälsouniversitetet, Campus US, Linköpings universitet, Linköping, 13:00 (Swedish)
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Supervisors
Available from: 2012-08-24 Created: 2012-08-24 Last updated: 2013-09-04Bibliographically approved

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Gauffin, Helenavan Ettinger-Veenstra, HeleneLandtblom, Anne-MarieMcAllister, AnitaKarlsson, ThomasEngström, Maria

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NeurologyFaculty of Health SciencesCenter for Medical Image Science and Visualization, CMIVRadiation PhysicsNeurobiologyDepartment of NeurologySpeech and Language PathologyDepartment of ENT - Head and Neck Surgery UHLThe Swedish Institute for Disability ResearchFaculty of Arts and SciencesRadiology
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