Neuropsychology/Language/Behavior: Adult

Abstract

EpilepsiaVolume 46, Issue s8 p. 59-74 Free Access Neuropsychology/Language/Behavior: Adult First published: 19 October 2005 https://doi.org/10.1111/j.1528-1167.2005.460801_9.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat Abstract 1 Carla C. Adda, 2 Luiz H. Castro, and 1 Rosa Kashiara ( 1 Division of Psychology, Hospital das Clinicas FMUSP, Sao Paulo, Sao Paulo, Brazil ; and 2 Neurology, Faculdade de Medicina USP, Sao Paulo, Sao Paulo, Brazil ) Rationale: Traditional neuropsychological testing may fail to detect abnormalities in declarative memory tests in epileptic patients. One possible explanation is that such tests do not adequately measure memory in real life activities. Prospective memory (PM), i.e. cognitive abilities related to remembering a planned intention in the correct setting, may be a more ecological measurement of memory function in daily activities. We studied the performance of patients with left and right mesial temporal sclerosis and normal controls in a prospective memory battery and compared results with performance in the Rey Auditory Verbal Learning Test (RAVLT) and with a self assessment questionaire for memory impairment (QMI). Methods: The battery consisted of six time and event related tasks to be recalled in the adequate situation, such as remembering to tell the examiner that they needed a new prescrition after fifteen minutes and remembering to ask for an personal object taken by the examiner at the end of a 105 minute session.Patients were submitted a neuropsychological test battery during the session, including the RAVLT and were asked to fill the QMI (24 items). Spontaneous and cued recall of the 15 RAVLT words was tested after 7 days. Performance in the PM tests was compared to RAVLT scores and to QMI score. A patient was considered impaired in either MP or RAVLT if performance fell below 2SD of controls. Significant memory compaints were considered if QMI score was 1SD above controls. Sensitivities and specificities for impairment measured by PM and RAVLT were calculated in relation to QMI assessed impairment (gold standard). Results: We studied 28 patients with mesial temporal sclerosis (MTS) (17 left) and 18 normal controls, matched by age (38±10 vs 40±12 yrs) and education (11±2 vs 11±2)(age 40 ±2). Left MTS patients performed significantly worse than controls in PM and spontaneous recall and in QMI score (p < 0.05). Both left and right MTS performed significantly worse than controls in 7-day cued recall (p < 0.05). Sensitivities in relation to QMI were 56.2% for PM, 50% for RAVLT, 37.5% RAVLT and PM and 68,8% for RAVLT or PM. Specificities were 100% for PM, 83.3% for RAVLT, 100% for RAVLT and PM and 91.6% for PM or RAVLT measured impairment. Conclusions: This prospective memory test was able to differentiate memory performance between left MTS patients and controls. It is has a better specificity than RAVLT in relation to a self assessment memory questionaire. Its sensitivity is increased when used in combination with RAVLT. Further studies should better delineate its use in combination with other tests in the assessment of memory dysfunction in epileptic patients and in patients with memory impairment of other etiologies. 1 Judith Butman, 2 Maria E. Fontela, 2,3 Veronica De Simone, 3 Marina Drake, 1 Cecilia Serrano, 2 Maria B. Viaggio, 2,3 Alfredo Thomson, and 1,3 Ricardo F. Allegri ( 1 Memory Center, Department of Neurolgy, Hospital Zubizarreta, Buenos Aires, Argentina ; 2 Epilepsy Section, Department of Neurology, Hospital Frances, Buenos Aires, Argentina ; and 3 Neuropsychology Section, Department of Neurology, Hospital Britanico, Buenos Aires, Argentina ) Rationale: It has been proposed that behavioral impairment in patients with amygdala dysfunction might be related to an inability to reverse their behavior despite receiving negative feedback. Epileptic patients who undergo anterior temporal lobectomy represent an “in vivo” model to study the role of amygdala in cognitive flexibility. The aim of this study is to evaluate cognitive flexibility in epileptic patients with amygdala resection when facing negative feedback. Methods: Ten epileptic patients who underwent anterior temporal lobectomy (6 left temporal lobectomy and 4 right temporal lobectomy) were matched for age and education with 10 healthy controls. Subjects underwent an extensive neuropsychological and neuropsychiatric evaluation. To asses cognitive flexibility we used a reversal –learning task. Results: Patients' mean and standard deviation score were: Beck depression Inventory 8 ± 1.5; PANSS (positive) 10 ± 1.3; PANSS (negative) 14 ± 2.2; PANSS total 28.3 ± 2; verbal IQ 104.2 ± 7, nonverbal IQ 97.2 ± 6, full scale IQ 101.4 ± 6.3. Categories achieved on Wisconsin Card Sorting Test 5.7 ± 0.16. Patients had less number of reversions (mean:9.3) compared to controls (mean: 4.23; p < 0.001), and needed more trials before the first reversion (patients: 23.42 vs controls: 5; p < 0.05). Conclusions: Patients with epilepsy who undergo anterior temporal lobectomy appear to have post operative difficulties to perform a learning-reversal task. Their lack of cognitive flexibility cannot be explained by psychiatric comorbidity, low IQs or a dysexecutive syndrome. 1 Gus A. Baker ( 1 Division of Neurosciences, University of Liverpool, Liverpool, Merseyside, United Kingdom ) Rationale: There is a wealth of evidence to suggest that people with epilepsy, when compared to normal controls, are much more likely to experience a range of neuropsychological impairments. There are a number of factor that have been linked to the causation of these effects including the underlying lesion, the effects of continuous seizures, the sedative effects of AED treatment and the impact of mood. Determining the relative contributions of these various factors has been difficult but previous studies have confirmed cognitive side effects of several antiepileptic drugs such as central slowing, motor slowing and impairment of attention and concentration. The SANAD trial, a randomised controlled clinical trial of standard versus novel antiepileptic drug treatment, represents a unique opportunity to study the natural history of cognitive impairment in patients with newly diagnosed epilepsy who havge yet to be exposed to AED treatment and who have expereinced few seizures. Methods: A standardised battery of neuropsychological tests including measures of psychomotor speed, attention, memory, mental flexibility, tracking tasks, higher executive functioning, mood and patient perceived cognitive effects were administered prior to AED treatment, 3 months and 12 months. Results: There were differences between the epilepsy group and published control data for a number of key domains including: immediate, delayed and recognition memory; new learning; tests of higher executive functioning; sustained attention; and motor speed. These differences were significant at p = 0.001 level. In addition patients also had significantly worse profiles on the profile of mood scale. Conclusions: These results highlight that newly diagnosed patients with epilepsy are already significantly compromised in terms of their neuropsychological and psychological functioning prior to starting AED treatment and exposure to a significant number of seizures. This study will provide and opportunity to study the development of these cognitive effects allowing for treatment and seizure history. It will also allow for the identification of individuals most at risk of developing signficant cognitive difficulties. (Supported by the following pharmaceutical companies: GlaxoSmithKline, Novatis, Jansen Cilag and Sanofi Synthelabo.) 1 William B. Barr, 2 Essie Larson, 1 Kenneth Alper, and 1 Orrin Devinsky ( 1 NYU Comprehensive Epilepsy Center, New York University School of Medicine, New York, NY ; and 2 Department of Psychology, Fordham University, Bronx, NY ) Rationale: The Minnesota Multiphasic Personality Inventory – 2 (MMPI-2) is an objective, self-report instrument that is used frequently to examine personality and psychopathology in patients with epilepsy. One advantage of this test is that it provides validity indicators useful for identifying biases in responding that could potentially invalidate its results. The goal of this study is to examine the rates of invalid MMPI-2 profiles in a sample of patients undergoing VEEG monitoring for the diagnosis and treatment of epilepsy. Methods: MMPI-2 profiles were obtained from 126 patients undergoing continuous inpatient VEEG monitoring. The mean age of the sample was 37.1 years (range, 17 to 74 years). The sex distribution was 74.6% female. Non-epileptic seizures (NES group) were identified in 75 patients. Fifty-one patients had VEEG findings indicating partial (n = 30) or generalized (n = 21) epilepsy (ES group). The groups were matched in terms of age, education, and IQ. The NES group had a higher proportion of females (87% vs. 57%, p < .01). All subjects completed the 567-item version of the MMPI-2. Analyses were conducted on standard validity indices, including the L, F, and K-scales, as well as the consistency indices, VRIN and TRIN. We also examined two other validity measures, the Fp-scale and the FBS-scale. The former was developed for assessment of rarely endorsed symptoms in populations with high rates of psychopathology. The latter (FBS, Fake-Bad-Scale) is used for measuring reporting bias in injury claimants attempting to exaggerate symptoms while maintaining a socially desirable appearance. Rates of invalid responding, as defined by scores exceeding published cutoffs, were assessed through standard tests of proportions. Results: Invalid MMPI-2 profiles were identified in 43.6% of the total sample. A significantly higher rate of invalid responding was observed in the NES group than in the ES group (53.3% vs. 29.4%, p < .001). Invalid profiles were obtained in only 18.6% of the NES group and 17.6% of the ES group when limited to analysis of conventional validity indices (e.g., L, F, K, VRIN, & TRIN; Chi-Square, NS). None of the 126 subjects participating in this study exhibited an elevation of the Fp-Scale. Elevations of the FBS-Scale were observed in 44.0% of the NES group and in 21.6% of the ES group (p < .001). Conclusions: Over 40% of our sample produced invalid MMPI-2 profiles, which raises concern about the prevalent use of the instrument in this population. Rates of invalid responding in the NES and ES groups were the same when identified through standard validity indices. Higher rates of invalid responding observed with the FBS-Scale indicate that patients with NES are twice as likely to produce exaggerated test profiles than patients diagnosed with partial or generalized epilepsy. 1 Brian D. Bell, and 1 Bruce P. Hermann ( 1 Neurology/Neuropsychology, University of Wisconsin Medical School, Madison, WI ) Rationale: Conventional memory assessment might fail to identify memory dysfunction that is characterized by intact recall for a relatively brief period, but rapid forgetting thereafter. A recent study of auditory and visual selective reminding test performance revealed that temporal lobe epilepsy (TLE) patients demonstrated poorer memory ability than controls, but there were no group differences in rate of information loss at the 30-minute and 24-hour delay trials (Bell et al., 2005). In addition, at the individual level of analysis accelerated forgetting over 24 hours was not more common in TLE patients compared to controls. Methods: In this study, we assessed Wechsler Memory Scale-3rd ed. (WMS-III) Logical Memory subtest (LM) performance, including immediate memory and recall after 30-minute and 14-day delays, in a control group (n = 25) and a group of individuals with TLE (n = 25). The mean age of epilepsy onset was 11 years (SD = 8). Individuals with a history of right, left, bilateral or indeterminate TLE laterality were included and five of the TLE patients had undergone a left anterior temporal lobectomy (ATL) at the time of this study. The results described below were unchanged when the ATL patients were excluded. Results: Group analysis: A 2 X 3 (Group X Trial) univariate ANOVA for LM free recall raw scores revealed main effects of group and trial, but no significant group X trial interaction effect. T tests revealed that the control group performed significantly better than the TLE group on the immediate, 30-minute delay, and 14-day delay trials. Individual analysis: Memory impairment was defined as a score ≥ 1 standard deviation below the control group mean. Examination of raw scores revealed that the TLE group had a significantly higher percentage of individuals with impairment at the immediate and 30-minute delay trials, but not at the 14-day delay. Moreover, none of the TLE patients versus three controls (12%) showed memory impairment solely at the 14-day trial. When examining percent retention scores, only 4% of the individuals with TLE versus 20% of the controls were unimpaired after 30 minutes but impaired after 14 days. Conclusions: Accelerated forgetting over a 14-day delay was not present on a widely used story memory test (WMS-III LM) in a group of individuals with TLE. This evidence suggests that the conventional 30-minute delay utilized in clinical neuropsychological evaluations typically is sufficient for measuring memory functioning in TLE patients. Future study of word list retention after a delay of weeks in subsets of TLE patients with clearly lateralized seizures would further test this hypothesis. (Supported by NIH grants NS 37738, NS 42251, and MO1 RR03186 (General Clinical Research Center).) Table 1. Patient characteristics Patient 1 Patient 2 Age of sz onset 17 14 Age at WADA 43 41 Handedness right right Yrs of education 13 12 Previous surgery right anterior temporal lobectomy left anterior temporal lobectomy Current sz localization right frontal left temporal 1 Donald B. Burton, 1 Pradeep Modur, 1 Rebecca Woods, 1 Edgar Pererra, and 1 Mike Gruenthal ( 1 Neurology, University of Louisville, Louisville, KY ) Rationale: WADA testing is a standard part of the work-up for epilepsy surgery, and assesses the likelihood of new post-surgical language/memory deficits. We present the WADA results of two patients who had undergone anterior temporal lobectomy, but who had not been evaluated using the WADA. To our knowledge the results of WADA testing in patients who have already undergone anterior temporal-hippocampal resection has not been previously reported. These cases allow for a comparison of the following conditions in regards to memory function: dominant hippocampus, nondominant hippocampus, and no hippocampus. Methods: Our WADA procedure includes a mental status exam, memory acquisition, sequential language testing, and memory recognition. The demographic and surgical data of our cases is detailed in Table 1. Patient 1 had previously undergone a right anterior temporal lobectomy and patient 2 had a left anterior temporal lobectomy. Neither surgery resulted in seizure control, necessitating a new surgical work-up. Results: Results reveal that both patients are left hemisphere dominant for language. The right hemisphere resection patient did not sustain a disruption in memory function as the result of right hemisphere injection, while injection of the dominant hemisphere disrupted memory. In contrast, the left hemisphere resection case displayed more functional memory deficit after nondominant hemisphere injection, while injection of both hemispheres suppressed memory compared to baseline. Figure 1 reveals that the no hippocampus condition resulted in total suppression of memory function for both cases. When the dominant hippocampus was functioning in isolation no disruption of memory function was noted compared to baseline. When the nondominant hippocampus was functioning in isolation memory function was significantly diminished, but not completely suppressed. Conclusions: Current results support the hypotheses that there can be a dominance for memory function that is not solely based on material specificity. Second, resection of the dominant hippocampus results in greater memory impairment compared to resection of the nondominant hippocampus. Third, current results suggest that the nondominant hippocampus can support memory function to an extent, although not at the level of the dominant hippocampus. Finally, our results highlight the need for a comprehensive presurgical work-up. (1) [Memory Assesment: collapsed across cases (% of targets recongnized correctly).] 1 Robyn M. Busch, 1 Heather D. Stott, 1 Thomas W. Frazier, 1 Richard I. Naugle, 2 Imad Najm, and 3 William Bingaman ( 1 Psychiatry & Psychology, Cleveland Clinic Foundation, Cleveland, OH ; 2 Neurology, Epilepsy & Sleep Disorders, Cleveland Clinic Foundation, Cleveland, OH ; and 3 Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH ) Rationale: Patients with temporal lobe epilepsy (TLE) have higher rates of depression and anxiety than patients with other focal epilepsies or generalized seizures. Memory problems are common among patients with mood and anxiety disorders as well as among patients with TLE. Given the high prevalence of mood and anxiety disorders and memory problems in patients with TLE, the present study sought to determine if presurgical mood and anxiety scores are useful in predicting memory change following anterior temporal lobectomy (ATL) and to ascertain if these scores have incremental validity over presurgical memory and intelligence scores. Methods: This retrospective study examined data from 174 patients with medically intractable TLE (Left = 79; Right = 95) seen for neuropsychological evaluations that included: Depression, Anxiety, Anxiety Related Disorders (ARD), and Mania subscales of the Personality Assessment Inventory; Beck Depression Inventory-II; General Memory Index (GENMEM) from the Wechsler Memory Scale-3rd Edition; and Full Scale IQ (FSIQ) from the Wechsler Adult Intelligence Scale-3rd Edition. All patients later underwent ATL for treatment of their epilepsy and completed postsurgical neuropsychological testing. Participants' mean age and education were 34.25 (SD = 11.51) and 12.84 (SD = 2.11), respectively. The mean age of seizure onset was 14.92 (SD = 12.25) and mean duration of seizures was 19.49 years (SD = 12.59). There were no significant differences between the left and right groups in terms of age, race, sex, education, age of seizure onset, or seizure duration. Results: Simple regression analyses were conducted with mood and anxiety as independent variables (IVs) and memory change score as the dependent variable (DV). A hierarchical regression analysis was then computed with presurgical GENMEM and FSIQ scores entered as IVs in step one, the five mood variables in step two, and GENMEM change as the DV. Regression analyses were conducted separately for left and right TLE patients. Results of the simple regression revealed that presurgical mood and anxiety scores were significant predictors of postsurgical change in GENMEM for left TLE but not right TLE patients. Of the mood variables, the ARD subscale made the largest contribution to the prediction. Similarly, hierarchical regression analyses demonstrated that mood and anxiety scores added significantly to the prediction of GENMEM change above and beyond the prediction made by presurgical GENMEM and FSIQ scores among left but not right TLE patients. Again, ARD made the largest contribution to this prediction. Conclusions: This study supports the clinical utility of presurgical mood and anxiety scores in predicting memory change following ATL in patients with left, but not right, TLE. Furthermore, this study demonstrates that mood and anxiety scores add significantly to the prediction of postsurgical memory change beyond the prediction made by presurgical memory scores. 1 Juliana P. DaPaz, 1 Carla C. Adda, 1 Leila M. DaRoz, 1 Leandro L. Valiengo, 1 Carmen L. Jorge, 1 Rosa Maria F. Valerio, 1 Rosa Kashiara, and 1 Luiz Henrique M. Castro ( 1 Neurology, Faculdade de Medicina USP, Sao Paulo, Sao Paulo, Brazil ) Rationale: Material specific memory deficits are often seen in temporal lobe epilepsy. Patients show verbal learning and confrontation naming deficits. These data were obtained lateralizing patients exclusively by MRI or interictal EEG (iEEG) data. Unilateral mesial temporal sclerosis (uMTS) is often a bilateral disease, with contralateral EEG abnormalities, which may impact on cognitive functioning. We compared neuropsychological scores (NP) in pure unilateral and bilateral uMTS patients. Methods: MRI-diagnosed uMTS, ages (17–55), education >8 yrs, without other MRI lesions or significant psychiatric/neurologic disease. Patients underwent video-EEG monitoring (VEEG), iEEG, WADA test and a NP battery [digit span, vocabulary and object assembly subtests (WAIS III), Stroop I,II,III, Trail Making Test, Wisconsin Card Sorting Test, Rey Auditory Verbal Learning Test (RAVLT), Boston Naming Test (BNT), Verbal Fluency (FAS), Rey Figure (Immediate and Late Recall)]. Patients were divided in four groups: right and left, unilateral or bilateral (RU, LU, RB and LB) by a laterality index obtained from a summated score of iEEG, VEEG and WADA, compared to MRI findings. Normal controls were matched by age and education. Scores on individual neuriopsychological tests were compared among all groups and controls. Results: 54 patients (30 or 56% men), 29 (or 54%) left MTS, education (10.6 ± 2.1yrs.) and 18 controls (4 or 22% men) education (11.1 ± 1.1yrs). 13 were RU, 20 LU, 12 RB and 9 LB.When comparing neuropsychological scores using MRI or iEEG isolatedly, classified as left or right, left MTS patients performed significantly worse in RAVLT (VI, VII and total score) and in FAS than controls and worse than controls and right MTS in BNT (p < 0.05, all tests) for both MRI or iEEG. When the 4 groups were compared, RU and LU differences disappeared. BL patients performed significantly worse than controls in RAVLT (VI, VII, total score), worse than controls, LU and RB in Stroop II and than RU in BNT. (p < 0.05, all tests). When iEEG was analyzed among the four groups, BL patients performed significantly worse than controls in RAVLT (VI, VII and total score) and worse than BR in BNT. Conclusions: Although it is widely accepted that left MTS patients show deficits in verbal learning and recall as well as confrontation naming, our data suggests that only patients with left MTS on MRI, but with bilateral involvement by other eletrophysiologic criteria (VEEG and iEEG) and cognitive functioning measures (WADA) perform significantly worse in episodic verbal memory and confrontation naming tasks. In this sample, pure left MTS patients do not show cognitive impairment in relation to right MTS patients (unilateral and bilateral) or controls. Bilateral temporal involvement with anatomic and/or functional involvement may be crucial for memory dysfunction in left temporal lobe epilepsy. (Supported by FAPESP.) 1 Marina Drake, 2,1 Veronica De Simone, 2 Santiago O'Neill, 2 Maria E. Fontela, 2 Maria B. Viaggio, 2 Alfredo Thomson, and 1 Ricardo F. Allegri ( 1 Neuropsychology Section, Department of Neurology, Hospital Britanico, Buenos Aires, Argentina ; and 2 Epilepsy Section, Department of Neurology, Hospital Frances, Buenos Aires, Argentina ) Rationale: Patients with temporal lobe epilepsy (TLE) show impairment in confrontation naming tasks. Furthermore naming difficulties have been related to left temporal dysfunction. The objective of this study is to characterize naming difficulties in a group of temporal epileptic patients and further compare naming abilities between patients with right and left temporal lobe epilepsy. Methods: Thirty three epileptic patients were matched for age and education with 31 healthy volunteers. Fourteen patients had left TLE epilepsy and nineteen right TLE. All patients were right handed with IQs within the normal range. All subjects were administered an extensive neuropsychological battery. Confrontation naming was explored using the Boston Naming Test adapted version for Argentina. Total number of correct responses and type of errors committed were analyzed. Errors were classified into 5 categories: semantic errors, phonemic errors, visual errors, circumlocutory errors or nonresponse. For analysis purposes only the first 40 naming errors were considered as previous local studies showed that naming deficits in the last 20 pictures is strongly influenced by education and cultural background. Results: The epilepsy group performed significantly worse than controls on a naming test (TLE = 46 ± 6 vs controls = 53 ± 2, p < 0.001). Type of errors were: 42% semantic, 32% nonresponses, 13% circumlocutory, 9% visual and only 1% phonemic errors. No naming differences were found between right and left TLE patients (p = 0.7). Conclusions: Temporal lobe epilepsy patients showed poor performance on a naming task compared to control subjects further supporting the language deficit observed in this population. The most common type of errors (anomia and semantic) reflect dysfunction of the semantic system. Surprisingly, no differences were found when right and left temporal epilepsy patients were compared. This finding might reflect functional reorganization of language-related neuronal networks in temporal lobe epilepsy. 1 Jelena Djordjevic, 1 Viviane Sziklas, 1 Dominique Piper, 1 Sidonie Penicaud, and 1 Marilyn Jones-Gotman ( 1 Neurology and Neurosurgery, McGill University ) Rationale: Auditory naming tasks may be more appropriate than visual ones as a measure of potential word-finding difficulties in patients who are candidates for resection from the dominant anterior temporal lobe (1). We wished to optimize clinical usefulness of the existing auditory naming task (ANT) by creating a French version that would yield results similar to those obtained in English, and by increasing the number of items so that auditory naming results could be compared more directly with those from visual naming. Methods: To facilitate a more direct comparison of auditory naming with the visual naming task used most commonly (Boston Naming Test; BNT), we increased the number of items on the existing auditory naming task from 50 to 69 by adding 19 new items, then testing 119 healthy volunteers (53 francophone, 66