Highlights From the Annual Meeting of the American Epilepsy Society 2022

With more than 6000 attendees between in-person and virtual offerings, the American Epilepsy Society Meeting 2022 in Nashville, felt as busy as in prepandemic times. An ever-growing number of physicians, scientists, and allied health professionals gathered to learn a variety of topics about epilepsy. The program was carefully tailored to meet the needs of professionals with different interests and career stages. This article summarizes the different symposia presented at the meeting. Basic science lectures addressed the primary elements of seizure generation and pathophysiology of epilepsy in different disease states. Scientists congregated to learn about anti-seizure medications, mechanisms of action, and new tools to treat epilepsy including surgery and neurostimulation. Some symposia were also dedicated to discuss epilepsy comorbidities and practical issues regarding epilepsy care. An increasing number of patient advocates discussing their stories were intertwined within scientific activities. Many smaller group sessions targeted more specific topics to encourage member participation, including Special Interest Groups, Investigator, and Skills Workshops. Special lectures included the renown Hoyer and Lombroso, an ILAE/IBE joint session, a spotlight on the impact of Dobbs v. Jackson on reproductive health in epilepsy, and a joint session with the NAEC on coding and reimbursement policies. The hot topics symposium was focused on traumatic brain injury and post-traumatic epilepsy. A balanced collaboration with the industry allowed presentations of the latest pharmaceutical and engineering advances in satellite symposia

Uses and abuses of the neuropsychological assessment in the presurgical evaluation of epilepsy surgery candidates

Recent guidelines from the International League Against Epilepsy (ILAE) delineating the role of the neuropsychologist in the assessment of epilepsy surgery patients stress the collaborative contribution neuropsychologists should make to seizure characterization, lateralization and localization in the pre-surgical setting. The role they should play in the comprehensive counselling of surgical candidates, including exploration of the patient's expectations of surgical treatment is also mandated. In this paper we present two contrasting case studies which illustrate the importance of these roles and the impact they can have on patient outcomes. In Case A we describe the patient journey of a 69-year-old women with left hippocampal sclerosis and concordant neurophysiology and seizure semiology. We present the series of discussions and decisions which led her to reject the surgical option following a detailed exploration of her motivations for surgery and the likely cognitive consequences of the procedure. In Case B we describe the series of errors and omissions which led to the failure of a clinical team to correctly interpret and integrate neuropsychological findings into the larger clinical picture of a 19-year-old woman with a seven year history of seizures. These errors ultimately culminated in the patient undergoing a right temporal lobe resection to treat psychogenic nonepileptic seizures (PNES). The extent of integration of the data from the clinical neuropsychological assessment in the full presurgical evaluation was critical in determining the outcomes in both of these cases. Surgery did not solve Case B's problems and left her with the lifelong cognitive vulnerabilities that are associated with unilateral temporal lobe resection. In contrast, Case A was a good surgical candidate, but comprehensive integration of the neuropsychological findings into the larger clinical picture established that surgery was not the best solution to the problem she wished to solve

The cognitive phenotype of juvenile absence epilepsy: An investigation of patients and unaffected siblings.

OBJECTIVE The cognitive profile of juvenile absence epilepsy (JAE) remains largely uncharacterized. This study aimed to: (i) elucidate the neuropsychological profile of JAE; (ii) identify familial cognitive traits, by investigating unaffected JAE siblings; (iii) establish the clinical meaningfulness of JAE-associated cognitive traits; (iv) determine whether cognitive traits across the idiopathic generalized epilepsy (IGE) spectrum are shared or syndrome-specific, by comparing JAE to juvenile myoclonic epilepsy (JME); and (v) identify relationships between cognitive abilities and clinical characteristics. METHODS We investigated 123 participants: 23 patients with JAE, 16 unaffected siblings of JAE patients, 45 healthy controls, and 39 patients with JME, who underwent a comprehensive neuropsychological test battery including measures within four cognitive domains: attention/psychomotor speed, language, memory, and executive function. We correlated clinical measures with cognitive performance data to decode effects of age at onset and duration of epilepsy. RESULTS Cognitive performance in individuals with JAE was reduced compared to controls across attention/psychomotor speed, language, and executive function domains; those with ongoing seizures additionally showed lower memory scores. Patients with JAE and their unaffected siblings had similar language impairment compared to controls. Individuals with JME had worse response inhibition than those with JAE. Across all patients, those with older age at onset had better attention/psychomotor speed performance. SIGNIFICANCE JAE is associated with wide-ranging cognitive difficulties that encompass domains reliant on frontal lobe processing, including language, attention, and executive function. JAE siblings share impairment with patients on linguistic measures, indicative of a familial trait. Executive function subdomains may be differentially affected across the IGE spectrum. Cognitive abilities are detrimentally modulated by an early age at seizure onset