Neuropsychological investigation of patients with frontal lobe epilepsy

The objective of this study was to investigate the likelihood of a specific neuropsychological profile in frontal lobe epilepsy patients, thus aiming to contribute to the preoperative assessment of epilepsy surgery candidates. Twenty-five patients with frontal lobe epilepsy were compared with twenty-two patients with medial temporal lobe epilepsy matched for age, education, and intelligence. An extensive neuropsychological battery was employed in order to assess different aspects of attention and memory, processing speed and working memory, the structure of crystallized intelligence, visual reasoning and new-flanged problem solving, executive functions and metacognitive skills. Moreover, self-administered questionnaires were administered to evaluate the intensity of emotional symptoms. Our results indicated that neuropsychological performance can hardly differentiate patients with these the two types of epilepsies, while what emerged was a difference as to the intensity of manic and depressive symptoms in patients with right and left seizure foci respectively. These findings suggest a lack of neuropsychological differentiation between frontal and medial temporal lobe epilepsy patients, while highlight the possible localization value of emotional data.Αντικείμενο της παρούσας μελέτης αποτέλεσε το ενδεχόμενο ανάδειξης ενός αντιπροσωπευτικού προτύπου γνωστικής δυσλειτουργίας σε ασθενείς με επιληψία του μετωπιαίου λοβού προκειμένου να συμβάλει με εντοπιστικά δεδομένα στην προεγχειρητική διερεύνηση ασθενών υποψηφίων για χειρουργική θεραπεία της ανθεκτικής στα φάρμακα επιληψίας. Εν προκειμένω, συνέκρινε τους ασθενείς με επιληψία του μετωπιαίου λοβού (n=25) με αντίστοιχη ομάδα ασθενών με έσω κροταφική επιληψία (n=22). Χρησιμοποιήθηκε μια ευρεία συστοιχία νευροψυχολογικών δοκιμασιών οι οποία εξέταζε ενδελεχώς τις διαφορετικές διαδικασίες προσοχής και μνήμης, τα συστήματα ενεργού μνήμης, την δομή της αποκρυσταλλωμένης νοημοσύνης, την ρέουσα νοημοσύνη και τον αφηρημένο οπτικό συλλογισμό, την ταχύτητα επεξεργασίας των πληροφοριών, τις επιτελικές και μεταγνωστικές λειτουργίες. Επίσης, συμπληρώθηκαν αυτοχορηγούμενα ερωτηματολόγια μέτρησης της έντασης των συμπτωμάτων σε διάφορες συναισθηματικές κλίμακες. Τα αποτελέσματά μας έδειξαν ότι οι δυο κλινικές ομάδες δεν διαφοροποιούνται σημαντικά με βάση την νευροψυχολογική τους επίδοση, ενώ αντίθετα υφίστανται διαφορές όσον αφορά την ένταση των συμπτωμάτων μανίας και κατάθλιψης σε ασθενείς με δεξιές και αριστερές εντοπίσεις των επιληπτογεννών εστιών αντιστοίχως. Τα ευρήματά μας είναι ενδεικτικά μιας ελλιπούς νευροψυχολογικής διαφοροποίησης ανάμεσα στην μετωπιαία και την έσω κροταφική επιληψία, ενώ καταδεικνύεται η πιθανή εντοπιστική αξία των συναισθηματικών δεδομένων

Detection and Prevention of Mild Cognitive Impairment and Dementia

Mild cognitive impairment (MCI) is characterized by cognitive deficits alongside essentially preserved competence in activities of daily living [...

Epilepsy and the “dark” literature of the Greek novelist Demosthenes Voutyras: an outstanding epileptic personality

Background The role of temporal lobe epilepsy (TLE) in determining personality traits and neurobehavioral symptoms, collectively known as the interictal behavioral syndrome (also known as Geschwind syndrome or “Gastaut-Geschwind syndrome”), as well as the syndrome's association with the particular artistic expression of many epileptic litterateurs are well known in neurology and psychiatry. A deepening of emotionality along with a serious, highly ethical, and spiritual behavior have been described as positive personality changes among patients with chronic mesial-TLE. Objectives Our narrative-based clinical hypothesis aims at contributing to the ongoing debate on the association between TLE and artistic expression, as well as the latter's supposed implication for epileptology in general and the neuropsychology of epilepsy in particular. Methods Through an analysis of the biography, language, and literary work of Greek novelist Demosthenes Voutyras, we hypothesize that his mystical and dark writing style could be attributed to medial temporal interictal dynamics. Conclusions We suggest that the psycholiterary profile of Voutyras is consistent with the idiosyncratic characteristics of the temporal lobe personality, while a non-dominant temporal lobe contribution has been proposed

Long-Term Neuropsychological Outcomes Following Temporal Lobe Epilepsy Surgery: An Update of the Literature

We present an update of the literature concerning long-term neuropsychological outcomes following surgery for refractory temporal lobe epilepsy (TLE). A thorough search was conducted through the PubMed and Medline electronic databases for studies investigating neuropsychological function in adult patients undergoing resective TLE surgery and followed for a mean/median > five years period. Two independent reviewers screened citations for eligibility and assessed relevant studies for the risk of bias. We found eleven studies fulfilling the above requirements. Cognitive function remained stable through long-term follow up despite immediate post-surgery decline; a negative relation between seizure control and memory impairment has emerged and a possible role of more selective surgery procedures is highlighted

Combined Invasive Peripheral Nerve Stimulation in the Management of Chronic Post-Intracranial Disorder Headache: A Case Report

The introduction of ventricular shunts dramatically changed the outcome and quality of life of hydrocephalic patients. However, shunt surgery continues to be associated with numerous adverse events. Headache is one of the most common complications after shunt operation. It is often of prolonged duration, the symptoms resemble those of migraine, and pain does not respond to medication. We propose invasive peripheral nerve stimulation as a potential solution in the treatment of patients suffering from chronic headache associated with shunted hydrocephalus. A young woman presented with daily holocephalic headache with diffuse pain exacerbated by lying down. Imaging revealed panventricular enlargement and possible aqueduct stenosis. When a ventriculoperitoneal shunt was placed, clinical symptoms resolved. Nevertheless, she gradually exacerbated after a second valve replacement due to wound infection. Imaging revealed decompressed ventricles and appropriate shunt placement. The diagnosis of chronic post-intracranial disorder headache was set. Therefore, occipital nerve stimulation was applied and, considering that the patient did not have a total response, bilateral parietal stimulation was added. Three months after the combined PNS, she experienced total remission of headache. Combined PNS eases refractory headaches much more than occipital nerve stimulation alone and could be considered as a solution for shunted hydrocephalus-associated headache