Electroencephalographic Correlates of Cognition among Nigerian Women with Epilepsy on Anti-epileptic Monotherapy


  • L Ogunjimi
  • A Alabi
  • B Osalusi
  • A Muritala
  • A Aderinola
  • A Ogunniyi




Anti-Epileptic Drug, Cognition, Electroencephalography, Epilepsy, Nigeria, Women


Background: The prospect of EEG as a potential biomarker for detecting a cognitive decline in those living with epilepsy has not been extensively studied.

Objective: To determine the relationship between electroencephalographic (EEG) changes and cognitive functions in Women with Epilepsy (WWE).

Methods: The study involved 100 adult WWE aged between 16 and 40 years on Levetiracetam (LEV) or Carbamazepine (CAB) monotherapy. Zung Self-Reporting Depression Scale (ZSRDS) was used to assess the mood of participants while the Community Screening Interview for Dementia (CSID) was used to assess various cognition domains.

Results:  The frequency of Periodic Epileptiform Discharges (PED) (p = 0.008), delta waves and theta waves (p = 0.004) were higher in WWE with Cognitive Impairment (CI) compared to those without CI. Lower cognitive scores were seen among those with delta wave across the domains of cognition with statistical significance for language fluency (p = 0.039), language comprehension (p = 0.000), and total CSID (p = 0.000). WWE with PED had a lower mean total CSID score compared to those without PED (p = 0.019). The absence of alpha wave (p = 0.027), presence of delta wave (p = 0.013), slow frequency (p = 0.015) and PED (p = 0.031) were EEG predictors of cognitive impairment. Medication type (p = 0.016) and depression (p = 0.001) were the clinical predictors of cognitive impairment in WWE.

Conclusion: The frequencies of PED and slow waves were higher in WWE with CI while the absence of alpha wave, presence of delta wave and PED were EEG predictors of CI.



Yassine IA, Eldeeb WM, Gad KA, Ashour YA, Yassine IA, Hosny AO. Cognitive functions, electroencephalographic and diffusion tensor imaging changes in children with active idiopathic epilepsy. Epilepsy Behav 2018; 84: 135–141. https://doi.org/10.1016/j.yebeh.2018.04.024

Nemtsas P, Birot G, Pittau F, Michel CM, Schaller K, Vulliemoz S, et al. Source localization of ictal epileptic activity based on high-density scalp EEG data. Epilepsia 2017; 58: 1027–1036. https://doi.org/10.1111/epi.13749

Landi S, Petrucco L, Sicca F, Ratto GM. Transient cognitive impairment in epilepsy. Front Mol Neurosci [Internet]. 2019 Jan 7 [cited 2020 Mar 19];11. https://doi.org/10.3389/fnmol.2018.00458

Höller Y, Butz KHG, Thomschewski AC, Schmid EV, Hofer CD, Uhl A, et al. Prediction of cognitive decline in temporal lobe epilepsy and mild cognitive impairment by EEG, MRI, and Neuropsychology. Comput Intell Neurosci [Internet]. 2020 May 20 [cited 2021 Feb 26]; 2020. https://doi.org/10.1155/2020/891961

Ferrara NC, Trask S, Pullins SE, Helmstetter FJ. The dorsal hippocampus mediates synaptic destabilization and memory lability in the amygdala in the absence of contextual novelty. Neurobiol Learn Mem 2019; 166: 107089. https://doi.org/10.1016/j.nlm.2019.107089

Trammell JP, MacRae PG, Davis G, Bergstedt D, Anderson AE. The relationship of cognitive performance and the Theta-Alpha Power Ratio is age-dependent: An EEG study of short term memory and reasoning during task and resting-state in healthy young and old adults. Front Aging Neurosci [Internet]. 2017 [cited 2021 Feb 28]; 9. Available from: https://www.frontiersin.org/articles/10.3389/fnagi.2017.00364/full

Sánchez-Moguel SM, Alatorre-Cruz GC, Silva-Pereyra J, González-Salinas S, Sanchez-Lopez J, Otero-Ojeda GA, et al. Two different populations within the healthy elderly: Lack of conflict detection in those at risk of cognitive decline. Front Hum Neurosci. 2017; 11: 658. https://doi.org/10.3389/fnhum.2017.00658

Hamson DK, Roes MM, Galea LAM. Sex hormones and cognition: Neuroendocrine influences on memory and learning. Compr Physiol 2016 13; 6: 1295–1337. https://doi.org/10.1002/cphy.c150031

Hirnstein M, Hugdahl K, Hausmann M. Cognitive sex differences and hemispheric asymmetry: A critical review of 40 years of research. Laterality 2019; 24: 204–252. https://doi.org/10.1080/1357650X.2018.1497044

Hyde JS. Sex and cognition: gender and cognitive functions. Curr Opin Neurobiol 2016; 38: 53–56. https://doi.org/10.1016/j.conb.2016.02.007

Wang J, Xiao LD, Wang K, Luo Y, Li X. Gender differences in cognitive impairment among rural elderly in China. Int J Environ Res Public Health 2020; 17: 3724. https://doi.org/10.3390/ijerph17103724

Duarte-Guterman P, Yagi S, Chow C, Galea LAM. Hippocampal learning, memory, and neurogenesis: Effects of sex and estrogens across the lifespan in adults. Horm Behav 2015; 74: 37–52. https://doi.org/10.1016/j.yhbeh.2015.05.024

Rubin LH, Carter CS, Drogos LL, Pournajafi-Nazarloo H, Sweeney JA, Maki PM. Effects of sex, menstrual cycle phase, and endogenous hormones on cognition in schizophrenia. Schizophr Res 2015; 166: 269–275. https://doi.org/10.1016/j.schres.2015.04.039

Huang YH, Chi NF, Kuan YC, Chan L, Hu CJ, Chiou HY, et al. Efficacy of phenytoin, valproic acid, carbamazepine and new antiepileptic drugs on control of late-onset post-stroke epilepsy in Taiwan. Eur J Neurol 2015; 22: 1459–1468. https://doi.org/10.1111/ene.12766

Ogunjimi L, Yaria J, Makanjuola A, Ogunniyi A. Sexual dysfunction among Nigerian women with epilepsy. Epilepsy Behav 2018; 83: 108–112. https://doi.org/10.1016/j.yebeh.2018.02.004

Hirsch LJ, LaRoche SM, Gaspard N, Gerard E, Svoronos A, Herman ST, et al. American Clinical Neurophysiology Society’s Standardized Critical Care EEG Terminology: 2012 version. J Clin Neurophysiol 2013; 30: 1–27. https://doi.org/10.10197/WNP.0b013e3182784729

Beniczky S, Hirsch LJ, Kaplan PW, Pressler R, Bauer G, Aurlien H, et al. Unified EEG terminology and criteria for nonconvulsive status epilepticus. Epilepsia 2013; 54 (Suppl 6): 28–29. https://doi.org/10.1111/epi.12270

Maganti RK, Rutecki P. EEG and epilepsy monitoring. Continuum (Minneap Minn) 2013; 19: 598–622. https://doi.org/10.1212/01.CON.0000431378.51935.d8

Bermeo-Ovalle A. Bringing EEG back to the future: Use of cEEG in Neurocritical Care. Epilepsy Curr 2019; 19: 243–245. https://doi.org/10.1177/1535759719858350

Hall KS, Gao S, Emsley CL, Ogunniyi AO, Morgan O, Hendrie HC. Community screening interview for dementia (CSI ’D’); performance in five disparate study sites. Int J Geriatr Psychiatry 2000; 15: 521–531. https://doi.org/10.1002/1099-1166(200006) 15

Jokelainen J, Timonen M, Keinänen-Kiukaanniemi S, Härkönen P, Jurvelin H, Suija K. Validation of the Zung self-rating depression scale (SDS) in older adults. Scand J Prim Health Care 2019; 37: 353–357. https://doi.org/10.10197/WNP.0b013e3182784729

Dunstan DA, Scott N. Clarification of the cut-off score for Zung’s self-rating depression scale. BMC Psychiatry 2019; 19: 177. https://doi.org/10.1186/s12888-019-2161-0

Dunstan DA, Scott N, Todd AK. Screening for anxiety and depression: reassessing the utility of the Zung scales. BMC Psychiatry 2017; 17: 329. https://doi.org/10.1186/s12888-017-1489-6

Sunmonu TA, Komolafe MA, Ogunrin AO, Ogunniyi A. Cognitive assessment in patients with epilepsy using the Community Screening Interview for Dementia. Epilepsy Behav 2009; 14: 535–539. https://doi.org/10.1186/s12888-019-2161-0

Lin L, Drislane FW. Lateralized Periodic Discharges: A Literature Review. J Clin Neurophysiol 2018; 35:189–198. https://doi.org/10.1097/WNP.0000000000000448

Hartl E, Rémi J, Stoyke C, Noachtar S. What is the “L” in LPDs? Localized as well as lateralized. Acta Neurologica Scandinavica 2017; 136: 160–163. https://doi.org/10.1111/ane.12730

Johnson L, Yao J, Zou L, Xiao T, Loprinzi PD. Mental Imagery and acute exercise on episodic memory function. Brain Sci 2019; 9: 237. https://doi.org/10.3390/brainsci9090237

Horvath AA, Csernus EA, Lality S, Kaminski RM, Kamondi A. Inhibiting epileptiform activity in cognitive disorders: Possibilities for a novel therapeutic approach. Front Neurosci [Internet]. 2020 Oct 15 [cited 2021 Feb 28];14. https://doi.org/10.3389/fnins.2020.557416.

Löscher W, Gillard M, Sands ZA, Kaminski RM, Klitgaard H. Synaptic Vesicle Glycoprotein 2A ligands in the treatment of epilepsy and beyond. CNS Drugs 2016; 30: 1055–1077. https://doi.org/10.1007/s40263-016-0384-x

Perini G, Cotta Ramusino M, Sinforiani E, Bernini S, Petrachi R, Costa A. Cognitive impairment in depression: recent advances and novel treatments. Neuropsychiatr Dis Treat 2019; 15: 1249–1258. https://doi.org/10.2147/NDT.S199746

Polito L, Davin A, Vaccaro R, Abbondanza S, Govoni S, Racchi M, et al. Serotonin transporter polymorphism modifies the association between depressive symptoms and sleep onset latency complaint in elderly people: results from the “InveCe.Ab” study. J Sleep Res 2015; 24: 215–222. https://doi.org/10.1111/jsr.12248

Margoob MA, Mushtaq D. Serotonin transporter gene polymorphism and psychiatric disorders: Is there a link? Indian J Psychiatry 2011; 53: 289–299. https://doi.org/10.4103/0019-5545.91901






Original Research