MODIFICATION OF SEIZURE DISORDERS: THE INTERRUPTION OF BEHAVIORAL CHAINS1

This study investigated the effects of interruption and differential reinforcement on seizures in children. Seizures were conceptualized as the terminal link in a behavioral chain, resulting in a strategy aimed at identifying and modifying behaviors that reliably preceded the seizure climax. Seizure frequency was reduced in four of five subjects, whereas the frequency of preseizure behavior was reduced in only three subjects. Parents and school personnel were successfully used as change agents.     

从不规范联合用药转变为单药治疗过程分析抗癫痫药物的选择策略

单药治疗或合理的联合用药是癫痫治疗的重要原则,本文运用抗癫痫药物的药代动力学知识,分析了1例复杂不规范的联合用药导致治疗失败的原因,系统讲解了将其转变为有效的传统或新型抗癫痫药物单药治疗的理论和实践过程,并以此展示抗癫痫药物的选择策略。     

Dreaming and cognition in patients with frontotemporal dysfunction

Individuals with Parkinson’s disease (PD) and temporal lobe epilepsy (TLE) have hallucinations and mild cognitive dysfunction. The objective of this work was to study dreams in PD and TLE patients using a common functional model of dream production involving the limbic and paralimbic structures.Dreams were characterised in early-stage PD (19 males) and TLE patients (52) with dream diaries classified by the Hall van de Castle system and were compared with matched controls.In PD, there were significant differences between patients’ dreams and those of controls: animals, physical aggression, and a befriender were more common in patients, and aggressor and bodily misfortunes were less common. The dreams of patients with frontal dysfunction showed more aggressive features.TLE patients had lower recall than PD patients and a higher proportion of dreams involving family and familiar settings, lower proportions involving success, and a higher incidence of frontal dysfunction.The dreams of PD and TLE patients share important features.     

Pilocarpine seizures cause age-dependent impairment in auditory location discrimination

Children who have status epilepticus have continuous or rapidly repeating seizures that may be life-threatening and may cause life-long changes in brain and behavior. The extent to which status epilepticus causes deficits in auditory discrimination is unknown. A naturalistic auditory location discrimination method was used to evaluate this question using an animal model of status epilepticus. Male Sprague-Dawley rats were injected with saline on postnatal day (P) 20, or a convulsant dose of pilocarpine on P20 or P45. Pilocarpine on either day induced status epilepticus; status epilepticus at P45 resulted in CA3 cell loss and spontaneous seizures, whereas P20 rats had no cell loss or spontaneous seizures. Mature rats were trained with sound-source location and sound-silence discriminations. Control (saline P20) rats acquired both discriminations immediately. In status epilepticus (P20) rats, acquisition of the sound-source location discrimination was moderately impaired. Status epilepticus (P45) rats failed to acquire either sound-source location or sound-silence discriminations. Status epilepticus in rat causes an age-dependent, long-term impairment in auditory discrimination. This impairment may explain one cause of impaired auditory location discrimination in humans.     

Balint After Lacan ... and After

This paper examines Balint and Lacan's views about regression and symbolism, language, and transference. The author points out their similarities, their differences, and then proposes a synthesis through his approach of history, genealogy, trauma, and crisis. Freud's notions of masochism, of fixation (innate or phylogenetic) may thus be renewed, leading to the analyst's capacity to cope with deep regression and borderline (Balint) psychosis and perversion (Lacan) or to psychosomatics, including epilepsy.     

Cognitive development in absence epilepsy during long-term follow-up

Absence epilepsy (AE) has been associated with lower than average cognitive functioning, which are clinically relevant in some and may predispose to problems later in life. This study aimed to assess cognitive development during long-term follow-up in children with AE. Thirty-one children with AE, who had undergone two neuropsychological assessments between 2010 and 2017 were analyzed retrospectively. Cognitive measurements were 1.7 ± 0.95 years apart. The difference in neurocognitive test scores was assessed on a group level and on an individual level using reliable change methodology. Results show that sustained attention was lower at the first measurement compared to the normative mean. Sustained attention improved during follow-up and 7 out of 14 children showed improvement after correction for practice effects. Receptive vocabulary showed a decline over time, but did not differ from the normative mean. Significant lower mean group scores were present for performance IQ, perceptual organization, processing speed, simple reaction times, and visual motor integration, while being stable over time in the majority of children. Cognitive development was not associated with seizure freedom. Mild-to-severe academic underachievement was present in 65% and comorbidities that might affect learning in 38%. This study in children with AE showed improvement in sustained attention during long-term follow-up while other cognitive weaknesses persisted over time, regardless of seizure freedom.     

癫痫儿童认知功能障碍诊断中的问题

癫痫是小儿常见的神经系统慢性疾病,相当一部分儿童伴有认知功能损伤,早期诊断是正确干预、改善预后的前提。但在癫痫儿童认知功能障碍诊断中存在许多的问题,给相关研究带来困难。认知理论尚不完善;认知损伤与修复的机理不清;影响因素众多,而且各不相同;更主要的是方法学上的问题。目前研究趋势是分离不同的认知成分,早期诊断某些特定的认知损伤,国内在这方面的研究起步较晚。     

Contributions of volumetrics of the hippocampus and thalamus to verbal memory in temporal lobe epilepsy patients

Recent theories have posited that the hippocampus and thalamus serve distinct, yet related, roles in episodic memory. Whereas the hippocampus has been implicated in long-term memory encoding and storage, the thalamus, as a whole, has been implicated in the selection of items for subsequent encoding and the use of retrieval strategies. However, dissociating the memory impairment that occurs following thalamic injury as distinguished from that following hippocampal injury has proven difficult. This study examined relationships between MRI volumetric measures of the hippocampus and thalamus and their contributions to prose and rote verbal memory functioning in 18 patients with intractable temporal lobe epilepsy (TLE). Results revealed that bilateral hippocampal and thalamic volume independently predicted delayed prose verbal memory functioning. However, bilateral hippocampal, but not thalamic, volume predicted delayed rote verbal memory functioning. Follow-up analyses indicated that bilateral thalamic volume independently predicted immediate prose, but not immediate rote, verbal recall, whereas bilateral hippocampal volume was not associated with any of these immediate memory measures. These findings underscore the cognitive significance of thalamic atrophy in chronic TLE, demonstrating that hippocampal and thalamic volume make quantitatively, and perhaps qualitatively, distinct contributions to episodic memory functioning in TLE patients. They are also consistent with theories proposing that the hippocampus supports long-term memory encoding and storage, whereas the thalamus is implicated in the executive aspects of episodic memory.     

Language in benign childhood epilepsy with centro-temporal spikes abbreviated form: rolandic epilepsy and language

Although Benign Childhood Epilepsy with Centrotemporal Spikes (BECTS) has a good prognosis, a few studies have suggested the existence of language disorders relating to the interictal dysfunction of perisylvian language areas. In this study, we focused on language assessment in 16 children aged 6-15 currently affected by BECTS or in remission. An important proportion of children showed moderate or more severe language impairment. The most affected domains were expressive grammar and literacy skills. We found linguistic deficits during the course of epilepsy but also persistent deficits in children in remission, suggesting possible long-term effects. Our results support the hypothesis that BECTS may be associated with impairment to language and suggest the possibility of a direct link between epileptic activity and language development, and the existence of long-term consequences.     

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) Donders. 1999. Structural analysis of the California Verbal Learning Test—Children's Version in the standardization sample. Developmental Neuropsychology, 15(3): 395–406. [CSA][Taylor &; Francis Online], [Web of Science ®] , [Google Scholar], for the California Verbal Learning Test-Children's Version (CVLT-C; Delis, Kramer, Kaplan, &; Ober, 1994 Delis, D. C., Kramer, J. H., Kaplan, E. and Ober, B. A. 1994. California Verbal Learning Test—Children's Version, San Antonio, TX: Psychological Corporation.  [Google Scholar]) 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) Donders. 1999. Structural analysis of the California Verbal Learning Test—Children's Version in the standardization sample. Developmental Neuropsychology, 15(3): 395–406. [CSA][Taylor &; Francis Online], [Web of Science ®] , [Google Scholar] in his reanalysis of the CVLT-C standardization sample data, supporting the validity of this factorial model in pediatric epilepsy populations.