Abstract Details

Title Cognitive-metabolic Correlations in Temporal Lobe Epilepsy: A Systematic Review

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P7 - Poster Session 7 (8:00 AM-9:00 AM)

Poster/Presentation
Number 11-009

Objective Evaluate the link between neurometabolic dysfunction and cognitive impairment in Temporal lobe epilepsy (TLE)

Background TLE is the most common focal epilepsy, affecting over 40 million individuals worldwide. While drug-resistant seizures drive much of the morbidity, cognitive decline contributes to disability and is poorly understood. Increasing evidence suggests that neurometabolic dysfunction contributes to this impairment. Characterizing metabolic changes in patients with TLE and cognitive impairment may identify biomarkers and inform new treatment strategies.

Design/Methods We conducted a systematic review of EMBASE, MEDLINE, CINAHL, PsycINFO, and Scopus through December 2024, in line with PRISMA guidelines. We included all observational studies correlating metabolic imaging in temporal lobe epilepsy with cognitive impairment. Data on metabolic alterations and their relationship to cognitive performance was extracted.

Results

Of 1449 reports, 38 met inclusion criteria, encompassing 1441 patients aged 5–66 years. Most had drug-resistant epilepsy with seizure frequencies ranging from seizure-free to 18 per month. Twenty-four studies used positron emission tomography, most frequently fluorodeoxyglucose (FDG)-positron emission tomography (22 studies, 885 subjects), to measure glucose metabolism. Other tracers assessed synaptic density and β-amyloid deposition. Fourteen studies used proton magnetic resonance spectroscopic imaging to measure metabolites including N-acetylaspartate (NAA), creatine (Cr), choline (Cho), and gamma-aminobutyric acid (GABA). Common markers included Cr/NAA and NAA/(Cho+Cr). Reported alterations correlated with global cognition, verbal and visual memory, working memory, attention, executive function, and language. Some markers were also linked to depression, an important confounder. Most studies focused on the temporal lobe and its subregions; fewer reported changes in frontal lobes, insula, fusiform gyrus, or precuneus.

Conclusions Across imaging modalities, altered glucose metabolism, metabolite ratios, and synaptic density were linked to various cognitive changes in TLE. Verbal memory specifically was commonly affected. These neurometabolic signatures hold promise as biomarkers for identifying patients at risk of cognitive decline and could represent potential targets for future therapeutic intervention.

Authors/Disclosures
Mathias Maisenbacher, MD PRESENTER	Dr. Maisenbacher has nothing to disclose.
Ola Alshaqi, MD	Dr. Alshaqi has nothing to disclose.
Xiaohan Peng, MD	Dr. Peng has nothing to disclose.
Cynthia M. Schmidt, MD, MD, MLS	Dr. Schmidt has received personal compensation in the range of $500-$4,999 for serving as a reviewer of the quality of journals applying for inclusion in PubMed Central with BLH Technologies.
Olha Taraschenko, MD, PhD (University of Nebraska Medical Center)	The institution of Dr. Taraschenko has received research support from NIH. The institution of Dr. Taraschenko has received research support from DHSS LB606 Nebraska Stem Cell Grant . Dr. Taraschenko has received personal compensation in the range of $0-$499 for serving as a Speaker with AES.

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