Abstract
Neuropsychological approach to epilepsy is indispensable to assess cognitive function in an interictal period, to disclose the semiology of non-convulsive status epilepticus, and to identify a seizure-precipitating factor. We have investigated the 3 rd point by loading systematic cognitive tasking, termed “neuropsychological EEG activation (NPA), ” during standard EEG recordings. NPA tasks consisted of reading, speaking, writing, written calculation, mental calculation, and spatial construction. The NPA tasks provoked epileptic discharges in 7.9% of the 480 epileptic patients and were often accompanied by myoclonic seizures. Seizure-precipitating mental activities were almost exclusively related to idiopathic generalized epilepsies (IGEs). Based on the results of various tasks, 2 forms of precipitating factors were identified: (1) action-programming activity, which is a higher mental activity associated with use ofthe hands (e. g., writing, written calculation, and block design test), and (2) thinking activity, which is a higher mental activity not requiring hand movements (e. g., making a sentence in mind, and mental rotation). These results surggest that NPA is a useful tool for examining the relationship between cognitive function and epileptic seizures, and that the IGE patients with myoclonic seizures are vulnerable to higher mental activity. We also discussed the classification of reflex epilepsy induced by higher mental activity.
