EpiTrack: Direct and indirect role in the assessment of executive functions and memory – Systematic review

Cognitive impairment is a common comorbidity in epilepsy, negatively affecting patients’ quality of life. Although various treatments—antiepileptic drugs (AEDs), vagus nerve stimulation (VNS), and surgery—may influence cognition, comparative data on their effects on executive functions and memory remain limited. This systematic review aimed to evaluate studies assessing the impact of these treatments on executive functions and memory using the EpiTrack cognitive screening tool. A systematic search identified 1,008 publications, of which 35 full-text articles were reviewed. After applying inclusion criteria, seven studies were included, examining cognitive changes in patients undergoing various treatments. Perampanel and Cenobamate exhibited a neutral cognitive profile, with scores stable at “moderate impairment” (29.67–30.04). Lamotrigine and Levetiracetam demonstrated persistent severe impairment. Brivaracetam improved from severe to moderate impairment (not clinically significant). Only Topiramate showed a clinically significant decline (30.0 to 26.6). VNS therapy led to slight improvement over five years (severe to moderate impairment), while combined VNS + 1–2AEDs produced clinically meaningful gains. In contrast, VNS with 3–4 AEDs maintained severe impairment. This review underscores the importance of accurate cognitive assessment in epilepsy management, with a monitoring frequency of no more than every six months for patients receiving AED therapy.

认知功能损害（Cognitive Impairment）是癫痫常见的共患病，可显著降低患者的生活质量。尽管现有多种治疗手段——抗癫痫药物（antiepileptic drugs, AEDs）、迷走神经刺激术（vagus nerve stimulation, VNS）以及外科手术——均可能对认知功能产生影响，但目前关于这些治疗方式对执行功能与记忆的影响的比较性研究数据仍较为有限。本系统综述旨在评估采用EpiTrack认知筛查工具，探究上述治疗手段对执行功能和记忆影响的相关研究。通过系统文献检索共获取1008篇出版物，其中35篇经全文审阅。在应用纳入标准筛选后，最终纳入7项研究，考察接受不同治疗方案的癫痫患者的认知功能变化情况。吡仑帕奈（Perampanel）与塞诺巴马特（Cenobamate）表现出中性的认知影响特征，患者评分稳定处于"中度损害"区间（29.67~30.04）。拉莫三嗪（Lamotrigine）与左乙拉西坦（Levetiracetam）则呈现出持续性重度认知损害。布瓦西坦（Brivaracetam）可使患者认知损害程度从重度改善至中度，但该变化无临床显著性意义。仅托吡酯（Topiramate）表现出具有临床显著性意义的认知功能下降（评分从30.0降至26.6）。迷走神经刺激术治疗可使患者在5年内出现轻度认知改善（从重度损害进展至中度损害），而联合迷走神经刺激术+1~2种抗癫痫药物的治疗方案可带来具有临床意义的认知获益。与之相反，联合迷走神经刺激术+3~4种抗癫痫药物的患者则持续处于重度认知损害状态。本综述强调了在癫痫管理中开展精准认知评估的重要性，对于接受抗癫痫药物治疗的患者，其认知监测频率不应超过每6个月一次。