L3 - Cognition & Neuroscience

Question 1

What is ictal semiology?

Answer 1

Symptoms of a seizure

Question 2

What can doubling of consciousness mean?

Answer 2

This is the sensation of being there, but not really there, removed from reality.

Usually bc one hemisphere is functioning.

Question 3

What are some methods of monitoring epilepsy?

Answer 3

PET - looks at brain at rest, glucose metabolism

MRI - looks at structure of brain

SPECT - functional imaging - inject w/ radioactive substance to highlight area of most bloodflow and O2 use.

Video - EEG : look at eeg while matching up with body movements

Question 4

what’s dysplasia?

Answer 4

A developmental lesion that occurs in utero, caused by disorganisation of migration pathways. Neurons don’t function in a normal way, but don’t necessarily contribute to cognitive functioning.

It is also not always epileptic tissue.

Also look for cortical thickening.

Question 5

what is the next step once you have identified a lesion?

Answer 5

Need to determine the contribution that the lesion is having onto cognitive function.
It’s size..dextrality

do this thrugh cognitive assessment
Normal functioning implies that the lesion is silent

then MRI to see if it lights up when in use

also do tests that are related to ictal semiology - any problems such as language deficits after seizure

Question 6

What is a psychogenic seizure

Answer 6

non-epileptic

prolonged, a typical nature

likely ‘aura continua’ - feeling of aura doesn’t get worse or stop

Question 7

Why is psychiatric assessment important pre-operatively?

Answer 7

B/c things such as anxiety and claustrophobia can be a big problem in operating theatre - need to be managed pre-operatively

Question 8

How can we differentiate abnormal from adaptive anxiety?

Answer 8

• Out of proportion to the level of threat
• persistence/deterioration (>3 wks) w/o intervention
• recurrent panic attacks, severe physical symptoms, abnormal cog beliefs
• disruption to everyday func

Question 9

What are some behavioural treatments for anxiety?

Answer 9

1. Systematic Desensitisation - controlled exposure to the anxiety provoking stimuli in relaxed conditions reduces anxiety symptoms - use hierarchy of fears, work through one by one
2. Progressive Muscle Relaxation Training (PMRT) - based on the principle in muscle phys that if you squeeze a muscle and let go, it MUST relax - teaches patient to induce relaxation in voluntary muscles - physiological changes oppose the flight/fight response and is effective in combo with other techniques

Question 10

What are the benefits of PMRT?

Answer 10

• decreased general anxiety
• decreased anticipatory anxiety related to phobias
• enhance effect of tranquilisers
• increase sense of control
• decrease freq and duration of panic attacks

Question 11

what are illness perceptions and why are they important?

Answer 11

• the bodily experience of illness
• external environment and the illness
• individual reactions to the illness
• affect coping, perceived severity, treatment adherence

important to be able to predict patient’s reaction and behaviour pre and post surgery

Question 12

What re predictors of perceived surgical success?

Answer 12

• PRE-OPD EXPECTATIONS - these need to be realistic
• POST-OP AFFECT - anxiety and depression comorbitity is higher
• DISCARDING THE SICK ROLE - they have to learn how to be ‘well’ - they are expected to be normal but they don’t know how to be.
• SEIZURE OUTCOME

These all feed into the patient’s perceived success post-op

Question 13

what is the placebo effect and its mechanisms?

Answer 13

When physiological change is reported by patients when taking an inert treatment

this happens due to treatment expectations..

1. triggering physiological response
2. engagement in behaviours that produce better outcomes
3. psychologically conditions the patient to observe certain symps and ignore others
4. Changes understanding of the disease
5. Acts w/ anxiety to heighten or reduce symptoms

Question 14

What should be done to make sure that patients have realistic expectations of surgery and have a positive outcome?

Answer 14

psychoeducation about post operative recovery and rehabilitation

giving information, effective communication and reassurance

cog and behavioural strategies effective immediately before and during the procedure
- relaxation techniques, positive coping statements

Question 15

How and why do we need to prepare for invasive medical procedures?

Answer 15

improves treatment efficacy and patient outcomes, manages anxiety, increases post op treatment adherence, reduces physiological effects of stress, increased familial support

do this through relaxation techniques, refocussing of attention, positive coping statements, direct pretreatment modelling and positive affirmation during the procedure

Question 16

What are the general trends in cognitive outcome post-operatively?

Answer 16

due to swelling, cognition is severely impaired for the first few months.

it improves but never completely recovers.

this is seen in COWAT

Question 17

What can post-operative fMRI show?

Answer 17

no activation on the side that was operated, all activation goes to other side

but 18 months later it shifts back

Question 18

What are some psychosocial outcomes post operatively?

Answer 18

• burden of normality
• fear of over doing it and that seizures will return
• difficulties letting go
• learning how to be well