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Sharma S, Nehra A, Pandey S, Tripathi M, Srivastava A, Padma MV, Garg A, Pandey RM, Chandra S, Tripathi M. Neuropsychological Rehabilitation for Epilepsy in India: Looking Beyond the Basics. Epilepsy Behav 2024; 153:109703. [PMID: 38452517 DOI: 10.1016/j.yebeh.2024.109703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 02/11/2024] [Accepted: 02/15/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Neuropsychological Rehabilitation (NR) helps manage cognitive deficits in epilepsy. As internationally developed programs have limited applicability to resource-limited countries, we developed a program to bridge this gap. This 6-week caregiver-assisted, culturally suitable program has components of (1) psychoeducation, (2) compensatory training, and, (3) cognitive retraining and is called EMPOWER (Indigenized Home Based Attention and Memory Rehabilitation Program for Adult Patients with Drug Refractory Epilepsy). Its efficacy needs to be determined. METHODS We carried out an open-label parallel randomized controlled trial. Adults aged 18-45 years with Drug Refractory Epilepsy (DRE), fluency in Hindi and or English, with impaired attention or memory (n = 28) were randomized to Intervention Group (IG) and Control Group (CG). The primary outcomes were objective memory (Auditory Verbal Learning Test), patient and caregiver reported everyday memory difficulties (Everyday Memory Questionnaire-Revised), number of memory aids in use, depression (Hamilton Depression Rating Scale), anxiety (Hamilton Anxiety Rating Scale) and quality of life (Quality of Life in Epilepsy-31). Intention to treat was carried out for group analysis. In the absence of norms necessary for computing Reliable Change Indices (RCIs), a cut-off of +1.0 Standard Deviation (SD) was utilized to identify clinically meaningful changes in the individual analysis of objective memory. A cut-off of 11.8 points was used for quality of life. Feedback and program evaluation responses were noted. RESULTS The majority of the sample comprised DRE patients with temporal lobe epilepsy who had undergone epilepsy surgery. Group analysis indicated improved learning (p = 0.013), immediate recall (p = 0.001), delayed recall (p < 0.001), long-term retention (p = 0.031), patient-reported everyday memory (p < 0.001), caregiver-reported everyday memory (p < 0.001), anxiety (p = 0.039) and total quality of life (p < 0.001). Individual analysis showed improvement in 50 %, 64 %, 71 %, 57 %, and 64 % of patients on learning, immediate recall, delayed recall, long-term retention, and total quality of life respectively. Despite improvements, themes indicative of a lack of awareness and understanding of cognitive deficits were identified. Overall, the program was rated favorably by patients and caregivers alike. CONCLUSION NR shows promise for patients with DRE, however larger studies are warranted. The role of cognition in epilepsy needs to be introduced at the time of diagnosis to help lay the foundation for education and acceptance.
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Affiliation(s)
- Shivani Sharma
- Neuropsychology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Ashima Nehra
- Neuropsychology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India.
| | - Shivam Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Madhavi Tripathi
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Achal Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - M V Padma
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Sarat Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Thompson K, Lo AHY, McGlashan HL, Ownsworth T, Haslam C, Pegna A, Reutens DC. Measures of Subjective Memory for People with Epilepsy: A Systematic Review of Measurement Properties. Neuropsychol Rev 2024; 34:67-97. [PMID: 36633798 DOI: 10.1007/s11065-022-09568-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/21/2022] [Indexed: 01/13/2023]
Abstract
People with epilepsy frequently express concern about the burden of memory problems in their everyday lives. Self-report memory questionnaires may provide valuable insight into individuals' perceptions of their everyday memory performance and changes over time. Yet, despite their potential utility, the measurement properties of self-report memory questionnaires have not been evaluated in epilepsy. This systematic review aimed to provide a critical appraisal of the measurement properties of self-report memory questionnaires for adults with epilepsy. Following protocol registration (PROSPERO CRD42020210967), a systematic search of PubMed, EMBASE, Web of Science, CINAHL, and PsychInfo from database inception until 27 May 2021 was conducted. Eligible studies were published in English-language peer-reviewed journals, recruited adults with epilepsy, and reported on the development or evaluation of the measurement properties of a self-report memory questionnaire. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology was used to evaluate each study of a measurement property, and results were qualitatively synthesised. In total, 80 articles and one test manual were located containing 153 studies of measurement properties pertinent to 23 self-report memory questionnaires. Overall, no scale could be recommended outright for the evaluation of subjective memory symptoms in adults with epilepsy. This was due to the near absence of dedicated content validation studies relevant to this population and shortcomings in the methodology and scientific reporting of available studies of structural validity. Recommendations to support the advancement and psychometric validation of self-report memory questionnaires for people with epilepsy are provided.
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Affiliation(s)
- Kate Thompson
- Centre for Advanced Imaging, the University of Queensland, Brisbane, QLD, Australia.
- Psychology Department, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia.
- School of Psychology, the University of Queensland, Brisbane, QLD, Australia.
| | - Ada H Y Lo
- Psychology Department, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
- School of Psychology, the University of Queensland, Brisbane, QLD, Australia
| | - Hannah L McGlashan
- School of Psychology, the University of Queensland, Brisbane, QLD, Australia
- Surgical Treatment and Rehabilitation Service, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Tamara Ownsworth
- School of Applied Psychology and The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
| | - Catherine Haslam
- School of Psychology, the University of Queensland, Brisbane, QLD, Australia
| | - Alan Pegna
- School of Psychology, the University of Queensland, Brisbane, QLD, Australia
| | - David C Reutens
- Centre for Advanced Imaging, the University of Queensland, Brisbane, QLD, Australia
- Neurology Department, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
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Puteikis K, Jakonienė A, Jasionis A, Wolf P, Mameniškienė R. Rehabilitation of cognition and psychosocial well-being - a better life with epilepsy (ReCaP-ABLE): a protocol for a randomized waitlist-controlled trial. Front Neurol 2023; 14:1273550. [PMID: 37965169 PMCID: PMC10641769 DOI: 10.3389/fneur.2023.1273550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 10/11/2023] [Indexed: 11/16/2023] Open
Abstract
Despite advances in the understanding of cognitive dysfunction among people with epilepsy (PWE), evidence for cognitive rehabilitation in epilepsy (CoRE) remains scarce. We present the protocol of a randomized waitlist-controlled trial (ClinicalTrials.gov ID NCT05934786) of a psychological-behavioral intervention aiming to ameliorate quality of life as well as cognitive functioning in a mixed PWE sample. The study is set at Vilnius University Hospital Santaros Klinikos and will offer adult PWE six individual and two group sessions led by a certified psychologist and directed toward improving memory, attention, self-regulation, mood and quality of life. The trial is expected to address major gaps in the literature by providing novel evidence on the effectiveness of CoRE in patients with genetic generalized epilepsies, the importance of epilepsy-specific factors for the response to CoRE, the impact of CoRE on long-term memory as well as its maintenance effects.
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Affiliation(s)
| | - Asta Jakonienė
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Arminas Jasionis
- Center for Neurology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Peter Wolf
- Center for Neurology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Danish Epilepsy Center Filadelfia, Dianalund, Denmark
- Postgraduation Programme in Clinical Medicine, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Rūta Mameniškienė
- Center for Neurology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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4
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Disability and life satisfaction in neurological disorders: The role of depression and perceived cognitive difficulties. Gen Hosp Psychiatry 2021; 73:16-23. [PMID: 34508992 DOI: 10.1016/j.genhosppsych.2021.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/23/2021] [Accepted: 08/30/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND This study assessed factors associated with disability and life satisfaction in a large cohort of 2246 Australian adults with neurological disorders who completed an online survey of mental health and wellbeing. It was hypothesised that depressive symptoms and perceived cognitive difficulties would be significantly associated with both outcomes, even after controlling for significant demographic/medical covariates (e.g., age, marital-status, employment, multi-morbidity, medication). Differences in profiles of four neurological subgroups (i.e., multiple sclerosis; n = 738, epilepsy; n = 672, Parkinson's disease; n = 263, and Acquired Bran Injury; n = 278) were explored. METHODS Multiple hierarchical linear regressions were run using cross-sectional data. RESULTS Depressive symptoms made a significant and large unique contribution to higher levels of disability (β = 0.333, p < .001), and poorer life satisfaction (β = -0.434, p < .001), in the overall sample and across all four neurological subgroups (β = 0.349 to 0.513, p < .001) Greater perceived cognitive difficulties were associated with disability in the overall sample (β = 0.318, p < .001) and across all neurological subgroups (β = 0.231 to 0.354, p < .001), but only life satisfaction in epilepsy (β = -0.107, p = 006). CONCLUSIONS The findings underscore the importance of managing psychological/neuropsychiatric comorbidities in neurological disorders.
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Sharma S, Nehra A, Tripathi M. Applicability of Compensatory Cognitive Training in Epilepsy to Low Resource and Literacy Settings: A Focused Review. Neurol India 2021; 69:717-723. [PMID: 34169875 DOI: 10.4103/0028-3886.319233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Epilepsy is one of the most prevalent neurological disorders, accounting for over 13 million disability-adjusted life years (DALYs). Nearly 80% of people with epilepsy live in low- and middle-income countries (WHO, 2019). Rehabilitation of cognitive impairments through compensatory training in such patients encompasses a wide range of techniques. However, interventional studies exploring their efficacy remain scarce despite being recommended in various reviews. Further, cultural contexts and other related factors have often been overlooked. We aimed to appraise the existing evidence on internal and external compensatory strategies in patients with epilepsy and identify the gaps and pitfalls in the existing literature for applicability to low resource and literacy settings from a neuropsychological perspective.
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Affiliation(s)
- Shivani Sharma
- Division of Neuropsychology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Ashima Nehra
- Division of Neuropsychology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
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Sugden N, Thomas M, Kiernan M. A scoping review of the utility of self-report and informant-report prospective memory measures. Neuropsychol Rehabil 2021; 32:1230-1260. [DOI: 10.1080/09602011.2021.1875851] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Nicole Sugden
- School of Psychology, Charles Sturt University, Bathurst, Australia
| | - Matt Thomas
- School of Psychology, Charles Sturt University, Bathurst, Australia
| | - Michael Kiernan
- School of Psychology, Charles Sturt University, Bathurst, Australia
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Gaston TE, Nair S, Allendorfer JB, Martin RC, Beattie JF, Szaflarski JP. Memory response and neuroimaging correlates of a novel cognitive rehabilitation program for memory problems in epilepsy: A pilot study. Restor Neurol Neurosci 2020; 37:457-468. [PMID: 31282442 DOI: 10.3233/rnn-190919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Memory deficits are very common in epilepsy, but no standard of care exists to effectively manage them. OBJECTIVE We assessed effectiveness of cognitive rehabilitation (CR) on memory and neural plasticity in people with epilepsy (PWE) reporting memory impairments. METHODS Nine PWE completed 6 weekly sessions adapted from 2 generic CR programs enriched with information regarding epilepsy. Participants completed neuropsychological, mood, and quality of life (QOLIE-31) measures prior and after completion of CR; 5/9 participants also completed pre- and post-CR fMRI while performing a verbal paired associates learning task. FMRI data were analyzed using group spatial independent components analysis methods; paired t-tests compared spatial activations for pre-/post-CR. RESULTS Improvements were seen in immediate recall in Rey Auditory Verbal Learning Task, QOLIE-31, and read word recognition in paired associates task (all p's≤0.05). FMRI changes comparing pre-to-post CR were noted through increased activation in the left inferior frontal gyrus (IFG) and anterior cingulate and decreased activation in the left superior temporal gyrus; also noted were decreased activations in the default mode network (DMN), right cingulate, right middle temporal gyrus, right supramarginal gyrus, and increased DMN activation in the left cuneus. CONCLUSIONS This study demonstrates feasibility of conducting CR program in PWE with fMRI as a mechanistic biomarker. Improvements in cognition and cortical plasticity await confirmation in larger samples.
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Affiliation(s)
- Tyler E Gaston
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA.,Birmingham Veterans Administration Medical Center, Birmingham, AL, USA
| | - Sangeeta Nair
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jane B Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Roy C Martin
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Julia Fleming Beattie
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
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Saard M, Bachmann M, Sepp K, Pertens L, Kornet K, Reinart L, Kööp C, Kolk A. Positive outcome of visuospatial deficit rehabilitation in children with epilepsy using computer-based FORAMENRehab program. Epilepsy Behav 2019; 100:106521. [PMID: 31577988 DOI: 10.1016/j.yebeh.2019.106521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 08/24/2019] [Accepted: 08/24/2019] [Indexed: 12/17/2022]
Abstract
Children with epilepsy often show deficits in attention and visuospatial functions. Still, very few systematically controlled evidence-based pediatric neurorehabilitation methods exist. The aim was to assess the effectiveness of a computer-based rehabilitation program for visuospatial deficit remediation in children with epilepsy. Fifty-eight children aged 8-12 years participated: 17 children with epilepsy diagnosis in intervention group, 22 patients in waiting-list control group, and 19 healthy age equivalent controls. The intervention group received guided visuospatial functions rehabilitation with FORAMENRehab software twice a week for a 5-week period. Baseline assessments were carried out before and immediately after the intervention period, and as follow-up 1.31 years later. Intervention group showed positive immediate rehabilitation effect in 3 out of 4 visuospatial components: visual organization, visual attention, and visuospatial perception. A long-term rehabilitation effect in the study group was observed in all 4 of the trained components. Also, a positive generalized effect was confirmed by the parents' and children's qualitative feedback with some of the improved skills transferring to children's everyday life. One hundred percent compliance further confirmed the children's motivation to participate and the effectiveness of FORAMENRehab for pediatric neurorehabilitation.
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Affiliation(s)
- Marianne Saard
- University of Tartu, Faculty of Medicine, Tartu, Estonia.
| | | | - Kirsi Sepp
- University of Tartu, Faculty of Social Sciences, Institute of Education, Tartu, Estonia
| | - Lisanna Pertens
- Tartu University Hospital Children's Clinic, Department of Pediatrics and Neurology, Tartu, Estonia
| | - Kai Kornet
- University of Tartu, Faculty of Medicine, Tartu, Estonia
| | - Liina Reinart
- Tartu University Hospital Children's Clinic, Department of Pediatrics and Neurology, Tartu, Estonia; University of Tartu, Faculty of Social Sciences, Institute of Psychology, Tartu, Estonia
| | - Christen Kööp
- University of Tartu, Faculty of Medicine, Tartu, Estonia
| | - Anneli Kolk
- University of Tartu, Faculty of Medicine, Tartu, Estonia; Tartu University Hospital Children's Clinic, Department of Pediatrics and Neurology, Tartu, Estonia
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Memory Rehabilitation in Patients with Epilepsy: a Systematic Review. Neuropsychol Rev 2018; 28:88-110. [PMID: 29450813 DOI: 10.1007/s11065-018-9367-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 01/21/2018] [Indexed: 10/18/2022]
Abstract
Memory failure is a common clinical concern of patients with epilepsy and is associated with significant functional impairments. Thus, memory rehabilitation is of critical clinical importance. In this article, we aimed to systematically evaluate the efficacy of memory rehabilitation in patients with epilepsy. The Preferred Items for Systematic Reviews and Meta-Analyses (PRISMA) was used to guide searches, extraction and reporting of data in this review. PsycINFO, Medline and PsychBITE searches yielded 95 studies. Twelve papers met inclusion criteria, reporting outcomes of cognitive or behavioural interventions that specifically targeted the rehabilitation of memory in patients with epilepsy. Methodological rigour was rated using the Single-Case Experimental Design (SCED) scale for single-case studies and a modified version of the Downs and Black checklist for group studies. Twelve prospective studies, nine group (six pre-post design, one waitlist crossover, two randomised controlled trials) and three single-case studies were identified. Eleven of the studies included adults, eight of which involved adults with temporal lobe epilepsy (TLE). One paediatric study was identified. The quality of group studies ranged from 36% (poor) to 72% (good), using the modified Downs and Black checklist. Single-case studies were assessed using the SCED scale and assessed to range in quality from four to seven out to 11. Overall, memory rehabilitation was associated with improved memory function in all studies. Verbal memory outcomes were most commonly examined and associated with improvements. This review found that the level of evidence available to support rehabilitation of memory in patients with epilepsy was generally weak and inconsistent. Nevertheless, studies conducted to date, albeit of limited methodological quality, offer preliminary evidence that memory rehabilitation is associated with improvements in verbal memory in patients with temporal lobe epilepsy. Little is known about the efficacy of memory rehabilitation in patients with non-TLE, children, and other aspects of memory difficulties. Guidelines for future research are proposed.
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Geraldi CDV, Escorsi-Rosset S, Thompson P, Silva ACG, Sakamoto AC. Potential role of a cognitive rehabilitation program following left temporal lobe epilepsy surgery. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 75:359-365. [DOI: 10.1590/0004-282x20170050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 02/14/2017] [Indexed: 11/22/2022]
Abstract
ABSTRACT Research into memory and epilepsy has focused on measuring problems and exploring causes with limited attention directed at the role of neuropsychological rehabilitation in alleviating post-operative memory difficulties. Objectives To assess the effects of a memory rehabilitation program in patients with left temporal lobe epilepsy following surgery. Methods Twenty-four patients agreed to participate and 18 completed the study; nine received memory rehabilitation while nine had no input and were designated as controls. Verbal learning efficiency, naming abilities, memory subjective ratings, ecological activity measures and a language fMRI paradigm were used as outcome measures. Results Improved verbal learning and naming test performance, increase in memory strategy use and improved self-perception were observed following the rehabilitation. Changes in fMRI activation patterns were seen in the rehabilitation group over the long term. Conclusion The findings support the potential role of a cognitive rehabilitation program following left temporal lobe surgery.
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Affiliation(s)
| | | | - Pamela Thompson
- UCL Institute of Neurology, UK; Epilepsy Society Research Centre, UK
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12
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Short-term neurocognitive outcomes following anterior temporal lobectomy. Epilepsy Behav 2016; 62:140-6. [PMID: 27474963 DOI: 10.1016/j.yebeh.2016.06.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 04/28/2016] [Accepted: 06/18/2016] [Indexed: 11/20/2022]
Abstract
Changes in cognitive function are a well established risk of anterior temporal lobectomy (ATL). Deficits in verbal memory are a common postoperative finding, though a small proportion of patients may improve. Postoperative evaluation typically occurs after six to 12months. Patients may benefit from earlier evaluation to identify potential needs; however, the results of a formal neuropsychological assessment at an early postoperative stage are not described in the literature. We compared pre- and postoperative cognitive function for 28 right ATL and 23 left ATL patients using repeated measures ANOVA. Changes in cognitive function were compared to ILAE seizure outcome. The mean time to postoperative neuropsychological testing was 11.1weeks (SD=6.7weeks). There was a side×surgery interaction for the verbal tasks: immediate memory recall (F(1,33)=20.68, p<0.001), short delay recall (F(1,29)=4.99, p=0.03), long delay recall (F(1,33)=10.36, p=0.003), recognition (F(1,33)=5.69, p=0.02), and naming (F(1,37)=15.86, p<0.001). This indicated that the left ATL group had a significant decrement in verbal memory following surgery, while the right ATL group experienced a small but significant improvement. For the right ATL group, there was a positive correlation between ILAE outcome and improvement in immediate recall (r=-0.62, p=0.02) and long delay recall (r=-0.57, p=0.03). There was no similar finding for the left ATL group. This study demonstrates that short-interval follow-up is effective in elucidating postoperative cognitive changes. Right ATL was associated with improvement in verbal memory, while left ATL resulted in a decrement in performance. Improvement in the right ATL group was related to improved seizure outcome. Short-interval follow-up may lend itself to the identification of patients who could benefit from early intervention.
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Enke AM, St Louis E, Jackson CF, Makin SM. Non-pharmacological treatments for improving memory in people with epilepsy. Hippokratia 2015. [DOI: 10.1002/14651858.cd011945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ashley M Enke
- Mayo Clinic and Foundation; Department of Sleep Medicine; 200 First Street Southwest Rochester Minnesota USA 55905
| | - Erik St Louis
- Mayo Clinic and Foundation; Neurology and Medicine; 200 First Street Southwest Rochester Minnesota USA 55905
| | - Cerian F Jackson
- Institute of Translational Medicine, University of Liverpool; Department of Molecular and Clinical Pharmacology; Clinical Sciences Centre for Research and Education, Lower Lane Fazakerley Liverpool UK L9 7LJ
| | - Selina M Makin
- The Walton Centre NHS Foundation Trust; Lower Lane Fazakerley Liverpool UK L9 7LJ
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Mazur-Mosiewicz A, Carlson HL, Hartwick C, Dykeman J, Lenders T, Brooks BL, Wiebe S. Effectiveness of cognitive rehabilitation following epilepsy surgery: Current state of knowledge. Epilepsia 2015; 56:735-44. [DOI: 10.1111/epi.12963] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Anya Mazur-Mosiewicz
- The Chicago School of Professional Psychology; Chicago Illinois U.S.A
- Alberta Children's Hospital; Calgary Alberta Canada
| | - Helen L. Carlson
- Alberta Children's Hospital; Calgary Alberta Canada
- Alberta Children's Hospital Research Institute; Calgary Alberta Canada
| | | | | | | | - Brian L. Brooks
- Alberta Children's Hospital; Calgary Alberta Canada
- Alberta Children's Hospital Research Institute; Calgary Alberta Canada
- University of Calgary; Calgary Alberta Canada
| | - Samuel Wiebe
- Foothills Medical Centre; Calgary Alberta Canada
- University of Calgary; Calgary Alberta Canada
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15
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Mosca C, Zoubrinetzy R, Baciu M, Aguilar L, Minotti L, Kahane P, Perrone-Bertolotti M. Rehabilitation of verbal memory by means of preserved nonverbal memory abilities after epilepsy surgery. EPILEPSY & BEHAVIOR CASE REPORTS 2014; 2:167-73. [PMID: 25667899 PMCID: PMC4307883 DOI: 10.1016/j.ebcr.2014.09.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 09/02/2014] [Accepted: 09/03/2014] [Indexed: 11/21/2022]
Abstract
We present a patient with epilepsy who underwent left anterior temporal cortex resection, sparing the hippocampus, to stop drug-refractory seizures. Given that one year after surgery the patient showed verbal memory difficulties, we proposed a short (twelve weeks) and intensive (two times a week) training based on visual imagery strategies as the nonverbal memory abilities were preserved. Neuropsychological and fMRI assessments were performed before and after rehabilitation to evaluate the cognitive progress and cerebral modifications induced by this rehabilitation program. Our results showed that the rehabilitation program improved both scores for verbal memory and the everyday quality of life. Changes in cerebral activity highlighted by fMRI suggest that the program might have facilitated the development of compensatory strategies, as reflected by the shift of activation from the anterior to the posterior cerebral network during a verbal memory task. One year after the rehabilitation program, the patient reported using mental imagery in everyday life for routine and professional activities. Although supplementary evidence is necessary to increase the robustness of these findings, this case report suggests that an efficient rehabilitation program is feasible and (a) should be based on the individual cognitive profile and on the preserved cognitive abilities, (b) can be short but intensive, (c) can be applied even months after the lesion occurrence, and (d) can induce a positive effect which may be sustainable over time.
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Affiliation(s)
- C. Mosca
- Service de Neurologie, CHU de Grenoble, Hôpital Michallon, F-38000 Grenoble, France
| | - R. Zoubrinetzy
- Grenoble Alpes University, LPNC, F-38040 Grenoble, France
- CNRS, LPNC, UMR 5105, F-38040 Grenoble, France
- Referent Centre for Diagnosis of Language and Learning Disorders, Grenoble University Hospital, France
| | - M. Baciu
- Grenoble Alpes University, LPNC, F-38040 Grenoble, France
- CNRS, LPNC, UMR 5105, F-38040 Grenoble, France
| | - L. Aguilar
- Service de Neurologie, CHU de Grenoble, Hôpital Michallon, F-38000 Grenoble, France
| | - L. Minotti
- Service de Neurologie, CHU de Grenoble, Hôpital Michallon, F-38000 Grenoble, France
- Inserm, U836, F-38000 Grenoble, France
- Univ. Grenoble Alpes, GIN, F-38000 Grenoble, France
| | - P. Kahane
- Service de Neurologie, CHU de Grenoble, Hôpital Michallon, F-38000 Grenoble, France
- Inserm, U836, F-38000 Grenoble, France
- Univ. Grenoble Alpes, GIN, F-38000 Grenoble, France
| | - M. Perrone-Bertolotti
- Grenoble Alpes University, LPNC, F-38040 Grenoble, France
- CNRS, LPNC, UMR 5105, F-38040 Grenoble, France
- Corresponding author at: LPNC, UMR CNRS 5105, BSHM, Université Pierre Mendès-France, BP 47, 38040 Grenoble Cedex 09, France. Tel.: + 33 476 82 58 80; fax: + 33 476 82 78 34.
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Miller LA, Radford K. Testing the effectiveness of group-based memory rehabilitation in chronic stroke patients. Neuropsychol Rehabil 2014; 24:721-37. [PMID: 24624993 DOI: 10.1080/09602011.2014.894479] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Memory complaints are common after stroke, yet there have been very few studies of the outcome of memory rehabilitation in these patients. The present study evaluated the effectiveness of a new manualised, group-based memory training programme. Forty outpatients with a single-stroke history and ongoing memory complaints were enrolled. The six-week course involved education and strategy training and was evaluated using a wait-list crossover design, with three assessments conducted 12 weeks apart. Outcome measures included: tests of anterograde memory (Rey Auditory Verbal Learning Test: RAVLT; Complex Figure Test) and prospective memory (Royal Prince Alfred Prospective Memory Test); the Comprehensive Assessment of Prospective Memory (CAPM) questionnaire and self-report of number of strategies used. Significant training-related gains were found on RAVLT learning and delayed recall and on CAPM informant report. Lower baseline scores predicted greater gains for several outcome measures. Patients with higher IQ or level of education showed more gains in number of strategies used. Shorter time since onset was related to gains in prospective memory, but no other stroke-related variables influenced outcome. Our study provides evidence that a relatively brief, group-based training intervention can improve memory functioning in chronic stroke patients and clarified some of the baseline factors that influence outcome.
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Affiliation(s)
- Laurie A Miller
- a Neuropsychology Unit , Royal Prince Alfred Hospital , Sydney , Australia
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Fitzgerald Z, Mohamed A, Ricci M, Thayer Z, Miller L. Accelerated long-term forgetting: A newly identified memory impairment in epilepsy. J Clin Neurosci 2013; 20:1486-91. [DOI: 10.1016/j.jocn.2013.04.037] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 04/18/2013] [Accepted: 04/21/2013] [Indexed: 10/26/2022]
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Wedlund EW, Nilsson L, Tomson T, Erdner A. What is important in rehabilitation for persons with epilepsy? Experiences from focus group interviews with patients and staff. Epilepsy Behav 2013; 28:347-53. [PMID: 23827317 DOI: 10.1016/j.yebeh.2013.05.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 05/09/2013] [Accepted: 05/20/2013] [Indexed: 10/26/2022]
Abstract
This study aimed to identify the issues experienced as essential in rehabilitation for persons with epilepsy. Six focus group interviews were conducted, five groups with patients that had completed comprehensive rehabilitation for persons with epilepsy, in a day-care setting, at the Neurological Rehabilitation Clinic at Stora Sköndal Hospital, between 2006 and 2009 (total n=17) and one group with staff members (n=5). Using content analysis, two themes emerged: life with epilepsy and rehabilitation experiences. The result emphasizes that rehabilitation for persons with epilepsy should be designed individually, in structure and in content. Encounters between patients were important, as well as the team's attitude in meeting with the patients. Therapeutic working alliance is essential between patients and staff for creating an individual rehabilitation.
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Improving memory in outpatients with neurological disorders using a group-based training program. J Int Neuropsychol Soc 2012; 18:738-48. [PMID: 22594962 DOI: 10.1017/s1355617712000379] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Memory problems are common in patients with a range of neurological conditions, but there have been few attempts to provide and evaluate the usefulness of memory training for groups of neurological outpatients. We used a waitlist-controlled trial design to assess the effectiveness of a newly created, 6-session intervention, which involved training in the use of compensatory strategies as well as education regarding memory function, neurological damage, sleep and lifestyle factors that have an impact on memory. Fifty-six patients with neurological conditions (e.g., stroke, epilepsy) and memory complaints completed the training and assessments. Outcomes were evaluated in terms of reported strategy use as well as objective and subjective measures of anterograde and prospective memory. Training resulted in significant improvements on number of strategies used, scores on the Rey Auditory Verbal Learning Test (total learning and delayed recall) and self-report on the Comprehensive Assessment of Prospective Memory. Improvements were stable at 3-month follow-up. Better individual outcomes were related to lower baseline memory scores, fewer symptoms of depression and greater self-awareness of memory function. Overall the study provides encouraging results to indicate that patients with neurological conditions such as stroke and epilepsy can show improvements in memory after a relatively short group-based intervention.
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