The effectiveness of cognitive rehabilitation for attention deficits in focal seizures: a randomized controlled study.
OBJECTIVE
Cognitive deficits are one of the major limiting factors in the everyday life functioning of patients with focal seizures. Although cognitive rehabilitation methods have been successfully applied to patients with other central nervous system (CNS) lesions, these methods have not yet been evaluated in cognitively impaired patients with epilepsy. The present study evaluated the effectiveness of two commonly used methods for attention deficits: (a) the Retraining Method, aimed at retraining impaired cognitive functions; and (b) the Compensation Method, aimed at teaching compensatory strategies while taking neuronal loss for granted.


METHODS
Fifty adult outpatients with focal seizures and attention impairments receiving carbamazepine (CBZ) monotherapy were randomly assigned to the Retraining Method, the Compensation Method, or to a waiting-list control group. Established and self-reported neuropsychological outcomes and self-reported quality of life of these groups were evaluated at pretraining, posttraining, and at a 6-month follow-up measurement point and were completed by 44 patients.


RESULTS
Neuropsychological outcomes related to training, self-reported neuropsychological outcomes, and quality of life at the 6-month follow-up measurement point improved both in the Retraining Method group (n = 19) and the Compensation Method group (n = 17) relative to the waiting-list control group (n = 8). The Compensation Method was more effective in improving self-reported neuropsychological outcomes and quality of life, especially for patients with less education. The patients with active epilepsy benefited more from both methods than did the seizure-free patients.


CONCLUSIONS
These data show that cognitive rehabilitation programs are effective for patients with focal seizures and attention deficits and should, therefore, be incorporated into comprehensive care programs.
Engelberts
Nadine H J
NH
Dutch Epilepsy Clinics Foundation, Heemstede, The Netherlands. nengelberts@sein.nl
Klein
Martin
M
Adèr
Herman J
HJ
Heimans
Jan J
JJ
Trenité
Dorothée G A Kasteleijn-Nolst
DG
van der Ploeg
Henk M
HM
D000293:Adolescent; D000328:Adult; D000368:Aged; D001288:Attention / Q000502:physiology; D001921:Brain / Q000502:physiology / Q000503:physiopathology; D003072:Cognition Disorders / Q000503:physiopathology / Q000534:rehabilitation* / Q000628:therapy; D004828:Epilepsies, Partial / Q000150:complications* / Q000534:rehabilitation; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008297:Male; D008568:Memory / Q000502:physiology; D008875:Middle Aged; D009473:Neuronal Plasticity / Q000502:physiology; D009483:Neuropsychological Tests; D017063:Outcome Assessment, Health Care; D011788:Quality of Life; D013813:Therapy, Computer-Assisted / Q000379:methods; D016896:Treatment Outcome