Posterior quadrant epilepsy surgery: predictors of outcome.

PURPOSE: To identify predictors of seizure recurrence following posterior quadrant epilepsy surgery. METHODS: Between 1983 and 2008, 43 medically refractory epilepsy patients underwent posterior quadrant epilepsy surgery. Epilepsy surgery involved the occipital lobe in all cases; some cases also included resection of the adjacent parietal or temporal cortex. Using a logistic regression model, we evaluated the relationship between outcome (Engel class I-IV) and 5 outcome predictors: absence of a visual aura, a temporal lobe type aura, versive head movement unaccompanied by a visual aura, non-focal interictal scalp EEG, and surgical pathology other than low grade tumor or cortical dysplasia. We also determined the relative risk for significant post-operative cognitive decline of Wechsler intelligence test score among those receiving complete lobectomies compared to those receiving partial lobectomies. RESULTS: Overall, outcome was favorable at 1 year following surgery: 22 (51.2%) patients Engel class I, 10 (24%) patients Engel class II, 5 (12%) patients Engel class III, and 6 (14%) patients Engel class IV. The 3 best univariate predictors of seizure recurrence were versive head movement unaccompanied by visual aura, non-focal interictal scalp EEG, and pathology other than low grade tumor or cortical dysplasia. A multivariate predictor combining temporal lobe type aura, versive head movement unaccompanied by visual aura, non-focal interictal scalp EEG, and pathology other than low grade tumor or cortical dysplasia was optimum. Complete lobectomy significantly increased the risk of post-operative decline of Wechsler intelligence score. CONCLUSIONS: These findings indicate that posterior quadrant epilepsy surgery may provide sustained seizure control. A multivariate model combining temporal lobe type aura, versive head movement unaccompanied by a visual aura, non-focal interictal scalp EEG, and pathology other than low grade tumor or cortical dysplasia may contribute to predicting seizure recurrence following posterior quadrant epilepsy surgery. The extent of cortical resection may predict significant cognitive decline in post-operative Wechsler intelligence score.

Human affection exchange: XIII. Affectionate communication accelerates neuroendocrine stress recovery.

Contemporary theory in interpersonal communication and health psychology supports the prediction that engaging in affectionate behavior within established relationships has a direct effect on the alleviation of stress symptoms following exposure to an acute stressor. Participants in this study were exposed to a series of standard laboratory stressors and were subsequently assigned either to an experimental group or to 1 of 2 control groups. Those in the experimental group were instructed to write a letter to a loved one in which they expressed their feelings of affection for that person. Those in 1 control group thought about a loved one but did not engage in any communicative behavior, and those in the other control group simply sat quietly. All 3 conditions were compared with respect to their levels of salivary free cortisol, an adrenal steroid hormone that is instrumental in the body's neuroendocrine stress response. Results indicated that, compared to the control groups, those in the experimental group experienced accelerated cortisol recovery following exposure to the acute stressors.

Human affection exchange: XIV. Relational affection predicts resting heart rate and free cortisol secretion during acute stress.

Participants in the present study reported the amount of affectionate communication characterizing the personal relationship they currently identified as their most affectionate relationship. The authors subsequently measured their resting heart rate and baseline salivary cortisol, and then exposed participants to a series of standard laboratory stressors. The authors monitored changes in the participants' heart rates and cortisol levels during exposure to the stressors. Results indicated that levels of verbal and supportive affectionate communication in the primary relationship were inversely associated with resting heart rate and with the magnitude of free cortisol increase in response to the acute stressors. The authors discuss implications for the association between relational communication and health.