Self-appraisal and objective assessment of cognitive and affective functioning in persons with epileptic and nonepileptic seizures

Subjective and objective assessments of cognitive and affective functioning of patients admitted to the EMU with epileptic (ES, n = 22) and psychogenic nonepileptic (NES, n = 23) seizures were compared. It was hypothesized that the patients with NES would overestimate their cognitive impairments and underestimate their affective disturbances relative to those with ES. Results revealed that the patients with NES reported greater word-finding difficulty than those with ES (P = 0.02), but performed better than the patients with ES on the Boston Naming Test (BNT, P = 0.03), suggesting a tendency to overestimate word-finding difficulty. Patients with NES and ES did not otherwise differ in subjective ratings of cognitive functions or emotional state; however, patients with NES performed worse on a test of affect expression/perception compared with those with ES (P = 0.02). For patients with NES, only performance on memory tests was significantly correlated with their anxiety level. Obtaining both subjective ratings and objective test findings of cognitive and affective functioning may help further differentiate between patients with NES and those with ES. © 2009 Elsevier Inc. All rights reserved

Modifications to the Subtemporal Selective Amygdalohippocampectomy Using a Minimal-Access Technique: Seizure and Neuropsychological Outcomes: Technical Note

Object. The authors introduce a minimal-access subtemporal approach for selective resection of the amygdala and hippocampus in patients with temporal lobe epilepsy and describe seizure and neuropsychological outcomes. Methods. Between October 2003 and April 2007, 41 consecutive patients with intractable unilateral nonlesional temporal lobe epilepsy underwent image-guided subtemporal amygdalohippocampectomy. Baseline characteristics, preoperative evaluations, and seizure outcomes were assessed. Eighteen patients underwent pre- and postoperative neuropsychological testing for cognitive functioning, executive functioning, verbal and visual memory, and mood. Results. Important aspects of the subtemporal approach include a low temporal keyhole craniotomy, use of image guidance, preservation of the tentorium, incision in the fusiform gyrus, and subpial, en bloc resection of the hippocampus. There were no deaths and no cases of significant postoperative morbidity. At 1 year, 29 of 36 patients (81%) were without seizures or auras. At 2 years, 17 of 23 (74%) patients were seizure- and aura-free. Detailed neuropsychological testing of language, memory, cognitive functioning, and executive functioning suggested that most patients exhibited either stability or improvement in their scores, regardless of language lateralization. Conclusions. A minimal-access subtemporal approach for amygdalohippocampectomy is an effective treatment for temporal lobe epilepsy yielding encouraging preliminary seizure and neuropsychological outcomes

Deep brain stimulation and cognitive outcomes among patients with Parkinson’s disease: A historical cohort study

© 2019, American Psychiatric Association. All rights reserved. Objective: Deep brain stimulation (DBS) is an effective treatment for motor symptoms of Parkinson’s disease; however, there is conflicting literature about the effect of DBS on cognitive function. The authors conducted a historical cohort study involving patients with Parkinson’s disease who underwent DBS of the globus pallidus pars interna (GPi; N=12) or subthalamic nucleus (STN; N=17). Methods: The authors i nvesti gated di fferences i n four neuropsychol ogi cal test scores at 6 months post-DBS (follow-up) as compared with baseline (i.e., Boston Naming Test, WAIS Verbal Comprehension Index [WAIS-VCI], Working Memory Index [WAIS-WMI], and Processing Speed Index [WAIS-PSI]). Results: GPi DBS patients showed no difference between baseline and follow-up on any neuropsychological test. STN DBS patients had lower scores indicating decreased performance at follow-up as compared with baseline on WAIS-PSI (mean [SD], 91.47 [10.42] versus 81.65 [12.03]; p=0.03). There was a significant (p=0.008) difference between the change in baseline to follow-up scores on the WAIS-VCI for the STN DBS and GPi DBS groups (i.e., STN DBS patients scored lower at the 6-month follow-up compared with baseline, whereas GPi DBS patients scored higher). Conclusions: GPi may be a preferred target for DBS in patients with Parkinson’s disease when considering cognitive outcomes