Among those with new onset focal epilepsy, migraine comorbidity has shown no correlation with objective cognitive scores, according to a study published in Epilepsy and Behavior. Symptoms of depression and anxiety may have a mediating effect on the association between subjective memory deficit and migraine comorbidity among those with epilepsy and comorbid migraine.
This post hoc analysis included 349 participants with newly diagnosed focal epilepsy, all of whom were recruited for the Human Epilepsy Project. Participants were screened for migraine via the 13-question American Migraine Prevalence and Prevention (AMPP) study, for anxiety via the Generalized Anxiety Disorder-7 scale, and for depression via the Center for Epidemiologic Studies Depression Scale and Neurological Disorder Depression Inventory for Epilepsy. The Cogstate Brief Battery and Aldenkamp–Baker Neuropsychological Assessment Schedule (ABNAS) was used to assess cognition. Objective and subjective cognitive scores constituted the primary outcomes. The Kolmogorov-Smirnov test was used to examine data distribution and linear regression. The Mann Whitney U test and chi-squared test were used to evaluate nonparametric data.
Migraine was diagnosed among 21.2% (n=74) of those with focal epilepsy. Compared with participants without comorbid migraine, those with migraine were more likely to be women (75.7% vs 55.6%; P =.0018), less likely to have full-time employment (50% vs 66.2%; P =.011), more likely to have symptoms of depression (P =.0037), and more likely to have symptoms of anxiety (P =.039), although anxiety was minimally reported. An association was also identified between migraine comorbidity and ABNAS memory score (P =.015), though no association was found between migraine comorbidity and Cogstate or ABNAS total/domain scores. ABNAS memory score was associated with depression (beta 0.16; significance 0.028) and anxiety (beta 0.37; significance 2.06E−7).
Limitations of this study included post hoc design, reliance on questionnaires for diagnosis, lack of accounting for migraine aura, and lack of data on antiepileptic medications and headache/seizure frequency.
Study researchers concluded that “[among] patients with newly diagnosed focal epilepsy, migraine comorbidity is associated with more subjective memory complaints, though this relationship is likely more clearly related to the degree of affective distress rather than to more primary factors related to migraine.”
This study received financial support from UCB Pharma, Eisai, Pfizer, Lundbeck, and Sunovion. Several authors report financial associations with pharmaceutical companies.
Begasse de Dhaema OAJ, French J, Morrison C, et al. Migraine comorbidity and cognitive performance in patients with focal epilepsy [published online June 7, 2019]. Epilepsy Behav. doi: 10.1016/j.yebeh.2019.05.008