Frontal lobe cognitive functions and electroencephalographic features in juvenile myoclonic epilepsy Senem Sezikli a,1 , Tuğba Argün Pulat a, ⁎ ,1 , Betül Tekin a , Pelin Doğan Ak b , Cahit Keskinkılıç a,2 , Dilek Ataklı a a Bakirkoy Research and Training Hospital for Psychiatry, Neurology, Neurosurgery, Department of Neurology, Istanbul, Turkey b Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey abstract article info Article history: Received 21 November 2017 Revised 3 June 2018 Accepted 6 June 2018 Available online xxxx Purpose: The study aimed to examine the relationship between frontal lobe functions and interictal electroen- cephalography (EEG) discharge characteristics of patients with juvenile myoclonic epilepsy (JME). Method: Thirty patients with JME who had EEG with asymmetrical generalized discharge (aEEG), 15 patients with JME who had EEG with symmetrical generalized discharge (sEEG), and 15 healthy controls were included in the study. To evaluate attention, the digit span and Corsi block tests were used; to evaluate memory, we ap- plied verbal and visual memory tests; to evaluate frontal lobe functions, we used clock drawing, verbal fluency, the Stroop test, trail making, mental control, and antisaccadic eye movement tests as well as the continuous per- formance (CPT) tests. Ethical Considerations: The research was approved by the Research Ethics Committee of the Bakirkoy Research and Training Hospital for Psychiatry, Neurology, Neurosurgery, with protocol number: 41340010/4891-262, date: 05.02.2013. Results: The mean age of the 45 patients with JME was 22.89 ± 6.77 years, and 34 (75.6%) were female. The age at onset of seizures and disease duration of the patients with JME was 15.56 ± 4.06 years (range, 9–26 years) and 7.20 ± 5.59 years (range, 1–25 years), respectively. All patients were under valproate (VPA) treatment, and the mean VPA dosage was 783.33 ± 379.14 mg/day. Patients with JME scored worse than the control group in atten- tion, memory, and frontal lobe functions. In patients with aEEG, scores of attention, memory, and frontal lobe function tests were lower than in patients with sEEG; however, with the exception of CPT, they were not statis- tically significant. Conclusion: Cognitive functions in JME have been shown to be impaired. Furthermore, we concluded that the frontal lobe cognitive functions may be worse in patients with aEEG than in patients with sEEG. Further studies in patients with JME with aEEG abnormalities may lead to a better understanding of the pathophysiology of JME. © 2018 Elsevier Inc. All rights reserved. Keywords: Epilepsy JME EEG Cognitive functions 1. Introduction Juvenile myoclonic epilepsy (JME) is an idiopathic generalized epilepsy (IGE) syndrome characterized by myoclonia, absence, and gen- eralized tonic–clonic seizures (GTCS) [1]. Ictal and interictal electroen- cephalography (EEG) demonstrates fast, generalized, usually irregular wave and spike and polyspike and wave discharge activities [1,2]. Fur- ther focal or asymmetric abnormalities on EEG occur in approximately 30–40% of patients [3,4]. Photosensitivity is frequently seen, and the re- sponse to appropriate drug treatment is generally good [5]. In recent years, it is emphasized that patients with JME are affected by cognitive functions. Sonmez and Ataklı demonstrated cognitive im- pairment in patients with JME compared with healthy subjects [6]. Piazzini et al. found that the tests they designed for the evaluation of frontal lobe cognitive functions of patients with JME determined cognitive impairment similar to patients with JME when applied to patients with frontal lobe epilepsy [7]. The most important risk fac- tors for the cognitive impairment were reported as age at seizure onset, family history, and the existence of absence seizures. The rela- tion between the cognitive impairment and existence of spike–wave discharges on EEG was not exactly understood [8]. Demir et al. dem- onstrated that frontal lobe functions were important for provoking the EEG discharges [9]. We aimed to investigate whether the frontal lobe was more affected, and if so, which functions were affected more prominently in patients whose EEGs showed persistent asymmetry for a particular side. Epilepsy & Behavior xxx (2018) xxx–xxx ⁎ Corresponding author at: Bakirkoy Research and Training Hospital for Psychiatry, Neurology, Neurosurgery, Department of Neurology, Bakırköy, 34147 Istanbul, Turkey. E-mail address: lucteria81@hotmail.com (T.A. Pulat). 1 First (SS) and second authors (TP) have contributed equally in this study. 2 Neuropsychologist. YEBEH-05842; No of Pages 6 https://doi.org/10.1016/j.yebeh.2018.06.009 1525-5050/© 2018 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Epilepsy & Behavior journal homepage: www.elsevier.com/locate/yebeh Please cite this article as: Sezikli S, et al, Frontal lobe cognitive functions and electroencephalographic features in juvenile myoclonic epilepsy, Ep- ilepsy Behav (2018), https://doi.org/10.1016/j.yebeh.2018.06.009