Epilepsy by looking at patterns]

The author, after pointing out the rare occurence and peculiarities of pattern-sensitive forms of epilepsy, reports the case of a seven-year-old boy with infantile cerebral paresis characterized by symptomatic attacks, who was observed to show absence-like conditions when looking at small-checkered patterns of nylon fabric. Grasping and looking at such fabrics assumed the form of an addiction, with a sense of pleasure being believed to be derived therefrom. Although anticonvulsive therapy resulted in attacks of epilepsy being no longer detectable clinically and by electroencephalography, seizures were still triggered by looking at patterns. Also discussed in this article is the problem of transition from real to psychogenic attacks.     

Conditioning of cerebral dysrhythmia induced by Pattern Presentation and Eye Closure

Previous communications from the Epilepsy Center of the University of Wisconsin described the conditioning of certain types of sensory-induced epilepsy. These included stroboscopic-induced seizures, startle epilepsy and musicogenic epilepsy. The present communication adds two types of sensory-evoked seizures treated by conditioning techniques. These additional types are the dysrhythmias induced by pattern presentation and by eye closure. The techniques employed are similar in their main concept to those previously reported. The presentation of a noxious stimulus is altered in such a way as to be innocuous, then is presented repeatedly without producing a seizure. Next, the stimulus is altered gradually until the noxious state is reached. Although these techniques are of value in the treatment of refractory cases of sensory-evoked epilepsy, their major importance is the demonstration that it is possible by the use of behavioral techniques to alter the electroencephalogram and the neurophysiological-neurochemical state which is epilepsy.     

Understanding and management of epilepsy in a rural community in South Africa: An exploratory study

The aim of the study was to explore how people living with epilepsy in an indigenous rural South African community understood and managed their epilepsy. Six people with epilepsy were informants (male = 3, female = 3; age range = 16 to 58 years, unemployed = 5, learner = 1). They completed individual interviews on their meanings of epilepsy and also on their experiences managing the illness. The results indicated that the participants’ understanding of epilepsy is closely linked to their own experiences of the condition, as well as to cultural beliefs about seizure disorder. Moreover, they reported that the unpredictability associated with a seizure generated a greater level of distress to the participants than the fact that they had seizure disorder. The participants reported to rely on family, and both traditional and Western medicine to manage their epilepsy.     

Epilepsie – eine potenziell chirurgisch behandelbare Erkrankung

Epilepsy is one of the most frequent neurological diseases in adults. First line therapy consists of antiepileptic drugs. However, up to 50?% of patients with focal epilepsy do not adequately respond to medical therapy. After failure of two first-line drugs, patients should be referred to a comprehensive epilepsy center for evaluation of the possibility for epilepsy surgery. The noninvasive phase 1 includes history with eye witness report, clinical examination, structural and functional imaging techniques, simultaneous video-EEG monitoring as well as a neuropsychological examination. An invasive phase 2 can be added in cases with incongruent results. Subdural strip and grid electrodes as well as stereotactically implanted depth electrodes give more detailed information on seizure origin and spread. Detailed planning of the surgical approach is of utmost importance. In patients with temporal lobe epilepsy, seizure freedom can be achieved in 60–80?% of cases after epilepsy surgery.     

Assessment of executive functioning in childhood epilepsy: the Tower of London and BRIEF

Children and adolescents with epilepsy are known to demonstrate executive function dysfunction, including working memory deficits and planning deficits. Accordingly, assessing specific executive function skills is important when evaluating these individuals. The present investigation examined the utility of two measures of executive functions-the Tower of London and the Behavioral Rating Inventory of Executive Functioning (BRIEF)-in a pediatric epilepsy sample. Ninety clinically referred children and adolescents with seizures were included. Both the Tower of London and BRIEF identified executive dysfunction in these individuals, but only the Tower of London variables showed significant relations with epilepsy severity variables such as age of epilepsy onset, seizure frequency, number of antiepileptic medications, etc. Further, the Tower of London and BRIEF variables were uncorrelated. Results indicate that objective measures of executive function deficits are more closely related to epilepsy severity but may not predict observable deficits, as reported by parents. Comprehensive evaluation of such deficits, therefore, should include both objective measures as well as subjective ratings from caregivers.     

Assessment of executive functioning in childhood epilepsy: The Tower of London and BRIEF

Children and adolescents with epilepsy are known to demonstrate executive function dysfunction, including working memory deficits and planning deficits. Accordingly, assessing specific executive function skills is important when evaluating these individuals. The present investigation examined the utility of two measures of executive functions—the Tower of London and the Behavioral Rating Inventory of Executive Functioning (BRIEF)—in a pediatric epilepsy sample. Ninety clinically referred children and adolescents with seizures were included. Both the Tower of London and BRIEF identified executive dysfunction in these individuals, but only the Tower of London variables showed significant relations with epilepsy severity variables such as age of epilepsy onset, seizure frequency, number of antiepileptic medications, etc. Further, the Tower of London and BRIEF variables were uncorrelated. Results indicate that objective measures of executive function deficits are more closely related to epilepsy severity but may not predict observable deficits, as reported by parents. Comprehensive evaluation of such deficits, therefore, should include both objective measures as well as subjective ratings from caregivers.     

Conditional reflexes and sensory-evoked epilepsy: The nature of the therapeutic process

Studies of conditional reflex therapy for patients with sensory-evoked epilepsy are reviewed and experimental studies in animals reported. The behavioral methods employed in the therapy are reviewed. They are of a conditioning nature and are defined as clinical therapeutic conditioning. Sensory-evoked epilepsy can be induced in animals by conditioning techniques, provided the animal brain has been rendered epileptogenic. Sensory-evoked epilepsy in patients can be made worse by conditioning, and can be changed from one type to another. However, sensory-evoked seizures in humans are not the result of conditional reflexes.     

The epidemiology of the epilepsies in children

The epilepsies are a heterogeneous collection of neurological conditions and syndromes characterized by recurrent, unprovoked, paroxysmal seizure activity. There are several types of epileptic seizures and syndromes that are unique to children, including infantile spasms, Lennox-Gastaut syndrome and absence seizures. Febrile seizures and neonatal seizures, while not epilepsy, are relatively common types of seizures in infants and children and are likely markers of risk of later epilepsy. Thus, it is important to consider the epidemiological features of the epilepsies as they occur specifically in infants and children. The purpose of this review is to summarize what is currently known about the epidemiology of the childhood epilepsies and to identify promising areas for further population-based studies. The epilepsies are an important cause of neurological morbidity in children. The average annual rate of new cases (incidence) of epilepsy is approximately 5-7 cases per 10,000 children from birth to age 15 years, and in any given year, about 5 of every 1,000 children will have epilepsy. There is evidence that the incidence of the epilepsies in some populations of children may be decreasing over time, and this possibility merits further investigation. Factors that are known to increase risk of the epilepsies in children include congenital malformations of the central nervous system (CNS), moderate or severe head trauma, CNS infections, certain inherited metabolic conditions, and genetic factors. However, these account for only 25% to 45% of cases, and thus, the etiology of most cases of the epilepsies remains obscure. The paucity of well-controlled etiological studies is due largely to formidable methodological problems in conducting epidemiological studies of the epilepsies. The prognosis for seizure control is generally good, although children with remote symptomatic seizures and those with additional neurological disabilities do less well.     

Executive Function and Emotional,Behavioral, and Social Competence Problems in Children with Epilepsy

Many researchers have reported elevated rates of emotional, behavioral, and social competence problems (EBSP) in children with epilepsy. Although executive function has been found to be associated with EBSP in children with typical development, almost no research has looked at the individual components of executive function as potential predictors of EBSP in children with epilepsy. This is surprising given the deficits in executive function in children with epilepsy. We investigated EBSP and executive function in 42 children with epilepsy, aged 6.0 to 18.1 years and found, as expected, that EBSP were associated with executive function in these children even after epilepsy-related variables, such as seizure type, were accounted for. However, different components of executive function were related to different emotional, behavioral, and social competence problems in these children. Shifting of mental sets was a significant predictor of emotional, behavioral, and social competence problems whereas inhibition was a significant predictor of behavioral problems. This suggests that different executive function profiles in children with epilepsy may place them at-risk for developing different types of emotional, behavioral, and social competence problems. These results may help researchers and clinicians develop new techniques to identify and treat emotional, behavioral, and social competence problems in children with epilepsy.     

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.     

Is there a "temporal psychosyndrome (Landolt)"?

With reference to features of two cases of grave traumatic temporal cerebral injury, where a "temporal psychosyndrome" as defined by Landolt was not ascertainable, the question is raised whether, apart from temporal-lobe epilepsy, such a syndrome really exists. Computed tomography offers an enhanced objective basis for an investigation embracing an extensive patient population.     

Theory of Mind in Patients with Epilepsy: a Systematic Review and Meta-analysis

The ability to understand our own thoughts, intentions, beliefs and emotions and those of others (Theory of Mind; ToM) is a high-order social cognitive skill that is vital for social interaction and which has been found to be impaired in patients with epilepsy. Studies examining ToM in patients with epilepsy, however, have yielded inconsistent findings. The main aim of this study is to determine whether the magnitude of ToM deficits varies as a function of the site of epilepsy focus and/or the type of ToM task used. Electronic databases searches included Psychinfo, Medline/PubMed and EMBASE. Studies were included if they examined a group of patients with epilepsy and a group of healthy controls, reported original research, were published in the English language in peer reviewed journals, and used one of five empirically validated measures of ToM: False Belief, Reading the Mind in the Eyes Task (RMET), Faux-pas, Strange Stories, Cartoon ToM vignettes. Twelve studies were identified, ten included adults and two included children with epilepsy. Findings revealed marked ToM deficits in adults with focal seizures emanating from core brain regions underpinning ToM: temporal and frontal lobes (frontal lobe epilepsy, FLE; temporal lobe epilepsy, TLE), but not in adults with focal seizures outside the temporal and frontal lobes (extra-TLE/FLE). ToM deficits were also observed in children with generalised seizures (idiopathic generalised epilepsy, IGE). ToM deficits were documented across ToM tasks. In conclusion, ToM deficits represent a robust finding in adults with frontal and temporal epilepsy, but are also found in children with generalised seizures. Further research into ToM is needed, especially in children with epilepsy as early ToM may have cumulative, negative effects on development of social skills that continues into adulthood.     

Are we documenting performance validity testing in pediatric neuropsychological assessments? A brief report

A 2016 survey of pediatric neuropsychologists found that 92% of clinicians reported use of “at least one” performance validity test (PVT) in each assessment. The present investigation sought to verify documented PVT use among clinicians by review of actual reports. A convenience sample of pediatric neuropsychological reports of children ages 6–17 were reviewed over an 24-month period (January 2015–January 2017); reports were those seen as part of our routine practice, including reports on children we were reevaluating, cases that we consulted on, or cases evaluated elsewhere presenting to our centers that required record review for clinical decision making (e.g., presurgical epilepsy evaluations). A total of 131 reports, from 102 unique neuropsychologists were reviewed. PVT usage was documented in only six reports, from six unique clinicians, representing only 4.58% of the reports (or 5.88% of clinicians), far below expectations recent survey results. Though sampling differences and documentation factors may account for some of this disparity, a “social desirability bias” on surveys is likely a major factor in explaining these discordant findings.     

Frequency of scale elevations and factor structure of the Behavior Rating Inventory of Executive Function (BRIEF) in children and adolescents with intractable epilepsy.

The Behavior Rating Inventory of Executive Function (BRIEF) is a standardized rating scale that provides information about the nature and extent of executive function deficits displayed by children and adolescents in daily life. BRIEF protocols completed by parents of 80 children with intractable epilepsy were evaluated with respect to prevalence and severity of scale elevations in the sample, and also with respect to factor structure. Overall, the sample was rated as having significantly more executive function problems than healthy children in the BRIEF standardization sample; elevations on the Working Memory and Plan/Organize scales were most frequently seen. Fully 36% of the sample had four or more significantly elevated scales. However, 31% of the sample had no clinically elevated scales, indicating that executive difficulties, though frequent, are not necessarily characteristic of all children with severe epilepsy. As in the validation studies reported in the manual, a two-factor solution emerged from a principal factor analysis of BRIEF scales. However, the factor structure as given in the manual was not entirely replicated; specifically, the Monitor scale was found to load equivalently on both factors. The results of this study suggest that a substantial proportion of children with intractable epilepsy display significant executive function deficits in daily life. Research into the relationship of BRIEF scores to other measures of executive functioning in children with epilepsy is needed to further clarify its clinical utility.     

Frequency of Scale Elevations and Factor Structure of the Behavior Rating Inventory of Executive Function (BRIEF) in Children and Adolescents With Intractable Epilepsy

The Behavior Rating Inventory of Executive Function (BRIEF) is a standardized rating scale that provides information about the nature and extent of executive function deficits displayed by children and adolescents in daily life. BRIEF protocols completed by parents of 80 children with intractable epilepsy were evaluated with respect to prevalence and severity of scale elevations in the sample, and also with respect to factor structure. Overall, the sample was rated as having significantly more executive function problems than healthy children in the BRIEF standardization sample; elevations on the Working Memory and Plan/Organize scales were most frequently seen. Fully 36% of the sample had four or more significantly elevated scales. However, 31% of the sample had no clinically elevated scales, indicating that executive difficulties, though frequent, are not necessarily characteristic of all children with severe epilepsy. As in the validation studies reported in the manual, a two-factor solution emerged from a principal factor analysis of BRIEF scales. However, the factor structure as given in the manual was not entirely replicated; specifically, the Monitor scale was found to load equivalently on both factors. The results of this study suggest that a substantial proportion of children with intractable epilepsy display significant executive function deficits in daily life. Research into the relationship of BRIEF scores to other measures of executive functioning in children with epilepsy is needed to further clarify its clinical utility.     

Quantitative Meta-Analyses: Lateralization of Memory Functions Before and After Surgery in Children with Temporal Lobe Epilepsy

Neuropsychology Review - Memory deficits in children with epilepsy have been reported in some but not all studies assessing the effects of side of seizures and resection from the temporal lobe on...     

Behandlung von Epilepsie bei Menschen mit Intelligenzminderung

People with intellectual disability frequently suffer from epilepsy. Management of epilepsy in this population is particularly challenging because of the different ways of communicating, cognitive impairment, changes in behavior which can be disruptive, the severity of the epilepsy syndrome, the seizure types, and the seizure frequency. Treatment of epilepsy is complicated due to the interaction of the intellectual disability and the behavior as well as behavioral changes caused by the antiepileptic drugs or the change of seizure types or frequency. This article provides the reader with a guidance for managing epilepsy in this particular population and raises important open questions.     

Observation of an absence status in the EEG without clinically detected psychopathology

It is reported that a patient suffering from generalized idiopathic epilepsy accidentally showed continuous epileptic activity as spike-wave pattern during an electroencephalographic lead without observing any clinical changes to whom. This state having been ended by a grand mal, the patient could give unspecific subjective complaints for the period of the "bioelectrical petit mal state", but he was fully able to remember. It is referred to that the phenomenon of the clinical inconspicuous appearance and the missing amnesia are special features.     

Neurocognitive functioning of preschool children with uncomplicated epilepsy

Only few studies are available on the cognitive functioning of preschool children with uncomplicated epilepsy. The aim of this study was to describe the neurocognitive functioning of 3–6-year-old children with uncomplicated epilepsy. A subgroup of children with uncomplicated epilepsy from a population based cohort of preschool children with active epilepsy (N = 64) participated in the study. The neurocognitive functioning of these children (N = 13) was compared to that of matched healthy controls (N = 13). The Wechsler's Primary and Preschool Scale of Intelligence - Revised and the Developmental Neuropsychological Assessment were administered. The intellectual functioning of the children with uncomplicated epilepsy was within normal range, but differed significantly from that of healthy controls, which was contrary to expectations. Statistically significant differences emerged between the study and the control group in Verbal IQ and Full Scale IQ, but no differences were found in Performance IQ. The children with uncomplicated epilepsy also had minor neurocognitive difficulties in verbal short-term memory (p <.01) compared to healthy children. The result suggests that uncomplicated epilepsy in preschool children may interfere with language and verbal short-term memory functions. Further studies with detailed neuropsychological assessments and follow-up time are needed to gain more insight into the developmental course of children with uncomplicated epilepsy. Also, because of the developmental risks reported in this study, psychological screening and detailed neuropsychological assessment are recommended in clinical practice.     

Medical prerequisites for the rehabilitation of adult epileptics]

The rehabilitation of adult epileptics may be substantially improved by (1) having all patients suffering from attacks carefully examined by specialists; (2) perfecting methods of diagnosis with the goal of drastically reducing the number of inexplainable cases of epilepsy; (3) making further progress in therapy and improving the present methods of checking the results of treatment; (4) and removing prejudices against both epilepsy and epileptics.