Sociodemographic correlates of health-related quality of life in pediatric epilepsy.

In most chronic conditions, better health-related quality of life (HRQOL) is associated with higher socioeconomic status (SES) and ethnic majority status, with disadvantaged groups typically reporting lower HRQOL. In 163 children with intractable epilepsy, we evaluated the relationship between HRQOL and a broad spectrum of demographic variables (SES, parental education, gender, age, marital status, family size, and ethnic and linguistic status), in relation to known neurological and behavioral correlates of HRQOL. No demographic variable was found to be related to child HRQOL, except for marital status, where children from divorced/separated parents had lower HRQOL. However, marital status was not uniquely predictive of HRQOL when neurological and behavioral variables were taken into account. Exploratory analyses indicated that children of separated/divorced parents were more likely to have early epilepsy onset, lower adaptive/developmental levels, and worse seizure frequency, suggesting that severe epilepsy may be a risk factor for marital stress. In sum, contrary to research in other chronic conditions, sociodemographic variables in pediatric epilepsy were weak predictors of HRQOL in comparison to neurological and behavioral variables. The results are discussed with respect to epilepsy-specific determinants of HRQOL.

The impact of monetary reward on memory in schizophrenia spectrum disorder.

The impact of monetary reward on verbal working memory (vWM) and verbal long-term memory (vLTM) was evaluated in 50 patients with schizophrenia spectrum disorders and 52 matched healthy participants. This research was motivated by the observations that negative symptoms in schizophrenia are associated with reduced drive and that patients with these symptoms exhibit greater mnemonic impairments. Reward-related gains were evaluated across two levels of vWM load on the n-back task and across three aspects of vLTM derived from the California Verbal Learning Test-II (i.e., learning, total immediate recall, and retention). Although healthy individuals benefited from reward at a high vWM load level, schizophrenia patients exhibited no reward-related improvements in vWM. In contrast, improvement in vLTM retention was induced by reward for both patients and controls. Finally, symptomatic and pharmacology treatment factors were associated with reward-related gains in persons with schizophrenia. In conclusion, contingent monetary rewards delivered during vWM and vLTM enhanced specific aspects of memory. The influence was relatively small and dependent on the specific neurocognitive operation examined, the mental health status of the participants, and for patients, their particular symptoms and pharmacological treatments.

Postsurgical health-related quality of life (HRQOL) in children following hemispherectomy for intractable epilepsy.

Health-related quality of life (HRQOL) is an important outcome measure in clinical research. Given the psychosocial and behavioral difficulties associated with pediatric epilepsy, evaluating HRQOL in this patient population is of particular importance. Though HRQOL has been examined in pediatric patients receiving focal resection or pharmacological (antiepileptic drug; AED) treatment, it has not been assessed in patients receiving hemispherectomy (HE) for intractable epilepsy. The current study evaluated HRQOL in a sample of pediatric HE cases (N=26) using previously validated questionnaires relative to surgical (N=30) and nonsurgical (N=84) comparison groups. Compared with focal resection and nonsurgical patients, parents of children who received HE reported similar levels of HRQOL. In surgical cases, worse HRQOL was correlated with residual seizure frequency. In both surgical and nonsurgical cases, female gender, higher AED load, and lower functional independence predicted worse HRQOL. Interestingly, HE status (i.e., having undergone HE) predicted fewer epilepsy-related limitations. Consistent with previous findings, AED load, in addition to lower functional abilities, appear particularly detrimental to life quality in pediatric epilepsy. HE, however, is not associated with increased risk for poor HRQOL. When considered in light of the multiple, significant risk factors for poor outcome associated with HE, children who undergo the procedure fare surprisingly well.

Memory interference in multiple sclerosis.

To explore verbal memory impairments associated with multiple sclerosis (MS), we compared proactive and retroactive interference effects on the California Verbal Learning Test (CVLT; Delis et al., 1987) in a sample of 83 community-residing individuals with MS and 80 healthy participants. Individuals with MS demonstrated normal accumulation of proactive interference (PI), but attenuated release from PI relative to healthy individuals. Furthermore, accumulation of retroactive interference (RI) at short-delay free recall (SDFR) was intensified for those with MS as compared to healthy participants. Interestingly, accumulation of RI predicted long-term memory (LTM) only for participants with MS. These findings suggest that individuals with MS may experience particular difficulty when required to use semantic properties of information flexibly to facilitate verbal LTM.