Do generalized epilepsies exhibit more attentional or executive disorders?

This study aimed to characterize attentional and executive dysfunctions in patients with genetic generalized epilepsies (GGE), using specific and validated neuropsychological tools. Secondary objectives included estimating the prevalence of cognitive impairments and exploring potential clinical and psychosocial determinants. A total of 69 adult patients with GGE were enrolled in this multicentric observational study. Participants completed screening questionnaires for anxiety and depression and underwent a battery of neuropsychological tests assessing four attentional components (alertness, sustained, selective, and divided attention), executive functions (flexibility, inhibition, verbal initiation and auditory working memory). Attentional and executive impairments were highly prevalent, affecting approximately 60-64 % of the cohort. Divided attention was the most frequently impaired attentional component (44.93 %), while mental flexibility was the most commonly affected executive function (39.68 %). Selective and sustained attention were relatively preserved. Working memory manipulation was impaired in 17.4 % of patients. Cognitive performance was weakly influenced by clinical and psychosocial factors. Anxiety or depression was associated with poorer divided attention, epilepsy duration with lower selective attention, and education and number of anti-seizure medications with better performance across selective, sustained, and executive attention domains. These findings highlight the need for targeted neuropsychological assessments in GGE, prioritizing divided attention and flexibility. Since divided attention reflects both attentional control and working memory interventions focusing on working memory may offer greater clinic utility. Given the scarcity of studies on cognition rehabilitation in epilepsy, further research is needed, particularly on divided attention as a potential cognitive remediation target.