Complex executive functions assessed by the trail making test (TMT) part B improve more than those assessed by the TMT part A or digit span backward task during vagus nerve stimulation in patients with drug-resistant epilepsy.

Autor:	Lähde N; Department of Neurology, Tampere University Hospital, Tampere, Finland.; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland., Basnyat P; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland., Raitanen J; Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland.; UKK Institute for Health Promotion Research, Tampere, Finland., Kämppi L; Epilepsia Helsinki, Member of EpiCARE ERN, Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland., Lehtimäki K; Department of Neurosurgery, Tampere University Hospital, Tampere, Finland., Rosti-Otajärvi E; Department of Neurology, Tampere University Hospital, Tampere, Finland.; Department of Rehabilitation and Psychosocial Support, Tampere University Hospital, Tampere, Finland., Peltola J; Department of Neurology, Tampere University Hospital, Tampere, Finland.; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Jazyk:	angličtina
Zdroj:	Frontiers in psychiatry [Front Psychiatry] 2024 Feb 14; Vol. 15, pp. 1349201. Date of Electronic Publication: 2024 Feb 14 (Print Publication: 2024).
DOI:	10.3389/fpsyt.2024.1349201
Abstrakt:	Introduction: There is a paucity of clinical studies examining the long-term effects of vagus nerve stimulation (VNS) on cognition, although a recent study of patients with drug-resistant epilepsy (DRE) treated with VNS therapy demonstrated significant improvement in executive functions as measured by the EpiTrack composite score. The present study aimed to investigate performance variability in three cognitive tests assessing executive functions and working memory in a cohort of DRE patients receiving VNS therapy during a follow-up duration of up to 5 years. Methods: The study included 46 DRE patients who were assessed with the Trail Making Test (TMT) (Parts A and B) and Digit Span Backward (DB) task prior to VNS implantation, 6 months and 12 months after implantation, and yearly thereafter as a part of the clinical VNS protocol. A linear mixed-effects (LME) model was used to analyze changes in test z scores over time, accounting for variations in follow-up duration when predicting changes over 5 years. Additionally, we conducted descriptive analyses to illustrate individual changes. Results: On average, TMT-A z scores improved by 0.024 units (95% confidence interval (CI): 0.006 to 0.042, p  = 0.009), TMT-B z scores by 0.034 units (95% CI: 0.012 to 0.057, p  = 0.003), and DB z scores by 0.019 units per month (95% CI: 0.011 to 0.028, p  < 0.001). Patients with psychiatric comorbidities achieved the greatest improvements in TMT-B and DB z scores among all groups (0.0058 units/month, p  = 0.036 and 0.028 units/month, p  = 0.003, respectively). TMT-A z scores improved the most in patients taking 1-2 ASMs as well as in patients with psychiatric comorbidities (0.042 units/month, p  = 0.002 and p  = 0.003, respectively). Conclusion: Performance in all three tests improved at the group level during the follow-up period, with the most robust improvement observed in TMT-B, which requires inhibition control and set-switching in addition to the visuoperceptual processing speed that is crucial in TMT-A and working-memory performance that is essential in DB. Moreover, the improvement in TMT-B was further enhanced if the patient had psychiatric comorbidities. Competing Interests: NL has participated in a clinical trial for UCB; received speaker’s honoraria from LivaNova (OmaMedical). LK has received speaker’s honoraria from UCB, Merck, and Eisai; received support for travel to congress from UCB and Angelini Pharma. KL has received speaker’s honoraria from Medtronic. ER-O has received speaker’s honoraria from Novartis and Biogen. JP has participated in clinical trials for Eisai, UCB, and Bial; received research grants from Angelini Pharma, Eisai, Medtronic, UCB, and LivaNova; received speaker’s honoraria from LivaNova, Angelini Pharma, Eisai, Jazz Pharma, Medtronic, Orion Pharma, and UCB; received support for travel to congresses from LivaNova, Eisai, Medtronic, and UCB; and participated in advisory boards for LivaNova, Angelini Pharma, Jazz Pharma, Eisai, Medtronic, UCB, and Pfizer. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2024 Lähde, Basnyat, Raitanen, Kämppi, Lehtimäki, Rosti-Otajärvi and Peltola.)
Databáze:	MEDLINE
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