1
|
Barr WB, Pecci CC. Last menstrual period versus ultrasound for pregnancy dating. Int J Gynaecol Obstet 2017; 87:38-9. [PMID: 15464776 DOI: 10.1016/j.ijgo.2004.06.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2003] [Revised: 06/10/2004] [Accepted: 06/21/2004] [Indexed: 10/26/2022]
Affiliation(s)
- W B Barr
- Department of Family Practice and Community Medicine and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | | |
Collapse
|
2
|
Hamid H, Liu H, Cong X, Devinsky O, Berg AT, Vickrey BG, Sperling MR, Shinnar S, Langfitt JT, Walczak TS, Barr WB, Dziura J, Bazil CW, Spencer SS. Long-term association between seizure outcome and depression after resective epilepsy surgery. Neurology 2011; 77:1972-6. [PMID: 22094480 DOI: 10.1212/wnl.0b013e31823a0c90] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study explored the association between long-term epilepsy surgery outcome and changes in depressive symptoms. METHODS Adults were enrolled between 1996 and 2001 in a multicenter prospective study to evaluate outcomes of resective epilepsy surgery. The extent of depressive symptoms and depression case status (none, mild, or moderate/severe) were assessed using the Beck Depression Inventory (BDI) preoperatively and 3, 12, 24, 48, and 60 months postoperatively. A mixed-model repeated-measures analysis was performed, adjusting for covariates of seizure location, gender, age, race, education, and seizure control. RESULTS Of the total 373 subjects, 256 were evaluated at baseline and 5 years after surgery. At baseline, 164 (64.1%) were not depressed, 34 (13.3%) were mildly depressed, and 58 (22.7%) had moderate to severe depression. After 5 years, 198 (77.3%) were not depressed, 20 (7.8%) were mildly depressed, and 38 (14.8%) were moderately to severely depressed. Five years after surgery, the reduction in mean change from baseline in BDI score was greater in subjects with excellent seizure control than in the fair and poor seizure control groups (p = 0.0006 and p = 0.02 respectively). Those with good seizure control had a greater reduction in BDI score than the poor seizure control group (p = 0.02) and borderline significant reduction compared with the fair seizure control group (p = 0.055). CONCLUSION Although study participants had initial improvement in depressive symptoms, on average, after resective surgery, only patients with good or excellent seizure control had sustained long-term improvement in mood.
Collapse
Affiliation(s)
- H Hamid
- Yale University School of Medicine, Department of Neurology, 950 Campbell Ave., West Haven, CT 06516-2700, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Nakhutina L, Pramataris P, Morrison C, Devinsky O, Barr WB. Reliable change indices and regression-based measures for the Rey-Osterreith Complex Figure test in partial epilepsy patients. Clin Neuropsychol 2009; 24:38-44. [PMID: 19606396 DOI: 10.1080/13854040902960091] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The Rey-Osterreith Complex Figure (ROCF) is commonly used in evaluations of patients undergoing epilepsy surgery. We assessed test-retest performance on ROCF in 30 partial epilepsy patients (mean interval = 33.7 months) to derive reliable change indices (RCIs) and regression-based measures for change. ROCF reproductions were rescored by three raters (IRR Copy: 0.963; Delayed Recall: 0.986). The derived adjusted RC (90% CI) cutoff values for the ROCF Copy were (<or=-6.5, >or=8.4) and were (<or=-6.8, >or=10.0) for the Delayed Recall. Results from regression-based analyses were negative, using age, education, seizure duration, and age of onset, whereas a baseline score was a significant predictor of a follow-up score. The results provide a means to evaluate long-term outcome in epilepsy patients using the ROCF.
Collapse
Affiliation(s)
- L Nakhutina
- New York University Langone Medical Center, Comprehensive Epilepsy Center, 223 East 34th Street, New York, NY 10016, USA.
| | | | | | | | | |
Collapse
|
4
|
Langfitt JT, Westerveld M, Hamberger MJ, Walczak TS, Cicchetti DV, Berg AT, Vickrey BG, Barr WB, Sperling MR, Masur D, Spencer SS. Worsening of quality of life after epilepsy surgery: Effect of seizures and memory decline. Neurology 2007; 68:1988-94. [PMID: 17548548 DOI: 10.1212/01.wnl.0000264000.11511.30] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Surgery for intractable temporal lobe epilepsy usually controls seizures and improves health-related quality of life (HRQOL), but some patients experience continued seizures, memory decline, or both. The relative impact of these unfavorable outcomes on HRQOL has not been described. METHODS We studied seizure control, memory change, and HRQOL among 138 patients in the Multicenter Study of Epilepsy Surgery (MSES), an ongoing, prospective study of epilepsy surgery outcomes. Seizure remission at 2 years and 5 years was prospectively determined based upon regularly scheduled follow-up calls to study patients throughout the follow-up period. HRQOL was assessed annually using the Quality of Life in Epilepsy Inventory (QOLIE-89). Memory decline was determined by change in verbal delayed recall from baseline to the 2- or 5-year follow-up. RESULTS HRQOL improved in patients who were in remission at the 2-year or 5-year follow-up, regardless of memory outcome. Among those not in remission at both 2 and 5 years (25/138, 18%), HRQOL remained stable when memory did not decline (14/138, 10%), but HRQOL declined when memory did decline (11/138, 8%). These 11 patients had baseline characteristics predictive of poor seizure or memory outcome. Declines were most apparent on HRQOL subscales assessing memory, role limitations, and limitations in work, driving, and social activities. CONCLUSIONS After temporal resection, health-related quality of life (HRQOL) improves or remains stable in seizure-free patients despite memory decline, but HRQOL declines when persistent seizures are accompanied by memory decline. These results may be useful in presurgical counseling and identifying patients at risk for poor psychosocial outcome following surgery.
Collapse
Affiliation(s)
- J T Langfitt
- Department of Neurology, University of Rochester, Rochester, NY 14642, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Devinsky O, Barr WB, Vickrey BG, Berg AT, Bazil CW, Pacia SV, Langfitt JT, Walczak TS, Sperling MR, Shinnar S, Spencer SS. Changes in depression and anxiety after resective surgery for epilepsy. Neurology 2005; 65:1744-9. [PMID: 16344516 DOI: 10.1212/01.wnl.0000187114.71524.c3] [Citation(s) in RCA: 207] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine changes in depression and anxiety after resective surgery. METHODS Data from subjects enrolled in a prospective multicenter study of resective epilepsy surgery were reviewed with the Beck Psychiatric Symptoms Scales (Beck Depression Inventory [BDI] and Beck Anxiety Inventory [BAI]) and Composite International Diagnostic Interview (CIDI) up to a 24-month period. chi2 analyses were used to correlate proportions. RESULTS A total of 358 presurgical BDI and 360 BAI results were reviewed. Moderate and severe levels of depression were reported in 22.1% of patients, and similar levels of anxiety were reported by 24.7%. Postoperative rates of depression and anxiety declined at the 3-, 12-, and 24-month follow-up periods. At the 24-month follow-up, moderate to severe levels of depression symptoms were reported in 17.6 and 14.7% of the patients who continued to have postoperative seizures. Moderate to severe depression and anxiety were found in 8.2% of those who were seizure-free. There was no relationship, prior to surgery, between the presence or absence of depression and anxiety and the laterality or location of the seizure onset. There were no significant relationships between depression or anxiety at 24-month follow-up and the laterality or location of the surgery. CONCLUSIONS Depression and anxiety in patients with refractory epilepsy significantly improve after epilepsy surgery, especially in those who are seizure-free. Neither the lateralization nor the localization of the seizure focus or surgery was associated with the risk of affective symptoms at baseline or after surgery.
Collapse
Affiliation(s)
- O Devinsky
- New York University School of Medicine, New York, NY, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
|
7
|
Abstract
Neuropsychology, with its emphasis on standardized and empirically based methods, has made a number of scientific contributions to address growing concerns about concussions resulting from sports injuries. This study employs a test-retest paradigm to determine the immediate effects of concussion in high-school and college athletes. The Standardized Assessment of Concussion (SAC) was administered to 1,313 male athletes prior to the beginning of the competitive season. Reliable change indices and multiple regression models were computed on retest scores obtained from 68 noninjured athletes who were readministered the SAC at either 60 or 120 days following baseline testing. Receiver operating characteristic (ROC) curve analyses were used to test these models with data obtained on 50 athletes tested immediately following concussion. The results indicate that a decline of I point on the SAC at retesting classified injured and noninjured participants with a level of 94% sensitivity and 76% specificity. The RCI and multiple regression models provided comparable levels of group classification, but provided cut-offs that are conservative for use with this population. The results support and extend previous research findings indicating that the SAC is a valid instrument for detecting the immediate effects of mild traumatic brain injury.
Collapse
Affiliation(s)
- W B Barr
- Department of Neurology, New York University Medical Center, New York 10016, USA.
| | | |
Collapse
|
8
|
Abstract
Attentional dysfunction can be found in nearly every form of psychopathology, not just in attention deficit disorder (ADD). Being able to distinguish ADD from other psychiatric conditions is crucial for clinicians working with adolescents and young adults, particularly in the case of psychoses where making the correct diagnosis and beginning treatment promptly is extremely important. In this paper we review the literature on the attentional dysfunction found in schizophrenia and compare it to that found in ADD in an effort to increase our knowledge of etiology and underlying mechanisms. Investigators studying ADD may learn from the study of schizophrenia by realizing that ADD is also a complex disorder of attention that occurs across the developmental spectrum and is characterized by various predispositional, environmental, and maturational factors.
Collapse
Affiliation(s)
- W B Barr
- Departments of Neurology and Psychiatry, New York University Medical Center, New York, New York 10016, USA.
| |
Collapse
|
9
|
Westerveld M, Sass KJ, Chelune GJ, Hermann BP, Barr WB, Loring DW, Strauss E, Trenerry MR, Perrine K, Spencer DD. Temporal lobectomy in children: cognitive outcome. J Neurosurg 2000; 92:24-30. [PMID: 10616078 DOI: 10.3171/jns.2000.92.1.0024] [Citation(s) in RCA: 104] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The authors sought to determine the impact of early temporal lobectomy (in patients younger than age 17 years) on intellectual functioning. The efficacy of temporal lobectomy for treating seizures is well established and the procedure is becoming more acceptable as a treatment for children whose seizures are intractable. However, cognitive outcomes of temporal lobectomy in children and adolescents are largely unreported. The present study takes advantage of a unique multicenter collaboration to examine retrospectively intellectual functioning in a large sample of children who underwent temporal lobectomy. METHODS Intellectual functioning was assessed before and after temporal lobectomy for treatment of medication-resistant seizures in 82 patients at eight centers of epilepsy surgery. All children underwent standard presurgical examinations, including electroencephalography-video monitoring, magnetic resonance (MR) imaging, and neuropsychological testing, at their respective centers. Forty-three children underwent left temporal lobectomy and 39 underwent right temporal lobectomy. For the entire sample, there were no significant declines in intelligence quotient (IQ) following surgery. Children who underwent left temporal lobectomy demonstrated no significant loss in verbal intellectual functioning and improved significantly in nonverbal intellectual functioning. Children who underwent right temporal lobectomy did not demonstrate significant changes in intellectual functioning. Although group scores showed no change in overall IQ values, an analysis of individual changes revealed that approximately 10% of the sample experienced a significant decline and 9% experienced significant improvement in verbal functioning. Significant improvement in nonverbal cognitive function was observed in 16% of the sample and only 2% of the sample showed significant declines. Risk factors for significant decline included older patient age at the time of surgery and the presence of a structural lesion other than mesial temporal sclerosis on MR imaging. CONCLUSIONS The present study provides preliminary data for establishing the risk of cognitive morbidity posed by temporal lobectomy performed during childhood. With respect to global intellectual functioning, a slight improvement was significantly more likely to occur than a decline. However, there were several patients in whom significant declines did occur. It will be necessary to study further the factors associated with such declines. In addition, further study of more specific cognitive functions, particularly memory, is needed.
Collapse
Affiliation(s)
- M Westerveld
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut 06520-8082, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Barr WB, Rastogi R, Ravdin L, Hilton E. Relations among indexes of memory disturbance and depression in patients with Lyme borreliosis. Appl Neuropsychol 1999; 6:12-8. [PMID: 10382566 DOI: 10.1207/s15324826an0601_2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
This study examined the relation between complaints of memory disturbance and measures of mood and memory functioning in 55 patients with serological evidence of late-stage Lyme Borreliosis (LB). Patients completed the Self-Ratings of Memory Questionnaire (SRMQ) and the Beck Depression Inventory. Memory functioning was assessed with the California Verbal Learning Test. Depressed patients exhibited more frequent complaints of memory disturbance on the SRMQ, although their pattern of responses did not differ from nondepressed patients. There was a significant correlation between subjective memory ratings and self-reported depression (Spearman rho = -.57, p < .001). No relation was observed between subjective memory ratings and objective memory performance. The results indicate subjective complaints of more severe memory disturbance in patients with LB and depression. Particular attention should be paid to the assessment of depression and subjective symptoms of memory disturbance when administering neuropsychological tests of memory functioning in patients with LB.
Collapse
Affiliation(s)
- W B Barr
- Department of Neurology and Psychiatry, Long Island Jewish Medical Center, New Hyde Park, New York 11040, USA
| | | | | | | |
Collapse
|
11
|
Abstract
Although subjective complaints of word finding and naming deficits are commonly reported by patients with Lyme Borreliosis (LB), the existence of these disturbances has not been thoroughly investigated. Forty-four patients with LB and 43 healthy controls were administered a symptom questionnaire, the Boston Naming Test (BNT), the Controlled Oral Word Association Test (COWAT), and a series of category naming tasks. LB patients had a higher rate of complaints of word-finding disturbance (55% vs. 14%). Lower mean scores were observed on the BNT, but not on the COWAT, nor on category naming tasks. Thirty-six percent of the LB sample exhibited BNT scores in the impaired range. BNT scores in this group were correlated with a measure of memory retrieval, but not with verbal fluency indexes. There was no relation between naming scores and depression. LB patients exhibit impairments in word finding that appear to be secondary to a generalized retrieval deficit.
Collapse
Affiliation(s)
- C Svetina
- Department of Medicine, Long Island Jewish Medical Center/Hillside Hospital, New Hyde Park, New York 11040, USA
| | | | | | | |
Collapse
|
12
|
Loring DW, Strauss E, Hermann BP, Perrine K, Trenerry MR, Barr WB, Westerveld M, Chelune GJ, Lee GP, Meador KJ. Effects of anomalous language representation on neuropsychological performance in temporal lobe epilepsy. Neurology 1999; 53:260-4. [PMID: 10430411 DOI: 10.1212/wnl.53.2.260] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine the effects of anomalous language representation (i.e., mixed- and right-cerebral dominant) on neuropsychological performance. BACKGROUND Right cerebral language dominance resulting from early cerebral injury is associated with relatively preserved language function with decreased visuospatial ability. However, previous reports of this phenomenon have examined patients with relatively large cerebral injuries (e.g., infantile hemiplegia) or limited sample sizes. METHODS A total of 561 patients with complex partial seizures of left temporal lobe origin were studied. Patients were classified into left (n = 455), bilateral (n = 58), and right (n = 48) language dominant groups based on Wada testing. RESULTS Right language dominant patients performed more poorly on multiple tests of visuospatial function, including Performance IQ (PIQ), than did left language patients. No significant group differences were detected for measures of language or general verbal function. The effects of bilateral language on PIQ differed according to handedness. Lowered PIQ was present in the bilateral nondextral group but not for bilateral dextral patients, and this pattern was observed with other visuospatial measures. CONCLUSIONS In patients with relatively small lesions restricted to the left mesial temporal lobe, a shift in language dominance to the right hemisphere is associated with decreased visuospatial functions but preserved verbal abilities. Nondextral patients with bilateral language representation also displayed decreased visuospatial performance, although dextral patients with bilateral language did not.
Collapse
Affiliation(s)
- D W Loring
- Department of Neurology, Medical College of Georgia, Augusta 30912-3275, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Horowitz TL, Barr WB, Ney G, Schaul N. Reevaluating the use of fine motor test scores in classifying seizure focus in TLE: Receiver operating characteristic curve analyses. Arch Clin Neuropsychol 1999. [DOI: 10.1093/arclin/14.1.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
14
|
Abstract
BACKGROUND The emergence of psychogenic seizures after surgery for epilepsy is not well recognized. OBJECTIVES To identify the frequency of psychogenic seizures in an 11-year surgical experience and to characterize the patients with this complication. METHODS Ninety-six patients underwent surgery for epilepsy between 1985 and 1996. The surgical database was reviewed and all patients who experienced postoperative psychogenic seizures were identified. Patients were characterized by sex, age, psychopathologic conditions, full-scale IQ, duration of epilepsy, surgical procedure, and operative complications. Patients were compared with the surgical group as a whole for these variables. SETTING A comprehensive epilepsy center. RESULTS Five patients were identified: 3 men and 2 women. Mean full-scale IQ was 73 (range, 66-82). Mean age was 29.8 years (range, 22-36 years). Three patients were diagnosed as having psychosis, 1 with borderline personality disorder and 1 with generalized anxiety. Operations included 4 anterior temporal lobectomies and 1 occipital lobectomy. Two patients experienced operative complications. Compared with the surgical cohort, patients had a higher frequency of preoperative psychopathologic conditions, lower mean full-scale IQ, and a greater occurrence of operative complications. CONCLUSIONS (1) Patients can develop new-onset psychogenic seizures after surgery for epilepsy. (2) Low full-scale IQ, serious preoperative psychopathologic conditions, and major surgical complications may be risk factors. (3) Atypical postoperative seizures should be evaluated with video electroencephalographic monitoring before concluding that they are epileptic.
Collapse
Affiliation(s)
- G C Ney
- Department of Neurology, Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park, NY 11042, USA
| | | | | | | | | |
Collapse
|
15
|
Chelune GJ, Naugle RI, Hermann BP, Barr WB, Trenerry MR, Loring DW, Perrine K, Strauss E, Westerveld M. Does presurgical IQ predict seizure outcome after temporal lobectomy? Evidence from the Bozeman Epilepsy Consortium. Epilepsia 1998; 39:314-8. [PMID: 9578051 DOI: 10.1111/j.1528-1157.1998.tb01379.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE Considerable debate exists concerning whether the presence of low preoperative IQ should be a contraindication for focal resective epilepsy surgery. METHODS We examined the relationship between baseline IQ scores and seizure outcome in 1,034 temporal lobectomy cases from eight epilepsy surgery centers participating in the Bozeman Epilepsy Consortium. RESULTS Those patients who continued to have seizures following surgery had statistically lower preoperative IQ scores than those who were seizure-free (p < 0.009), but only by 2.3 points. This small but statistically significant relationship was fairly robust; it was observed across seven of the eight centers, and indicates that the findings can be generalized. Among patients with IQ scores of < or = 75, 32.8% continued to have seizures following surgery, whereas 23.8% and 16.9% were not seizure-free when IQ scores were between 76 and 109 and > or = 110, respectively. Relative risk analyses revealed no significant increase in risk among patients with low IQ scores who had no structural lesions other than mesial temporal sclerosis. However, patients with IQ scores of < or = 75 had nearly a fourfold (390%) increase in risk for continued seizures as compared with those with higher IQ scores if structural lesions were present. CONCLUSIONS While our results suggest that preoperative IQ scores alone are not good predictors of seizure outcome and should not be used to exclude patients as potential surgical candidates. IQ scores can be useful for counseling patients and their families concerning the relative risks of surgery.
Collapse
Affiliation(s)
- G J Chelune
- Section of Neuropsychology, Cleveland Clinic Foundation, Ohio 44195, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Abstract
OBJECTIVES To examine the degree and frequency of reductions in hippocampal volume in patients with temporal lobe epilepsy with and without a history of febrile seizures. METHODS In vivo measures of hippocampal volume were computed from three dimensional gradient echo (FLASH) images in 44 patients undergoing comprehensive evaluations for epilepsy surgery. Twenty one patients (48%) reported a history of febrile seizures. The volumes from these patients were compared with those from 23 patients without a history of febrile seizures and 34 healthy controls. RESULTS The febrile seizure group had significant reductions in volume, both ipsilateral (30% decrease) and contralateral (15% decrease), to the EEG seizure focus. Twelve of 18 patients with febrile seizures exhibited clinically significant ipsilateral volume reductions, defined as volumes falling 2 SD below the mean obtained from the control sample. Only four of 19 patients without febrile seizures exhibited this degree of reduction. No significant correlations were found between seizure variables (for example, duration of epilepsy, seizure frequency) and ipsilateral reductions in volume. However, a significant inverse correlation (r=-0.45, P<0.05) between seizure frequency and the volume of the hippocampus contralateral to the seizure focus was found in the febrile seizure group. CONCLUSION These results suggest that a history of febrile seizures is associated with the finding of a smaller hippocampus on the side ipsilateral to the subsequent temporal lobe focus whereas chronic factors seem to be be related to pathology contralateral to the seizure focus.
Collapse
Affiliation(s)
- W B Barr
- Department of Neurology, Long Island Jewish Medical Center, Long Island Campus for the Albert Einstein College of Medicine, New Hyde Park, New York 10042, USA
| | | | | |
Collapse
|
17
|
Abstract
Tests of facial recognition and spatial learning were administered to presurgical patients with unilateral temporal lobe EEG foci. Right temporal lobe patients obtained lower facial recognition scores than left temporal lobe patients. The groups performed equally on the spatial learning test. A factor analysis revealed two independent factors: a general visuospatial factor and a more specific facial identification factor. The findings provide support for the existence of two dissociable visual processing systems. Memory impairments associated with right temporal lobe dysfunction may be characterized as an impairment in a ventral visual processing system responsible for facial memory and pattern recognition.
Collapse
Affiliation(s)
- W B Barr
- Department of Neurology, Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park, New York, USA
| |
Collapse
|
18
|
Strauss E, Hunter M, Hermann BP, Loring DW, Trenerry MR, Barr WB, Chelune GJ, Perrine K, Westerveld M, Wada J. Differential rates of age of seizure onset between sexes and between hemispheres? J Int Neuropsychol Soc 1997; 3:428-34. [PMID: 9322401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In a descriptive analysis of 158 patients with temporal lobe epilepsy, Taylor (1969) reported that the age of first seizure varied systematically as a function of laterality and sex. We conducted inferential analyses of Taylor's original data which (1) provided support for his proposal of disproportionate left hemisphere vulnerability to seizure onset in early life, but (2) failed to provide evidence of sex differences in age of onset of unilateral seizures. Examination of these effects in a larger sample of 844 patients drawn from the Bozeman Epilepsy Consortium provided some additional support for findings from the inferential analysis. Specifically, the left hemisphere appeared more vulnerable to seizure onset in childhood, this increased vulnerability extending to about age 5 years. Age of onset of seizures was not different when males and females were compared. Thus, reanalysis of Taylor's original data as well as examination of data from a larger, more contemporary sample suggest that seizure onset varies as a function of laterality, but not sex.
Collapse
Affiliation(s)
- E Strauss
- University of Victoria, British Columbia, Canada
| | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Barr WB, Chelune GJ, Hermann BP, Loring DW, Perrine K, Strauss E, Trenerry MR, Westerveld M. The use of figural reproduction tests as measures of nonverbal memory in epilepsy surgery candidates. J Int Neuropsychol Soc 1997; 3:435-43. [PMID: 9322402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The construct of nonverbal memory, as assessed by figural reproduction tests, has recently been questioned by a number of investigators. The purpose of this study was to reexamine this construct and its relationship to right temporal lobe dysfunction. Figural reproduction test scores were examined in 757 epilepsy surgery candidates obtained from 8 epilepsy centers participating in the Bozeman Epilepsy Consortium. All participants exhibited unequivocal evidence of left (LTL) or right (RTL) temporal lobe epilepsy observed in ictal and interictal EEG recordings. All subjects also had IQ scores exceeding 70, right-hand preference, and left hemisphere language dominance confirmed by intracarotid sodium amytal testing. Comparisons of LTL and RTL groups showed no significant differences in scores on the Visual Reproduction subtests from the Wechsler Memory Scale (WMS) or Wechsler Memory Scale-Revised (WMS-R) or on the copy and delayed recall conditions of the Rey-Osterrieth Complex Figure Test (ROCFT). Significant differences were observed among centers on WMS and ROCFT scores, which are likely to be a result of variations in administration and/or scoring procedures. The lack of significant differences between LTL and RTL groups in this large sample raise questions about the nature of nonverbal memory and its relationship to right temporal lobe dysfunction.
Collapse
Affiliation(s)
- W B Barr
- Departments of Neurology & Psychiatry, Long Island Jewish Medical Center, New Hyde Park, NY 11040, USA.
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Abstract
BACKGROUND Converging evidence has suggested that the abnormalities in brain morphology observed in schizophrenia are similar to those seen in temporal lobe epilepsy (TLE). The purpose of this study was to compare the features of these groups directly with measures of the brain using magnetic resonance (MR) morphometry. METHOD Morphometric measures of ventricular and hippocampal volumes obtained from FLASH MR images were studied in 32 patients with first-episode schizophrenia (FES), 39 patients with TLE (21 left, 18 right), and 42 healthy controls. RESULTS Ventricular volumes in the FES and TLE groups were both significantly larger that those seen in controls and did not differ from each other. The FES group showed significantly larger temporal horns, while the TLE group had relatively larger frontal horns. Analyses of hippocampal volumes revealed a significant group by hemisphere effect. The FES group showed relative reductions in left hippocampal volume that were comparable only to TLE patients with seizures originating from the left hemisphere. CONCLUSION The results indicate that FES and TLE groups both show evidence of ventricular enlargement. Lateralised morphological abnormalities of the hippocampal formation in FES and left TLE are comparable, and may be specific to temporolimbic regions.
Collapse
Affiliation(s)
- W B Barr
- Hillside Hospital, Long Island Jewish Medical Center, Glen Oaks, New York, USA
| | | | | | | | | |
Collapse
|
21
|
Ravdin LD, Hilton E, Primeau M, Clements C, Barr WB. Memory functioning in Lyme borreliosis. J Clin Psychiatry 1996; 57:282-6. [PMID: 8666568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND To objectively measure memory functioning in patients with Lyme borreliosis and examine the relationship between subjective reports of memory dysfunction and actual impairment. METHOD A prospective pretreatment study of patients with Lyme borreliosis (N = 21), a patient control group (osteomyelitis, N = 21), and healthy controls (N = 21) was conducted by using tests of verbal memory functioning (California Verbal Learning Test) and self-reported depression (Beck Depression Inventory-Cognitive Index), fatigue (Fatigue Severity Scale), and subjective ratings of memory abilities (Self-Rating Scale of Memory Functions). RESULTS Patients with Lyme borreliosis performed worse than healthy controls on verbal memory testing, but did not perform significantly differently from patient controls. Lyme borreliosis patients reported increased fatigue, which was correlated with poorer memory performance. Although the Lyme borreliosis patients rated their memory as more impaired, subjective complaints were not correlated with objective memory scores. CONCLUSION These findings suggest impaired memory performance is not specific to Lyme borreliosis and may be a result of evaluating cognitive functioning in patients with physical illness and somatic complaints. Fatigue is a prominent presenting complaint in patients with Lyme borreliosis and needs to be controlled for since it is known to influence neuropsychological performance. Subjective complaints are not correlated with objective memory assessment, so self-report of memory impairment should not be the criterion for inclusion in studies investigating cognitive manifestations of Lyme borreliosis.
Collapse
Affiliation(s)
- L D Ravdin
- Department of Medicine, Division of Infectious Diseases, Long Island Jewish Medical Center, New Hyde Park, NY, USA
| | | | | | | | | |
Collapse
|
22
|
Rubin E, Dhawan V, Moeller JR, Takikawa S, Labar DR, Schaul N, Barr WB, Eidelberg D. Cerebral metabolic topography in unilateral temporal lobe epilepsy. Neurology 1995; 45:2212-23. [PMID: 8848196 DOI: 10.1212/wnl.45.12.2212] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE Fluorodeoxyglucose positron emission tomography (FDG-PET) studies of temporal lobe epilepsy (TLE) generally report interictal hypometabolism in the vicinity of the seizure focus. Yet, other evidence suggests that interictal metabolic abnormalities might extend to remote brain areas. We used FDG-PET to evaluate metabolism in selected regions distant from the focus in TLE. SUBJECTS Twenty adult patients with medically intractable TLE were selected by criteria favoring a unilateral mesiobasal temporal focus. Structural imaging in this sample were normal except for medial temporal sclerosis in 13 patients. Twenty normal volunteers were controls. DESIGN PET imaging was performed interictally. Regional glucose metabolism normalized by global metabolism was analyzed using t tests and correlation analysis. RESULTS Ipsilateral to the seizure focus, metabolism was depressed compared with normal in the temporal pole (p = 0.001), but relatively elevated in the mesiobasal region (p = 0.005). Contralateral to the focus, metabolism was elevated in lateral temporal cortex (p = 0.0003) and mesiobasal regions (p = 0.0001). Metabolic correlation between ipsilateral and contralateral mesiobasal regions was similar in normal subjects (r = 0.74) and patients (r = 0.68). In contrast, correlations were abnormal between temporal poles and other temporal lobe subregions, both ipsilateral and contralateral to the seizure focus. CONCLUSIONS Relative to normal values, both elevations and depressions of metabolism exist interictally in TLE. Such abnormalities, and accompanying changes in interregional correlations, may have wide spatial distribution. These findings are atypical among PET studies but are consistent with other physiologic, anatomic, and neuropsychological investigations of TLE.
Collapse
Affiliation(s)
- E Rubin
- Department of Biological Psychiatry, Columbia University/New York State Psychiatric Institute, NY, USA
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Tröster AI, Warmflash V, Osorio I, Paolo AM, Alexander LJ, Barr WB. The roles of semantic networks and search efficiency in verbal fluency performance in intractable temporal lobe epilepsy. Epilepsy Res 1995; 21:19-26. [PMID: 7641672 DOI: 10.1016/0920-1211(95)00002-r] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Two competing hypotheses (i.e., disruption of semantic networks vs. search inefficiency) concerning the mechanisms underlying impaired semantic verbal fluency in temporal lobe epilepsy (TLE) were tested within a single paradigm. Reports that semantic verbal fluency is more impaired in left than right TLE groups were confirmed by the findings that the left TLE group produced fewer words on a supermarket fluency task than did the normal control (NC) group, and that the performance of the right TLE group was intermediate to that of the left TLE and NC groups. Because both TLE groups generated fewer words per category of supermarket items sampled, and produced a higher ratio of category labels relative to category exemplars than did the NC group, it can be surmised that TLE disrupts semantic memory networks. The findings did not support the competing hypothesis that reduced semantic verbal fluency in TLE is a manifestation of inefficient search/retrieval strategies, possibly associated with distal frontal lobe pathophysiology. Specifically, the TLE and NC groups did not differ significantly in their mean number of perseverations, intrusions, or search efficiency (operationalized as the ratio of the number of shifts between categories to the number of categories sampled).
Collapse
Affiliation(s)
- A I Tröster
- Department of Neurology, University of Kansas Medical Center, Kansas City 66160-7314, USA
| | | | | | | | | | | |
Collapse
|
24
|
Abstract
Bismuth subsalicylate preparations are over-the-counter products for gastrointestinal complaints. Bismuth toxicity causes delirium, psychosis, ataxia, myoclonus, and seizures and is reversible over several weeks or months, when bismuth intake is stopped. We report a 54-year-old man with a 6-week history of progressive confusion and memory difficulty and a 2-3-week history of involuntary movements and gait impairment. His encephalopathy was further characterized by marked multifocal myoclonic jerks, coarse postural tremors, postural instability, and gait ataxia. He gradually improved. Extensive toxic, metabolic, and infectious workup demonstrated bismuth toxicity. Spinal tap and brain magnetic resonance scan were normal. Electroencephalography showed bihemispheric slowing. As his encephalopathy cleared, he reported using bismuth subsalicylate long term (daily intake of 8 oz). Bismuth levels 5 weeks after cessation of bismuth were elevated and normalized after 12 weeks. He followed a typical course for bismuth toxicity with subacute progressive encephalopathy and gradual recovery. Creutzfeldt-Jakob was strongly considered due to his rapidly progressive encephalopathy, multifocal myoclonus, and ataxia. Due to its rarity, bismuth toxicity is often overlooked. We hope this presentation will increase recognition of bismuth toxicity. We believe more detailed labeling of bismuth products is needed to avoid similar toxicity from this readily available product.
Collapse
Affiliation(s)
- M F Gordon
- Department of Neurology, Long Island Jewish Medical Center, New Hyde Park, NY 11042, USA
| | | | | | | | | |
Collapse
|
25
|
Abstract
OBJECTIVE This study sought to elucidate the relation of clinical, neuropsychological, and seizure variables to chronic and postictal psychoses in patients with temporal lobe epilepsy. METHOD Forty-four patients with treatment-refractory temporal lobe epilepsy were given formal psychiatric evaluations; 29 patients had no psychiatric disorder or a nonpsychotic disorder, eight patients had postictal psychoses, and seven patients had chronic psychoses. Comparisons of clinical, neuropsychological, magnetic resonance imaging, and seizure variables were made between the nonpsychotic and the psychotic patients and, secondarily, between the patients with transient postictal psychoses and those with chronic psychoses. RESULTS Bitemporal seizure foci, clustering of seizures, and absence of febrile convulsions were associated with both postictal psychoses and chronic psychoses. Younger age at onset of epilepsy and lower verbal and full-scale IQs differentiated the patients with chronic psychoses from those with postictal psychoses. CONCLUSIONS Patients with temporal lobe epilepsy with chronic and postictal psychoses show similar profiles of clinical and seizure variables, suggesting shared etiologic factors. These factors may increase the propensity to develop psychotic symptoms, while other factors, such as time of onset of epilepsy and underlying neuropathology, may determine whether transient or chronic psychotic symptoms develop. Even among patients with treatment-refractory temporal lobe epilepsy, a specific subgroup of patients, characterized by bitemporal seizure foci, an absence of febrile convulsions, and a history of clustering of seizures, appears to be particularly prone to develop psychotic disorders. A process similar to secondary epileptogenesis may be involved in the development of the psychoses.
Collapse
Affiliation(s)
- D Umbricht
- Psychiatric Research Department, Hillside Hospital, Glen Oaks, NY 11004
| | | | | | | | | | | |
Collapse
|
26
|
|
27
|
Abstract
OBJECTIVE Cerebellar atrophy has been noted in patients with phenytoin exposure. This finding has been attributed by some investigators to seizures, but by others to phenytoin. Previous studies included patients with mental retardation and convulsive seizures. We undertook a study in a group of nonretarded patients with partial epilepsy to better elucidate the cause of the cerebellar atrophy. DESIGN Case control study. SETTING Referral population from an epilepsy center. PATIENTS Thirty-six patients with partial epilepsy and long-term phenytoin exposure were selected from a consecutive sample of admissions to an epilepsy center. Patients with histories of ethanol abuse, perinatal distress, anoxia, status epilepticus, or neurodegenerative disorders were excluded. Age- and sex-matched controls were selected from a pool of healthy volunteers and patients who had undergone magnetic resonance imaging for complaints of headache and dizziness. INTERVENTIONS All patients and controls underwent magnetic resonance imaging. MAIN OUTCOME MEASURE Degree of cerebellar atrophy. RESULTS The magnetic resonance imaging scans were reviewed in a blind fashion. A rating was assigned to each scan based on the degree of cerebellar atrophy. Cerebellar atrophy was significantly more pronounced in patients than in controls. No correlation was found between cerebellar atrophy and variables reflective of seizure severity or degree of phenytoin exposure. CONCLUSIONS Cerebellar atrophy may be seen in phenytoin-exposed patients with epilepsy in the absence of generalized tonic-clonic seizures or preexistent brain damage. Whether it is the phenytoin or the seizures that play the primary etiologic role remains unanswered. These factors may be synergistic.
Collapse
Affiliation(s)
- G C Ney
- Department of Neurology, Long Island Jewish Medical Center, New Hyde Park, NY
| | | | | | | |
Collapse
|
28
|
Abstract
A 25-year-old woman with documented generalized seizures evoked by playing checkers was given a battery of psychological tests as well as a series of cognitive and non-game-related tasks during a session of intensive EEG-video monitoring. Generalized epileptiform discharges during each task, as well as during intervals of checkers playing, were quantified to determine possible triggering factors. Previous reports have discussed the roles of attention, concentration, stress, thinking, and spatial processing in similar cases. Our analysis showed significant activation of the EEG only with tasks involving strategic thinking, i.e., considering a sequence of moves based on evaluating the consequences of previous moves.
Collapse
Affiliation(s)
- M Siegel
- Department of Psychology, Long Island Jewish/Hillside Medical Center, New Hyde Park, New York
| | | | | | | |
Collapse
|
29
|
Ashtari M, Barr WB, Schaul N, Bogerts B. Three-dimensional fast low-angle shot imaging and computerized volume measurement of the hippocampus in patients with chronic epilepsy of the temporal lobe. AJNR Am J Neuroradiol 1991; 12:941-7. [PMID: 1950926 PMCID: PMC8333491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This study investigated the use of three-dimensional fast low-angle shot (FLASH) imaging and computer-assisted morphometry for identifying hippocampal changes associated with unilateral temporal lobe seizures. Contiguous 3.1-mm coronal FLASH images were obtained in 28 patients with electroencephalographically verified left (n = 17) or right (n = 11) temporal lobe seizures and 28 age- and sex-matched control subjects. Hippocampal volumes were calculated with the use of a computerized mensuration system developed for detailed morphometric assessment. The results of a multivariate analysis of variance revealed a significant group difference by hemisphere interaction (F = 26.3, p less than .001). Significant reductions in left hippocampal volume (32%, p less than .001) were exhibited in patients with left temporal lobe seizures, and significant reductions in right hippocampal volume (35%, p less than .001) were seen in patients with right temporal lobe seizures. A discriminant analysis with the use of left and right hippocampal volumes classified patients with left temporal lobe seizures with 94% sensitivity and 73% specificity and patients with right temporal lobe seizures with 89% sensitivity and 94% specificity. The results of this study demonstrate that unilateral temporal lobe seizures are accompanied by significant reductions in hippocampal volume ipsilateral to the seizure focus. The use of FLASH imaging and computer-assisted morphometry of the hippocampus appears to provide valuable structural information for confirming the laterality of the electroencephalographic seizure focus.
Collapse
Affiliation(s)
- M Ashtari
- Department of Radiology, Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park NY 10042
| | | | | | | |
Collapse
|
30
|
Barr WB, Bilder RM, Kaplan E. Pathophysiologic mechanisms underlying spatial disorientation in patients with Alzheimer's disease. Arch Neurol 1990; 47:618-9. [PMID: 2346383 DOI: 10.1001/archneur.1990.00530060022004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
31
|
Abstract
Remote memory performance was assessed in a carefully matched sample of temporal lobectomy subjects and normal controls. Left temporal lobectomy subjects exhibited a consistent pattern of remote memory disturbance. Right temporal lobectomy subjects performed at the same level as normal controls. The pattern of impairment observed in left temporal lobectomy subjects was characterized by deficits in recall of chronological information from the past decade and extended to deficits in recall in some aspects of factual knowledge. The disorder could not be attributed solely to language deficits and was at least as severe as accompanying deficits in recent memory. These findings suggest that the left medial temporal region may play a significant role in recall of remote information in addition to its role in recent memory functions.
Collapse
Affiliation(s)
- W B Barr
- Hillside Hospital, A Division of Long Island Jewish Medical Center, Glen Oaks, NY 11044
| | | | | | | |
Collapse
|
32
|
Ashtari M, Zito JL, Schaul N, Barr WB. Correlation of Hippocampal Volume and Seizure focus. Invest Radiol 1989. [DOI: 10.1097/00004424-198912000-00175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
33
|
Barr WB, Jaffe J, Wasserstein J, Michelson WJ, Stein BM. Regional distribution of cerebral arteriovenous malformations. Interactions with sex and handedness. Arch Neurol 1989; 46:410-2. [PMID: 2705901 DOI: 10.1001/archneur.1989.00520400070021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
On the basis of clinical observation and a developmental theory of cerebral laterality, Geschwind and Galaburda suggested that cerebral arteriovenous malformations (AVMs) are more common in the left hemispheres of male patients. We tested this hypothesis by examining interactions among sex, handedness, and location of lateralized, supratentorial AVMs. Data from 112 cases were analyzed by log-linear procedures. We found that (1) females had a greater proportion of left-hemisphere AVMs, whereas males showed an opposite trend; (2) there were no interactions between sex and handedness; and (3) nondextrals showed a higher proportion of AVMs located in frontal regions, regardless of the hemispheric side of the lesion. Although these findings appear to be inconsistent with the Geschwind-Galaburda hypothesis, the inconsistency may be attributable to the embryonic stage at which this developmental abnormality occurs. In addition, the unexpected findings may also reflect our use of multivariate statistical procedures, which control for interaction effects.
Collapse
Affiliation(s)
- W B Barr
- Department of Psychology, Graduate Faculty, New School for Social Research, New York
| | | | | | | | | |
Collapse
|
34
|
Abstract
We examined handedness and cerebral hemispheric asymmetries on computed tomography (CT) scan in a sample of schizophrenic patients who were rated also for the presence or absence of persistent tardive dyskinesia (TD). Patients with TD showed a more standard dominance pattern, with dextral hand preference and normal occipital asymmetry. Anomalous dominance was associated with a marked underrepresentation of TD. Stepwise discriminant analyses indicated that the statistical prediction of TD was enhanced by the inclusion of dominance measures. Schizophrenic patients with strong standard dominance patterns may be more susceptible to developing TD, or conversely, anomalous dominance may confer protection against TD.
Collapse
Affiliation(s)
- W B Barr
- Department of Psychiatry, College of Physicians & Surgeons, Columbia University, New York, NY
| | | | | | | |
Collapse
|
35
|
Abstract
Twenty asymptomatic, HIV-seropositive homosexual men and a control group of 20 seronegative homosexual men were evaluated for evidence of neuropsychological impairment. Two-tailed paired t-tests of group differences revealed that the seropositive patients had significantly lower scores on two of 20 neuropsychological measures. Ten seropositive patients had scores two standard deviations below the sample, compared with three seronegative patients, a significantly different distribution (p = .04). The HIV-infected group exhibited lower mean scores on 17 of 20 variables (binomial probability, p less than .005). The 10 seropositive patients with scores that fell below the cut-off had significantly lower mean T4/T8 ratios than the 10 seropositive patients with scores above the cut-off (p = .02). The data suggest that a subpopulation of HIV-infected adults may exhibit subtle neuropsychological impairment before they develop clinical signs of cognitive deficit or immunosuppression.
Collapse
Affiliation(s)
- S Perry
- Department of Psychiatry, New York Hospital-Cornell University Medical College, New York
| | | | | | | |
Collapse
|
36
|
Abstract
We document a case of isolated epileptic aphasia with clear correlation between episodic clinical and electrographic events. This disorder is rarely recognized, perhaps because it is obscured by ictal motor activity or speech arrest, or by the lack of clinical manifestations if the seizure occurs when the patient is not attempting to speak.
Collapse
|