Abstract
ObjectiveThe establishment of patient-centered measures capable of empirically determining meaningful cognitive change after surgery can significantly improve the medical care of epilepsy patients. Thus, this study aimed to develop reliable change indices (RCIs) and standardized regression-based (SRB) change norms for a comprehensive neuropsychological test battery in the German language.MethodsForty-seven consecutive patients with temporal lobe epilepsy underwent neuropsychological assessments, both before and 12 months after surgery. Practice-effect-adjusted RCIs and SRB change norms for each test score were computed. To assess their usefulness, the presented methods were applied to a clinical sample, and binary logistic regression analyses were conducted to model the odds of achieving improvement in quality of life (QOL) after surgery.ResultsThe determined RCIs at 90% confidence intervals and the SRB equations for each test score included in the test battery are provided. Cohen’s kappa analyses revealed a moderate mean agreement between the two measures, varying from slight to almost perfect agreement across test scores. Using these measures, a negative association between improvement in QOL and decline in verbal memory functions after surgery was detected (adjusted odds ratio = 0.09, p = 0.006).SignificanceTo the best of our knowledge, this study is the first to develop RCIs and SRB change norms necessary for the objective determination of neuropsychological change in a comprehensive test battery in the German language, facilitating the individual monitoring of improvement and decline in each patients’ cognitive functioning and psychosocial situations after epilepsy surgery. The application of the described measures revealed a strong negative association between improvement in QOL and decline in verbal memory functions after surgery.
Highlights
In approximately 30% of epilepsy patients, anti-seizure drugs (ASD) fail to sufficiently control seizures (Sander, 2003)
The assessment of neuropsychological change has been associated with several psychometric difficulties, as change in test results can be attributed to multiple factors that are unrelated to the intervention investigated
No significant differences were identified between the two subgroups with regard to sociodemographic and clinical characteristics, except for verbal IQ, which was lower in patients with an epileptogenic focus in the language-dominant hemisphere (Table 1)
Summary
In approximately 30% of epilepsy patients, anti-seizure drugs (ASD) fail to sufficiently control seizures (Sander, 2003). As demonstrated by numerous studies (Wiebe et al, 2001; Engel et al, 2012; Engel, 2018; Mohan et al, 2018), for selected drug-resistant patients, epilepsy surgery is considered to be a safe, evidence-based, and effective treatment option that is superior to continued medical therapy. Seizure control remains the primary aim and is the most examined outcome of epilepsy surgery, the investigation of treatment effects on the patients’ cognitive functioning and psychosocial situations has gained increasing importance in the field. Empirical methods are required to determine whether change in repeated neuropsychological test results represent true change, which can be considered statistically meaningful, or change caused by random fluctuations in measurements (Hermann et al, 1996; Chelune and Franklin, 2003; Perdices, 2005)
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