Impulsiveness, personality traits and executive functioning in patients with juvenile myoclonic epilepsy.

PURPOSE: To evaluate impulsiveness in adult patients with JME and its relationship with personality traits and executive functioning. METHODS: Patients completed psychiatric evaluation (DSM IV), Barratt Impulsiveness Scale (BIS-11), Neo Revised Personality Inventory (NEO PI-R) and executive functioning evaluation comprising Controlled Oral Word Association (COWA), Digit Span, Trail Making Tests (TMT), Stroop Test (ST) and Wisconsin Card Sorting Test (WSCT). Healthy controls (63 % female, mean age 35.7 yrs. (±8.37)) were examined to allow calculation of z-scores. RESULTS: 50 patients (70 % female; mean age 32.5 yrs. (±9.2)) presented higher scores of Total (z=-0.37; p = 0.005) and Motor Impulsiveness (z=-0.79; p < 0.001) on BIS-11. Motor Impulsiveness was associated with higher rates of mild psychiatric disorders (depression and anxiety) (p = 0.035) and worse myoclonic seizure control (p = 0.007). NEO PI-R showed differences on Neuroticism (z=-0.60; p < 0.001), Openness (z = 0.38; p = 0.043), Agreeableness (z=-0.38; p = 0.033) and Conscientiousness (z=-0.53; p = 0.003). There were positive correlations between BIS-11 and Neuroticism with Total, Motor and Non-Planning Impulsiveness, on the other hand, Conscientiousness was negatively correlated with these as well as with Attentive Impulsiveness. Patients performance was worse than that of controls on COWA (z=-0.43; p = 0.009) and WCST's Total Number of Completed Categories (z=-2.08; p = 0.005), Trials Taken to Complete First Category (z=-1.56; p = 0.013), Percentage of Total Errors (z=-1.56; p < 0.001), Perseverative Errors (z=-0.73; p = 0.002), Non-Perseverative Errors (z=-1.05; p = 0.003) and Conceptual Level Responses (z=-1.52; p < 0.001). Non-Planning Impulsiveness correlated with Performance (ST and TMT). CONCLUSION: Patients with JME present with impulsive behavior, personality features and executive dysfunction which are linked and may lead to lack of commitment in treatment and affect other aspects of life.

Neuropsychological findings related to the presence of pre-surgical comorbid depression in Latin-American patients with mesial temporal lobe epilepsy and hippocampal sclerosis.

PURPOSE: To evaluate the neuropsychological findings related to the presence of pre-surgical comorbid depression in Latin-American patients with mesial temporal lobe epilepsy (MTLE) and unilateral hippocampal sclerosis (HS). METHOD: Patients with drug-resistant MTLE and unilateral, left (L-) or right (R-) HS were studied. To diagnose depression, psychiatrists with expertise in epilepsy applied a semi-structured interview based on DSM. The depression group (DG) included patients with a psychiatric diagnosis in addition to a Beck Depression Inventory (BDI) score >16 points, and the non-depression group (NDG) included those without this diagnosis and with a BDI score ≤16. We analysed two clusters of neuropsychological tests, which evaluated memory (Complex Rey Figure III, Logical Memory II and RAVLT VII) and attention plus executive functions (Stroop I/II/III and Trail Making A/B). Moreover, we calculated the z-scores (Zs) using a local control group. The DG was compared to the NDG, independently and according to the HS side, using non-parametrical analyses. Due to the multivariate analysis, the p-value was corrected by applyingpost hoc Bonferroni adjustment. RESULTS: We analysed 65 patients. The NDG included 51 (78.4 %) patients, and the DG included 14 (21.5 %) patients. Pre-surgical comorbid depression occurred in eight patients with L- (n = 29) and in six patients with R-MTLE-HS (n = 36). All of these groups had similar gender, age, IQs, and years of schooling. Compared to the healthy subjects, the L-MTLE-HS patients had lower Zs in verbal episodic memory tests [Logical Memory II (p < 0.001), and RAVLT VII (p < 0.001)], and the R-MTLE-HS patients had lower scores in visual episodic memory [Complex Rey Figure III (p < 0.001)]. In the analysis of the DGvs. NDG, there were no differences in the clusters of tests of memory or in those of attention and executive functions. Moreover, when we analysed the patients according to HS side, no neuropsychological difference was observed in the DG and NDG in terms of L- and R-MTLE-HS. CONCLUSIONS: The patients with MTLE and unilateral HS in this study showed no differences in memory, attention and executive functions in relation to the presence of pre-surgical comorbid depression and independently of HS side. In this series from Latin-America, this psychiatric comorbidity did not affect cognition more than epilepsy alone.

Migraine and cognition in children: a controlled study.

OBJECTIVE: Evaluate the cognitive functions of children with migraine and compare them to A control group. METHOD: 30 migraineur children and 30 control group children without migraine, age ranging from 8 to 12 years old, were subjected to a cognitive functions assessment with Wechsler Intelligence Scale for Children (WISCIII). RESULTS: Although both groups had a normal cognitive performance, children with migraine had significantly worse scores compared to the control group in the subtests of Information, Arithmetic, Vocabulary, Object Assembly and in the Indexes of Perceptual Organization, Resistance to Distraction and Processing Speed. CONCLUSION: Children with migraine had impairment in some cognitive functions such as attention, memory, information speed, and perceptual organization compared to the control group.

Migraine and cognition in children: a controlled study / Migrânea e cognição em crianças: um estudo controlado

OBJECTIVE: Evaluate the cognitive functions of children with migraine and compare them to A control group. METHOD: 30 migraineur children and 30 control group children without migraine, age ranging from 8 to 12 years old, were subjected to a cognitive functions assessment with Wechsler Intelligence Scale for Children (WISCIII). RESULTS: Although both groups had a normal cognitive performance, children with migraine had significantly worse scores compared to the control group in the subtests of Information, Arithmetic, Vocabulary, Object Assembly and in the Indexes of Perceptual Organization, Resistance to Distraction and Processing Speed. CONCLUSION: Children with migraine had impairment in some cognitive functions such as attention, memory, information speed, and perceptual organization compared to the control group.

OBJETIVO: Avaliar as funções cognitivas de crianças com e sem migrânea, utilizando a Escala de Inteligência Wechsler para Crianças (WISC-III). MÉTODO: A amostra foi composta por 30 crianças com diagnóstico de migrânea na idade entre 8 a 12 anos e grupo controle de 30 crianças sem migrânea na mesma faixa etária. Todas foram avaliadas pela Escala de WISC-III. RESULTADOS: Embora ambos os grupos tenham demonstrado um quociente de inteligência dentro da média, as crianças com migrânea, quando comparados aos controles, tiveram desempenho inferior nos subtestes de Informação, Aritmética, Vocabulário, Armar Objetos e nos Índices de Compreensão verbal, Organização Perceptual, Resistência à Distração e Velocidade de Processamento. CONCLUSÃO: Quando comparadas aos controles, crianças com migrânea apresentaram desempenhos inferiores em vários domínios cognitivos como atenção, velocidade de processamento, memória e organização perceptual.

Validity and reliability of the Portuguese-Brazilian version of the Quality of Life in Epilepsy Inventory-89.

OBJECTIVE: The purpose of this article was to report the translation of the Quality of Life in Epilepsy Inventory-89 (QOLIE-89) into a Portuguese-Brazilian version and evaluate its reliability and validity. METHODS: This study involved 105 outpatients: 54 patients with refractory temporal lobe epilepsy (TLE) with mesial temporal sclerosis (MTS) and 51 with juvenile myoclonic epilepsy (JME). Reliability and test-retest reliability were assessed. Relationships between QOLIE-89 domains and other questionnaires (Nottingham Health Profile, Beck Depression Inventory, Adverse Event Profile, Neuropsychological Evaluation), and external measures such as demographic and clinical variables were analyzed to examine construct validity. RESULTS: Internal consistency (Cronbach's alpha=0.73-0.92) and test-retest reliability (intraclass correlation coefficient=0.60-0.84) for individual domains were acceptable. For construct validity, we verified high correlations between the QOLIE-89 and the Nottingham Health Profile, Beck Depression Inventory, Adverse Event Profile, and Neuropsychological Evaluation. For clinical characteristics, the patients with juvenile myoclonic epilepsy had better quality-of-life scores on 11 of 17 QOLIE-89 subscales compared with patients with temporal lobe epilepsy (P<0.05). CONCLUSION: These results support the reliability and validity of the Portuguese-Brazilian translation of QOLIE-89.

Serial position curve and semantic facilitation in patients with mesial temporal lobe epilepsy / Curva de posição serial e facilitação semântica em pacientes com epilepsia de lobo temporal mesial / Curva de posición serial y facilitación semantica en pacientes con epilepsia del lóbulo temporal medial

We investigated the serial position curve and semantic facilitation effect in patients with left and right mesial temporal lobe epilepsy (MTLE) with hipocampal sclerosis compared to a matched control group. Subjects (L-MTLE = 19, R-MTLE = 15, and controls = 21) were assessed by recalling word lists either with the three middle wordssemantically related or not. The total number of words recalled from both types of lists did not differ between groups. Recency was preserved, showing that short-term memory (phonological loop) is not affected in these patients. Primacy was equally present for the lists with no semantic relationships in all groups, but was absent for lists with semantically related words. The semantic facilitation effect was seen in all groups, but with a lower magnitude in the L-MTLE group, suggesting that the spread of discharges in the left hemisphere interferes with the automatic processing of semantic networks.(AU)

Nós investigamos a curva de posição serial e o efeito de facilitação semântica em pacientes com epilepsia do lobo temporal mesial (ELTM) esquerda e direita com esclerose hipocampal, comparados a um grupo controle. Os sujeitos (ELTM-E = 19, ELTM-D = 15 e controles = 21) foram submetidos ao teste de recordação livre de palavras, sendo que metade das listas de palavras continham três palavras semanticamente relacionadas inseridas nas posições intermediárias. O número total de palavras recordadas em ambos tipos de listas não diferiu entre os grupos. A recência foi preservada sugerindo que a memória de curto prazo (alça fonológica) não é afetada nestes pacientes. A primazia foi observada somente nas listas sem relacionamento semântico, independentemente do grupo. O efeito de facilitação semântica foi obtido em todos os grupos, mas com menor magnitude ao ELTM-E, sugerindo que a propagação das descargas no hemisfério esquerdo interfere com o processamento automático da rede semântica.(AU)

Cognitive decline in temporal lobe epilepsy due to unilateral hippocampal sclerosis.

OBJECTIVE: We assessed the cognitive performance of patients with temporal lobe epilepsy (TLE) caused by unilateral hippocampal sclerosis (HS), in comparison with that of matched, healthy controls. We report the relationship between cognitive measures and duration of epilepsy, correlating with hippocampal volumes, and the impact of educational level on cognitive decline. METHODS: This study involved 61 outpatients (40 with < or = 8 years and 21 with >8 years of formal education) with unilateral HS and 61 controls. Volumetric MRI was performed on all patients and 10 controls. The results (mean, SD) of the neuropsychological tests of healthy subjects and patients were compared using the Student t and Mann-Whitney tests. RESULTS: Patients performed worse than controls in the neuropsychological evaluation. When adjusted z scores were used to calculate the impairment index, patients had a greater percentage of abnormal tests compared with controls. The cognitive decline, assessed through the impairment index, correlated with duration of epilepsy. Higher level of education did not protect against this decline, thus not supporting the hypothesis of cerebral reserve in this population. A significant correlation between hippocampal volumetric measures and duration of epilepsy was observed only in patients with left HS. CONCLUSION: Patients with TLE caused by HS present with cognitive morbidity that extends beyond memory deficits. Cognitive decline is associated with duration of epilepsy, and in patients with left-sided HS, duration may correlate with volumetric hippocampal loss.

Neuropsychological assessment and quality of life in patients with refractory temporal lobe epilepsy related to hippocampal sclerosis

INTRODUCTION: Epilepsy is a disorder that results in abnormal activity in a group of neurons that may have significant impact on the normal cognitive processes and behavior. Temporal lobe epilepsy (TLE) is the most frequent form of partial epilepsy in adults, and hippocampal sclerosis (HS) the most common neuropathologic finding in patients with medically refractory TLE. Patients with TLE often present cognitive difficulties that may be determined by the effects of epileptic discharges and side of the lesion. And its consequence is that patients have poor effects on quality of life (QOL). PURPOSE: We report the relationship between neuropsychological assessment and QOL under the hypotheses that patients with worst results in neuropsychological assessment have poorer QOL assessed by the QOLIE-31. RESULTS: Regarding seizure frequency, 23 (46 percent) had had 1-5, 20 (40 percent) 6-10 and 7 (14 percent) more than 10 seizures/month. In relation to seizure types, 5 (10 percent) had had auras, 37 (74 percent) complex partial seizures and 8 (16 percent) partial evolving to generalized tonic-clonic seizures (GTCS). Neuropsychological evaluation had a positive correlation with QOLIE-31 domains. QOL evaluations had the worst scores in QOLIE-31 were in Cognitive Function (45.0) and Social Function (46.0). The best was Overall QOL (62.0). CONCLUSION: People with epilepsy have great impact on their QOL not only because of daily seizures but because of the impact seizures cause in their cognitive functions. TLE is an example of how refractory epilepsy can exterminate any possibilities of work, study and live in a society that discriminates someone with epilepsy who also presents cognitive decline.

INTRODUÇÃO: Epilepsia é um distúrbio decorrente de atividade anormal de um grupo de neurônios, causando grande impacto no processo cognitivo e comportamental do indivíduo. A epilepsia do lobo temporal (ELT) é o tipo de epilepsia parcial mais comum e a esclerose hipocampal (EH) o substrato neuropatológico mais freqüentemente encontrado em pacientes com epilepsia refratária. Pessoas com ELT apresentam declínio cognitivo que pode ser determinado pela localização das descargas e da lesão. E, além disso, também apresentam limitação na qualidade de vida (QV) pelas crises diárias. OBJETIVO: Avaliar a relação entre a avaliação neuropsicológica e QV com a hipótese de que pacientes com piores resultados na primeira têm pior QV determinada pelo QOLIE-31. RESULTADOS: Quanto à freqüência de crises, 23 pacientes (46 por cento) tiveram até 5 crises, 20 (40 por cento) de 6 a 10 e 7 (14 por cento) mais de 10 por mês. Quanto ao tipo de crises, 5 (10 por cento) apresentaram apenas auras, 37 (74 por cento) crises parciais complexas e 8 (16 por cento) crises parciais complexas com generalização secundária. Os resultados da avaliação neuropsicológica tiveram correlação positiva com os domínios do QOLIE-31. Nos domínios Aspectos Sociais com testes de função executiva, Preocupação com as Crises e Qualidade de Vida Global com testes de memória verbal e Bem-estar Emocional com os testes utilizados para cálculo do QI. CONCLUSÃO: Pessoas com epilepsia têm grande impacto na QV não apenas pelas limitações causadas pelas crises diárias, mas também pelo que estas causam em suas funções cognitivas. ELT é um exemplo de como uma epilepsia refratária pode acabar com qualquer possibilidade dessas pessoas procurarem um emprego, estudarem e viverem em uma sociedade que as discrimina pelo fato de ter epilepsia e um declínio cognitivo comprovado.

Desempenho cognitivo de pacientes com epilepsia do lobo temporal e epilepsia mioclônica juvenil: avaliação por meio da Escala WAIS-III / Cognitive performance of patients with temporal lobe epilepsy and juvenile myoclonic epilepsy: evaluation through the Wechsler Intelligence Scale WAIS-III

OBJETIVOS: Comparar os resultados em uma prova cognitiva de pacientes com epilepsia com dois parâmetros: um fornecido pelas normas brasileiras e outro pelas norte-americanas, tendo em vista as diferenças culturais. MÉTODO: Quarenta e cinco pacientes adultos com diagnóstico de epilepsia foram submetidos à avaliação de nível intelectual por meio da Escala Wechsler de Inteligência, WAIS-III nos seguintes itens: Quociente de Inteligência Verbal (QI V), Quociente de Inteligência de Execução (QI E) e Quociente de Inteligência Total (QI T). As correções dos protocolos seguiram as normas brasileiras e as norte-americanas. RESULTADOS: Dos 45 pacientes, 30 tinham o diagnóstico de epilepsia do lobo temporal (ELT) por esclerose mesial temporal (EMT), 15 no hemisfério esquerdo e 15 no direito, e 15 de epilepsia mioclônica juvenil (EMJ). Em todos os 45 protocolos do WAIS-III os resultados de QI V, QI E e QI T foram maiores quando empregados os parâmetros brasileiros. Assim, 18 pacientes que alcançaram QI T nas faixas "Média" e "Média Inferior", segundo as normas brasileiras, obtiveram níveis inferiores quando corrigidos pelas normas norte-americanas, ou seja, o QI T destes mesmos pacientes caiu para as faixas "Limítrofe" e "Muito Rebaixado" respectivamente. Nos pacientes com ELT, as diferenças de pontos entre os QI V e QI E não foram concordantes quando cotejados por normas diferentes e em cinco deles o desempenho verbal foi maior do que o motor quando corrigidos pelas normas norte-americanas. Nos pacientes com EMJ, os valores do QI V e QI E foram maiores quando empregadas normas brasileiras. CONCLUSÃO: Os resultados da avaliação cognitiva pelo WAIS-III de pacientes com epilepsia mostram que a interpretação do nível intelectual é muito distinta quando corrigida segundo normas brasileiras ou norte-americanas. Há também diferença na análise qualitativa do desempenho intelectual, uma vez que o estudo das discrepâncias internas variou conforme a norma populacional utilizada.

To compare the results of a cognitive task of patients with epilepsy with two parameters: one provided by the Brazilian and the other by the US normative scores viewing the cultural differences. METHOD: Forty-five adult patients diagnosed with epilepsy were submitted to intellectual evaluation through the Wechsler Adult Intelligence Scale, WAIS-III, in the following items: Verbal Intelligence Quotient (V IQ), Performance Intelligence Quotient (P IQ) and Full Scale (FS IQ). The correction of the protocols followed the Brazilian and the US normative scores. RESULTS: Thirty out of the 45 patients were diagnosed with temporal lobe epilepsy (TLE) due to mesial temporal sclerosis (MTS), 15 in the left hemisphere and 15 in the right, and 15 with juvenile myoclonic epilepsy (JME). In all 45 WAIS protocols the results of the V IQ, P IQ and FS IQ were higher when the Brazilian parameters were employed. Therefore, 18 patients that achieved FS IQ in the "Average" and "Low Average" ranges, according to the Brazilian normative scores, got lower levels when corrected by the US normative scores, that is, the FS IQ of these 18 patients fell to the æBorderlineÆ and æExtremely LowÆ ranges respectively. In the patients with TLE, the differences in the scores between the V IQ and P IQ did not correspond when evaluated by different normative scores and in five of them the verbal was higher than the performance when corrected by the US normative scores. In the patients with JME, the values of V IQ and P IQ were higher when the Brazilian normative scores were employed. CONCLUSION: The results of the cognitive evaluation through the WAIS of patients with epilepsy showed that interpretation of the intellectual level is very dissimilar when corrected by the Brazilian or US normative scores. There is also a difference in the qualitative analysis of the intellectual performance since the study of the inner discrepancy varied according the population normative scores employed.

Especializaçäo funcional hemisférica na afasia motora: achados neurofisiológicos ao mapeamento eletrencefalográfico computadorizado sob estimulaçä sonora musical e verbal: estudo de dois casos / Hemispheric functional specialization in motor aphasia: neurophysiologic findings with electroencephalographic brain mapping during musical and oral sonours stimulation: study of 2 cases

Este estudo diz respeito à atividade elétrica cerebral durante estimulaçäo auditiva em dois pacientes afásicos, um com afasia clássica (lesäo no hemisfério esquerdo) e outro com afasia cruzada (lesäo no hemisfério direito). Ambos foram submetidos ao teste de estimulaçäo auditiva dicótica (consoante-vogal-consoante) e de audiçäo musical (canto gregoriano) durante mapeamento eletrencefalográfico cerebral. Encontramos, em ambos, grande proporçäo da frequência delta e potência no hemisfério näo lesado, durante a estimulaçäo dicótica e musical. Alé disso, foi observado aumento na frequência de atividade alfa somente no hemisfério näo lesado, restrito à regiäo do lobo temporal. Esses achados sugerem um interessante campo de pesquisa acerca da medida de correlatos neurofisiológicos de estimulaçäo auditiva e de atividade elétrica cerebral na afasia