Epilepsy Presenting as Memory Disturbances

Six patients presented with severe adult-onset memory deficit that was subsequently diagnosed as complex partial epilepsy. In three cases acute amnestic episodes also occurred. The seizures were characterized by short losses of contact and oral automatisms. Interictal EEG showed temporal abnormalities of varying degrees. Formal neuropsychological assessment revealed dissociation between the subjective complaint and the test performances that showed a selective impairment in a few long-term verbal memory tests. These patients present a characteristic clinical picture of memory disturbance as the prominent feature of partial seizures.     

Epilepsy surgery in children with developmental tumours

We report our experience regarding evaluation, surgical treatment and outcomes in a population of 21 children with histopathologically confirmed developmental tumours [nine dysembryoplastic neuroepithelial tumours (DNET), ten gangliogliomas (GG) and two gangliocytomas (GC)] and related epilepsy, analyzing video-EEG, MRI and neuropsychological data, before and after surgery.Most children had focal epilepsy correlating well with lesion location. One patient had epileptic spasms and generalized discharges. Tumours were located in the temporal lobe in 13 patients. Mean age at surgery was 11.16 years. Postsurgical MRI showed residual tumour growth in one DNET. One child had a recurrent ganglioglioma with anaplastic transformation. At latest follow-up (mean 4.68 years) 95.2% of patients were seizure-free and no significant neuropsychological declines were observed. Evidence from our study suggests that, in this setting, surgery should be performed before criteria for refractory epilepsy are met, particularly in cases with early seizure onset, in order to optimize cognitive outcome.     

Determinants of Service Placements for Youth with Serious Emotional and Behavioral Disturbances

This paper examines the association between race and type of service placement for youth with serious emotional and behavioral disturbances. Placements were reviewed for 2,803 black and white youth served in the community mental health system. Differences were found between black and white youth in the type of out-of-home placements they received after controlling for sociodemographic variables and presenting problems. Black youth were more likely than whites to be placed in correctional facilities and foster care while white youth were more likely than blacks to be hospitalized (p < .001). This variation in placement may not be clinically warranted. Placement criteria and outcome assessments are needed.     

Behavioral Effects of Anticonvulsant Prophylaxis: No Effect or Artifact?

We examined the effects that may be attributable to current use of anticonvulsants in patients with traumatic head injury. The performances of 15 head-injured matched pairs were compared on a comprehensive battery of neuropsychological and psychosocial measures 1 year post injury. The members of both groups were placed on anticonvulsants, principally phenytoin, immediately after the head injury. The members of one of the groups were still taking the drug at 1 year; the others had discontinued prior to that time. Although the results provided no evidence for appreciable side effects of anticonvulsants on formal neuropsychological or psychosocial measures, some methodological issues need to be considered in the interpretation of results and future studies of drug side effects.     

Nonidiopathic Focal Epilepsies: Methodological Problems for a Comprehensive Neuropsychological Evaluation

Summary:  In aiming to define better practice parameters for neuropsychological assessment in patients with nonidiopathic partial epilepsies, particularly in children, we discuss the reasons for the current lack of clear answers. The relevant factors include the epilepsy itself, the complexity of the issues related to cognitive function/dysfunction and the underlying developmental processes. Another factor is the lack of availability and high cost of neuropsychological testing, even in industrialized societies. Because of these factors, the need for neuropsychological testing must be considered on an individual basis in the initial evaluation of every child with focal epilepsy; it should be left to the clinician and parents to decide which children will actually be referred. Systematic presurgical and postsurgical testing is important for surgical candidates. Comprehensive research protocols should be designed on a collaborative basis between large epilepsy centers, covering all the essential parameters to be evaluated. Children with focal epilepsies should be included in these protocols from the onset of the epilepsy.     

Characterization of recovery and neuropsychological consequences of orbitofrontal lesion: A case study

We present a case study of a patient with acquired prefrontal lesion involving mainly ventromedial and orbital structures (VM-PFD). The patient showed behavioral and emotional disturbances one year after the injury. In a follow-up examination seven years later, we evaluated her performance in tasks found theoretically to be sensitive to orbital and medial lesions. In contrast to our hypothesis, her performance was in the normal range. We suggest that a possible explanation for her magnificent recovery may include a high cognitive reserve and the specific characteristics of her injury.     

Neuropsychological Performance in Posttraumatic Epilepsy

Performances on the Wechsler-Bellevue Intelligence Scale and on Halstead's neuropsychological measures were investigated in two groups of adult subjects with posttraumatic seizures. One of the groups, in addition to seizures, had abnormal and persistent focal cortical signs. The other group had seizures only and no other known deficits or complications. The results suggest that posttraumatic epilepsy, whether or not accompanied by abnormal and persistent focal cortical signs, is associated with significant psychological impairment. Patients with posttraumatic epilepsy alone perform somewhat better than those whose epilepsy is accompanied by independent evidence of cortical damage. However, the performance difference between such patients is not major, nor is it statistically significant on most measures such as those used in the present study. Possible reasons for the performance deficit in this group were discussed.     

Social Behavioral Problems and the Health-Related Quality of Life in Children and Adolescents with Epilepsy

ObjectiveThe purpose of this study was to investigate the impact of specific behavioral problems on the health-related quality of life (HRQOL) in children and adolescents with epilepsy.MethodsChildren and adolescents with epilepsy (n=92; age range=6–17 years) and their mothers completed questionnaires about behavioral problems, HRQOL, socio-demographics, and epilepsy-related variables. To determine significant predictor variables of the HRQOL, the stepwise regression analyses and partial correlations were performed to adjust for other behavioral problems and covariates.ResultsThe analyses revealed that an increase in social behavioral problems and delinquent behavior was associated with a decrease in the HRQOL. Lower levels of maternal education and the number of antiepileptic drugs were also associated with a decline in the HRQOL; the HRQOL and social behavioral problems remained significantly correlated after adjusting for maternal education level, number of antiepileptic drugs, and non-social behavioral problems.ConclusionParents and practitioners should provide intervention if behavioral problems, particularly social behavioral problems, are observed in children or adolescents with epilepsy.     

The relative importance of age and IQ as predictors of outcomes in Intensive Behavioral Intervention

Outcomes of Intensive Behavioral Intervention are known to be highly variable. We report on two studies examining the role of age at entry to treatment and initial IQ in relationship to cognitive and adaptive outcomes in the Ontario province-wide program. Study 1 included 207 children aged 2–14 at entry. Age was modestly negatively correlated with several outcome variables; IQ was strongly predictive of most cognitive and adaptive outcomes. Age accounted for additional variance, beyond that accounted for by IQ, for cognitive outcomes, especially change in IQ. Children who made very large gains were all under age 6 at entry. Children who were over 8 years of age and/or had very low IQ showed uniformly poor outcomes. Study 2 was a comparison of IQ-matched younger (2–5 years) versus older (6–13 years) children (n = 60 each). The two groups of children, who were on the same initial trajectory, showed different outcomes. Only the younger group showed substantial cognitive gains. Results strongly argue for the importance of early intervention.     

Evaluation of Brain Injury Related Behavioral Disturbances in Community Mental Health Centers

As a result of improved emergency trauma services, more individuals suffering a traumatic brain injury are surviving. Unfortunately, most of these survivors suffer chronic neuropsychiatric sequelae related to both the brain damage and the psychosocial impact of the injury on self-esteem, self-image, primary role, and vocational function. Current community supports are often inadequate to deal with the complex array of neurologic and psychiatric difficulties. This article outlines common features of brain injury, explores the link between these features and the common neuropsychiatric sequelae of brain injury, and suggests some principles helpful in the evaluation of the behaviorally challenged brain injured patient.     

Is Cognitive Reserve Applicable to Epilepsy? The Effect of Educational Level on the Cognitive Decline After Onset of Epilepsy

Summary:  Purpose: The aim of this study was to know the effect of education level (EL) on the cognitive change after onset of epilepsy. The rationale is that people with high EL may have more cognitive reserve and show resistance to damage brought about by epilepsy.
Methods: Patients were from an outpatient epilepsy clinic of a national university hospital. All received initial and repeated neuropsychological tests and the Cognitive Ability Screening Instrument (CASI), at an interval of 12 months. CASI consists of nine items, with a total score of 100. We compared the differences between the two tests, in terms of z-scores. The EL was divided into high and low with a cut-off at 12 years, and age at entry was divided with a cut-off at 38 years. Epilepsy severity was divided into intractable and nonintractable.
Results: A total of 64 patients completed the study, including 31 with high EL and 33 with low EL, with no differences in gender and epilepsy severity between groups. In general, patients had cognitive impairment in multiple domains. At the baseline, the effect of EL was found for all items except remote memory and orientation, whereas the effect of age was observed for remote and recent memory. At the 12-month follow-up, subjects with high EL showed deterioration in mental manipulation, whereas subjects with low EL showed improvement in verbal fluency but deterioration in attention.
Conclusions: Patients with high EL have better cognitive functioning than those with low EL after epilepsy has developed, which supports the cognitive reserve theory. However, 1-year follow-up might be too short to see significant changes between groups.     

The Difficult-to-Employ in Epilepsy Rehabilitation: Predictions of Response to an Intensive Intervention

In this prospective study, 46 adult seizure outpatients with suspected brain impairment were referred for vocational services at the University of Washington Regional Epilepsy Center and counseled for job placement. Among the demographic, intellectual, neuropsychological, and psychosocial variables considered, the Wechsler Adult Intelligence Scale (WAIS) Digit Symbol subtest and the name-writing procedure from the neuropsychological battery by Dodrill (1978) were the best discriminators of later employability. Using discriminant function analysis, these two tests correctly classified 75.0% of the group which ultimately became employed (n = 22) and 73.9% of the group which did not attain employment (n = 26). Implications of these findings are discussed in relation to rehabilitation planning.     

Psychological Disturbances and Folic Acid in Chronic Epileptic Outpatients

The relationship between serum folate level and psychological disturbances was studied in a series of 95 chronic epileptic outpatients. All were nondrinkers. Serum folic acid in all cases and vitamin B12 in 83 cases were determined by radioimmunoassay. Only three factors were significantly related with psychological disturbances: serum levels of folic acid were significantly lower and the mean corpuscular volume of the erythrocytes was significantly higher in disturbed patients, particularly in those with the most severe psychiatric syndromes, and the incidence of disturbances was significantly higher in patients treated with three or more drugs. Conversely, variables such as number or type of seizures, duration of epilepsy, duration of treatment, presence of structural neurological lesions, previous mental retardation, or focal temporal lobe disturbances in the EEG did not show any statistical relationship to the presence of psychological disturbances. No relevant relationship was found between serum vitamin B12 and psychological disturbances.     

Cognitive Impairment in Juvenile Myoclonic Epilepsy

Background and purpose

Cognitive impairments are frequent consequences of epilepsy, with intellectual ability reportedly being lower in patients with idiopathic generalized epilepsies than in the general population. However, neuropsychological investigations have been rarely performed in patients with juvenile myoclonic epilepsy (JME). We aimed to quantify the cognitive function in JME patients using various neuropsychological tests.

Methods

We compared cognitive function in 27 JME patients with that in 27 healthy volunteers using tests examining cognitive performance, such as the verbal and visual memory, frontal function, attention, IQ score, and mood. In the JME group, we examined risk factors for cognitive function such as age, sex, family history, education level, age at seizure onset, seizure frequency, EEG abnormality, disease duration, and previous intake of antiepileptic drugs.

Results

Verbal learning was significantly lower in JME patients than in controls, and attention and verbal fluency were impaired in JME patients compared with controls. However, general intellectual ability and mood did not differ between the groups. Early onset of seizure and long duration of disease were closely related to impaired cognitive function.

Conclusions

JME patients may exhibit impaired cognitive function, in terms of memory and execution, despite having normal intelligence and mood.     

Early Intensive Behavioral Interventions: Selecting behaviors for treatment and assessing treatment effectiveness

Early Intensive Behavioral Interventions (EIBI) is well established as the most effective treatment for young children with Autism Spectrum Disorders (ASD). A hallmark of this intervention model is the bundling of multiple behaviors simultaneously for intervention. With the addition of various comorbid problems such as challenging behaviors and psychopathology, it becomes incumbent on clinicians to prioritize behaviors for intervention. Based on the studies conducted to date, little has been done in this regard. Additionally, general measures of ASD, adaptive behavior and cognitive functioning are primarily used to assess outcomes, many of these measures were not designed to assess treatment effects, and little evidence is available to link intervention to specific items on these scales.