Neuropsychology and Epilepsy

Question 1

General Cognitive Outcomes

Answer 1

Generalized seizures worse than focal
GTC worse than absence
Earlier onset = more difficulties

Question 2

IQ and epilepsy

Answer 2

1/3 of people with epilepsy have IQ <70 (intellectual deficient)

Question 3

Risk factors for ID in Epilepsy

Answer 3

• Primary generalized epilepsy, West syndrome, lGS, focal epilepsy with out focus
• Severe volumetric abnormalities
• Early onset of epilepsy
• Frequent seizures, more episodes of status epilepticus
• Polytherapy
• Comorbid dx

Question 4

Language dominance

Answer 4

Higher incidence of 25-30% atypical language dominance

-More likely with large early developmental insults.

Question 5

Language with Adults with TLE

Answer 5

Word-finding problems

-Found on comfortation naming tasks (hippocampal word retrieval)

Question 6

Epilepsy with progressive language impairment

Answer 6

Rassmussen encephalitis

Landau Kleffner syndrome

Question 7

memory profile for TLE

Answer 7

Left=verbal memory problems

RIght= less so, visual memory problems.

Question 8

Neuropsych test most predictive for hippocampal dysfunction

Answer 8

List learning

Question 9

Prevalence of ADHD in epilepsy

Answer 9

20-40%

ADHD, inattentive type M=F
High rates of attention with frontal lobe epilepsy, Childhood absence epilepsy

Question 10

Executive Function (EF) impaired in epilepsy

Answer 10

Shifting
Cognitive flexibility
Working Memory
Organization

Question 11

Visual/Spatial with epilepsy patient

Answer 11

Less consistent
Includes object recognition, drawing objects, visual closure

Lower in right hemispheric seizure foci
Language dominance

Question 12

Epilepsy and Reaction time

Answer 12

Slower processing speed

• Possibly due to seizure meds
• Associated with polytherapy and type of epilepsy
• Seen in frontal lobe epilepsy and BRE

Question 13

Academic achievement and epilepsy

Answer 13

Poor academic achievement is associated with all epilepsy types

Question 14

Mood disorder and Epilepsy rate

Answer 14

Lifetime prevalence 35%
-Limbic/temporal seizures had greater risk

Evidence for both environmental + neurophysiologic causes

Question 15

Mapping cognition

Answer 15

Gold standard previously
-WADA/IAT = pharmacologically inactivate ipsilateral anterior and MCA

Aims:

1) Lateralize function (language and memory)
2) Demonstrate capacity of contralat hemisphere to sustain function

Question 16

Functional MRI

Answer 16

Blood oxygen level-dependent (BOLD) signal is extracted and analyzed

Pros: noninvasive
Cons: technically challenging (if moves - uninterpretable)

Question 17

Electrical cortical stimulation mapping

Answer 17

Intraop or bedside of motor and language mapping

• Language responses need to be brief during stim time
• Cooperation of patient

Question 18

Neurocognitive results after Anterior temporal lobectomy based on dominant/nondominant

Verbal memory
Visual spatial
Language

Answer 18

Dominant temporal lobectomy = verbal memory decline
Non-dominant temporal lobectomy = verbal memory improvement

Visuospatial memory

• improve after dominant temporal lobectomy
• decline after nondominant temporal lobectomy

Language - no change

Receptive comprehension (Token test)
Dominant = show a greater pre- to postoperative improvement in this measure than patients with nondominant temporal lobectomy (P < .001).