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Gandy M, Coleman H, Cutler H, Jones MP, Karin E, Kwan P, Nikpour A, Parratt K, Rayner G, Titov N, Todd L, Seil E, Winton‐Brown T, Wu W, Dear BF. Comparative effectiveness of digital mental healthcare models for adults with epilepsy: A study protocol of a randomized controlled trial. Epilepsia Open 2024; 9:808-818. [PMID: 38345357 PMCID: PMC10984311 DOI: 10.1002/epi4.12913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/25/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE Mental health complaints are prevalent among people with epilepsy, yet there are major barriers that prevent access to psychological care, including high out-of-pocket costs and a lack of accessible specialized services. The purpose of the current study is to examine the comparative efficacy, acceptability, cost-effectiveness, and long-term outcomes of a digital psychological intervention when delivered under two models of care (i.e., guided vs. unguided) in supporting the mental health and functioning of adults with epilepsy. METHOD Approximately 375 participants across Australia will be enrolled. Eligible participants will have a confirmed diagnosis of epilepsy, experience difficulties with their emotional health, be at least 18 years of age, and live in Australia. Participants will be randomized (2:2:1) to receive the Wellbeing Neuro Course, a 10-week internet-delivered program, with (i.e., guided) or without guidance by a mental health clinician (i.e., unguided), or be allocated to a treatment-as-usual waiting-list control group. Participants will complete online questionnaires at pre-, post-treatment, and 3- and 12-month follow-up and consent to have their data linked to their medical records to capture healthcare system resource use and costs. ANALYSIS Primary outcome measures will be symptoms of depression and anxiety. A cost-utility analysis will be undertaken using the Australian healthcare system perspective and according to current economic evaluation guidelines. Resource use and costs to the healthcare system during the study period will be captured via data linkage to relevant administrative datasets in Australia. SIGNIFICANCE The results of this trial will provide important data concerning the relative outcomes of these different models of care and will inform the integration of digital psychological interventions translation into healthcare services. ETHICS AND DISSEMINATION The Human Research Ethics Committee of Macquarie University approved the proposed study (Reference No: 520231325151475). The results will be disseminated through peer-reviewed publication(s). ANZCTR TRIAL REGISTRATION NUMBER ACTRN12623001327673. PLAIN LANGUAGE SUMMARY This study seeks to find out if a 10-week online psychological treatment can improve the mental health and well-being of Australian adults with epilepsy. Around 375 participants will be randomly assigned to different groups: one will receive treatment with guidance from mental health clinician (guided group), one without guidance (unguided group), and one starting later (waiting control group). All participants will fill out the same outcome measures online. The main goal of this research is to compare these groups and assess how well the treatment works in improving mental health outcomes.
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Affiliation(s)
- Milena Gandy
- School of Psychological SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Honor Coleman
- Melbourne School of Psychological SciencesThe University of MelbourneMelbourneVictoriaAustralia
| | - Henry Cutler
- Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
- Macquarie University Centre for the Health EconomySydneyNew South WalesAustralia
- Macquarie University Business SchoolSydneyNew South WalesAustralia
| | - Michael P. Jones
- School of Psychological SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Eyal Karin
- School of Psychological SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Patrick Kwan
- Department of Neuroscience, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - Armin Nikpour
- Department of NeurologyRoyal Prince Alfred HospitalCamperdownNew South WalesAustralia
| | - Kaitlyn Parratt
- Department of NeurologyRoyal Prince Alfred HospitalCamperdownNew South WalesAustralia
- The Epilepsy Society of AustraliaSouth AustraliaAustralia
| | - Genevieve Rayner
- Melbourne School of Psychological SciencesThe University of MelbourneMelbourneVictoriaAustralia
- Comprehensive Epilepsy ProgramAlfred HospitalMelbourneVictoriaAustralia
| | - Nickolai Titov
- School of Psychological SciencesMacquarie UniversitySydneyNew South WalesAustralia
- MindSpotMQ Health, Macquarie UniversityNew South WalesAustralia
| | - Lisa Todd
- Epilepsy Action AustraliaSydneyNew South WalesAustralia
| | - Elizabeth Seil
- Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
- Macquarie University Centre for the Health EconomySydneyNew South WalesAustralia
- Macquarie University Business SchoolSydneyNew South WalesAustralia
| | - Toby Winton‐Brown
- Comprehensive Epilepsy ProgramAlfred HospitalMelbourneVictoriaAustralia
| | - Wendy Wu
- School of Psychological SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Blake F. Dear
- School of Psychological SciencesMacquarie UniversitySydneyNew South WalesAustralia
- MindSpotMQ Health, Macquarie UniversityNew South WalesAustralia
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Puteikis K, Wolf P, Mameniškienė R. Longer-term verbal and visual memory patterns in patients with temporal lobe and genetic generalized epilepsies. Epilepsia Open 2023; 8:1279-1287. [PMID: 37381720 PMCID: PMC10690666 DOI: 10.1002/epi4.12779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/24/2023] [Indexed: 06/30/2023] Open
Abstract
OBJECTIVE To compare forgetting patterns between patients with temporal lobe (TLE) and generalized (GGE) epilepsies and to assess whether recall is associated with epileptic activity. METHODS Thirty-three patients with TLE (13 left, 17 right, and 3 nonlateralized TLE), 42 patients with GGE, and 57 healthy controls (HCs) were asked to recall words, verbal story material, and the Rey-Osterrieth complex figure at two delays. Accelerated long-term forgetting (ALF) was defined by group performance comparable to HCs at 30 min and worse recall than HCs after 4 weeks. ALF was assessed by comparing raw test scores in a two-way repeated measures analysis of variance (ANOVA) adjusted for the learning capacity. RESULTS Compared to HCs, patients with R-TLE remembered fewer items of the word list after 30 min as well as after 4 weeks. Patients with L-TLE and GGE had comparable learning-adjusted performance to HCs at the 30 min delay but scored less after 4 weeks (group by delay interaction F(3, 124) = 3.2, P = 0.026,η p 2 = 0.07). The epilepsy group (patients with TLE and GGE combined) performed as well as HCs at 30 min but worse after 4 weeks irrespective of experienced seizures during the 4-week delay or interictal bilateral (TLE) or generalized (GGE) activity before the study. We noted no statistically significant differences between patient and HC verbal story (group by delay interaction F(3, 124) = 0.7, P = 0.570,η p 2 = 0.02) or complex figure (F(3, 124) = 0.8, P = 0.488,η p 2 = 0.02) recall. SIGNIFICANCE Our data support verbal and visual memory impairment in both TLE and GGE with different performances between these groups in the task of word recall. We suggest the presence of ALF in patients with GGE and left TLE after adjusting for learning capacity. We could not confirm the influence of epileptic activity on long-term forgetting patterns. Future studies are required to better define domain-specific differences in memory impairment in TLE and GGE.
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Affiliation(s)
| | - Peter Wolf
- Center for NeurologyVilnius UniversityVilniusLithuania
- Danish Epilepsy Center FiladelfiaDianalundDenmark
- Postgraduation Program of Medical SciencesSanta Catarina Federal UniversityFlorianópolisBrazil
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Hüsser AM, Vannasing P, Tremblay J, Osterman B, Lortie A, Diadori P, Major P, Rossignol E, Roger K, Fourdain S, Provost S, Maalouf Y, Nguyen DK, Gallagher A. Brain language networks and cognitive outcomes in children with frontotemporal lobe epilepsy. Front Hum Neurosci 2023; 17:1253529. [PMID: 37964801 PMCID: PMC10641510 DOI: 10.3389/fnhum.2023.1253529] [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: 07/05/2023] [Accepted: 10/11/2023] [Indexed: 11/16/2023] Open
Abstract
Introduction Pediatric frontal and temporal lobe epilepsies (FLE, TLE) have been associated with language impairments and structural and functional brain alterations. However, there is no clear consensus regarding the specific patterns of cerebral reorganization of language networks in these patients. The current study aims at characterizing the cerebral language networks in children with FLE or TLE, and the association between brain network characteristics and cognitive abilities. Methods Twenty (20) children with FLE or TLE aged between 6 and 18 years and 29 age- and sex-matched healthy controls underwent a neuropsychological evaluation and a simultaneous functional near-infrared spectroscopy and electroencephalography (fNIRS-EEG) recording at rest and during a receptive language task. EEG was used to identify potential subclinical seizures in patients. We removed these time intervals from the fNIRS signal to investigate language brain networks and not epileptogenic networks. Functional connectivity matrices on fNIRS oxy-hemoglobin concentration changes were computed using cross-correlations between all channels. Results and discussion Group comparisons of residual matrices (=individual task-based matrix minus individual resting-state matrix) revealed significantly reduced connectivity within the left and between hemispheres, increased connectivity within the right hemisphere and higher right hemispheric local efficiency for the epilepsy group compared to the control group. The epilepsy group had significantly lower cognitive performance in all domains compared to their healthy peers. Epilepsy patients' local network efficiency in the left hemisphere was negatively associated with the estimated IQ (p = 0.014), suggesting that brain reorganization in response to FLE and TLE does not allow for an optimal cognitive development.
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Affiliation(s)
- Alejandra M. Hüsser
- Neurodevelopmental Optical Imaging Laboratory (LIONlab), Research Center, Sainte-Justine Mother and Child University Hospital Center, Montreal, QC, Canada
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Phetsamone Vannasing
- Neurodevelopmental Optical Imaging Laboratory (LIONlab), Research Center, Sainte-Justine Mother and Child University Hospital Center, Montreal, QC, Canada
| | - Julie Tremblay
- Neurodevelopmental Optical Imaging Laboratory (LIONlab), Research Center, Sainte-Justine Mother and Child University Hospital Center, Montreal, QC, Canada
| | - Bradley Osterman
- Division of Neurology, Sainte-Justine Mother and Child University Hospital Center, Montreal, QC, Canada
- Division of Pediatric Neurology, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Anne Lortie
- Division of Neurology, Sainte-Justine Mother and Child University Hospital Center, Montreal, QC, Canada
- Department of Neuroscience, Université de Montréal, Montreal, QC, Canada
- Department of Pediatrics, Université de Montréal, Montreal, QC, Canada
| | - Paola Diadori
- Division of Neurology, Sainte-Justine Mother and Child University Hospital Center, Montreal, QC, Canada
- Department of Pediatrics, Université de Montréal, Montreal, QC, Canada
| | - Philippe Major
- Division of Neurology, Sainte-Justine Mother and Child University Hospital Center, Montreal, QC, Canada
- Department of Neuroscience, Université de Montréal, Montreal, QC, Canada
- Department of Pediatrics, Université de Montréal, Montreal, QC, Canada
| | - Elsa Rossignol
- Division of Neurology, Sainte-Justine Mother and Child University Hospital Center, Montreal, QC, Canada
- Department of Neuroscience, Université de Montréal, Montreal, QC, Canada
- Department of Pediatrics, Université de Montréal, Montreal, QC, Canada
| | - Kassandra Roger
- Neurodevelopmental Optical Imaging Laboratory (LIONlab), Research Center, Sainte-Justine Mother and Child University Hospital Center, Montreal, QC, Canada
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Solène Fourdain
- Neurodevelopmental Optical Imaging Laboratory (LIONlab), Research Center, Sainte-Justine Mother and Child University Hospital Center, Montreal, QC, Canada
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Sarah Provost
- Neurodevelopmental Optical Imaging Laboratory (LIONlab), Research Center, Sainte-Justine Mother and Child University Hospital Center, Montreal, QC, Canada
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Yara Maalouf
- Neurodevelopmental Optical Imaging Laboratory (LIONlab), Research Center, Sainte-Justine Mother and Child University Hospital Center, Montreal, QC, Canada
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Dang Khoa Nguyen
- Department of Neuroscience, Université de Montréal, Montreal, QC, Canada
- CHUM Research Center, Université de Montréal, Montreal, QC, Canada
| | - Anne Gallagher
- Neurodevelopmental Optical Imaging Laboratory (LIONlab), Research Center, Sainte-Justine Mother and Child University Hospital Center, Montreal, QC, Canada
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
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Allebone J, Kanaan RA, Rayner G, Maller J, O'Brien TJ, Mullen SA, Cook M, Adams SJ, Vogrin S, Vaughan DN, Kwan P, Berkovic SF, D'Souza WJ, Jackson G, Velakoulis D, Wilson SJ. Neuropsychological function in psychosis of epilepsy. Epilepsy Res 2023; 196:107222. [PMID: 37717505 DOI: 10.1016/j.eplepsyres.2023.107222] [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: 05/16/2023] [Revised: 08/25/2023] [Accepted: 09/13/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVE The neuropsychological profile of patients with psychosis of epilepsy (POE) has received limited research attention. Recent neuroimaging work in POE has identified structural network pathology in the default mode network and the cognitive control network. This study examined the neuropsychological profile of POE focusing on cognitive domains subserved by these networks. METHODS Twelve consecutive patients with a diagnosis of POE were prospectively recruited from the Comprehensive Epilepsy Programmes at The Royal Melbourne, Austin and St Vincent's Hospitals, Melbourne, Australia between January 2015 and February 2017. They were compared to 12 matched patients with epilepsy but no psychosis and 42 healthy controls on standardised neuropsychological tests of memory and executive functioning in a case-control design. RESULTS Mean scores across all cognitive tasks showed a graded pattern of impairment, with the POE group showing the poorest performance, followed by the epilepsy without psychosis and the healthy control groups. This was associated with significant group-level differences on measures of working memory (p = < 0.01); immediate (p = < 0.01) and delayed verbal recall (p = < 0.01); visual memory (p < 0.001); and verbal fluency (p = 0.02). In particular, patients with POE performed significantly worse than the healthy control group on measures of both cognitive control (p = .005) and memory (p < .001), whereas the epilepsy without psychosis group showed only memory difficulties (delayed verbal recall) compared to healthy controls (p = .001). CONCLUSION People with POE show reduced performance in neuropsychological functions supported by the default mode and cognitive control networks, when compared to both healthy participants and people with epilepsy without psychosis.
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Affiliation(s)
- James Allebone
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia; The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia
| | - Richard A Kanaan
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; Department of Psychiatry, University of Melbourne, Austin Health, Melbourne, Australia.
| | - Genevieve Rayner
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia; The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; Comprehensive Epilepsy Program, Austin Health, University of Melbourne, Victoria, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia
| | - Jerome Maller
- ANU College of Health and Medicine, Australian National University, Canberra, Victoria, Australia; Monash Alfred Psychiatry Research Centre, The Alfred and Monash University, Melbourne, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia
| | - Terence J O'Brien
- Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Neuroscience, Alfred Hospital, Monash University, Melbourne, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia
| | - Saul A Mullen
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia
| | - Mark Cook
- Graeme Clark Institute, University of Melbourne, Melbourne, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia
| | - Sophia J Adams
- Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia
| | - Simon Vogrin
- St Vincent's Hospital, Melbourne, Victoria, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia
| | - David N Vaughan
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; Comprehensive Epilepsy Program, Austin Health, University of Melbourne, Victoria, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia
| | - Patrick Kwan
- Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Neuroscience, Alfred Hospital, Monash University, Melbourne, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia
| | - Samuel F Berkovic
- Comprehensive Epilepsy Program, Austin Health, University of Melbourne, Victoria, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia
| | - Wendyl J D'Souza
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia
| | - Graeme Jackson
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; Comprehensive Epilepsy Program, Austin Health, University of Melbourne, Victoria, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia
| | - Dennis Velakoulis
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne, Health, Melbourne, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia
| | - Sarah J Wilson
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia; The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; Comprehensive Epilepsy Program, Austin Health, University of Melbourne, Victoria, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia
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Smetana RM, Batchala PP, Lee BG, Albataineh T, Broshek DK, Fountain NB, Abbas S, Quigg M. Multifocal hypometabolic correlates to deficits of verbal memory in mesial temporal lobe epilepsy. Epilepsy Behav 2023; 143:109244. [PMID: 37192585 DOI: 10.1016/j.yebeh.2023.109244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Neuropsychological research on mesial temporal lobe epilepsy (MTLE) often highlights material-specific memory deficits, but a lesion-focused model may not accurately reflect the underlying networks that support episodic memory in these patients. Our study evaluated the pathophysiology behind verbal learning/memory deficits as revealed by hypometabolism quantified through 18-fluorodeoxyglucose positron emission tomography (FDG-PET). METHODS This retrospective study included thirty presurgical patients with intractable unilateral MTLE who underwent interictal FDG-PET and verbal memory assessment (12 females, mean age: 38.73 years). Fluorodeoxyglucose-positron emission tomography mapping was performed with voxel-based mapping of glucose utilization to a database of age-matched controls to derive regional Z-scores. Neuropsychological outcome variables included scores on learning and recall trials of two distinct verbal memory measures validated for use in epilepsy research. Pearson's correlations evaluated relationships between clinical variables and verbal memory. Linear regression was used to relate regional hypometabolism and verbal memory assessment. Post hoc analyses assessed areas of FDG-PET hypometabolism (threshold Z ≤ -1.645 below mean) where verbal memory was impaired. RESULTS Verbal memory deficits correlated with hypometabolism in limbic structures ipsilateral to language dominance but also correlated with hypometabolism in networks involving the ipsilateral perisylvian cortex and contralateral limbic and nonlimbic structures. DISCUSSION We conclude that traditional models of verbal memory may not adequately capture cognitive deficits in a broader sample of patients with MTLE. This study has important implications for epilepsy surgery protocols that use neuropsychological data and FDG-PET to draw conclusions about surgical risks.
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Affiliation(s)
- Racheal M Smetana
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, USA.
| | - Prem P Batchala
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA.
| | - Bern G Lee
- Department of Neuropsychology, Ochsner Health, Baton Rouge, LA, USA.
| | - Tamer Albataineh
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA.
| | - Donna K Broshek
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, USA.
| | - Nathan B Fountain
- Comprehensive Epilepsy Program, Department of Neurology, University of Virginia, Charlottesville, VA, USA.
| | - Salma Abbas
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA.
| | - Mark Quigg
- Comprehensive Epilepsy Program, Department of Neurology, University of Virginia, Charlottesville, VA, USA.
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Gandy M. The role of psychologists in managing mental health comorbidities in adults with neurological disorders. AUSTRALIAN PSYCHOLOGIST 2023. [DOI: 10.1080/00050067.2023.2183107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Affiliation(s)
- Milena Gandy
- The eCentreClinic, The School of Psychological Sciences, Macquarie University, Sydney, Australia
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Chauvière L. Early cognitive comorbidities before disease onset: A common symptom towards prevention of related brain diseases? Heliyon 2022; 8:e12259. [PMID: 36590531 PMCID: PMC9800323 DOI: 10.1016/j.heliyon.2022.e12259] [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: 08/08/2022] [Revised: 12/01/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022] Open
Abstract
Brain diseases are very heterogeneous; however they also display multiple common risk factors and comorbidities. With a paucity of disease-modifying therapies, prevention became a health priority. Towards prevention, one strategy is to focus on similar symptoms of brain diseases occurring before disease onset. Cognitive deficits are a promising candidate as they occur across brain diseases before disease onset. Based on recent research, this review highlights the similarity of brain diseases and discusses how early cognitive deficits can be exploited to tackle disease prevention. After briefly introducing common risk factors, I review common comorbidities across brain diseases, with a focus on cognitive deficits before disease onset, reporting both experimental and clinical findings. Next, I describe network abnormalities associated with early cognitive deficits and discuss how these abnormalities can be targeted to prevent disease onset. A scenario on brain disease etiology with the idea that early cognitive deficits may constitute a common symptom of brain diseases is proposed.
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Kishk NA, Farghaly M, Nawito A, Shamloul RM, Moawad MK. Neuropsychological performance in patients with focal drug-resistant epilepsy and different factors that affect their performance. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-022-00523-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Drug-resistant epilepsy (DRE) accounts for nearly 30% of patients with epilepsy, which is associated with high incidence of cognitive comorbidity. The aim of this work was to study the role of neuropsychological assessment in patients with epilepsy, and different factors that affect their performance in patients with multiple factors (focal onset DRE).
Methods
118 patients were recruited from Kasr Alainy hospital, epilepsy outpatient clinic with focal DRE. The patients’ demographic and clinical data were collected, Electroencephalograph (EEG) interictal/ictal (when available), and brain imaging (MRI epilepsy protocol). Neuropsychological assessment by Wechsler Adult Intelligence Scale (WAIS-IV), proposed neurocognitive assessment battery and mood assessment was done. Their performance in neuropsychological assessment was correlated with the collected data. Concordance between different assessment modalities and brain lesion were done.
Results
Among recruited patients, 67.3% of patients showed Full-scale Intelligence Quotient (FSIQ) was less than average. FSIQ score significantly correlated with years of education, and number of anti-seizure medications (ASMs). Neurocognitive assessment battery could achieve cognitive profile of the patients but with poor lateralizing value. Executive function was the most affected cognitive domain. History of status epilepticus significantly affect FSIQ and executive function performance. Fifty-six percent of patients had depression. Among the analyzed factors, FSIQ and lesional brain imaging significantly affected neurocognitive performance of studied patients. Clinical semiology had better concordance in lateralization (74.7%) and localization (69.5%) with brain imaging compared to ictal EEG. Among patients who had ictal EEG recording, 36.4% patients (25% were temporal lobe) had complete concordance, while 38.6% patients had partial concordance.
Conclusions
Among analyzed factors, FSIQ was the most significant determinant of studied population’s neurocognitive performance. Clinical semiology were the best correlated with brain lesion. Complete concordance was best detected at the temporal lobe.
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Heerwig C, Möller H, Brückner K. Neuropsychology of epilepsy in old age – English Version. ZEITSCHRIFT FÜR EPILEPTOLOGIE 2022. [DOI: 10.1007/s10309-022-00479-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Latreille V, Schiller K, Peter-Derex L, Frauscher B. Does epileptic activity impair sleep-related memory consolidation in epilepsy? A critical and systematic review. J Clin Sleep Med 2022; 18:2481-2495. [PMID: 35866226 PMCID: PMC9516593 DOI: 10.5664/jcsm.10166] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES People with epilepsy often complain about disturbed sleep and cognitive impairment. Beyond seizures, the occurrence of interictal epileptic activity during sleep is also increasingly recognized to negatively impact cognitive functioning, including memory processes. The aim of this study was to critically review the effect of interictal epileptic activity on sleep-related memory consolidation. METHODS PubMed and PsychINFO databases were systematically searched to identify experimental studies that investigated sleep-related memory consolidation and the relationships between sleep-related epileptic activity and memory in adults and children with epilepsy. This review also highlights hypotheses regarding the potential pathophysiological mechanisms. RESULTS A total of 261 studies were identified; 27 of these met selection criteria. Only 13 studies prospectively assessed the effect of sleep on memory in epilepsy. Most studies reported no alteration of sleep-related memory consolidation in patients, with either similar retention levels following a period containing sleep (n = 5) or improved memory performance postsleep (n = 4). Two studies in children with epilepsy found impaired sleep-related memory consolidation. Ten studies, of which 6 were in childhood epilepsy syndromes, reported a debilitating effect of sleep-related epileptic activity on memory functioning. CONCLUSIONS Conclusions from existing studies were hampered by small sample sizes, heterogeneous patient groups, and variations in memory assessment techniques. Overall, results to date preclude any definitive conclusions on the alteration of sleep-related memory consolidation in epilepsy. We discuss methodological considerations specific to people with epilepsy and provide suggestions on how to best investigate the relationship between epileptic activity, sleep, and memory consolidation in future studies. CITATION Latreille V, Schiller K, Peter-Derex L, Frauscher B. Does epilepticimpair sleep-related memory consolidation in epilepsy? A critical and systematic review. J Clin Sleep Med. 2022;18(10):2481-2495.
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Affiliation(s)
- Véronique Latreille
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Katharina Schiller
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
- Department of Pediatrics, Hospital Group Ostallgaeu-Kaufbeuren, Kaufbeuren, Germany
| | - Laure Peter-Derex
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
- Center for Sleep Medicine and Respiratory Diseases, Croix-Rousse Hospital, University Hospital of Lyon, Lyon 1 University, France
- Lyon Neuroscience Research Center, INSERM 1028/CNRS 5292, Lyon, France
| | - Birgit Frauscher
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
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Samson S, Denos M. Neuropsychology of temporal lobe epilepsies. HANDBOOK OF CLINICAL NEUROLOGY 2022; 187:519-529. [PMID: 35964990 DOI: 10.1016/b978-0-12-823493-8.00012-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This chapter focuses on the neuropsychology of adults with temporal lobe epilepsy (TLE). First, a thorough description of the brain-behavior relationship characterizing focal TLE with and without hippocampal sclerosis is presented. Then, the aim and the specificity of the NPA in the care of epilepsy are described. Considering the high frequency of medically intractable TLE that can be treated by surgery, an assessment carried out in the context of pre- and postoperative evaluation is presented and discussed in light of insights from functional neuroimaging findings. Finally, we propose concluding remarks about the place of neuropsychology in the care of epilepsy in improving our understanding of the cognitive and emotional phenotypes associated with TLE.
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Affiliation(s)
- Séverine Samson
- Department of Psychology, University of Lille, Lille, France; Epilepsy Unit, Neurosciences Department, Hôpital de la Pitié-Salpêtrière, Paris, France.
| | - Marisa Denos
- Rehabilitation Unit, Neurosciences Department, Hôpital de la Pitié-Salpêtrière, Paris, France
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Abstract
OBJECTIVE The National Neuropsychology Network (NNN) is a multicenter clinical research initiative funded by the National Institute of Mental Health (NIMH; R01 MH118514) to facilitate neuropsychology's transition to contemporary psychometric assessment methods with resultant improvement in test validation and assessment efficiency. METHOD The NNN includes four clinical research sites (Emory University; Medical College of Wisconsin; University of California, Los Angeles (UCLA); University of Florida) and Pearson Clinical Assessment. Pearson Q-interactive (Q-i) is used for data capture for Pearson published tests; web-based data capture tools programmed by UCLA, which serves as the Coordinating Center, are employed for remaining measures. RESULTS NNN is acquiring item-level data from 500-10,000 patients across 47 widely used Neuropsychology (NP) tests and sharing these data via the NIMH Data Archive. Modern psychometric methods (e.g., item response theory) will specify the constructs measured by different tests and determine their positive/negative predictive power regarding diagnostic outcomes and relationships to other clinical, historical, and demographic factors. The Structured History Protocol for NP (SHiP-NP) helps standardize acquisition of relevant history and self-report data. CONCLUSIONS NNN is a proof-of-principle collaboration: by addressing logistical challenges, NNN aims to engage other clinics to create a national and ultimately an international network. The mature NNN will provide mechanisms for data aggregation enabling shared analysis and collaborative research. NNN promises ultimately to enable robust diagnostic inferences about neuropsychological test patterns and to promote the validation of novel adaptive assessment strategies that will be more efficient, more precise, and more sensitive to clinical contexts and individual/cultural differences.
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The link between neurology and behavior in veterinary medicine: A review. J Vet Behav 2021. [DOI: 10.1016/j.jveb.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Roger E, Torlay L, Banjac S, Mosca C, Minotti L, Kahane P, Baciu M. Prediction of the clinical and naming status after anterior temporal lobe resection in patients with epilepsy. Epilepsy Behav 2021; 124:108357. [PMID: 34717247 DOI: 10.1016/j.yebeh.2021.108357] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/15/2021] [Accepted: 09/25/2021] [Indexed: 01/20/2023]
Abstract
By assessing the cognitive capital, neuropsychological evaluation (NPE) plays a vital role in the perioperative workup of patients with refractory focal epilepsy. In this retrospective study, we used cutting-edge statistical approaches to examine a group of 47 patients with refractory temporal lobe epilepsy (TLE), who underwent standard anterior temporal lobectomy (ATL). Our objective was to determine whether NPE may represent a robust predictor of the postoperative status, two years after surgery. Specifically, based on pre- and postsurgical neuropsychological data, we estimated the sensitivity of cognitive indicators to predict and to disentangle phenotypes associated with more or less favorable outcomes. Engel (ENG) scores were used to assess clinical outcome, and picture naming (NAM) performance to estimate naming status. Two methods were applied: (a) machine learning (ML) to explore cognitive sensitivity to postoperative outcomes; and (b) graph theory (GT) to assess network properties reflecting favorable vs. less favorable phenotypes after surgery. Specific neuropsychological indices assessing language, memory, and executive functions can globally predict outcomes. Interestingly, preoperative cognitive networks associated with poor postsurgical outcome already exhibit an atypical, highly modular and less densely interconnected configuration. We provide statistical and clinical tools to anticipate the condition after surgery and achieve a more personalized clinical management. Our results also shed light on possible mechanisms put in place for cognitive adaptation after acute injury of central nervous system in relation with surgery.
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Affiliation(s)
- Elise Roger
- Univ. Grenoble Alpes, CNRS LPNC UMR 5105, 38000 Grenoble, France.
| | - Laurent Torlay
- Univ. Grenoble Alpes, CNRS LPNC UMR 5105, 38000 Grenoble, France
| | - Sonja Banjac
- Univ. Grenoble Alpes, CNRS LPNC UMR 5105, 38000 Grenoble, France
| | - Chrystèle Mosca
- Univ. Grenoble Alpes, Grenoble Institute of Neuroscience, Synchronisation et modulation des réseaux neuronaux dans l'épilepsie' & Neurology Department, 38000 Grenoble, France
| | - Lorella Minotti
- Univ. Grenoble Alpes, Grenoble Institute of Neuroscience, Synchronisation et modulation des réseaux neuronaux dans l'épilepsie' & Neurology Department, 38000 Grenoble, France
| | - Philippe Kahane
- Univ. Grenoble Alpes, Grenoble Institute of Neuroscience, Synchronisation et modulation des réseaux neuronaux dans l'épilepsie' & Neurology Department, 38000 Grenoble, France
| | - Monica Baciu
- Univ. Grenoble Alpes, CNRS LPNC UMR 5105, 38000 Grenoble, France
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Olbrich Guzmán C, Alvarado Paiva L, Fuentes-García A, Fuentes Alburquenque M. Translation and cross-cultural adaptation of the "Quality of Life in Epilepsy (QOLIE-31-P)" Questionnaire for Chile. Epilepsy Behav 2021; 122:108169. [PMID: 34265621 DOI: 10.1016/j.yebeh.2021.108169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To report the translation and cross-cultural adaptation of the Quality of Life in Epilepsy (QOLIE-31-P) Questionnaire in patients with epilepsy (PWE) in Chile. METHODS Translation from the original and posterior back-translation was performed by independent translators, two in each step. The final consensual translation was modified for the Chilean context and assessed by cognitive interviews with 12 PWE from Chile's public healthcare system, selected by quotas. RESULTS Main changes made to the original questionnaire were the addition, in some items, of an alternative, indicating the nonexistence of limitations produced by epilepsy, examples to clarify some questions, and some minor wording modifications. There was no addition or deletion of items. CONCLUSION A culturally adapted version of the QOLIE-31-P questionnaire was obtained in conditions to be assessed psychometrically in a sample of PWE in Chile.
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Affiliation(s)
| | - Luis Alvarado Paiva
- Department of Psychiatry and Mental Health, Faculty of Medicine, University of Chile, Chile; Department of Psychology, Faculty of Social Sciences, University of Chile, Chile.
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A six-year longitudinal study of neurocognitive problems in children with epilepsy. Brain Dev 2021; 43:833-842. [PMID: 33892994 DOI: 10.1016/j.braindev.2021.03.007] [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: 01/13/2021] [Revised: 03/11/2021] [Accepted: 03/28/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION This study describes the specific neuropsychological abnormalities among children with epilepsy (CH-E) living in Georgia. METHODS A cohort of CH-E and children without epilepsy (CH-NoE), aged 6-13 years, admitted to the epilepsy center of the Institute of Neurology and Neuropsychology from 1st January 2010 to 31st December 2015, was selected and investigated with a structured protocol. Neurological/epileptological assessments were made and neuropsychological testing was done on all study subjects. RESULTS Abnormalities in praxis, verbal functions, verbal learning, visual-spatial matching, visual-motor ability, and fine motor skills, working memory, and phonological memory span were often revealed in CH-E as compared to CH-NoE. Early age of seizure onset, epilepsy duration, and anti-seizure medication (ASM) use, in combination with brain structural abnormalities on neuroimaging, and structural etiology were independent predictors of impaired functioning in various neuropsychological domains. DISCUSSION More than half of children with epilepsy have a variety of cognitive impairments, which may increase with ASM therapy, especially when the cause of seizures is structural damage to the brain. Therefore, in the process of diagnosing epilepsy, evaluation of cognitive functions should become an integral part to ensure effective management of the disorder.
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Nunna RS, Borghei A, Brahimaj BC, Lynn F, Garibay-Pulido D, Byrne RW, Rossi MA, Sani S. Responsive Neurostimulation of the Mesial Temporal White Matter in Bilateral Temporal Lobe Epilepsy. Neurosurgery 2021; 88:261-267. [PMID: 33026439 DOI: 10.1093/neuros/nyaa381] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 06/27/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Responsive neuromodulation (RNS) is a treatment option for patients with medically refractory bilateral mesial temporal lobe epilepsy (MTLE). A paucity of data exists on the feasibility and clinical outcome of hippocampal-sparing bilateral RNS depth lead placements within the parahippocampal white matter or temporal stem. OBJECTIVE To evaluate seizure reduction outcomes with at least a 1-yr follow-up in individuals with bilateral MTLE undergoing hippocampus-sparing implantation of RNS depth leads. METHODS A retrospective analysis of prospectively collected data was performed on patients at our institution with bilateral MTLE who were implanted with RNS depth leads along the longitudinal extent of bitemporal parahippocampal white matter or temporal stem. Baseline and postoperative seizure frequency, previous surgical interventions, and postimplantation electrocorticography and stimulation data were analyzed. RESULTS Ten patients were included in the study (7 male, 3 female). Overall seizure frequency declined by a median 44.25% at 3.13 yr (standard deviation 3.31) postimplantation. Four patients (40%) achieved 50% responder rate at latest follow-up. Two of four patients with focal onset bilateral tonic-clonic seizures became completely seizure-free. Forty percent of patients were previously implanted with a vagus nerve stimulator, and 20% underwent a prior temporal lobectomy. All depth lead placements were confirmed as radiographically located in the parahippocampal white matter or temporal stem without hippocampus violation. There were no cases of lead malposition. CONCLUSION Extrahippocampal or temporal stem white matter targeting during RNS surgery for bitemporal MTLE is feasible and allows for electrographic seizure detection. Larger controlled studies with longer follow-up are needed to validate these preliminary findings.
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Affiliation(s)
- Ravi S Nunna
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Alireza Borghei
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Bledi C Brahimaj
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Fiona Lynn
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Diego Garibay-Pulido
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
| | - Richard W Byrne
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Marvin A Rossi
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
| | - Sepehr Sani
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
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Consales A, Casciato S, Asioli S, Barba C, Caulo M, Colicchio G, Cossu M, de Palma L, Morano A, Vatti G, Villani F, Zamponi N, Tassi L, Di Gennaro G, Marras CE. The surgical treatment of epilepsy. Neurol Sci 2021; 42:2249-2260. [PMID: 33797619 DOI: 10.1007/s10072-021-05198-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 03/16/2021] [Indexed: 01/07/2023]
Abstract
In 2009, the Commission for Epilepsy Surgery of the Italian League Against Epilepsy (LICE) conducted an overview about the techniques used for the pre-surgical evaluation and the surgical treatment of epilepsies. The recognition that, in selected cases, surgery can be considered the first-line approach, suggested that the experience gained by the main Italian referral centers should be pooled in order to provide a handy source of reference. In light of the progress made over these past years, some parts of that first report have accordingly been updated. The present revision aims to harmonize the general principles regulating the patient selection and the pre-surgical work-up, as well as to expand the use of epilepsy surgery, that still represents an underutilized resource, regrettably. The objective of this contribution is drawing up a methodological framework within which to integrate the experiences of each group in this complex and dynamic sector of the neurosciences.
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Affiliation(s)
- Alessandro Consales
- Division of Neurosurgery, IRCCS Giannina Gaslini Children's Hospital, Genoa, Italy
| | - Sara Casciato
- Epilepsy Surgery Centre, IRCCS Neuromed, Via Atinense, 18, 86170, Pozzilli, IS, Italy
| | - Sofia Asioli
- Department of Biomedical and Neuromotor Sciences, Section of Anatomic Pathology "M. Malpighi", Bellaria Hospital, Bologna, Italy
| | - Carmen Barba
- Neuroscience Department, Meyer Children's Hospital-University of Florence, Florence, Italy
| | - Massimo Caulo
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
| | | | - Massimo Cossu
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Luca de Palma
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children Hospital, Rome, Italy
| | - Alessandra Morano
- Department of Human Neurosciences, "Sapienza" University, Rome, Italy
| | - Giampaolo Vatti
- Department of Neurological and Sensorial Sciences, University of Siena, Siena, Italy
| | - Flavio Villani
- Division of Neurophysiology and Epilepsy Centre, IRCCS San Martino Policlinic Hospital, Genoa, Italy
| | - Nelia Zamponi
- Child Neuropsychiatric Unit, University of Ancona, Ancona, Italy
| | - Laura Tassi
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Giancarlo Di Gennaro
- Epilepsy Surgery Centre, IRCCS Neuromed, Via Atinense, 18, 86170, Pozzilli, IS, Italy.
| | - Carlo Efisio Marras
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children Hospital, Rome, Italy
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Kahana Levy N, Segalovsky J, Benifla M, Elkana O. Quantitative Meta-Analyses: Lateralization of Memory Functions Before and After Surgery in Children with Temporal Lobe Epilepsy. Neuropsychol Rev 2021; 31:535-568. [PMID: 33675457 DOI: 10.1007/s11065-020-09470-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 11/29/2020] [Indexed: 11/26/2022]
Abstract
RATIONALE Memory deficits in children with epilepsy have been reported in some but not all studies assessing the effects of side of seizures and resection from the temporal lobe on cognitive performance. This meta-analysis provides a quantitative systematic review of previous studies on this issue. METHOD A critical review and meta-analysis of the literature on memory performance in children with Temporal Lobe Epilepsy (TLE) was conducted. Search identified 25 studies, 13 of which compared children with TLE to healthy age-matched controls and 12 of which compared children with TLE before and after surgery. RESULTS Heterogeneity of the comparisons of children with TLE to healthy controls impeded drawing definitive conclusions. However, in 55% of the studies, verbal memory in children with left TLE (LTLE) was impaired as compared to healthy controls. Verbal memory performance slightly declines after pediatric LTLE surgery, but nonverbal memory tasks are not affected. By contrast, verbal memory performance is not affected by pediatric right TLE (RTLE) surgery. CONCLUSIONS The findings suggest that side of the epileptogenic zone and resection from the temporal lobe affect verbal memory in children with LTLE. Right resection seems to be safe with respect to verbal memory performance.
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Affiliation(s)
- Naomi Kahana Levy
- Comprehensive Epilepsy Center, Rambam Health Care Campus, Haifa, Israel
| | - Jonathan Segalovsky
- School of Behavioral Sciences, Academic College of Tel Aviv-Jaffa, P.O.B. 8401, 61083, Tel-Aviv-Jaffa, Israel
| | - Mony Benifla
- Comprehensive Epilepsy Center, Rambam Health Care Campus, Haifa, Israel
| | - Odelia Elkana
- School of Behavioral Sciences, Academic College of Tel Aviv-Jaffa, P.O.B. 8401, 61083, Tel-Aviv-Jaffa, Israel.
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20
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Gandy M, Modi AC, Wagner JL, LaFrance WC, Reuber M, Tang V, Valente KD, Goldstein LH, Donald KA, Rayner G, Michaelis R. Managing depression and anxiety in people with epilepsy: A survey of epilepsy health professionals by the ILAE Psychology Task Force. Epilepsia Open 2021; 6:127-139. [PMID: 33681656 PMCID: PMC7918327 DOI: 10.1002/epi4.12455] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/09/2020] [Accepted: 11/23/2020] [Indexed: 01/19/2023] Open
Abstract
Objectives The Psychology Task Force of the Medical Therapies Commission of the International League Against Epilepsy (ILAE) has been charged with taking steps to improve global mental health care for people with epilepsy. This study aimed to inform the direction and priorities of the Task Force by examining epilepsy healthcare providers' current practical experiences, barriers, and unmet needs around addressing depression and anxiety in their patients. Methods A voluntary 27-item online survey was distributed via ILAE chapters and networks. It assessed practices in the areas of screening, referral, management, and psychological care for depression and anxiety. A total of 445 participants, from 67 countries (68% high income), commenced the survey, with 87% completing all components. Most respondents (80%) were either neurologists or epileptologists. Results Less than half of respondents felt adequately resourced to manage depression and anxiety. There was a lack of consensus about which health professionals were responsible for screening and management of these comorbidities. About a third only assessed for depression and anxiety following spontaneous report and lack of time was a common barrier (>50%). Routine referrals to psychiatrists (>55%) and psychologists (>41%) were common, but approximately one third relied on watchful waiting. A lack of both trained mental health specialists (>55%) and standardized procedures (>38%) was common barriers to referral practices. The majority (>75%) of respondents' patients identified with depression or anxiety had previously accessed psychotropic medications or psychological treatments. However, multiple barriers to psychological treatments were endorsed, including accessibility difficulties (52%). Significance The findings suggest that while the importance of managing depression and anxiety in patients with epilepsy is being recognized, there are ongoing barriers to effective mental health care. Key future directions include the need for updated protocols in this area and the integration of mental health professionals within epilepsy settings.
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Affiliation(s)
- Milena Gandy
- The eCentreClinicDepartment of PsychologyFaculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyAustralia
| | - Avani C. Modi
- Division of Behavioral Medicine and Clinical PsychologyCincinnati Children’s Hospital Medical CenterUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - Janelle L. Wagner
- College of NursingMedical University of South CarolinaCharlestonSCUSA
| | - W. Curt LaFrance
- Departments of Psychiatry and NeurologyRhode Island HospitalBrown UniversityProvidenceRIUSA
| | - Markus Reuber
- Academic Neurology UnitRoyal Hallamshire HospitalUniversity of SheffieldSheffieldUK
| | - Venus Tang
- Department of Clinical PsychologyPrince of Wales Hospital, Hospital AuthoritySha TinHong Kong
- Division of NeurosurgeryDepartment of SurgeryFaculty of MedicineChinese University of Hong KongShatinHong Kong
| | - Kette D. Valente
- Department of PsychiatryFaculty of MedicineUniversity of Sao Paulo (HCFMUSP)Sao PauloBrazil
| | - Laura H. Goldstein
- Department of PsychologyInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | - Kirsten A. Donald
- Division of Developmental PaediatricsDepartment of Paediatrics and Child HealthRed Cross War Memorial Children’s Hospital and the Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
| | - Genevieve Rayner
- Melbourne School of Psychological SciencesUniversity of MelbourneMelbourneVictoriaAustralia
| | - Rosa Michaelis
- Department of NeurologyGemeinschaftskrankenhaus HerdeckeUniversity of Witten/HerdeckeHerdeckeGermany
- Department of NeurologyUniversity Hospital Knappschaftskrankenhaus BochumRuhr‐University BochumBochumGermany
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Helmstaedter C, Sadat-Hossieny Z, Kanner AM, Meador KJ. Cognitive disorders in epilepsy II: Clinical targets, indications and selection of test instruments. Seizure 2020; 83:223-231. [PMID: 33172763 DOI: 10.1016/j.seizure.2020.09.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 12/26/2022] Open
Abstract
This is the second of two narrative reviews on cognitive disorders in epilepsy (companion manuscript: Cognitive disorders in epilepsy I: Clinical experience, real-world evidence and recommendations). Its focus is on the clinical targets, indications, and the selection of neuropsychological test instruments. Cognitive assessment has become an essential tool for the diagnosis and outcome control in the clinical management of epilepsy. The diagnostics of basic and higher brain functions can provide valuable information on lateralized and localized brain dysfunctions associated with epilepsy, its underlying pathologies and treatment. In addition to the detection or verification of deficits, neuropsychology reveals the patient's cognitive strengths and, thus, information about the patient reserve capacities for functional restitution and compensation. Neuropsychology is an integral part of diagnostic evaluations mainly in the context of epilepsy surgery to avoid new or additional damage to preexisting neurocognitive impairments. In addition and increasingly, neuropsychology is being used as a tool for monitoring of the disease and its underlying pathologies, and it is suited for the quality and outcome control of pharmacological or other non-invasive medical intervention. This narrative review summarizes the present state of neuropsychological assessments in epilepsy, reveals diagnostic gaps, and shows the great need for education, homogenization, translation and standardization of instruments.
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Affiliation(s)
- C Helmstaedter
- University Clinic Bonn, Department of Epileptology, Germany.
| | - Z Sadat-Hossieny
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, 213 Quarry Road, MC 5979, CA, 94304, USA
| | - A M Kanner
- University of Miami Health System, Uhealth Neurology, 1150 NW 14th St #609, Miami, FL 33136, USA
| | - K J Meador
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, 213 Quarry Road, MC 5979, CA, 94304, USA
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Tedrus GMAS, Passos MLGA, Vargas LM, Menezes LEFJ. Cognition and epilepsy: Cognitive screening test. Dement Neuropsychol 2020; 14:186-193. [PMID: 32595889 PMCID: PMC7304275 DOI: 10.1590/1980-57642020dn14-020013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Cognitive deficits often occur in people with epilepsy (PWE). However, in Brazil, PWE might not undergo neurocognitive evaluation due to the low number of validated tests available and lack of multidisciplinary teams in general epilepsy outpatient clinics.
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Affiliation(s)
| | | | - Letícia Muniz Vargas
- Undergraduate Student - Faculty of Medicine, Pontifical Catholic University of Campinas, Campinas, SP, Brazil
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Tan LZ, Long LL, Xiao B. [Research advances in multimodal magnetic resonance for cognitive impairment in children with benign childhood epilepsy with centrotemporal spikes]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020; 22:528-532. [PMID: 32434653 PMCID: PMC7389406 DOI: 10.7499/j.issn.1008-8830.2002006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/01/2020] [Indexed: 06/11/2023]
Abstract
Cognitive impairment in children with benign childhood epilepsy with centrotemporal spikes (BECT) has complex etiologies and is closely associated abnormal neural networks. Multimodal magnetic resonance imaging of brain structure and function is a powerful tool for studying abnormal neural networks of cognitive impairment in epilepsy and can explore the pathogenesis of cognitive impairment in epilepsy at the level of brain structure and function by analyzing the imaging features of brain structure and function. This article reviews the research advances in multimodal magnetic resonance for cognitive impairment in children with BECT.
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Affiliation(s)
- Lang-Zi Tan
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, China.
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Tan LZ, Long LL, Xiao B. [Research advances in multimodal magnetic resonance for cognitive impairment in children with benign childhood epilepsy with centrotemporal spikes]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020; 22:528-532. [PMID: 32434653 PMCID: PMC7389406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/01/2020] [Indexed: 08/01/2024]
Abstract
Cognitive impairment in children with benign childhood epilepsy with centrotemporal spikes (BECT) has complex etiologies and is closely associated abnormal neural networks. Multimodal magnetic resonance imaging of brain structure and function is a powerful tool for studying abnormal neural networks of cognitive impairment in epilepsy and can explore the pathogenesis of cognitive impairment in epilepsy at the level of brain structure and function by analyzing the imaging features of brain structure and function. This article reviews the research advances in multimodal magnetic resonance for cognitive impairment in children with BECT.
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Affiliation(s)
- Lang-Zi Tan
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, China.
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25
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Gonzalez LM, Wrennall JA. A neuropsychological model for the pre-surgical evaluation of children with focal-onset epilepsy: An integrated approach. Seizure 2020; 77:29-39. [DOI: 10.1016/j.seizure.2018.12.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/28/2018] [Accepted: 12/17/2018] [Indexed: 12/20/2022] Open
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Hwang G, Hermann B, Nair VA, Conant LL, Dabbs K, Mathis J, Cook CJ, Rivera-Bonet CN, Mohanty R, Zhao G, Almane DN, Nencka A, Felton E, Struck AF, Birn R, Maganti R, Humphries CJ, Raghavan M, DeYoe EA, Bendlin BB, Prabhakaran V, Binder JR, Meyerand ME. Brain aging in temporal lobe epilepsy: Chronological, structural, and functional. NEUROIMAGE-CLINICAL 2020; 25:102183. [PMID: 32058319 PMCID: PMC7016276 DOI: 10.1016/j.nicl.2020.102183] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 12/03/2019] [Accepted: 01/13/2020] [Indexed: 10/26/2022]
Abstract
The association of epilepsy with structural brain changes and cognitive abnormalities in midlife has raised concern regarding the possibility of future accelerated brain and cognitive aging and increased risk of later life neurocognitive disorders. To address this issue we examined age-related processes in both structural and functional neuroimaging among individuals with temporal lobe epilepsy (TLE, N = 104) who were participants in the Epilepsy Connectome Project (ECP). Support vector regression (SVR) models were trained from 151 healthy controls and used to predict TLE patients' brain ages. It was found that TLE patients on average have both older structural (+6.6 years) and functional (+8.3 years) brain ages compared to healthy controls. Accelerated functional brain age (functional - chronological age) was mildly correlated (corrected P = 0.07) with complex partial seizure frequency and the number of anti-epileptic drug intake. Functional brain age was a significant correlate of declining cognition (fluid abilities) and partially mediated chronological age-fluid cognition relationships. Chronological age was the only positive predictor of crystallized cognition. Accelerated aging is evident not only in the structural brains of patients with TLE, but also in their functional brains. Understanding the causes of accelerated brain aging in TLE will be clinically important in order to potentially prevent or mitigate their cognitive deficits.
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Affiliation(s)
- Gyujoon Hwang
- Medical Physics, University of Wisconsin-Madison, Madison, WI, USA.
| | - Bruce Hermann
- Neurology, University of Wisconsin-Madison, Madison, WI, USA
| | - Veena A Nair
- Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Lisa L Conant
- Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kevin Dabbs
- Neurology, University of Wisconsin-Madison, Madison, WI, USA
| | - Jed Mathis
- Radiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Cole J Cook
- Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Rosaleena Mohanty
- Electrical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Gengyan Zhao
- Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Dace N Almane
- Neurology, University of Wisconsin-Madison, Madison, WI, USA
| | - Andrew Nencka
- Radiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Aaron F Struck
- Neurology, University of Wisconsin-Madison, Madison, WI, USA
| | - Rasmus Birn
- Medical Physics, University of Wisconsin-Madison, Madison, WI, USA; Psychiatry, University of Wisconsin-Madison, Madison, WI, USA
| | - Rama Maganti
- Neurology, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Manoj Raghavan
- Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Edgar A DeYoe
- Radiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Vivek Prabhakaran
- Medical Physics, University of Wisconsin-Madison, Madison, WI, USA; Radiology, University of Wisconsin-Madison, Madison, WI, USA; Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, USA; Psychiatry, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Mary E Meyerand
- Medical Physics, University of Wisconsin-Madison, Madison, WI, USA; Radiology, University of Wisconsin-Madison, Madison, WI, USA; Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
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Tan L, Chen Y, Wu W, Liu C, Fu Y, He J, Zhang M, Wang G, Wang K, Long H, Xiao W, Xiao B, Long L. Impaired Cognitive Abilities in Siblings of Patients with Temporal Lobe Epilepsy. Neuropsychiatr Dis Treat 2020; 16:3071-3079. [PMID: 33363375 PMCID: PMC7752648 DOI: 10.2147/ndt.s258074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 11/23/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Patients with temporal lobe epilepsy (TLE) are at high risk of cognitive impairment. In addition to persistent seizures and antiepileptic drugs (AEDs), genetic factors also play an important role in the progression of cognitive deficits in TLE patients. Defining a cognitive endophenotype for TLE can provide information on the risk of cognitive impairment in patients. This study investigated the cognitive endophenotype of TLE by comparing neuropsychological function between patients with TLE, their unaffected siblings, and healthy control subjects. PATIENTS AND METHODS A total of 46 patients with TLE, 26 siblings, and 33 control subjects were recruited. Cognitive function (ie, general cognition, short- and long-term memory, attention, visuospatial and executive functions, and working memory) was assessed with a battery of neuropsychological tests. Differences between groups were evaluated by analysis of covariance, with age and years of education as covariates. The Kruskal-Wallis test was used to evaluate data that did not satisfy the homogeneity of variance assumption. Pairwise comparisons were adjusted by Bonferroni correction, with a significance threshold of P<0.05. RESULTS Patients with TLE showed deficits in the information test (P<0.001), arithmetic test (P=0.003), digit symbol substitution test (P=0.001), block design test (BDT; P=0.005), and backward digit span test (P=0.001) and took a longer time to complete the Hayling test Part A (P=0.011) compared to controls. Left TLE patients tended to have worse executive function test scores than right TLE patients. The siblings of TLE patients showed deficits in the BDT (P=0.006, Bonferroni-corrected) relative to controls. CONCLUSION Patients with TLE exhibit cognitive impairment. Executive function is worse in patients with left TLE than in those with right TLE. Siblings show impaired visuospatial function relative to controls. Thus, cognitive deficits in TLE patients have a genetic component and are independent of seizures or AED use.
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Affiliation(s)
- Langzi Tan
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Yayu Chen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Wenyue Wu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Chaorong Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Yujiao Fu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Jialinzi He
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Min Zhang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Ge Wang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Kangrun Wang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Hongyu Long
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Wenbiao Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Lili Long
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, People's Republic of China
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28
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Almane DN, Jones JE, McMillan T, Stafstrom CE, Hsu DA, Seidenberg M, Hermann BP, Oyegbile TO. The Timing, Nature, and Range of Neurobehavioral Comorbidities in Juvenile Myoclonic Epilepsy. Pediatr Neurol 2019; 101:47-52. [PMID: 31122836 PMCID: PMC6752993 DOI: 10.1016/j.pediatrneurol.2019.03.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/05/2019] [Accepted: 03/10/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Accumulating evidence suggests that considerable cognitive and psychiatric comorbidity is associated with juvenile myoclonic epilepsy, for which the etiology remains controversial. Our goal was to comprehensively characterize the status of multiple neurobehavioral comorbidities in youth with new- or recent-onset juvenile myoclonic epilepsy, before effects of chronic seizures and medications. METHODS A total of 111 children aged eight to 18 years (41 new- or recent-onset juvenile myoclonic epilepsy and 70 first-degree cousin controls) underwent neuropsychological assessment (attention, executive, verbal, perceptual, speed), structured review of need for supportive academic services, parent reports of behavior and executive function (Child Behavior Checklist and Behavior Rating Inventory of Executive Function), and formal structured psychiatric interview and diagnosis (Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version). RESULTS Children with juvenile myoclonic epilepsy performed worse than controls across all tested cognitive domains (F(1,105) = 3.85, P < 0.01), utilized more academic services (47% versus 19%, P = 0.002), had more parent-reported behavioral problems and dysexecutive function with lower competence (P < 0.001), and had a higher prevalence of current Axis I diagnoses (attention-deficit/hyperactivity disorder, depression, and anxiety; 54% versus 23%, P = 0.001). Academic and psychiatric problems occurred antecedent to epilepsy onset compared with comparable timeline in controls. CONCLUSION Comprehensive assessment of cognitive, academic, behavioral, and psychiatric comorbidities in youth with new- or recent-onset juvenile myoclonic epilepsy reveals a pattern of significantly increased neurobehavioral comorbidities across a broad spectrum of areas. These early evident comorbidities are of clear clinical importance with worrisome implications for future cognitive, behavioral, and social function. It is important for health care providers to avoid delays in intervention by assessing potential comorbidities early in the course of the disorder to optimize their patients' social, academic and behavioral progress.
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Affiliation(s)
- Dace N Almane
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison Wisconsin
| | - Jana E Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison Wisconsin
| | - Taylor McMillan
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison Wisconsin
| | - Carl E Stafstrom
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore Maryland
| | - David A Hsu
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison Wisconsin
| | | | - Bruce P Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison Wisconsin
| | - Temitayo O Oyegbile
- Department of Pediatrics and Neurology, Georgetown University, Washington District of Columbia.
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29
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Baumgartner C, Koren JP, Britto-Arias M, Zoche L, Pirker S. Presurgical epilepsy evaluation and epilepsy surgery. F1000Res 2019; 8. [PMID: 31700611 PMCID: PMC6820825 DOI: 10.12688/f1000research.17714.1] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2019] [Indexed: 12/21/2022] Open
Abstract
With a prevalence of 0.8 to 1.2%, epilepsy represents one of the most frequent chronic neurological disorders; 30 to 40% of patients suffer from drug-resistant epilepsy (that is, seizures cannot be controlled adequately with antiepileptic drugs). Epilepsy surgery represents a valuable treatment option for 10 to 50% of these patients. Epilepsy surgery aims to control seizures by resection of the epileptogenic tissue while avoiding neuropsychological and other neurological deficits by sparing essential brain areas. The most common histopathological findings in epilepsy surgery specimens are hippocampal sclerosis in adults and focal cortical dysplasia in children. Whereas presurgical evaluations and surgeries in patients with mesial temporal sclerosis and benign tumors recently decreased in most centers, non-lesional patients, patients requiring intracranial recordings, and neocortical resections increased. Recent developments in neurophysiological techniques (high-density electroencephalography [EEG], magnetoencephalography, electrical and magnetic source imaging, EEG-functional magnetic resonance imaging [EEG-fMRI], and recording of pathological high-frequency oscillations), structural magnetic resonance imaging (MRI) (ultra-high-field imaging at 7 Tesla, novel imaging acquisition protocols, and advanced image analysis [post-processing] techniques), functional imaging (positron emission tomography and single-photon emission computed tomography co-registered to MRI), and fMRI significantly improved non-invasive presurgical evaluation and have opened the option of epilepsy surgery to patients previously not considered surgical candidates. Technical improvements of resective surgery techniques facilitate successful and safe operations in highly delicate brain areas like the perisylvian area in operculoinsular epilepsy. Novel less-invasive surgical techniques include stereotactic radiosurgery, MR-guided laser interstitial thermal therapy, and stereotactic intracerebral EEG-guided radiofrequency thermocoagulation.
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Affiliation(s)
- Christoph Baumgartner
- Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria.,Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Johannes P Koren
- Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria.,Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria
| | - Martha Britto-Arias
- Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria.,Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria
| | - Lea Zoche
- Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria.,Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria
| | - Susanne Pirker
- Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria.,Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria
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30
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Kaestner E, Reyes A, Macari AC, Chang YH, Paul B, Hermann B, McDonald CR. Identifying the neural basis of a language-impaired phenotype of temporal lobe epilepsy. Epilepsia 2019; 60:1627-1638. [PMID: 31297795 PMCID: PMC6687533 DOI: 10.1111/epi.16283] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/17/2019] [Accepted: 06/17/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To identify neuroimaging and clinical biomarkers associated with a language-impaired phenotype in refractory temporal lobe epilepsy (TLE). METHODS Eighty-five patients with TLE were characterized as language-impaired (TLE-LI) or non-language-impaired (TLE-NLI) based on comprehensive neuropsychological testing. Structural magnetic resonance imaging (MRI), diffusion tensor imaging, and functional MRI (fMRI) were obtained in patients and 47 healthy controls (HC). fMRI activations and cortical thickness were calculated within language regions of interest, and fractional anisotropy (FA) was calculated within deep white matter tracts associated with language. Analyses of variance were performed to test for differences among the groups in imaging measures. Receiver operator characteristic curves were used to determine how well different clinical versus imaging measures discriminated TLE-LI from TLE-NLI. RESULTS TLE-LI patients showed significantly less activation within left superior temporal cortex compared to HC and TLE-NLI, regardless of side of seizure onset. TLE-LI also showed decreased FA in the inferior longitudinal fasciculus and arcuate fasciculus compared to HC. Cortical thickness did not differ between groups in any region. A model that included language-related fMRI activations within the superior temporal gyrus, age at onset, and demographic variables was the most predictive of language impairment (area under the curve = 0.80). SIGNIFICANCE These findings demonstrate a unique imaging signature associated with a language-impaired phenotype in TLE, characterized by functional and microstructural alterations within the language network. Reduced left superior temporal activation combined with compromise to language association tracts underlies this phenotype, extending our previous work on cognitive phenotypes that could have implications for treatment-planning or cognitive progression in TLE.
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Affiliation(s)
- Erik Kaestner
- Center for Multimodal Imaging and Genetics, University of California, San Diego
| | - Anny Reyes
- Center for Multimodal Imaging and Genetics, University of California, San Diego
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego
| | | | - Yu-Hsuan Chang
- Center for Multimodal Imaging and Genetics, University of California, San Diego
| | - Brianna Paul
- Department of Neurology, University of California – San Francisco, San Francisco
- UCSF Comprehensive Epilepsy Center, San Francisco
| | - Bruce Hermann
- Matthews Neuropsychology Section, University of Wisconsin
| | - Carrie R. McDonald
- Center for Multimodal Imaging and Genetics, University of California, San Diego
- UCSD Comprehensive Epilepsy Center, San Diego
- Department of Psychiatry, University of California, San Diego
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31
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Danguecan AN, Smith ML. Re-examining the crowding hypothesis in pediatric epilepsy. Epilepsy Behav 2019; 94:281-287. [PMID: 30904421 DOI: 10.1016/j.yebeh.2019.01.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 01/29/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE In adults with left-sided epilepsy, reorganized language may "crowd out" right-hemisphere visual-spatial skills, with relative sparing of language (i.e., the crowding hypothesis). However, this effect has not consistently been demonstrated in pediatric epilepsy studies. The objective of this study was to investigate the crowding hypothesis using a heterogeneous sample of children with intractable epilepsy and typical (left) language dominance or atypical (right or bilateral) language dominance. We examined the relative contributions of seizure onset (before or after age 5), handedness (right versus left), seizure localization (temporal versus extratemporal), as well as language dominance on verbal versus visual cognitive skills. METHOD We retrospectively analyzed neuropsychology assessment results from a sample of 91 children who completed presurgical evaluation at the Hospital for Sick Children in Toronto, Canada (34 with typical language, 57 with atypical language, mean age = 12 years). We considered a selection of verbal skills (naming, vocabulary knowledge, verbal abstract reasoning) and visual skills (visual-motor integration, block construction, visual abstract reasoning). RESULTS Consistent with several previous adult studies supporting the crowding hypothesis, univariate analyses showed that the typical and atypical language groups were comparable on the measures of vocabulary knowledge and abstract verbal reasoning whereas the atypical language group produced lower scores across visual measures. Multivariate analyses (taking into account language dominance and associated factors) showed that language dominance was the strongest predictor of performance on two of three visual measures whereas language dominance was not a significant predictor of performance on most verbal measures. Unexpectedly, both sets of analyses indicated that the atypical language group had poorer naming abilities than the typical language group. SIGNIFICANCE Our data provide some evidence of right-hemisphere functional crowding effects in a heterogeneous sample of children with intractable left-sided epilepsy. Specifically, those with atypical versus typical language dominance showed poorer visual-motor integration and visual-motor problem-solving skills, with comparable scores on certain verbal measures. It is critical that potential crowding effects be considered when interpreting the neuropsychological profiles of children being evaluated for epilepsy surgery.
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Affiliation(s)
- Ashley N Danguecan
- Department of Psychology, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada.
| | - Mary Lou Smith
- Department of Psychology, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada; Department of Psychology, University of Toronto Mississauga, Mississauga, Canada; Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, Canada.
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32
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Hwang G, Dabbs K, Conant L, Nair VA, Mathis J, Almane DN, Nencka A, Birn R, Humphries C, Raghavan M, DeYoe EA, Struck AF, Maganti R, Binder JR, Meyerand E, Prabhakaran V, Hermann B. Cognitive slowing and its underlying neurobiology in temporal lobe epilepsy. Cortex 2019; 117:41-52. [PMID: 30927560 DOI: 10.1016/j.cortex.2019.02.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 12/06/2018] [Accepted: 02/23/2019] [Indexed: 11/17/2022]
Abstract
Cognitive slowing is a known but comparatively under-investigated neuropsychological complication of the epilepsies in relation to other known cognitive comorbidities such as memory, executive function and language. Here we focus on a novel metric of processing speed, characterize its relative salience compared to other cognitive difficulties in epilepsy, and explore its underlying neurobiological correlates. Research participants included 55 patients with temporal lobe epilepsy (TLE) and 58 healthy controls from the Epilepsy Connectome Project (ECP) who were administered a battery of tests yielding 14 neuropsychological measures, including selected tests from the NIH Toolbox-Cognitive Battery, and underwent 3T MRI and resting state fMRI. TLE patients exhibited a pattern of generalized cognitive impairment with very few lateralized abnormalities. Using the neuropsychological measures, machine learning (Support Vector Machine binary classification model) classified the TLE and control groups with 74% accuracy with processing speed (NIH Toolbox Pattern Comparison Processing Speed Test) the best predictor. In TLE, slower processing speed was associated predominantly with decreased local gyrification in regions including the rostral and caudal middle frontal gyrus, inferior precentral cortex, insula, inferior parietal cortex (angular and supramarginal gyri), lateral occipital cortex, rostral anterior cingulate, and medial orbital frontal regions, as well as three small regions of the temporal lobe. Slower processing speed was also associated with decreased connectivity between the primary visual cortices in both hemispheres and the left supplementary motor area, as well as between the right parieto-occipital sulcus and right middle insular area. Overall, slowed processing speed is an important cognitive comorbidity of TLE associated with altered brain structure and connectivity.
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Affiliation(s)
- Gyujoon Hwang
- Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Kevin Dabbs
- Neurology, University of Wisconsin-Madison, Madison, WI, USA
| | - Lisa Conant
- Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Veena A Nair
- Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Jed Mathis
- Radiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Dace N Almane
- Neurology, University of Wisconsin-Madison, Madison, WI, USA
| | - Andrew Nencka
- Radiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rasmus Birn
- Medical Physics, University of Wisconsin-Madison, Madison, WI, USA; Psychiatry, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Manoj Raghavan
- Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Edgar A DeYoe
- Radiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aaron F Struck
- Neurology, University of Wisconsin-Madison, Madison, WI, USA
| | - Rama Maganti
- Neurology, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Elizabeth Meyerand
- Medical Physics, University of Wisconsin-Madison, Madison, WI, USA; Radiology, University of Wisconsin-Madison, Madison, WI, USA; Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Vivek Prabhakaran
- Medical Physics, University of Wisconsin-Madison, Madison, WI, USA; Radiology, University of Wisconsin-Madison, Madison, WI, USA; Psychiatry, University of Wisconsin-Madison, Madison, WI, USA
| | - Bruce Hermann
- Neurology, University of Wisconsin-Madison, Madison, WI, USA.
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Rayner G, Tailby C, Jackson G, Wilson S. Looking beyond lesions for causes of neuropsychological impairment in epilepsy. Neurology 2019; 92:e680-e689. [PMID: 30635484 PMCID: PMC6382365 DOI: 10.1212/wnl.0000000000006905] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 10/08/2018] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Patients with temporal lobe epilepsy (TLE) are similar in their epileptology regardless of whether they have a lesion evident on MRI; this study aims to prospectively clarify whether they are also similar in their neuropsychological profiles. METHODS Participants comprised 152 adults: 79 patients with TLE and 73 healthy controls. Patients and controls did not differ in age, sex, or education (p > 0.05). Sixty-two percent of patients had an MRI-resolvable lesion (39% with presumed hippocampal sclerosis [HS-TLE], 61% with a lesion other than HS [MRI-positive TLE]); the remaining 38% of patients were lesion-negative. Psychometric measures well established in epilepsy were used. RESULTS Relative to controls, all 3 patient subgroups showed significantly impaired autobiographical, verbal, and visual memory (p < 0.05-0.001) and significantly more depression and anxiety (p < 0.05-0.01). Yet, contrary to expectations, the 3 TLE subgroups did not differ in their severity of memory or mood impairment (p > 0.05). Lower Full-Scale IQ predicted memory impairments across all TLE subtypes, with early age at seizure onset a predictor unique to MRI-negative TLE. CONCLUSIONS MRI-negative TLE is associated with memory and mood dysfunction equivalent to that seen in patients with hippocampal sclerosis and other MRI-resolvable pathologies. As such, neuropsychological impairments in TLE are not contingent on a macroscopic lesion and might be an intrinsic property of the underlying network disease.
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Affiliation(s)
- Genevieve Rayner
- From the Florey Institute of Neuroscience and Mental Health (G.R., C.T., G.J., S.W.), and Comprehensive Epilepsy Programme, Austin Health (G.J., S.W.), Melbourne Brain Centre, Heidelberg; Melbourne School of Psychological Sciences (G.R., S.W.), the University of Melbourne, Parkville; and Institute for Social Neuroscience (C.T.), Heidelberg, Australia.
| | - Chris Tailby
- From the Florey Institute of Neuroscience and Mental Health (G.R., C.T., G.J., S.W.), and Comprehensive Epilepsy Programme, Austin Health (G.J., S.W.), Melbourne Brain Centre, Heidelberg; Melbourne School of Psychological Sciences (G.R., S.W.), the University of Melbourne, Parkville; and Institute for Social Neuroscience (C.T.), Heidelberg, Australia
| | - Graeme Jackson
- From the Florey Institute of Neuroscience and Mental Health (G.R., C.T., G.J., S.W.), and Comprehensive Epilepsy Programme, Austin Health (G.J., S.W.), Melbourne Brain Centre, Heidelberg; Melbourne School of Psychological Sciences (G.R., S.W.), the University of Melbourne, Parkville; and Institute for Social Neuroscience (C.T.), Heidelberg, Australia
| | - Sarah Wilson
- From the Florey Institute of Neuroscience and Mental Health (G.R., C.T., G.J., S.W.), and Comprehensive Epilepsy Programme, Austin Health (G.J., S.W.), Melbourne Brain Centre, Heidelberg; Melbourne School of Psychological Sciences (G.R., S.W.), the University of Melbourne, Parkville; and Institute for Social Neuroscience (C.T.), Heidelberg, Australia
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34
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Do Seizures Induce Brain Tissue Loss? Epilepsy Curr 2018; 18:35-36. [DOI: 10.5698/1535-7597.18.1.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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