Thesis (Ph.D.) - Cairo University - Faculty of Medicine- Department of Neuropsychiatry

as been reported with significant impairment on tests of frontal functioning. The JME group had poor performance on tests requiring concept formation and mental flexibility, and had difficulties in focusing attention and inhibiting habitual response sets. Cognitive correlates of JME have received little attention despite the extensive studies of cognition in other types of epilepsy. Aim of work: Study the cognitive performance in patients with JME. Determine the relation between neuroanatomical/neurophysiological abnormalities, and epileptic clinical characteristics with the cognitive performance in patients with JME. Methods: Fifty patients with JME and a sample of healthy controls were assessed using a series of neuropsychological tests as well as diffusion tensor MRI (DTI) and tractography. DTI measures assessed fractional anisotropy (FA) within a white matter skeleton. Results: Cognitive testing indicated subtle dysfunction in verbal learning and memory, phonemic and semantic fluency, attention, speed and mental flexibility. Using white matter diffusion MRI data, we found reductions in FA in underlying white matter of the left anterior corpus callosum, right supplementary motor area and left anterior cingulate. Reduced FA in the left anterior corpus callosum predicted uncontrolled generalized tonic-clonic convulsions (GTCs). As well as reduced FA in the left anterior corpus callosum and left anterior cingulate predicted uncontrolled myoclonus. Conclusion: Patients with JME had lower cognitive performance in verbal learning and memory, attention, speed and mental flexibility, which was associated with white matter cortical/subcortical microstuctural alterations. Uncontrolled GTCs is an important predictor of lower cognitive performance between JME patients. As well as a cortical/subcortical alterations being a predicting factor for uncontrolled GTCs and Myoclonus

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