Tara T. Lineweaver

Failure of gamma knife radiosurgery for mesial temporal lobe epilepsy: report of five cases.

OBJECTIVE:We sought to determine the efficacy of gamma knife radiosurgery (GKRS) in controlling mesial temporal lobe epilepsy. METHODS:From August 1999 to January 2001, five patients with drug-resistant mesial temporal lobe epilepsy due to hippocampal sclerosis underwent GKRS amygdalohippocampectomy. All of the patients underwent standard epilepsy preoperative evaluation at the comprehensive epilepsy center of the Cleveland Clinic Foundation. A marginal dose of 20 Gy to the 50% isodose line was delivered to the mesial temporal structures in all patients. Postoperative follow-up included serial neurological examinations, neuroimaging studies, and neuropsychological evaluations. RESULTS:None of the patients were seizure-free after GKRS. Two patients died, 1 month and 1 year after the procedure, as a result of complications related to recurrent seizures. At 1 year, T2-weighted magnetic resonance imaging changes were noted in all three patients, which suggested radiational changes. None of the three surviving patients had any seizure reduction, so 18, 20, and 22 months after GKRS, they underwent temporal lobectomy, which resulted in complete seizure control in all patients. CONCLUSION:GKRS at the 20-Gy dose level did not lead to seizure control in patients with mesial temporal lobe epilepsy due to hippocampal sclerosis.

Evaluating the Contributions of State of the Art Assessment Techniques to Predicting Memory Outcome after Unilateral Anterior Temporal Lobectomy

Summary:  Purpose: Although anterior temporal lobectomy (ATL) is an effective treatment for many patients with medically refractory temporal lobe epilepsy (TLE), one risk associated with this procedure is postsurgical decline in memory. A substantial number of past studies examined factors that predict memory decline after surgery, but few have investigated multiple predictors simultaneously or considered measures that are currently in use.

Atypical Language Lateralization in Epilepsy Patients

Purpose:  To investigate whether atypical language dominance in epilepsy patients is related to localization and type of lesions.

Effect of Knowledge of APOE Genotype on Subjective and Objective Memory Performance in Healthy Older Adults

OBJECTIVE The knowledge that one carries the apolipoprotein E (APOE) ε4 allele risk factor for Alzheimers disease was recently found to have little short-term psychological risk. The authors investigated the impact of knowledge of carrying the risk allele on subjective ratings of memory and objective memory test performance of older adults. METHOD Using a nested case-control design, the authors administered objective verbal and visual memory tests and self-rating scales of memory function to 144 cognitively normal older adults (ages 52-89) with known APOE genotype who knew (ε4+, N=25; ε4-, N=49) or did not know (ε4+, N=25; ε4-, N=45) their genotype and genetic risk for Alzheimers disease prior to neuropsychological evaluation. RESULTS Significant genotype-by-disclosure interaction effects were observed on several memory rating scales and tests of immediate and delayed verbal recall. Older adults who knew their ε4+ genotype judged their memory more harshly and performed worse on an objective verbal memory test than did ε4+ adults who did not know. In contrast, older adults who knew their ε4- genotype judged their memory more positively than did ε4- adults who did not know, but these groups did not differ in objective memory test performance. CONCLUSIONS Informing older adults that they have an APOE genotype associated with an increased risk of Alzheimers disease can have adverse consequences on their perception of their memory abilities and their performance on objective memory tests. The patients knowledge of his or her genotype and risk of Alzheimers disease should be considered when evaluating cognition in the elderly.

Specific Epileptic Syndromes Are Rare Even in Tertiary Epilepsy Centers: A Patient-oriented Approach to Epilepsy Classification

Summary:  Purpose: To assess the practicability and reliability of a five‐dimensional patient‐oriented epilepsy classification and to compare it with the International League Against Epilepsy (ILAE) classification of epilepsy and epileptic syndromes. The dimensions consist of the epileptogenic zone, semiologic seizure type(s), etiology, related medical conditions, and seizure frequency.

Longer duration of epilepsy and earlier age at epilepsy onset correlate with impaired cognitive development in infancy

We assessed the impact of age at onset of epilepsy and duration and frequency of seizures on cognitive development in children less than 3 years old. Retrospective analysis was conducted on clinical data and neuropsychological testing of 33 infants with epilepsy. Developmental quotients were calculated and were correlated with age at epilepsy onset, duration of epilepsy, seizure frequency, brain pathology, and types of seizures (with/without spasms) as potential predictors. Infants with longer duration and earlier onset of epilepsy performed worse on developmental neuropsychological testing. Regression analyses showed that age at epilepsy onset and percentage of life with epilepsy were both strongly associated (regression model P<0.0001) with developmental quotient. There was no correlation with seizure frequency. Infants with spasms had worse developmental quotients than infants without spasms (P<0.001). These results suggest that duration of epilepsy and age at onset may be the best developmental predictors during the first years of life in patients with epilepsy. Early aggressive intervention should be considered.

Repeated Intracarotid Amobarbital Tests

Summary:  Rationale: Our goal was to determine the frequency of repeated intracarotid amobarbital test (IAT) at our center and to estimate the retest reliability of the IAT for both language and memory lateralization.

ApoE-ε4 is associated with reduced memory in long-standing intractable temporal lobe epilepsy

Objective: To investigate the relationship between the apolipoprotein (ApoE) ε4 allele and memory performance (verbal and nonverbal) in patients with medically intractable temporal lobe epilepsy (TLE) who underwent temporal lobectomy. Methods: Presurgical and postsurgical memory performance was examined in 87 adult patients with TLE (ε4 = 22; non-ε4 = 65) to determine whether the expression of ApoE-ε4 may be associated with memory performance in this population and to examine how this relationship may be affected by duration of epilepsy. Results: There was a significant interaction between ApoE-ε4 status and duration of epilepsy such that ε4 carriers with a long duration of epilepsy demonstrated the poorest memory performance on both verbal and nonverbal measures. This relationship was observed both before and after temporal lobectomy, with little change in test performance over time. Conclusions: The ApoE-ε4 allele interacts with longstanding seizures to affect memory performance, both verbal and nonverbal, in patients with medically intractable temporal lobe epilepsy.

Expectations about memory change across the life span are impacted by aging stereotypes.

This study examined whether expectations about memory change with age vary for different personality types. Four adjectives from each of M. L. Hummert, T. A. Garstka, J. L. Shaner, and S. Strahms (1994) age-stereotype trait sets were selected to create 11 adjective clusters varying in both valence (positive vs. negative) and relevance to memory functioning. There were 373 participants in 3 age groups who rated the memory abilities of target adults, defined by the adjective clusters, across the adult life span. Consistent with past studies, participants believed in age-related memory decline. However, participants rated target adults with positive personality traits as having better memory ability and less age-related memory decline than target adults with negative personality traits. This effect was larger when the traits were relevant to memory than when they were not. Finally, older participants were more strongly influenced by both the valence and the relevance of the personality descriptions than younger participants.

Differential effects of Alzheimer's disease and Huntington's disease on the performance of mental rotation

The ability to spatially rotate a mental image was compared in patients with Alzheimers disease (AD; n = 18) and patients with Huntingtons disease (HD; n = 18). Compared to their respective age-matched normal control (NC) group, the speed, but not the accuracy, of mental rotation abnormally decreased with increasing angle of orientation for patients with HD. In contrast, the accuracy, but not the speed, of rotation abnormally decreased with increasing angle of orientation for patients with AD. Additional analyses showed that these unique patterns of performance were not attributable to different speed/accuracy trade-off sensitivities. This double dissociation suggests that the distinct brain regions affected in the two diseases differentially contribute to speed and accuracy of mental rotation. Specifically, the slowing exhibited by HD patients may be mediated by damage to the basal ganglia, whereas the spatial manipulation deficit of AD patients may reflect pathology in parietal and temporal lobe association cortices important for visuospatial processing.