Neuropsychologische Begutachtungen in der Schweiz – aktuelle Beiträge

Die vorliegende Publikation befasst sich mit den Aufgaben und der Rolle der Neuropsychologie als gutachtliche Disziplin. Beleuchtet werden unter anderem formale und inhaltliche Aspekte eines neuropsychologischen Gutachtens, das sogenannte «informierte Einverständnis», Instrumente der Performanz- und Beschwerdenvalidierung, Verfahren der Konsistenz- und Plausibilitätsprüfung, konzeptuelle Unterschiede zwischen der Verdeutlichung, der Aggravation und der Simulation, die Problematik des «Coachings», die Einschätzung der Arbeitsfähigkeit und des Integritätsschadens aus neuropsychologischer Sicht sowie Aspekte der Fahreignung. Die Publikation soll klare Handlungsempfehlungen – mit dem Ziel einer möglichst einheitlichen Vorgehensweise sowohl bei der Durchführung neuropsychologischer Begutachtungen wie auch im Rahmen der Berichterstattung – vermitteln. Die folgenden Ausführungen beziehen sich auf das Schweizer Rechtssystem. Folglich sind diese nicht einfach auf den Rechtsrahmen anderer Länder übertragbar

Carbamazepine reduces memory induced activation of mesial temporal lobe structures: a pharmacological fMRI-study

BACKGROUND AND PURPOSE: It is not known whether carbamazepine (CBZ; a drug widely used in neurology and psychiatry) influences the blood oxygenation level dependent (BOLD) contrast changes induced by neuronal activation and measured by functional MRI (fMRI). We aimed to investigate the influence of CBZ on memory induced activation of the mesial temporal lobes in patients with symptomatic temporal lobe epilepsy (TLE). MATERIAL AND METHODS: Twenty-one individual patients with refractory symptomatic TLE with different CBZ serum levels and 20 healthy controls were studied using BOLD fMRI. Mesial temporal lobe (MTL) activation was induced by a task that is based on the retrieval of individually familiar visuo-spatial knowledge. The extent of significant MTL fMRI activation was measured and correlated with the CBZ serum level. RESULTS: In TLE patients, the extent of significant fMRI activation over both MTL was negatively correlated to the CBZ serum level (Spearman r = -0.654, P < 0.001). Activation over the supposedly normal MTL, i.e. contralateral to the seizure onset of TLE patients, was smaller than the averaged MTL activation in healthy controls (P < 0.005). Age, duration of epilepsy, side of seizure onset, and intelligence were not correlated to the extent of the significant BOLD-response over both MTL in patients with TLE. CONCLUSIONS: In TLE patients, carbamazepine reduces the fMRI-detectable changes within the mesial temporal lobes as induced by effortful memory retrieval. FMRI appears to be suitable to study the effects of chronic drug treatment in patients with epilepsy

Quality of life is social – Towards an improvement of social abilities in patients with epilepsy

AbstractQuality of life (QoL) for people with epilepsy is considered worse than the condition's clinical and medical prognosis would predict. Quantity and quality of social interaction considerably determine QoL. Research shows that a significant proportion of patients with epilepsy experience difficulties with social functioning that is thought to be related to impaired QoL. The aim of this review article is to provide an evidence base for conceptualising and developing interventions to improve quality of life through social functioning, for adults with epilepsy. Previous and current research is considered initially with regards to why such difficulties arise and established interventions that address social competence and functioning are reviewed and explored from the field of schizophrenia, a condition also associated with similar difficulties in social cognition, cognition and negative symptoms. The paper considers the advantages and disadvantages of these interventions, the outcomes and emerging research in this area. Positive findings are found from interventional studies in schizophrenia such as the enhancing potential and generalisation of training in social cognition, the benefits of an integrated approach to improving social functioning and proposal of ‘online’ interaction approaches. These findings provide interesting and exciting directions for the ultimate goal towards interventions for the improvement of social functioning and quality of life in patients with epilepsy. This is of particular significance as at present there is currently no such dedicated program for people with epilepsy

Why epilepsy challenges social life

Social bonds are at the center of our daily living and are an essential determinant of our quality of life. In people with epilepsy, numerous factors can impede cognitive and affective functions necessary for smooth social interactions. Psychological and psychiatric complications are common in epilepsy and may hinder the processing of social information. In addition, neuropsychological deficits such as slowed processing speed, memory loss or attentional difficulties may interfere with enjoyable reciprocity of social interactions. We consider societal, psychological, and neuropsychological aspects of social life with particular emphasis on socio-cognitive functions in temporal lobe epilepsy. Deficits in emotion recognition and theory of mind, two main aspects of social cognition, are frequently observed in individuals with mesial temporal lobe epilepsy. Results from behavioural studies targeting these functions will be presented with a focus on their relevance for patients’ daily life. Furthermore, we will broach the issue of pitfalls in current diagnostic tools and potential directions for future research. By giving a broad overview of individual and interpersonal determinants of social functioning in epilepsy, we hope to provide a basis for future research to establish social cognition as a key component in the comprehensive assessment and care of those with epilepsy

Precision epileptology: digital biomarkers and cognitive proxies for personalized care

The widespread accessibility of smart devices, even if not designated as medical devices, coupled with the critical need for ongoing monitoring of patients taking anti-seizure medication or undergoing new stimulation therapies highlights the urgent need for collaborative research across disciplines. These therapies, while beneficial, may cause sporadic or temporally dynamic side effects affecting cognition and behavior that cannot be adequately assessed by traditional neuropsychological testing methods at certain time points. This scenario highlights the importance of developing innovative approaches to fully monitor and understand these dynamic effects.Die weit verbreitete Verf & uuml;gbarkeit intelligenter Ger & auml;te, selbst wenn sie nicht als medizinische Ger & auml;te eingestuft werden, in Verbindung mit der entscheidenden Notwendigkeit einer fortlaufenden & Uuml;berwachung von Patienten, die anfallssuppressive Medikamente einnehmen oder bei denen neuartige Stimulationstherapien durchgef & uuml;hrt werden, unterstreicht den dringlichen Bedarf an gemeinsamer Forschung & uuml;ber die Fachgebiete hinweg. Obwohl diese Therapien nutzbringend sind, k & ouml;nnen sie sporadisch und vor & uuml;bergehend dynamische Nebenwirkungen hervorrufen, welche die Kognition und das Verhalten betreffen und die nicht mithilfe herk & ouml;mmlicher neuropsychologischer Testmethoden zu festen Zeitpunkten untersucht werden k & ouml;nnen. Dieses Szenario macht die Bedeutung der Entwicklung innovativer Ans & auml;tze deutlich, um diese dynamischen Auswirkungen vollst & auml;ndig zu erfassen und zu verstehen.ISSN:2948-1058ISSN:2948-104

The relation between neuronal firing, local field potentials and hemodynamic activity in the human amygdala in response to aversive dynamic visual stimuli

The amygdala is a central part of networks of brain regions underlying perception and cognition, in particular related to processing of emotionally salient stimuli. Invasive electrophysiological and hemodynamic measurements are commonly used to evaluate functions of the human amygdala, but a comprehensive understanding of their relation is still lacking. Here, we aimed at investigating the link between fast and slow frequency amygdalar oscillations, neuronal firing and hemodynamic responses. To this aim, we recorded intracranial electroencephalography (iEEG), hemodynamic responses and single neuron activity from the amygdala of patients with epilepsy. Patients were presented with dynamic visual sequences of fearful faces (aversive condition), interleaved with sequences of neutral landscapes (neutral condition). Comparing responses to aversive versus neutral stimuli across participants, we observed enhanced high gamma power (HGP, >60 ​Hz) during the first 2 ​s of aversive sequence viewing, and reduced delta power (1-4 ​Hz) lasting up to 18 ​s. In 5 participants with implanted microwires, neuronal firing rates were enhanced following aversive stimuli, and exhibited positive correlation with HGP and hemodynamic responses. Our results show that high gamma power, neuronal firing and BOLD responses from the human amygdala are co-modulated. Our findings provide, for the first time, a comprehensive investigation of amygdalar responses to aversive stimuli, ranging from single-neuron spikes to local field potentials and hemodynamic responses

Dataset of spiking and LFP activity invasively recorded in the human amygdala during aversive dynamic stimuli

We present an electrophysiological dataset collected from the amygdalae of nine participants attending a visual dynamic stimulation of emotional aversive content. The participants were patients affected by epilepsy who underwent preoperative invasive monitoring in the mesial temporal lobe. Participants were presented with dynamic visual sequences of fearful faces (aversive condition), interleaved with sequences of neutral landscapes (neutral condition). The dataset contains the simultaneous recording of intracranial EEG (iEEG) and neuronal spike times and waveforms, and localization information for iEEG electrodes. Participant characteristics and trial information are provided. We technically validated this dataset and provide here the spike sorting quality metrics and the spectra of iEEG signals. This dataset allows the investigation of amygdalar response to dynamic aversive stimuli at multiple spatial scales, from the macroscopic EEG to the neuronal firing in the human brain

Temporal lobe epilepsy alters neural responses to human and avatar facial expressions in the face perception network

Abstract Background and Objective Although avatars are now widely used in advertisement, entertainment, and business today, no study has investigated whether brain lesions in neurological patients interfere with brain activation in response to dynamic avatar facial expressions. The aim of our event‐related fMRI study was to compare brain activation differences in people with epilepsy and controls during the processing of fearful and neutral dynamic expressions displayed by human or avatar faces. Methods Using functional magnetic resonance imaging (fMRI), we examined brain responses to dynamic facial expressions of trained actors and their avatar look‐alikes in 16 people with temporal lobe epilepsy (TLE) and 26 controls. The actors' fearful and neutral expressions were recorded on video and conveyed onto their avatar look‐alikes by face tracking. Results Our fMRI results show that people with TLE exhibited reduced response differences between fearful and neutral expressions displayed by humans in the right amygdala and the left superior temporal sulcus (STS). Further, TLE was associated with reduced response differences between human and avatar fearful expressions in the dorsal pathway of the face perception network (STS and inferior frontal gyrus) as well as in the medial prefrontal cortex. Conclusions Taken together, these findings suggest that brain responses to dynamic facial expressions are altered in people with TLE compared to neurologically healthy individuals—regardless of whether the face is human or computer‐generated. In TLE, areas sensitive to dynamic facial features and associated with processes relating to the self and others are particularly affected when processing dynamic human and avatar expressions. Our findings highlight that the impact of TLE on facial emotion processing must be extended to artificial faces and should be considered when applying dynamic avatars in the context of neurological conditions