Molly H. Warner

Relationships Between IQ and Neuropsychological Measures in Neuropsychiatric Populations: Within-Laboratory and Cross-Cultural Replications Using WAIS and WAIS-R

Several studies have reported positive correlations between measures of intelligence (a quasi-subject variable) and level of performance on neuropsychological tests; few, however, have presented test results by IQ grouping, which could be useful for comparative purposes. The present study examined the relationships of WAIS and WAIS-R Full Scale IQ to performance on a neuropsychological battery consisting of the Halstead-Reitan Battery (HRB), the Wide Range Achievement Test (WRAT), and the Wechsler Memory Scale (WMS). Four mixed neuropsychiatric samples provided cross-cultural and within-laboratory replications, two tested with WAIS and two with WAIS-R. Means and standard deviations for each measure were presented by five IQ levels within each sample. IQ was strongly related to scores on problem-solving tasks, auditory and linguistic measures, memory tasks, academic achievement levels, and tactual imperceptions, while motor functioning and sensory suppressions were less strongly related to IQ. IQ level was related to educational level in all samples. Correlations of years of education with dependent variables in the two WAIS-R samples were strong and replicable for WRAT scores, verbal memory measures, linguistic errors on the Aphasia Screening Test, and finger-tapping speeds but not for other HRB measures. Finally, IQ-HRB relationships were compared to those reported for other populations.

Use of dexmedetomidine in awake craniotomy in adolescents: report of two cases

Awake craniotomy is a key tool in resection of lesions near critical functional regions, particularly the speech area. Craniotomy with an awake portion for mapping may be performed in carefully selected adolescents and preteenaged children. A number of different regimens may be used for sedation and anesthesia in these cases. We describe two adolescent patients in whom awake craniotomy was performed using an intravenous anesthesia technique with dexmedetomidine and without need for airway instrumentation.

Functional magnetic resonance imaging for presurgical evaluation of very young pediatric patients with epilepsy

OBJECT The authors describe their experience with functional MR (fMR) imaging in children as young as 5 years of age, or even younger in developmental age equivalent. Functional MR imaging can be useful for identifying eloquent cortex prior to surgical intervention. Most fMR imaging clinical work has been done in adults, and although children as young as 8 years of age have been included in larger clinical series, cases in younger children are rarely reported. METHODS The authors reviewed presurgical fMR images in eight patients who were 8 years of age or younger, six of whom were 5 or 6 years of age. Each patient had undergone neuropsychological testing. Three patients functioned at a below-average level, with adaptive functioning age scores of 3 to 4 years. Self-paced finger tapping (with passive movement in one patient) and silent language tasks were used as activation tasks. The language task was modified for younger children, for whom the same (not novel) stimuli were used for extensive practice ahead of time and in the MR imaging unit. Patient preparation involved techniques such as having experienced staff present to work with patients and providing external management during imaging. Six of eight patients had extensive training and practice prior to the procedure. In the two youngest patients, this training included use of a mock MR unit. RESULTS All cases yielded successful imaging. Finger tapping in all seven of the patients who could perform it demonstrated focal motor activation in the frontal-parietal region, with expected activation elsewhere, including in the cerebellum. Three of four patients had the expected verb generation task activations, with left-hemisphere dominance, including a 6-year-old child who functioned at the 3-year, 9-month level. The only child (an 8-year-old) who was not prepared prior to the imaging session for the verb generation task failed this task due to movement artifact. CONCLUSIONS Despite the challenges of successfully using fMR imaging in very young and clinically involved patients, these studies can be performed successfully in children with a chronological age of 5 or 6 years and a developmental age as young as 3 or 4 years.

Effect of carnitine on measures of energy levels, mood, cognition, and sleep in adolescents with epilepsy treated with valproate

Abstract Valproate therapy has been associated with significant decreases in serum-free carnitine plasma concentrations. This double-blind, placebo-controlled cross-over study investigated the usefulness of carnitine supplementation in affecting perceived energy levels in a group of adolescents with epilepsy treated with valproate monotherapy. Eleven males and eight females received a randomized placebo phase and a treatment phase that consisted of L-carnitine, 1 gm twice daily for 5–6 weeks. Baseline, phase I, and phase II measurements included free and total carnitine, valproate serum concentration, venous ammonia concentration, self- and parent-ratings of mood state and energy levels, a screening test for cognitive ability, and 1-week sleep records. No significant group differences between carnitine and placebo conditions were found on any of the cognitive, mood, energy, or sleep measures. Only 2 out of 19 had low baseline serum carnitine. In conclusion, carnitine supplementation appears to have no discernable effects in this healthy sample and should be reserved for those patients on valproate with clinical evidence of carnitine deficiency.

Age group differences on neuropsychological battery performance in a neuropsychiatric population: An international descriptive study with replications ☆

The relationship of age to performance on the Halstead-Reitan Neuropsychological Battery was examined in three samples drawn from neuropsychiatric populations: an initial sample of 217 subjects, a within-laboratory replication of 307 subjects, and a cross-national replication sample of 101 subjects. The results showed significant relationships of age to subtests of the Halstead-Reitan Battery involving problem-solving abilities and motor strength, which were replicated across the three samples. Verbal and perceptual subtests were not consistently related to age across samples. For those problem-solving and motor tests showing replicated correlations with age. mean scores are provided for three age groups (16-34, 35-54, and 55 and above), and group differences were tested with analysis of variance. These results help clarify for which measures age group differences are consistent in neuropsychiatric populations. Implications of these results for treatment program planning are discussed

Impact of epilepsy surgery on development of preschool children: identification of a cohort likely to benefit from early intervention

OBJECT Outcomes of focal resection in young children with early-onset epilepsy are varied in the literature due to study differences. In this paper, the authors sought to define the effect of focal resection in a small homogeneous sample of children who were otherwise cognitively intact, but who required early surgical treatment. Preservation of and age-appropriate development of intelligence following focal resection was hypothesized. METHODS Cognitive outcome after focal resection was retrospectively reviewed for 15 cognitively intact children who were operated on at the ages of 2-6 years for lesion-related, early-onset epilepsy. Intelligence was tested prior to and after surgery. Effect sizes and confidence intervals for means and standard deviations were used to infer changes and differences in intelligence between 1) groups (pre vs post), 2) left versus right hemisphere resections, and 3) short versus long duration of seizures prior to resection. RESULTS No group changes from baseline occurred in Full Scale, verbal, or nonverbal IQ. No change from baseline intelligence occurred in children who underwent left or right hemisphere surgery, including no group effect on verbal scores following surgery in the dominant hemisphere. Patients with seizure durations of less than 6 months prior to resection showed improvement from their presurgical baseline in contrast to those with seizure duration of greater than 6 months prior to surgery, particularly in Wechsler Full Scale IQ and nonverbal intelligence. CONCLUSIONS This study suggests that surgical treatment of focal seizures in cognitively intact preschool children is likely to result in seizure remediation, antiepileptic drug discontinuation, and no significant decrement in intelligence. The latter finding is particularly significant in light of the longstanding concern associated with performing resections in the language-dominant hemisphere. Importantly, shorter seizure duration prior to resection can result in improved cognitive outcome, suggesting that surgery for this population should occur sooner to help improve intelligence outcomes.

Advances in the Care of Children with Spina Bifida

Susan D. Apkon, MD*, Richard Grady, MD, Solveig Hart, PT, MSPT, PCS, Amy Lee, MD, Thomas McNalley, MD, MA, Lee Niswander, PhD, Juliette Petersen, MS, Sheridan Remley, PT, DPT, Deborah Rotenstein, MD, Hillary Shurtleff, PhD, Molly Warner, PhD, ABPP-CN, William O. Walker Jr, MD Rehabilitation Medicine, University of Washington, Seattle, WA, USA; Rehabilitation Medicine, Seattle Children’s Hospital, 4800 Sand Point Way Northeast, M/S OB-8414, Seattle, WA 98105, USA; Section of Pediatric Urology, Seattle Children’s Hospital, University of Washington School of Medicine, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA; Rehabilitation Services, Seattle Children’s Hospital, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA; Pediatric Neurosurgery, Seattle Children’s Hospital, University of Washington, 4800 Sand Point Way Northeast, M/S W7729, PO Box 5371, Seattle, WA 98105, USA; Rehabilitation Medicine, Seattle Children’s Hospital, University of Washington, 4800 Sand Point Way Northeast, M/S OB-8404, Seattle, WA 98105, USA; Department of Pediatrics, Children’s Hospital Colorado, Howard Hughes Medical Institute, University of Colorado School of Medicine, Mail Stop 8133, Building RC1 South, Room L18-12106, 12801 East 17th Avenue, Aurora, CO 80045, USA; Molecular Biology Program, University of Colorado Denver Anschutz Medical Campus, Mail Stop 8133, Building RC1 South, L18-12400D, 12801 East 17th Avenue, Aurora, CO 80045, USA; Pediatric Endocrinology, Endocrine Division, Pediatric Alliance, 1789 South Braddock Avenue, Suite 294, Pittsburgh, PA 15218, USA; Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA; Department of Child Psychiatry, Seattle Children’s Hospital, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA; Neuropsychology Consult Service, Department of Psychiatry, Seattle Children’s Hospital, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA; Division of Developmental Medicine, Seattle Children’s Hospital, University of Washington School of Medicine, 4800 Sand Point Way Northeast, M/S OC.9.940, Seattle, WA 98105, USA

High-fat diets and seizure control in myoclonic-astatic epilepsy: A single center's experience

PURPOSE To determine the efficacy of the Modified Atkins Diet (MAD) and Ketogenic Diet (KD) in seizure control within a population of myoclonic-astatic epilepsy (MAE) patients. METHODS This was a retrospective, single center study evaluating the seizure control by high fat diets. Seizure diaries kept by the parents performed seizure counts. All patients met the clinical criteria for MAE. RESULTS Nine patients met the clinical criteria. We found that both the MAD and KD were efficacious in complete seizure control and allowed other medications to be stopped in seven patients. Two patients had greater than 90% seizure control without medications, one on the KD and the other on the MAD. Seizure freedom has ranged from 13 to 36 months, and during this time four patients have been fully weaned off of diet management. One patient was found to have a mutation in SLC2A1. CONCLUSION Our results suggest that strictly defined MAE patients respond to the MAD with prolonged seizure control. Some patients may require the KD for seizure freedom, suggesting a common pathway of increased requirement for fats. Once controlled, those fully responsive to the Diet(s) could be weaned off traditional seizure medications and in many, subsequently off the MAD or KD.

Mitochondrial electron transport chain deficiency, cardiomyopathy, and long-term cardiac transplant outcome

Golden AS, Law YM, Shurtleff H, Warner M, Saneto RP. Mitochondrial electron transport chain deficiency, cardiomyopathy, and long‐term cardiac transplant outcome.

Factor analysis of the Wechsler Memory Scale: is the associate learning subtest an unclear measure?

A factor analysis of the Wechsler Memory Scale (WMS) with 30-minute delayed recall scores (percent retained) for the Logical Memory, Visual Reproduction, and Associate Learning subtests indicated that this variant of the WMS taps different types of learning and memory for new material. With regard to the verbal learning/recall subtests, Logical Memory appears to be related to attention/ concentration ability, while Associate Learning is relatively independent. The results also showed that both the easy and hard items from Associate Learning tap the same ability, providing evidence that this subtest is a measure of rote verbal learning. These results support the clinical utility of the WMS with delayed recalls in neuropsychiatric populations.