Linda M. Selwa

Nonepileptic Seizure Outcome Varies by Type of Spell and Duration of Illness

Purpose: To determine whether differences in clinical manifestations of psychogenic nonepileptic events are associated with differences in outcome and whether the length of illness before diagnosis correlates with outcome.

Serial Cognitive Testing in Temporal Lobe Epilepsy: Longitudinal Changes with Medical and Surgical Therapies

Summary: Cognitive testing was repeated at intervals ranging from 1 to 8 years in 47 adult patients with temporal lobe epilepsy (TLE). Each patient underwent standardized batteries, including the Wechsler Adult Intelligence Scale, Revised (WAIS‐R), and Wechsler Memory Scale (WMS). Both surgically treated and nonsurgical patients were examined. The nonsurgical group underwent serial testing for clinical indications, usually for complaints of memory dysfunction. Longitudinal testing could not verify any mean deterioration of intellect or memory in this group; variance over time was similar to test‐retest norms in healthy controls. WAIS‐R scores before and after resection in the surgical group were similar to our serial WAIS‐R data in nonsurgical patients. When we divided surgical patients according to side of epileptogenesis, we noted the expected differences in verbal and visual memory. Right‐sided surgery patients improved significantly in Full‐scale IQ (FSIQ) and tended to improve in logical memory on postoperative testing. Patients undergoing left resections had no retest improvement and tended to show decrease in several measures of verbal memory. Our findings should stimulate continued investigation into the natural history of lateralized memory and intellectual function in epilepsy, particularly to clarify longterm cognitive outcome in nonsurgical patients.

Lateralizing value of interictal spikes on overnight sleep-EEG studies in temporal lobe epilepsy

Summary: Purpose: To determine the lateralizing value of interictal epileptiform discharges (IEDs) recorded during overnight sleep‐EEG studies in temporal lobe epilepsy. Because IEDs are more prevalent in non‐rapid eye movement (NREM) sleep than in wakefulness, overnight sleep‐EEG recordings may contribute additional lateralizing information to the epilepsy surgery evaluation beyond daytime EEGs.

Efficacy of Topiramate in Children with Refractory Status Epilepticus

Summary:  Purpose: Status epilepticus (SE) is a life‐threatening medical condition associated with significant morbidity and mortality that requires urgent medical intervention. Although several agents are available to treat SE, they occasionally fail to abort seizure activity. Topiramate (TPM) was anecdotally reported to be effective in adult patients with refractory SE. In this study, we evaluated the efficacy of TPM administered to children with this condition.

Long-term outcome of nonsurgical candidates with medically refractory localization-related Epilepsy

Summary:  Purpose: Epilepsy surgery can result in complete seizure remission rates of upto 80% in patients with mesial temporal sclerosis and unilateral seizures. The seizure‐free rate after surgery for patients with extratemporal nonlesional epilepsy has ranged between 30% and 40%. Some patients with medically refractory localization‐related epilepsy cannot be offered surgical resection because of inadequate localization of the epileptogenic zone, documentation of bilateral ictal onsets, or functionally important areas of cortex that prohibit resection. The short‐term rate of complete remission with medications in temporal lobe epilepsy is poor. Less is known about remission rates in patients who are not surgical candidates. In this study, we evaluated the outcome of medical treatment in patients with medically refractory partial epilepsy who were evaluated for possible epilepsy surgery but deemed to be inadequate surgical candidates.

Sodium methohexital (brevital) as an anesthetic in the Wada test.

Summary:  Purposes: We report our experience with sodium methohexital (Brevital) as an anesthetic used in the Wada test for language and memory in 86 epilepsy surgery patients (173 procedures).

Persistent headache after supratentorial craniotomy.

OBJECTIVEAlthough the incidence, possible causes, and treatment of persistent headache after suboccipital craniotomy have been discussed extensively, few data have been published regarding persistent headache after supratentorial craniotomy. METHODSWe retrospectively analyzed the senior author’s patient series of 145 consecutive anterior temporal lobectomies for intractable epilepsy performed during a 9-year period. To eliminate confounding causes of headache, all patients studied were seizure-free, none had progressive mass lesions or persisting vascular anomalies, and none had major complications of surgery. With the permission of the institutional review board, information on headache was obtained from patient records, the patients’ neurologists, and the patients themselves. RESULTSOf the 145 consecutive patients who underwent operations, 126 patients had adequate follow-up for analysis. Of the 126 patients, 104 did not have headaches and were not using regular analgesics 2 months postoperatively. Twenty-two patients had headaches persisting beyond 2 months. Seven (5.6%) of the 126 patients had headaches that lasted more than 2 months but less than 1 year, and they were free of recurrent headaches 1 year postoperatively. Fifteen (11.9%) of the 126 patients had ongoing headaches 1 year after surgery. Regarding headache severity, 4.0% of patients had medically uncontrolled headaches, and 3.2% continued to require prescription drugs for headaches 1 year postoperatively. CONCLUSIONAlthough the incidence of persistent head pain after supratentorial craniotomy is lower than that reported for posterior fossa procedures, the incidence is not trivial. The cause of persistent pain deserves further investigation.

The Prevention Research Centers’ Managing Epilepsy Well Network

The Managing Epilepsy Well (MEW) Network was created in 2007 by the Centers for Disease Control and Preventions (CDC) Prevention Research Centers and Epilepsy Program to promote epilepsy self-management research and to improve the quality of life for people with epilepsy. MEW Network membership comprises four collaborating centers (Emory University, University of Texas Health Science Center at Houston, University of Michigan, and University of Washington), representatives from CDC, affiliate members, and community stakeholders. This article describes the MEW Networks background, mission statement, research agenda, and structure. Exploratory and intervention studies conducted by individual collaborating centers are described, as are Network collaborative projects, including a multisite depression prevention intervention and the development of a standard measure of epilepsy self-management. Communication strategies and examples of research translation programs are discussed. The conclusion outlines the Networks role in the future development and dissemination of evidence-based epilepsy self-management programs.

Value of Inpatient Diagnostic CCTV-EEG Monitoring in the Elderly

Summary: Purpose: To examine the outcome of inpatient diagnostic closed circuit TV‐EEG (CCTV‐EEG) monitoring in a consecutive series of elderly patients admitted to an adult epilepsy‐monitoring unit (EMU) over a continuous 6‐year period.

Expanding the Efficacy of Project UPLIFT: Distance Delivery of Mindfulness-based Depression Prevention to People with Epilepsy

OBJECTIVE Depression affects about 16% of the U.S. population over a lifetime. People with chronic diseases have especially high rates of comorbid depression; 32% to 48% of people with epilepsy experience depression. This study evaluated the efficacy of a mindfulness-based cognitive therapy intervention for preventing major depressive disorder (MDD) episodes in people with epilepsy. METHOD Participants (n = 128) were adults from Georgia, Michigan, Texas, and Washington with epilepsy and mild/moderate depressive symptoms. The 8-session weekly Project UPLIFT intervention, based on mindfulness-based cognitive therapy, was group-delivered via Web or telephone. Using a randomized, controlled crossover design, participants were assigned to Project UPLIFT or a treatment-as-usual (TAU) waitlist and assessed at baseline, and after intervening in the intervention group (∼10 weeks) and in the TAU group (∼20 weeks). Assessments included valid self-report measures of depression and MDD, knowledge/skills, and satisfaction with life. RESULTS The incidence of MDD episodes (new or relapse) from baseline to interim assessment was significantly lower in the intervention condition (0.0%) than in TAU (10.7%). Depressive symptoms decreased significantly more in the intervention condition than in TAU; Web and telephone did not differ. Change in knowledge/skills mediated the effect, which persisted over the 10 weeks of follow-up. Knowledge/skills and life satisfaction increased significantly more in the intervention condition than in TAU. CONCLUSIONS Distance delivery of group mindfulness-based cognitive therapy can prevent episodes of MDD, reduce symptoms of depression, and increase life satisfaction in people with epilepsy. This intervention is easily modified for persons with other chronic diseases and other disparity populations. (PsycINFO Database Record