Dados do Trabalho

Título

IMPACT OF COGNITIVE REHABILITATION IN JUVENILE MYOCLONIC EPILEPSY.

Introdução

Executive and attentional deficits are frequently described in JME. Cognitive rehabilitation is defined as any intervention strategy or technique that aims to enable the reduction or compensation of cognitive deficits resulting from a brain insult. The few studies with cognitive rehabilitation in patients with epilepsy are heterogeneous and focus on surgical cases, especially those with Temporal Lobe Epilepsy. To our knowledge, no previous studies addressed cognitive rehabilitation in persons with JME.

Objetivo

We aimed to evaluate the short-term impact of a newly developed rehabilitation protocol on the most frequent cognitive deficits of persons with Juvenile Myoclonic Epilepsy (JME).

Método

Fifty-four patients were invited to participate after neurological and psychiatric evaluation. Forty-two patients agreed with the rehabilitation protocol (12 individual sessions), divided into planning/organization, attention, and impulsivity. Twenty-seven patients finished the protocol, and all patients had pre and post neuropsychological evaluations and responded to self-rating questionnaires. Generalized Estimating Equations (GEE) inferential statistics were used to verify the protocol's effect, and a 95% confidence interval was adopted.

Resultados

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 Scalefor Adults also changed significantly [p ≤ 0.01].

Conclusão

Executive function and attention had an improvement in objective and subjective tests. Impulsiveness improved in instruments based on ecological evaluation. Our findings support that cognitive rehabilitation may be a valuable resource to alleviate cognitive deficits in patients with JME.

Palavras-chave

juvenile myoclonic epilepsy; rehabilitation; cognitive training; executive functions; impulsivity.