Austin Woodard

Neuropsychological and behavioral status of children with complex partial seizures

Neuropsychological and behavioral status were examined in 57 children aged 7 to 16 years with complex partial seizures (CPS) and compared with 27 sibling control children of the same age. Epilepsy had a significant effect on both cognitive and behavioral adjustment measures. Children with CPS had significant impairment across all seven cognitive domains assessed, reflective of a profile of relatively diffuse and generalized cognitive dysfunction. Age at onset of recurrent seizures was the strongest and most consistent predictor of adequacy of cognitive functioning; earlier age at onset was associated with poorer cognitive status. Children with CPS also had more problems compared with sibling control children on measures of social and school competence and internalizing behavior problems, but not externalizing behaviors. Further, frequency of seizure activity in the past year, rather than age at seizure onset, emerged as the strongest predictor of these behavioral difficulties. These findings are discussed in the context of understanding the impact of CPS on cognition and behavioral adjustment, and identifying the contribution of various aspects of the neurodevelopmental course of CPS to these issues.

Long-term psychosocial outcomes of anterior temporal lobectomy.

Summary:  Purpose: To examine the long‐term psychosocial outcomes of a consecutive series of patients who underwent anterior temporal lobectomy (ATL) compared with medically managed patients. This study focused primarily on actual long‐term changes (mean, 5 years) in life performance. There are relatively few long‐term controlled studies of actual lifetime performance changes.

Ipsilateral Reorganization of Language in Early-Onset Left Temporal Lobe Epilepsy.

Purpose. Decline in confrontation naming ability occurs in a subset of temporal lobe epilepsy (TLE) patients following left (dominant) anterior temporal lobectomy (ATL). Patients with late age of onset of seizures are most vulnerable to such decline. In addition, object names typically acquired later in language development are the words most likely to be inaccessible after ATL. Early-onset left TLE patients may be at lower risk for post-ATL dysnomia either because they have a limited preoperative lexicon that does not include most late-age-of-acquistion names or they undergo early ipsilateral language reorganization, which results in a lexicon similar to that of late-onset TLE patients but offers protection from post-ATL naming decline.Methods. Sixty-five left hemisphere speech dominant left TLE patients who had undergone ATL were assessed pre- and postoperatively on the Boston Naming Test (BNT).Results. The early- and late-onset groups performed similarly across three BNT age-of-acquisition categories at the preoperative assessment. Words acquired relatively later in life were most likely to become inaccessible postoperatively for both groups, but the early-onset patients showed significantly less overall postoperative decline in naming ability compared with the late-onset group.Conclusions. The more stable pre- to postoperative naming performance exhibited by early-onset patients cannot be attributed to lack of acquisition of the words shown to be most vulnerable to postoperative decline (i.e., late-age-of-acquisition words). Their object naming stability suggests that early-onset left TLE patients undergo intrahemispheric reorganization of language early in life that provides protective benefits.

Learning Disabilities and Language Function in Epilepsy

PATTERNS OF ACADEMIC ACHIEVEMENTParadiso et al. (1994) conducted the only cluster ana-lytic investigation of learning disability subtypes in epi-lepsy (1). Study subjects were well-characterized pa-tients with chronic and intractable temporal lobe epi-lepsy. Selection criteria included WAIS-R Full Scale IQ,>79; age 18 years or older; at least 12 years of education;no magnetic resonance imaging (MRI) findings otherthan atrophy; left hemisphere dominant for speech; andunilateral temporal lobe epilepsy. Mean (standard devia-tion) demographic and clinical characteristics werechronologic age of 31.9 years (9.5 years); gender (56male/61 female subjects); education, 13.1 years (2.4years); age at onset, 13.0 years (11.2 years); laterality oftemporal lobe epilepsy, 59 left, 58 right; and full-scaleIQ, 92.0 (9.9).Wide Range Achievement Test–Revised (WRAT-R)Reading, Spelling, and Arithmetic subtests were the de-pendent measures. Statistical procedures were as fol-lows: (a) the initial cluster structure solution was deter-mined using complete linkage hierarchical technique, (b)the internal validity (reliability) of the initial solutionwas tested with additional analytic techniques using bothWard’s procedure and one-stage iterative partitioningtechniques, and (c) the external validity was then exam-ined by investigating the neuropsychological and clinicalpredictors of the identified clusters.Six clusters were identified: average academicachievement (36% of sample), high average achievement(12%), moderate reading/spelling underachievement(21%), marked reading/spelling (8%), arithmetic under-achievement (10%), and reading/arithmetic under-achievement (13%). The mean WRAT-R scaled scoresfor these clusters are provided in Table 1. Overall, ad-equate academic achievement was evident in 48% of thesample, whereas various patterns of underachievementwere evident in 52%.INTERICTAL LANGUAGE FUNCTION INCHILDREN AND ADULTS WITH EPILEPSYLanguage batteriesThis summary highlights a few investigations of lan-guage function in epilepsy. Davey and Thompson (2)conducted an early investigation of language function in60 patients with chronic epilepsy. Patients were assessedwith the ITPA and the BMUS and reported that a largeproportion, >30% in some instances, exhibited impairedlanguage performance. Impairments were more wide-spread in receptive functions compared with expressivelanguage abilities and reading. Interestingly, Davey andThompson found that previous caregivers and education-al systems had largely overlooked language problems inthat none of the subjects had undergone recent evalua-tions or speech therapy. Predictors of language abnor-mality were identified, but laterality of focus was notsignificant.Hermann et al. (3) examined a series of patients withunilateral temporal lobe epilepsy using a standard lan-guage battery including tests of naming, repetition, flu-ency, spelling, and aural and reading comprehension. Ascan be seen in Table 2, patients with left temporal lobeepilepsy generally performed significantly worse thanright temporal lobe patients across most scales. The dif-ferences were significant in naming, repetition, and sev-eral tests of comprehension, consistent with Davey andThompson’s observations. It also is of interest that theright temporal lobe epilepsy group scored higher than the50th percentile on only one scale, suggesting that lan-guage problems may be evident in temporal lobe epi-lepsy more generally, but are exacerbated in left tempo-ral lobe epilepsy.

Narrative and procedural discourse in temporal lobe epilepsy

It is well established that some individuals with temporal lobe epilepsy (TLE) demonstrate language deficits at the single word level. However, discourse production rarely has been examined quantitatively within this group. This study compared adult TLE patients with an early seizure onset (< or = age 14 years, n = 27) to a control group (n = 28) on narrative and procedural discourse tasks. As a group, the TLE patients performed normally on the procedural discourse task, but differed significantly from the controls on several narrative discourse variables. At the individual level, 30% of the TLE patients versus 4% of the controls demonstrated impaired discourse ability (p and 0.01). Within this early onset TLE group, discourse performance was not associated with demographic or seizure history variables. Considering the cognitive domain, discourse performance correlated significantly with working memory. In summary, mild discourse dysfunction was present in a significant minority of early onset TLE patients, but this deficit was not closely associated with other language measures. Discourse ability and its neuropsychological, neuroanatomical and conversational speech correlates deserve further study in TLE patients.

Negative symptoms and psychosocial status in temporal lobe epilepsy

PURPOSE To determine the relationship between negative symptoms, psychosocial function and quality of life in temporal lobe epilepsy. METHODS 23 patients with temporal lobe epilepsy with negative symptoms were matched on gender, age, years of education, duration and age of epilepsy onset with 23 temporal lobe epilepsy patients exhibiting no negative symptoms as determined by a standardized rating system (SANS/SAPS). The matched groups were compared in regard to: (1). employment status, (2). dependence on government financial subsidy, (3). relationship/marital status, and (4). self-reported quality of life. RESULTS Temporal lobe epilepsy patients with negative symptoms exhibited higher rates of unemployment, dependence on government aid, social isolation, and poorer self-reported quality of life relative to temporal lobe patients without negative symptoms. CONCLUSIONS Interictal negative symptoms are associated with significantly increased psychosocial morbidity and poorer quality of life in temporal lobe epilepsy.

Epilepsy surgery outcome among US veterans.

We retrospectively studied the outcome of anterior temporal lobectomy (ATL) among a population of veterans and evaluated outcome related to comorbidities. Veterans who underwent ATL between 1990 and 2001 at the Veterans Administration Hospital in Madison, Wisconsin, were included. Data related to postoperative seizure outcome, quality of life outcome, and employment outcome were collected. Factors associated with favorable outcome and outcome related to comorbidities were evaluated. Twenty-seven patients were entered into the study. The mean age at onset of seizures was 25 years (+/-10.2). History of a non-substance abuse psychiatric diagnosis, and substance abuse was present in 26% (7/27) and 30% (9/27), respectively, prior to surgery. While 66.6% (18/27) had a good outcome (Engels Class I), no difference in the frequency of good outcome was seen among the patients with a history of substance abuse, other psychiatric diagnosis (71%), or no psychiatric diagnosis (67%). There was a significant correlation between seizure outcome and quality of life score (r(s)=0.67, p<0.001) and postoperative employment gains (r(s)=0.48, p=0.01). Outcomes among veterans that underwent ATL can be satisfactory even in the context of the late mean age of epilepsy onset and the psychiatric diagnoses that were present in this sample.

The Biofeedback Treatment of Neurological and Neuropsychological Disorders of Childhood and Adolescence

Biofeedback is one of several behavioral treatments designed to increase an individual’s self-regulation of physiology. It employs instrumentation to provide patients with both immediate and precise information about otherwise occult physiological processes. In clinical settings, biofeedback is typically used in conjunction with other behavioral or medical interventions to reduce the frequency of distressing symptoms or to minimize physical impairments. The mechanisms underlying biofeedback’s clinical efficacy are unclear. Different theorists have advanced varying explanations including operant conditioning of discrete physiological responses (Miller, 1969), the learning of a generalized relaxation response (Silver and Blanchard, 1978), and the production of cognitive changes promoting an increased sense of self-control and self-efficacy (Holroyd et al., 1984; Turk, Meichenbaum, and Berman, 1979). Despite these different viewpoints, agreement exists that motivated individuals are able to use biofeedback signals to learn voluntary control over a variety of physiologic parameters.