Is Speech Arrest during Wada Testing a Valid Method for Determining Hemispheric Representation of Language?

Background and objective: The intracarotid amobarbital procedure, or Wada test, is the method of choice to determine hemispheric representation of language, and is routinely used in the presurgical evaluation for intractable epilepsy. Some investigators perform comprehensive language assessments, but others base language lateralization solely on speech arrest. This study sought to determine whether speech arrest alone during Wada testing provides valid data regarding language lateralization. Methods: The subjects (previously reported) were 21 patients evaluated for intractable epilepsy, who underwent language lateralization by Wada testing and functional MRI (FMRI). For each patient, language representation was determined by calculating: (1) a Wada laterality index based exclusively on speech arrest; (2) a Wada laterality index based on comprehensive language assessment; and (3) an FMRI laterality quotient. Correlation coefficients and categorical classifications were analyzed. Results: There was no significant correlation between the Wada laterality quotient derived from duration of speech arrest and either the comprehensive Wada language laterality score (r= .35,p= .12) or FMRI language laterality score (r= .32,p= .16). Categorical classification as left, right or bilateral language also showed marked discordance between speech arrest and the other two methods. Conclusion: Duration of speech arrest during Wada testing is not a valid measure of language dominance.     

Fleeting Signs of the Course of Life: Facial Expression and Personal Adjustment

In this article, we consider whether facial expressions of emotion relate in theoretically interesting ways to personal adjustment. We first consider the conceptual benefits of this line of inquiry. Then, to anticipate why brief samples of emotional behavior should relate to personal adjustment, we review evidence indicating that facial expressions of emotion correspond to intrapersonal processes and social outcomes. We then review studies showing that facial expressions relate in theoretically significant ways to adjustment after the death of a spouse, in long-term relationships, and in the context of chronic psychological disorders.     

DETERMINANTS AND CONSEQUENCES OF CREATIVITY IN A COHORT OF GIFTED WOMEN

Forty women who had been selected by Lewis Terman in 1921 for his study of intellectually gifted California school children were reinterviewed in 1987 (Mean = 77 years, SE±1). These women had been prospectively followed by questionnaire over the intervening 65 years. Their capacity for creativity–putting something in the world that was not there before–was assessed by review of their prospectively gathered questionnaires and by retrospective interview. The 20 women viewed as most creative (usually for literary publication, art, music, or starting an organization) were more likely in the past to have manifested generativity, and at the present to have adjusted well to old age. Although the ego defenses of sublimation, humor, and altruism were more frequent among the creative women, no differences were noted in the happiness of their childhoods or their mental health prior to the present.     

Vagus nerve stimulation: a new form of therapeutic brain stimulation

Although the vagus nerve has traditionally been considered to perform efferent functions, in reality it performs significant afferent functions as well, carrying information from the body, head, and neck to the brain. Preliminary studies examining this afferent activity led to the theory that vagus nerve stimulation (VNS) could successfully control seizure activity in persons who are refractory to antiepileptic medications. Unlike other forms of brain stimulation, VNS is unable to directly stimulate multiple discrete areas of the brain; however, through several pathways, it is able to relay sensory information to higher brain regions. An implantable VNS device known as the VNSTM NeuroCybernetic Prosthesis (NCP) System has been used in approximately 9,000 epilepsy patients in Europe and the United States since 1994. The implant has reduced seizure frequency by an average of 25% to 30%, with minimal side effects. Studies underway are also showing some degree of success in the management of treatment-refractory depression. The future efficacy of the implantable system in other disorders may depend on whether the implant can be more precisely focused to affect different brain regions. Research in this area is underway.