Cognitive Impairment in Drug-resistant and Drug-responsive Focal Cryptogenic Epilepsy

To evaluate the prevalence of cognitive impairment in a population of focal cryptogenic epilepsy patients, comparing subjects diagnosed with DRE (drug resistant epilepsy) and subjects diagnosed with DSE (drug sensitive epilepsy);

At baseline, DRE and DSE patients will undergo a screening and comprehensive cognitive battery. We will adopt the following scales: EpiTrack screening battery; Rey Auditory Verbal Learning Test and with the Rey's figure recall; Token Test; Paced Auditory Serial Addition Test; Modified Card Sorting Test; Cognitive Estimation Task; Rey's figure copy, Beck Depression Inventory, Dimensional Apathy Scale, 12-item Short Form Survey. The suspect of cognitive impairment (CI) will be defined with EpiTrack screening battery (score \< 32 points indicates CI). This will be confirmed by the comprehensive battery (Level II): Impairment should be present on at least 2 tests. For each test, impairment will be demonstrated with performances below appropriate normative values. Since the classification for CI is not yet defined for epilepsy we will adopt the classification for Parkinson's disease which, as patients with epilepsy, mainly have disturbances in executive, attentive and memory functioning.

To monitor the evolution of cognitive performance in DRE patients over a period of one year;

we evaluate the cognitive state of the patients with the measures and scales listed in "Outcome 1" at 12 months and compare the results to the baseline results.

To evaluate whether seizure frequency constitute the main determinant of cognitive impairment;

We evaluate if patients who reduced the seizure frequence over a period of 12 months showed an improvement in the cognitive assesment, comparing baseline assesment and the follow up assesment at 12 months.

To explore EEG-markers of DRE and DSE

High-density EEGs, with a duration of 20 minutes, will be acquired in resting awake conditions on a computer-based system (Micromed System PLUS, Micromed S.p.A., Mogliano Veneto, Italy) from 32 surface electrodes, placed on an EEG cap according to the international 10/20 system, with linked-ear or mesial prefrontal reference. Vigilance will be continuously monitored in order to avoid drowsiness. EEG will be performed to investigate patterns of cortical sources and functional connectivity alteration in the two different groups od DRE and DSE.

To evaluate longitudinal evolution of cognitive performances in patients newly diagnosed with focal cryptogenic epilepsy (NDE)

At baseline, NDE patients will undergo a screening and a comprehensive cognitive battery in order to define performance differences among groups. The NDE patients groups only will perform the same neuropsychological assessment at month 6 and 12 for monitoring the potential progression of cognitive and/or behavioral disturbances in these patients. We will use the same neuropsychological scales listed in "Outcome 1".

To evaluate longitudinal evolution of drug responsiveness in patients newly diagnosed with focal cryptogenic epilepsy (NDE)

We evaluate if over a period of 6 and 12 months the patients of NDE groups have showed drug responsiveness, assessed as "reduction of number of seizure per month", compared to the baseline data.