diplomate of national board, new delhi · web viewpatients with primary generalized tonic clonic...
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Rajiv Gandhi University of Health Sciences, Karnataka,
Bangalore
“COGNITIVE IMPAIRMENT IN EPILEPSY A
CLINICAL STUDY
Name of the candidate : Dr. Siddharth Shetty .A
Guide : Dr. P. John Mathai
Co-Guide :
Course and Subject : M.D. (Psychiatry)
Department of Psychiatry
Father Muller Medical College,
Kankanady, Mangalore – 575002.
AUGUST – 2007
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE
ANNEXURE – II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1. Name of the Candidate
and Address
[in block letters]
DR. SIDDHARTH SHETTY A.
DEPARTMENT OF PSYCHIATRY
FATHER MULLER MEDICAL COLLEGE
KANKANADY
MANGALORE – 575002.
2. Name of the Institution FR. MULLER MEDICAL COLLEGE
KANKANADY
MANGALORE – 575002.
3. Course of study and M.D. PSYCHIATRY
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subject
4. Date of admission to
Course
18 t h APRIL 2007
5. TITLE OF THE TOPIC:
“COGNITIVE IMPAIRMENT IN EPILEPSY
A CLINICAL STUDY”
6.
BRIEF RESUME OF THE INTENDED WORK:
6.1 NEED FOR THE STUDY:
Patients with epilepsy have relatively higher risk for
psychopathology and cognitive impairment. There are several reports
about the cognitive impairment and cognitive deterioration in patients
with epilepsy. In recent years some of the factors underlying the
cognitive deficits l ike attention impairment, intellectual deterioration
and memory deficits have been investigated. There are reports about
cognitive deterioration to suggest possible ‘dementia of epilepsy’. The
research data indicate that the cognitive impairment and deterioration
are due to associated brain damage and not attributable to epilepsy.
There are only a limited number of studies investigating the cognitive
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impairment in patients with uncomplicated epilepsy, with good
seizures control and without obvious structural brain damage. There
have been only a few research reports on cognitive impairment in
patients with uncomplicated epilepsy, with good seizure control and
without obvious structural brain damage. There have been only a few
research reports on cognitive impairment in epilepsy in India.
6.2 REVIEW OF LITERATURE:
Cognitive impairment and cognitive deterioration have been
described as a complication of epilepsy for many years. According to
Trimble and Coworkers 1 there have been accumulating research data
indicating comorbid psychopathology and cognitive impairment in
patients with epilepsy. Other investigators report that preexisting brain
damage while being an important variable, does not entirely explain
the neuropsychological deficits. There appears to be some ‘epileptic
factor’ that contributes to the cognitive impairment in addition to the
brain damage, Perrine and Kiolbasa 2 , reported that a substantial
minority of patients with epilepsy develop cognitive impairment in the
domains of attention concentration, memory, word finding, executive
function and visuo spatial abilit ies.
Lishman 3 observed that patients with symptomatic epilepsy and
those with preexisting brain damage are more l ikely to have cognitive
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and intellectual impairment. There are evidences to indicate that the
intellectual decline is not progressive like in degenerative diseases, it
is st ill uncertain whether epilepsy as such could be responsible for
dementia.
6.3 OBJECTIVES OF THE STUDY:
1. To evaluate the frequency and nature of the cognitive impairment
in patients with epilepsy.
2. To evaluate the relationship between sociodemographic and
clinical variables and cognitive impairment in patients with
epilepsy.
3. To evaluate the quality of life in patients with epilepsy.
7.
MATERIALS AND METHODS:
7.1 SOURCE OF DATA:
The clinical study will be conducted in Father Muller Medical
College, Kankanady, Mangalore. All patients attending the out patient and
in patient facil ities of the department of neurology and psychiatry with a
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clinical diagnosis of epilepsy will constitute the population for the study.
7.2 METHOD OF COLLECTION OF DATA:
The sample for the study will consist of thirty consecutive patients
with epilepsy who satisfy the inclusion and exclusion criteria.
Inclusion Criteria
Male and female patients between the ages of 18 and 50yrs.
Patients with atleast primary school education
Patients with primary generalized tonic clonic epilepsy and complex
partial epilepsy (frontal and temporal lobe epilepsy)
Patients with epilepsy of less than 10 year duration
Exclusion Criteria
Patients with comorbid neuro psychiatric disorders.
Patients with epilepsy secondary to other causes, intractable epilepsy
or with poor seizure control and patients with epilepsy who have
undergone neuro surgical interventions.
Patients with epilepsy having medical disorders like diabetes melli tus,
thyroid and other endocrine disorders and other chronic debilitating
medical conditions known to cause cognitive impairment and patients
on long term regular treatment other than anti epileptic drugs.
Thirty first degree male and female non affected relatives of the
patients between the ages of 18-50yrs without comorbid psychopathology
will constitute the control for the study.
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Type of study – Clinical Analytical study
A written informed consent will be obtained from all patients and the
first degree relatives recruited for the study. The socio demographic and
clinical variables will be recorded in a specific proforma prepared for this
clinical study. All the patients and control will undergo a through clinical
examination to rule out psychopathology and medical disorders if any.
The cognitive functions of all the patients in the clinical sample and all
the subjects in the control group and their quality of life will be assessed
using the following instruments.
Standardized mini mental status examination
Digit symbol substi tution test
Trail making test B
Brief cognitive rating sale.
Short form health survey- 36
The patients with epilepsy will be evaluated during the interictal
period at least six weeks after the last seizure.
Statistics
The results obtained will be analyzed using the following statist ical
methods.
T –test
Chi-square test
Analysis of variable (ANOVA)
7.3 Does the study require any investigations or interventions to be
conducted on patients or other humans or animals? If so, please
describe briefly. – No -
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7.4 Has ethical clearance been obtained from your institution in case
of 7.3 - Yes -
8. LIST OF REFERENCES:
1. Trimble MR, Ring H.A and Schmitz B. Neuro psychiatric aspects
of epilepsy, Baltimore: Williams and Wilkins, 1996, 771-803.
2. Perrine K and Kiolbasa. T. “Cognitive deficits in epilepsy and
contribution to psychopathlogy”. Neurology [Supp 2] 1995; 53:
539-548.
3. Lishman W.A. Organic psychiatry. Ed -3. Oxford: Blackwell
Science Limited, 1998; 237-314.
4. Molloy DW et al. “Reliabili ty of Standardized mini mental status
examination compared with the traditional mini mental status
examination”. American journal of psychiatry 1991;148:102-105.
5. Reisberg B, Ferris SH. “Brief cognitive rating scale BCRS”.
Psychopharmacology bulletin, 1988; 24: 629-636.
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9. SIGNATURE OF THE CANDIDATE:
10. REMARK OF THE GUIDE:
11. NAME AND DESIGNATION OF (in block letters)
11.1 GUIDE DR. P. JOHN MATHAI
PROFESSOR
DEPARTMENT OF PSYCHIATRY
FATHER MULLER MEDICAL
COLLEGE- KANKANADY
MANGALORE-575002
11.2 SIGNATURE
11.3 HEAD OF THE DEPARTMENT
DR. K. KRISHNA MURTHY
PROFESSOR AND HOD
DEPARTMENT OF PSYCHIATRY
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FATHER MULLER MEDICAL
COLLEGE
KANKANADY
MANGALORE-575002
11.4 SIGNATURE
12. 12.1 REMARKS OF THE CHAIRMAN AND DEAN
12.2 SIGNATURE
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