Association between serum apolipoprotein E and cognitive functions in Egyptian patients with temporal lobe epilepsy

  • Iman Elbanhawy
  • Ebtesam Mohamed Fahmy
  • Sahar Sharaf
  • Rania Shehata IsmailEmail author
  • Karim Elmehdawy
Original article


Memory, cognition and visuospatial aspects of temporal lobe epilepsy (TLE) have not been fully analyzed yet. From among the huge growing population of circulating apoproteins analyzed in TLE, apolipoprotein E (APOE) was discovered; however, its role in TLE has not been fully elucidated yet. This study was designed to investigate the relation between the serum level of APOE and cognition in TLE patients. Sixty-five subjects (35 TLE patients and 30 healthy matched controls) were included. Evaluation of cognitive functions was done using Addenbrooke’s Cognitive Examination Revised (ACE-R) scale. Serum APOE level was measured by ELISA. The mean total score, memory and visuospatial scores of ACE-R were significantly lower in TLE patients compared to healthy subjects. The mean total score and memory score of ACE-R were significantly lower in seizures originating from mesial temporal lobe (MTL) and left temporal lobe seizures. Serum APOE levels were significantly higher in TLE patients compared to healthy subjects. Serum APOE levels significantly negatively correlated with total score, memory, and visuospatial ability scores of ACE-R. Serum APOE was significantly higher in MTL seizures compared to lateral lobe seizures and in left temporal lobe seizures compared to right temporal seizures. Memory and visuospatial aspects were significantly affected in TLE patients. So, the serum APOE level can possibly contribute to cognitive dysfunction in such patients.


Cognition Temporal lobe epilepsy Apolipoprotein E 



The authors acknowledge subjects for their participation and cooperation in this study.

Author contributions

EE: research conception, EF: research idea and conception, data acquisition, data analysis and interpretation, and manuscript writing and reviewing, SS: performing and reviewing the laboratory workup, RSI: data interpretation, manuscript writing and reviewing, KE: data acquisition, data analysis and interpretation.


This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that the research was conducted in absence of any commercial relationships that could be construed as a potential conflict of interest.


  1. 1.
    Cavalleri GL, Lynch JM, Depondt C, Burley MW, Wood NM, Sisodiya SM, Goldstein DB (2005) Failure to replicate previously reported genetic associations with sporadic temporal lobe epilepsy: where to from here? Brain 128:1832–1840CrossRefGoogle Scholar
  2. 2.
    Gee JR, Keller JN (2005) Astrocytes: regulation of brain homeostasis via apolipoprotein E. Int J Biochem Cell Biol 37:1145–1150CrossRefGoogle Scholar
  3. 3.
    Mahley RW, Rall SC (2000) Apolipoprotein E: far more than a lipid transport protein. Annu Rev Genom Hum Genet 1:507–537CrossRefGoogle Scholar
  4. 4.
    Polvikoski T, Sulkava R, Haltia M, Kainulainen K, Vuorio A, Verkkoniemi A et al (1995) Apolipoprotein E, dementia, and cortical deposition of beta-amyloid protein. N Engl J Med. 333:1242–1247CrossRefGoogle Scholar
  5. 5.
    Palop JJ, Mucke L (2009) Epilepsy and cognitive impairments in Alzheimer disease. ArchNeurol 66(4):435–440Google Scholar
  6. 6.
    Helmstaedter C (2002) Effects of chronic epilepsy on declarative memory systems. Progr Brain Res 135:439–453CrossRefGoogle Scholar
  7. 7.
    Hermann S (2007) Classification of epileptic seizures. Continuum: lifelong learning in neurology. Epilepsy 13(4):13–47Google Scholar
  8. 8.
    Qassem T, Khateeb M, Emara T, Rasheedy D, Tawfik H, Mohammedin AS, Tolba M, Abdel Aziz K (2015) Normative data for healthy adult performance on the Egyptian–Arabic Addenbrooke’s cognitive examination III. Middle East Current Psychiatry 22:27–36CrossRefGoogle Scholar
  9. 9.
    Engel J (2001) A proposed diagnostic scheme for people with epileptic seizures and with epilepsy: report of the ILAE task force on classification and terminology. Epilepsia 42(6):796–803CrossRefGoogle Scholar
  10. 10.
    Bell BD, Fine J, Dow C, Seidenberg M, Hermann BP (2005) Temporal lobe epilepsy and the selective reminding test: the conventional 30-minute delay suffices. Psychol Assess 17(1):103–109CrossRefGoogle Scholar
  11. 11.
    Hermann BP, Seidenberg M, Dow C, Jones J, Rutecki P, Bhattacharya A et al (2006) Cognitive prognosis in chronic temporal lobe epilepsy. Ann Neurol 60(1):80–87CrossRefGoogle Scholar
  12. 12.
    Jones-Gotman M, Zatorre RJ, Olivier A, Andermann F, Cendes F, Staunton H et al (1997) Learning and retention of words and designs following excision from medial or lateral temporal-lobe structures. Neuropsychologia 35(7):963–973CrossRefGoogle Scholar
  13. 13.
    Busch RM, Lineweaver TT, Naugle RI, Kim KH, Gong Y, Tilelli CQ et al (2007) ApoE-epsilon4 is associated with reduced memory in long-standing intractable temporal lobe epilepsy. Neurology 68(6):409–414CrossRefGoogle Scholar
  14. 14.
    Tavakoli M, Barekatain M, Doust HT, Molavi H, Nouri RK, Moradi A (2011) Cognitive impairments in patients with intractable temporal lobe epilepsy. J Res Med Sci 16:1466–1472Google Scholar
  15. 15.
    Zhao F, Kang H, You L, Rastogi P, Venkatesh D, Chandra M (2014) Neuropsychological deficits in temporal lobe epilepsy: a comprehensive review. Ann Indian Acad Neurol 17(4):374–382CrossRefGoogle Scholar
  16. 16.
    Hermann B, Seidenberg M, Bell B, Rutecki P, Sheth RD, Wendt G, O’Leary D, Magnotta V (2003) Extratemporal quantitative MR volumetrics and neuropsychological status in temporal lobe epilepsy. J Int Neuropsychol Soc 9:353–362CrossRefGoogle Scholar
  17. 17.
    Kumar A, Tripathi M, Pandey RM, Ramakrishnan L, Srinivas M, Luthra K (2006) Apolipoprotein E in temporal lobe epilepsy: a case–control study. Dis Markers 22(5–6):335–342CrossRefGoogle Scholar
  18. 18.
    Gouras G, Relkin N, Sweeney D (1997) Increased apolipoprotein E ϵ4 in epilepsy with senile plaques. Ann Neurol 41(3):402–404CrossRefGoogle Scholar
  19. 19.
    Elger C, Helmstaedter C, Kurthen M (2004) Chronic epilepsy and cognition. Lancet Neurol 3(11):663–672CrossRefGoogle Scholar
  20. 20.
    Simons J, Spiers H (2003) Prefrontal and medial temporal lobe interactions in long-term memory. Nat Rev Neurosci 4:637–648CrossRefGoogle Scholar
  21. 21.
    Squire L, Stark C, Clark R (2004) The medial temporal lobe. Annu Rev Neurosci 27:279–306CrossRefGoogle Scholar
  22. 22.
    Golby A, Poldrack R, Illes J, Chen D (2002) Memory lateralization in medial temporal lobe epilepsy assessed by functional MRI. Epilepsia 43(8):855–863CrossRefGoogle Scholar

Copyright information

© Belgian Neurological Society 2019

Authors and Affiliations

  • Iman Elbanhawy
    • 1
  • Ebtesam Mohamed Fahmy
    • 1
  • Sahar Sharaf
    • 2
  • Rania Shehata Ismail
    • 1
    Email author
  • Karim Elmehdawy
    • 1
  1. 1.Department of Neurology, Faculty of MedicineCairo UniversityGizaEgypt
  2. 2.Department of Clinical Pathology, Faculty of MedicineCairo UniversityGizaEgypt

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