A cognitive rehabilitation program to improve hot and cool executive dysfunction in juvenile myoclonic epilepsy: Preliminary findings

• Published in: Epilepsy & behavior Vol. 144; p. 109281
• Main Authors: Luisa Maia Nobre Paiva, Maria, Serafim, Antônio, Vincentiis, Silvia, Alessi, Ruda, Marin, Rachel, Braga Melo, Marcio, Valente, Kette D.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-07-2023
• Subjects: Cognitive training; Executive functions; Impulsivity; Juvenile myoclonic epilepsy; Rehabilitation; Executive functions; Cognitive training; Impulsivity; Rehabilitation; Juvenile myoclonic epilepsy
• ISSN: 1525-5050; 1525-5069
• DOI: 10.1016/j.yebeh.2023.109281

•This is the first study of cognitive rehabilitation in Juvenile Myoclonic Epilepsy.•A new protocol was created to address four domains of attention and Executive Functions of persons with JME.•Our results demonstrate improved working memory, mental flexibility, inhibitory control, and selective attention in objective measures and self-report questionnaires.•Cognitive rehabilitation may be a promising resource to ease cognitive deficits.
Executive and attentional deficits are often described in Juvenile Myoclonic Epilepsy (JME). We aimed to evaluate the short-term impact of rehabilitation developed for the most frequent cognitive deficits of persons with JME.
Thirty-three patients entered this study which consisted of 12 individual sessions once a 60-minute week, divided into planning/organization, attention, and impulsivity. Twenty-seven patients finished the protocol, and all patients had pre-and-post evaluations from neuropsychological tests and self-rating questionnaires. Generalized Estimating Equations (GEE) inferential statistics were used to verify the protocol's effect, and a 95% confidence interval was adopted.
We found significant improvement in selective attention (TMT A [p < 0.01] and Stroop test 2 [p = 0.03]), inhibitory control (Stroop test 3 [p = 0.02], FAS [p < 0.01], CPT commissions [p < 0.01]), mental flexibility [WCST categories p < 0.01] and implicit decision making (IGT blocks A [p < 0.01], B [p = 0.02], C [p < 0.01] and D [p < 0.01]). All components of the Behavioral Rating Index of Executive Functions metacognition index and the general quotient had significant improvement (initiative [p ≤ 0.01], working memory [p ≤ 0.01], planning and organization [p ≤ 0.01], task monitor [p = 0.02] and organization of materials [p = 0.02]). Regarding the Behavioral Regulation Index, the “Emotional Control” was improved [p = 0.03]. The attentional component and general scores of the Adult Self-Report Scale for Adults also changed significantly [p ≤ 0.01].
Executive function and attention had an improvement in objective and subjective tests. The context-dependent reactive mechanism of impulsivity improved in instruments based on the ecological evaluation. Our findings, though preliminary due to a lack of controls and practice effect corrections, support that cognitive rehabilitation may be a valuable resource to alleviate cognitive deficits in patients with JME.