An evidence-based checklist to assess neuropsychological outcomes of epilepsy surgery: how good is the evidence?

PURPOSE: We aimed to assess the quality of evidence on neuropsychological outcomes after epilepsy surgery (ES). Accordingly, we created an evidence-based neuropsychology (EBNP) checklist to assess neuropsychological outcomes and applied this tool to studies from a systematic review. METHODS: The EBNP checklist was created using clinical expert input, scale development methodology for item generation and reduction and inter-rater reliability, and critical appraisal guidelines for studies about treatment. The checklist was applied to articles obtained through a systematic review of resective ES neuropsychological outcomes. The proportion of studies fulfilling the quality criteria and the total quality score were used to assess the quality of the evidence. RESULTS: An initial 45-item checklist was applied to 147 articles, with excellent inter-rater agreement (kappa=0.80). The mean quality score was 23 (SD: 4, range: 12-33). There was substantial variability in the percentage of studies meeting the criteria for specific items (0-99%). The median proportion of papers fulfilling various quality criteria was 1.4% for items related to group comparisons, 37% for clinical applicability, 67% for patient description, 78% for outcome assessment, and 91% for interventions. Higher quality correlated with longitudinal design, reporting presurgical IQ, seizure frequency and antiepileptic drugs, and using validated measures of change in individual patients. The final EBNP checklist consisted of 19 items. DISCUSSION: The EBNP checklist reliably identified quality strengths and threats to validity of neuropsychological outcome studies in ES. Studies would be most improved by the inclusion of random allocation to interventions or at minimum blinded outcome assessment, empirically based measures of reliable change and completeness of reporting of follow-up.

Health behavior in teens with epilepsy: how do they compare with controls?

The goal of the study was to determine if adolescents with epilepsy have poorer health behavior than healthy controls. Health behavior was compared in two cohorts: cognitively normal teens aged 11-16 with epilepsy and similarly aged controls. Teens completed the Health Behaviour in School-Aged Children (HBSC) and Piers-Harris II, and the primary caregiver completed the Family Assessment Measure III. Forty-four teens with epilepsy and 119 orthopedic controls returned questionnaires. Adolescents with epilepsy had poorer health behavior than controls (P<0.003). They felt significantly less positive about their health (P<0.01) and were less physically active (P<0.02). Poorer family function (P<0.05) and lower self-esteem (P<0.001) were predictors of poorer health behavior. Given the increased prevalence of comorbid diseases in adults with epilepsy, clinicians should routinely query teens with epilepsy regarding health behavior and provide anticipatory guidance and appropriate interventions for poor health behavior choices.

The factor structure of the CVLT-C in pediatric epilepsy.

The current study used archival data to evaluate the fit of six latent variable models, originally generated by Donders (1999), for the California Verbal Learning Test-Children's Version (CVLT-C; Delis, Kramer, Kaplan, & Ober, 1994) in a large (N = 289) sample of pediatric epilepsy cases presenting at three tertiary treatment centers. Using confirmatory factor analysis, we found that a model including factors of Attention Span, Learning Efficiency, Free Delayed Recall, Cued Delayed Recall, and Inaccurate Recall demonstrated the best relative fit for our data. These findings are consistent with those reported by Donders (1999) in his reanalysis of the CVLT-C standardization sample data, supporting the validity of this factorial model in pediatric epilepsy populations.