MMPI-2 profiles of patients with intractable epilepsy.

MMPI-2 profiles of 93 presurgical intractable epilepsy patients were examined using Ward's method of cluster analysis. Three clusters were identified. The means of each cluster suggest that 45% of the sample had minimal psychological complaints, 30% presented with generalized clinical elevations, and 25% of the patients had profiles of intermediate elevations with a tendency to emphasize somatic complaints and/or depression. Gender, age of seizure onset, and seizure laterality were not found to be uniquely associated with the cluster profiles. Further examination of correlates of group membership is warranted to provide information for treatment planning.     

Measuring personality and emotional functioning in multiple sclerosis: a cautionary note.

Changes in personality and emotional status are common in individuals with multiple sclerosis (MS). The purpose of this study was to examine results based on the MMPI-2 before and following application of a statistical correction procedure (Gass, 1992). This was done to help determine changes in scale score elevations when items containing actual physical symptoms are identified and statistically removed. Twenty-eight participants with MS were administered the MMPI-2, then retested 1 year later. Stability of MMPI-2 scores over time was demonstrated. Results showed that when the correction procedure was applied to the MMPI-2, eight standard clinical scale scores dropped an average of 6.66 T-score points. Significant differences were obtained between standard MMPI-2 scored profiles and corrected profiles on Scales 1-3 and 8. Cautious interpretation of MMPI-2 results for neurological samples was indicated. This study extended prototypic research by using patients with MS, examining the stability of results over time (1 year), and introducing a more reliable method of deriving standard T-scores in the correction procedure.     

The MMPI-2 in sexual harassment and discrimination litigants

In order to understand patterns of respondents on validity and clinical scales, this study analyzed archival Minnesota Multiphasic Personality Inventory 2s (MMPI-2s) produced by 192 women and 14 men who initiated legal claims of ongoing emotional harm related to workplace sexual harassment and discrimination. The MMPI-2s were administered as a part of a comprehensive psychiatric forensic evaluation of the claimants' current psychological condition. All validity and clinical scale scores were manually entered into the computer, and codetype and cluster analyses were obtained. Among the women, 28% produced a "normal limits" profile, providing no MMPI-2 support for their claims of ongoing emotional distress. Cluster analysis of the validity scales of the remaining profiles produced four distinctive clusters of profiles representing different approaches to the test items.     

停止迷走神经刺激术后2年内7例癫癎患者的临床与EEG分析

目的：总结迷走神经刺激术(VNS)对顽固性癫痫的疗效及评价其临床应用的价值。方法：用VNS治疗7例顽固性癫痫患者，治疗期为3年，结束治疗后继续观察2年，共观察5年。整个观察期内患者仍用足量抗癫痫药物。比较治疗前、治疗期及结束治疗后癫痫的发作情况及EEG变化。结果：7例患者在VNS治疗期内5例有效，其中3例发作频率减少25％～50％，2例终止发作，另2例无效。结束VNS治疗后原有效的3例中，2例发作加重，1例发作类型改变，发作次数增加，但强度减轻；2例终止发作者中1例目前仍未发作，另1例癫痫复发。EEG情况与临床相一致，当癫痫发作被控制时，EEG明显好转，棘(尖)慢复合波减少。癫痫复发时EEG会出现相应的痫样放电。7例患者在结束随访的第五年，有6例EEG仍明显异常，有棘(尖)或棘(尖)慢复合波。结论：VNS治疗顽固性癫痫具有安全性，且治疗期间有一定的疗效，但由于其对发作的完全控制率低，停止刺激后易复发，且费用昂贵，很难作为一种令人满意的治疗方法。     

MMPI-2评估应激障碍的效果

目的:采用MMPI-2评估应激障碍(SD)患者的病理心理特征,并探讨其辅助诊断的应用价值。方法:实验组为入院治疗的29名急性应激障碍(ASD)患者及14名创伤后应激障碍(PTSD)患者,对照组为44名适应良好的应激创伤幸存者,在不影响测验症状的情况下完成MMPI-2测试。结果:ASD患者MMPI-2的F、Fb、Fp、Pa、Pt、Sc和Ma的因子得分高于对照组,K和S低于对照组,差异有统计学显著性(P<0.05-0.001);PTSD患者F、Fb、Fp、Hs、D、Hy、Pa、Pt和Sc高于对照组,S低于对照组,差异有统计学显著性(P<0.05-0.001);ASD患者Hs、D和Hy低于PTSD患者,差异有统计学显著性(P<0.05-0.001)。两组患者剖面图均呈M678型。Pa和Sc进入判别函数,该函数在训练样本和验证样本中的预测符合率分别为83.9%和72.0%。结论:SD患者和适应良好的创伤幸存者的心理病理表现明显不同,ASD患者和PTSD患者的症状特征也有所差异;MMPI-2对应激失常症状比较敏感,Pa和Sc具有较好的鉴别能力。     

MMPI-2 short form proposal: CAUTION.

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) is widely used in neuropsychology, though its length (567 items) is sometimes prohibitive. This study investigated some psychometric characteristics of the 180-item version of the MMPI-2 () in order to delineate its strengths, limitations, and appropriate scope of clinical application. Limited reliability and poor predictive accuracy were recently reported for many of the MMPI-2 short-form scales in a study that used 205 brain-injured patients. In the present investigation, we used a psychiatric sample (N=186) with normal neurological findings to examine short-form accuracy in predicting basic scale scores, profile code types, identifying high-point scales, and classifying scores as pathological (T>/=65) or normal-range. The results suggest that, even as applied to neurologically normal individuals, the proposed short form of the MMPI-2 is unreliable for predicting clinical code types, identifying the high-point scale, or predicting the scores on most of the basic scales. In contrast, this short form can be used to predict whether the full-scale scores fall within the pathological range (T>/=65). These findings suggest that clinicians might be able to salvage a small amount of information from the shortened (180-item) version of the MMPI-2 when MMPI-2 protocols are incomplete. However, clinicians should not use a standard interpretive approach with this test, and routine clinical application is unwarranted. Future evaluations of short-form validity should provide a more detailed examination of individual protocols, including an analysis of the frequency of accurate prediction of full-form scores.     

Early identification of refractory epilepsy

BACKGROUND: More than 30 percent of patients with epilepsy have inadequate control of seizures with drug therapy, but why this happens and whether it can be predicted are unknown. We studied the response to antiepileptic drugs in patients with newly diagnosed epilepsy to identify factors associated with subsequent poor control of seizures. METHODS: We prospectively studied 525 patients (age, 9 to 93 years) who were given a diagnosis, treated, and followed up at a single center between 1984 and 1997. Epilepsy was classified as idiopathic (with a presumed genetic basis), symptomatic (resulting from a structural abnormality), or cryptogenic (resulting from an unknown underlying cause). Patients were considered to be seizure-free if they had not had any seizures for at least one year. RESULTS: Among the 525 patients, 333 (63 percent) remained seizure-free during antiepileptic-drug treatment or after treatment was stopped. The prevalence of persistent seizures was higher in patients with symptomatic or cryptogenic epilepsy than in those with idiopathic epilepsy (40 percent vs. 26 percent, P=0.004) and in patients who had had more than 20 seizures before starting treatment than in those who had had fewer (51 percent vs. 29 percent, P<0.001). The seizure-free rate was similar in patients who were treated with a single established drug (67 percent) and patients who were treated with a single new drug (69 percent). Among 470 previously untreated patients, 222 (47 percent) became seizure-free during treatment with their first antiepileptic drug and 67 (14 percent) became seizure-free during treatment with a second or third drug. In 12 patients (3 percent) epilepsy was controlled by treatment with two drugs. Among patients who had no response to the first drug, the percentage who subsequently became seizure-free was smaller (11 percent) when treatment failure was due to lack of efficacy than when it was due to intolerable side effects (41 percent) or an idiosyncratic reaction (55 percent). CONCLUSIONS: Patients who have many seizures before therapy or who have an inadequate response to initial treatment with antiepileptic drugs are likely to have refractory epilepsy.     

The course of seizures after treatment for cerebral cysticercosis.

BACKGROUND. Worldwide, cerebral cysticercosis is one of the most common causes of seizure disorders. Modern cysticidal drugs can usually eliminate the parasite from the brain, but there have been doubts as to whether such treatment improves the seizure disorder. METHODS. We studied 240 patients with seizures and cysticercosis of the brain parenchyma. Of these patients, 118 received cysticidal therapy (albendazole, praziquantel, or both) for lesions without inflammation on imaging studies (group 1); 49 patients with similar lesions either were not offered or refused cysticidal medication (group 2). Another 58 patients with inflammation around cysts (making spontaneous resolution more likely) also did not receive cysticidal medication (group 3), whereas cysticerci were removed surgically in 15 patients (group 4). The 240 patients were followed for a mean (+/- SE) of 92 +/- 7 months. RESULTS. In the patients treated with cysticidal medications, there was an 82 percent reduction in the mean number of brain cysts (from 5.0 to 0.9) and a 95 percent reduction in the mean frequency of seizures (from 11.3 to 0.6 per year; P less than 0.001). After three years of follow-up, 64 patients in group 1 (54 percent) were seizure-free. By contrast, the untreated patients (group 2) averaged 10.9 seizures per year; none were seizure-free. Among those with inflamed cysts (group 3), there was a 74 percent reduction in the frequency of seizures (from 7.5 to 2.7 per year), and 18 patients (31 percent) became seizure-free. After surgical treatment (group 4), there was an 87 percent reduction in the frequency of seizures (from 12.8 to 1.7 per year), and six patients (40 percent) became seizure-free. CONCLUSIONS. After medical treatment of neurocysticercosis, there is usually remission or marked improvement in the associated seizure disorder.     

MMPI-2 profiles of NGRI and civil patients.

Limited information is available comparing individuals found Not Guilty by Reason of Insanity (NGRI) to other psychiatric patients. This study examined the MMPI-2 profiles of 36 NGRIs and 35 civilly committed inpatients at 3 state psychiatric hospitals. The NGRI and civil patient groups differed in terms of race and gender with more minority individuals and fewer women in the NGRI group. Therefore, these demographic variables were used as covariates in a MANCOVA comparing the MMPI-2 validity and clinical scales for these 2 groups. NGRIs and civil inpatients produced significantly different mean MMPI-2 profiles, with NGRIs reporting less pathology overall compared to civil inpatients. Specifically, NGRIs had lower scores on scales F, 1, 2, 7, 8, and O and higher scores on scale K. Contrary to expectations, NGRIs and civil patients did not differ on scale 4, supplementary scale Re, and content scales ANG, CYN, and ASP, or Harris-Lingoes subscale Pd2. Overall, these results suggest that NGRI patients are functioning at a higher level than civil patients. These findings are considered in terms of previous results and potential selection bias. Implications for treatment and future research are also considered.     

Epilepsy in Coffin–Siris syndrome: A report from the international CSS registry and review of the literature

Coffin–Siris syndrome (CSS, MIM135900) is a rare multiple congenital anomaly syndrome caused by pathogenic variants in the BAF complex; up to 28% of patients have previously been reported to have seizures, however, a comprehensive review of epilepsy has not been undertaken in this population. The International CSS Patient Report Database was queried for patients with self-reported seizures, epilepsy, and EEG results. Data gathered included demographic data, pathogenic gene variants, seizure characteristics and treatments, and EEG findings. In addition, a PubMed search was performed using keywords “Coffin–Siris syndrome” and “epilepsy,” “seizures,” or “EEG.” Results from relevant papers are reported. Twenty-four (7.2%) of 334 patients in the database reported having seizures, EEG abnormalities, and/or epilepsy. Median age of seizure onset was 2. 7 years. Fifteen of the 23 patients with seizures or epilepsy had an ARID1B causative variant. Seventeen patients (5.1%) reported EEG abnormalities, the majority of which were described as focal or multifocal (87.5%). In all but one patient, seizures were controlled on antiseizure medications (ASMs). The literature review yielded 311 unique CSS patients, 82 of which (26.4%) carried diagnoses of seizures or epilepsy. Details on seizure type(s), EEG findings, and response to treatment were limited.     

难治性复杂部分性癫癎发作患者癎灶病理变化

目的：探讨难治性复杂部分性癫　发作患者致　灶病理改变的特点。方法：对６例难治性复杂部分性癫　发作患者进行手术治疗。术前进行临床、神经电生理、神经心理及头颅ＣＴ检查,术中在脑皮层电图监测下作病侧前颞叶切除术,并作致　灶组织的病理学检查。结果：６例病人手术切除致　灶组织的病理学检查,有脑微血管的基底膜增厚与周细胞变性,均为非特异性改变。６例中术后发作减少＞５０％者１例,发作消失者５例,说明　灶定位正确,手术切除成功。结论：难治性复杂部分性发作的癫痫病人,其致　灶病理学检查多见周细胞变性及毛细血管基底膜增厚,　灶切除后可使发作消失或减少,若药物治疗无效应考虑手术治疗。     

The construct validity of the Lees-Haley Fake Bad Scale. Does this scale measure somatic malingering and feigned emotional distress?

The Fake Bad Scale (FBS [Psychol. Rep. 68 (1991) 203]) was created from MMPI-2 items to assess faking of physical complaints among personal injury claimants. Little psychometric information is available on the measure. This study was conducted to investigate the psychometric characteristics of the FBS using MMPI-2 profiles from six settings: Psychiatric Inpatient (N=6731); Correctional Facility (N=2897); Chronic Pain Program (N=4408); General Medical (N=5080); Veteran's Administration Hospital Inpatient (N=901); and Personal Injury Litigation (N=157). Most correlations of the FBS and raw scores on the MMPI-2 were positive with correlations among the validity scales being lower than correlations among the clinical and content scales. The FBS was most strongly correlated with raw scores on Hs, D, Hy, HEA, and DEP. When the more conservative cutoff of 26 was used, the FBS classified 2.4-30.6% of individuals as malingerers. The highest malingering classification was for the women's personal injury sample (37.9%) while the lowest was among male prison inmates (2.3%). Compared to men, in most samples, almost twice as many women were classified as malingerers. The results indicate that the FBS is more likely to measure general maladjustment and somatic complaints rather than malingering. The rate of false positives produced by the scale is unacceptably high, especially in psychiatric settings. The scale is likely to classify an unacceptably large number of individuals who are experiencing genuine psychological distress as malingerers. It is recommended that the FBS not be used in clinical settings nor should it be used during disability evaluations to determine malingering.     

Construct validity of the PCSQ as related to the MMPI-2.

The Postconcussion Syndrome Questionnaire (PCSQ) total and factor scores were compared to the primary validity and clinical scales from the Minnesota Multiphasic Personality Inventory-II (MMPI-2) in an effort to better define the structure of the PCSQ. The sample used was composed of a heterogeneous group of 79 patients referred for clinical neuropsychological evaluation. In reviewing the results, patients with higher PCSQ scores presented with higher clinical elevations on the MMPI-2. In addition, each of the PCSQ factor scores was related to a different pattern of MMPI-2 scales and subscales. The somatic factor was most associated with physical ailments, generalized distress, and social insecurity. In contrast, the psychological factor was related to complaints of dysphoria, brooding, and social connectedness. The cognitive and infrequent factors were related to reports of cognitive changes and unusual sensory experiences, respectively. The data present validation of the multifaceted nature of the PCSQ and its general sensitivity to subjective complaints.     

Clinical predictors of drug-resistant epilepsy in children

Background/aimIn up to 20% of epilepsy patients, seizures may not be controlled despite the use of antiepileptic drugs, either alone or in combination. These individuals are considered to have drug-resistant epilepsy. Drug-resistant epilepsy is usually associated with intellectual disability, psychiatric comorbidity, physical injury, sudden unexpected death, and low quality of life. Early detection and prediction of drug-resistant epilepsy are essential in determining the patient’s most appropriate treatment option. This retrospective study aimed to determine the clinical, electroencephalographic, and radiological factors associated with medically intractable childhood seizures.Materials and methods Data regarding 177 patients diagnosed with drug-resistant epilepsy were compared with 281 patients with drug-responsive epilepsy. Results Univariate analysis showed that age at seizure onset, having mixed seizure types, history of status epilepticus, history of neonatal seizures, history of both having febrile and afebrile seizures, daily seizures at the onset, abnormality on the first electroencephalogram, generalized epileptic abnormality on electroencephalogram, abnormal neurodevelopmental status, abnormal neuroimaging, and having symptomatic etiology were significant risk factors for the development of drug-resistant epilepsy (p < 0.05). In multivariable analysis, having mixed seizure types, history of status epilepticus, having multiple seizures in a day, intellectual disability, symptomatic etiology, and neuroimaging abnormality remained significant predictors for developing drug-resistant epilepsy.ConclusionsIn the course of childhood epilepsy, some clinical features may predict the outcome. Early identification of patients with high risk for drug-resistant epilepsy will help plan the appropriate treatment option. Further prospective studies should confirm these findings.     

肌阵挛失神癫痫的临床及神经电生理学研究

目的：提高对肌阵挛失神癫痫（EMA）的认识。方法：收集2005年3月至2011年6月确诊为EMA的患儿5例,对其临床及神经电生理特征进行回顾性分析。结果：5例患儿以2岁零4个月至5岁起病,平均起病年龄4岁。3例以肌阵挛失神（MA）为唯一或主要发作形式,2例以全身强直阵挛发作（GTCS）首发,分别于1年和3年后转变为MA;临床表现为频繁的双侧节律性肌阵挛抽动。EEG＋EMG联合检查可见在EEG双侧同步的3Hz节律性棘慢波放电的同时,同步的EMG记录可见3Hz肌阵挛电活动和逐渐增强的强直性肌肉收缩电位。过度换气试验及闪光刺激均易诱发脑电一临床发作。发作间期EEG均见全导棘慢波,2例双额区尤显。治疗主要为丙戊酸钠单药或联合其他抗癫痫药物,分别随访6个月至4年,5例均有效（4例发作控制,1例仍有些许发作伴学习困难）。结论：EMA是一种以MA为主要发作类型的儿童期癫痫综合征,EMA的诊断主要依赖于临床症状观察和EEG＋EMG记录,早期准确诊断,正确选用抗癫痫药物,有助于远期预后改善。     

儿童肌阵挛癫痫临床和录像脑电图分析

目的：探讨儿童肌阵挛癫痫患儿的临床、脑电图（EEG）和治疗特点。方法：对35例肌阵挛癫痫患儿的临床表现、录像脑电图（V-EEG）及抗癫痫药物的治疗效果进行回顾性分析。结果：35例均有肌阵挛发作,以肌阵挛为唯一的发作形式9例,其它26例合并强直阵挛发作、强直发作、部分性发作等发作类型。30例患儿EEG可见全导棘慢波或多棘慢波暴发,5例患儿为局灶性异常。28例明确为癫痫综合征,以青少年肌阵挛性癫痫和Lennox-Gastaut综合征最常见。多数患儿对丙戊酸治疗有效。结论：肌阵挛癫痫以肌阵挛发作为主要表现,正确的诊断依靠详细的询问肌阵挛发作的病史和V-EEG检查结果,治疗应首选丙戊酸。     

Correspondence of MMPI and MMPI-2 with chemically dependent patients

One hundred (39 women and 61 men) hospitalized substance abusers were administered the MMPI and MMPI-2. The correspondence of T-Scores, Code-types, and MAC/MAC-R scores were analyzed. Results showed that the MMPI-2 produced profiles that were consistent with previous research on the MMPI with substance abusers. However, the relationship between MMPI and MMPI-2 T-scores appeared complex and varied across individual scales for both men and women. Codetype congruence was 38% for one, two, and three-point code-types. Well-defined codetypes accounted for 30% of the profiles. MAC/MAC-R raw scores were different for men but not for women. Codetypes established for the MMPI may not be fully transferable to the MMPI-2 in a substance abusing population. © 1996 John Wiley & Sons, Inc.     

MMPI/MMPI-2: comparisons of amnesic patients.

The amnesic population provides a unique opportunity to examine the reliability of clinical tests because amnesics do not consciously recollect initial testing sessions. In this study, amnesic subjects were studied to examine the reliability between the Minnesota Multiphasic Personality Inventory (MMPI) and the MMPI-2. Findings indicated that there were no statistical differences between versions of the MMPI and further revealed that many of the scales were significantly correlated. Amnesic patients produced elevated scores on subscales two (depression) and eight (schizophrenia), not unlike various other groups of neurologically impaired individuals. This indicates that MMPI and MMPI-2 scores in these patient populations may reflect the medical and psychosocial effects of brain damage rather than premorbid personality dysfunction. A close evaluation of amnesics' performance, in conjunction with the critical items they endorsed, offers insight into the personality traits of the amnesic patient population. The relative stability of performance across personality tests administered over several weeks is relevant to the formation and stability of the amnesic's concept of self.     

Successful management of refractory psychomotor seizures with gabapentin and phenobarbital in a Doberman pinscher dog

Gabapentin is a new antiepileptic drug which is used in humans with complex partial epilepsy. Recently, two published studies described the efficacy of gabapentin in dogs with refractory epilepsy. However, clinical application of gabapentin in dogs with refractory psychomotor seizure has not been documented. The present report describes a 2-year-old male Doberman pinscher dog with a history of recurrent bizarre behaviors such as aggression, circling, and flank-biting. Initial oral administration of phenobarbital resulted in resolution of psychomotor seizures, but 3 months after the initial presentation, the dog became refractory to the selected treatment. The treatment was changed to a combination therapy with phenobarbital and gabapentin. Two days after starting the combination therapy, the dog became seizure-free, and there were no detectable signs of previous abnormal behaviors during the 14-month follow-up period.     

大剂量苯巴比妥治疗难治性惊厥性癫痫持续状态的临床观察

目的：观察大剂量苯巴比妥治疗难治性癫痫持续状态（SE）的效果,企为临床工作提供参考。方法：对急诊人院的21例以全身惊厥性SE为突出症状的患者,在针对病因进行积极治疗的同时,进行常规抗癫痫药物（AED）静脉滴注,若癫痫发作症状难以控制则改用大剂量苯巴比妥进行治疗,观察分析其治疗效果。结果：常规AED治疗时,患者24h内癫痫缓解率为20％;没有完全控制者,改用大剂量苯巴比妥静脉滴注后24h内癫痫均得到完全控制。结论：大剂量苯巴比妥治疗难治性SE是安全有效的方法,常规治疗方法无效时可以采用该方法进行治疗。