Language reorganization in aphasics: an electrical stimulation mapping investigation.

Objective: The purpose of this investigation was to determine whether clinical speech deficits after brain injury are associated with functional speech reorganization.

Methods: Across an 18-year interval, 11 patients with mild-to-moderate speech deficits underwent language mapping as part of their treatment for intractable epilepsy. These "aphasics" were compared with 14 matched "control" patients with normal speech who also were undergoing epilepsy surgery.

Do patients with psychogenic nonepileptic seizures produce trustworthy findings on neuropsychological tests?

Drane et al. (2006) has recently raised the possibility that patients with psychogenic nonepileptic seizures (PNES) may make poor effort in taking neuropsychological tests in comparison with patients with epilepsy (ES). Therefore, findings previously reported with PNES patients may be in error, especially with regard to tests of mental abilities.

Do recent seizures and recent changes in antiepileptic drugs impact performances on neuropsychological tests in subtle ways that might easily be missed?

Purpose: The possibility that a recent seizure or a recent change in antiepileptic medication might produce an occult change in neuropsychological performance is of interest, and especially so in the context of evaluation for epilepsy surgery. Such an evaluation is often done in a setting of video-EEG monitoring where a strong effort is made to produce seizures as quickly as possible with abrupt changes in medication, alterations in sleep, etc., which could impact the validity of neuropsychological findings.

Gender differences in handedness and speech lateralization related to early neurologic insults.

Left-handedness is a normal variant but also may result from early-life brain insults. Speech typically resides in the left cerebral hemisphere in normal subjects. In 170 subjects with past brain injuries, bilateral or right hemisphere speech lateralization, determined by the intracarotid amobarbital procedure, was more frequent in females (19 vs 5, p = 0.

Neuropsychological effects of seizures.

The neuropsychological effects of seizures, including an accumulation of single attacks, on mental abilities are explored through a selective review of the world's literature. Each paper included in this review was longitudinal in nature, and in each case, formal psychological testing was accomplished both at the beginning and at the end of the study. Of the 22 investigations meeting all requirements for inclusion, 9 focused on children and 13 on adolescents and adults.

Identifying potential surgical candidates in patients with evidence of bitemporal epilepsy.

Purpose: To determine which patients with evidence of medically refractory bitemporal epilepsy are potentially good candidates for surgical therapy.

Methods: We reviewed 42 adults with intractable seizures who were found to have bitemporal ictal onsets, based on scalp video-EEG long-term monitoring (LTM). All underwent invasive LTM before surgery.

Assessment of CNS effects of antiepileptic drugs by using quantitative EEG measures.

Purpose: Antiepileptic drugs (AEDs) can be associated with adverse neurologic effects including cognitive dysfunction. Objective methods for recognizing AED effects on the brain could be valuable for long-term management. We compared quantitative EEG measures and cognitive tests in a group of patients beginning or ending AED therapy.

Factors predicting outcome of surgery for intractable epilepsy with pathologically verified mesial temporal sclerosis.

Purpose: To examine the subgroup of patients with medically intractable epilepsy receiving temporal lobectomies who have pathologically verified mesial temporal sclerosis (MTS) and to determine the relation of demographic and clinical factors, results of diagnostic testing, and details of the surgical procedure with prognosis for achieving control of seizures.

Methods: All patients receiving surgical treatment for intractable epilepsy between 1991 and 1998 at the University of Washington were reviewed. There were 118 patients who met inclusion criteria of adequate pathological analysis showing MTS without a progressive process and a minimum of 1-year follow-up.

Language Disturbances as Side Effects of Topiramate and Zonisamide Therapy.

Reversible side effects of two sulfa-containing antiepileptic drugs (AEDs), topiramate (TPM) and zonisamide (ZNS), are reported. These effects differ from those of other AEDs in that language impairment was the predominant cognitive complaint. Information was available for 42 patients exposed to TPM.

Evidence That Emotional Maladjustment Is Worse in Men Than in Women with Psychogenic Nonepileptic Seizures.

The purpose of this study is to examine the effects of gender on adjustment and cognition in patients with psychogenic nonepileptic seizures (NES) and on patients with epilepsy. We compared 57 women and 27 men, all at least 16 years old, with only NES as documented by long-term EEG-video monitor studies, to equal numbers of randomly selected women and men with only epileptic seizures. Variables examined included age, age of onset, education, scales from the MMPI, the WAIS-R, and the number of tests outside normal limits from the Neuropsychological Battery for Epilepsy.

Effects of Vagal Nerve Stimulation on Cognition and Quality of Life in Epilepsy.

To evaluate the cognitive and quality-of-life (QOL) impacts of vagal nerve stimulation (VNS), 160 patients with uncontrolled partial seizures from 20 sites were enrolled in a double-blind study. Patients were randomly assigned to low (minimal) stimulation (n = 82) or high (now clinically used) stimulation (n = 78) conditions and given a group of cognitive and QOL tests before implantation and after 12-16 weeks of VNS treatment. Results showed no clear cognitive changes.

Progressive cognitive decline in adolescents and adults with epilepsy.

The effects of an accumulation of single seizures upon mental abilities in adolescents and adults is explored through a selective review of the world's literature. The papers reviewed were divided up into cross-sectional and longitudinal studies. Of 16 investigations meeting all requirements for inclusion, 12 produced results pointing to a relationship between seizures and adverse cognitive change.

Effects of gabapentin and carbamazepine on the EEG and cognition in healthy volunteers.

Purpose: Antiepileptic drug (AED) therapy can be associated with neurotoxic side effects including cognitive dysfunction. Objective methods for detection of neurotoxicity in individual patients would be useful. We studied the effects of gabapentin (GBP) and carbamazepine (CBZ) on neurophysiologic and cognitive/behavioral measures in healthy volunteers.

The experience of earthquakes by patients with epileptic and psychogenic nonepileptic seizures.

Purpose: We sought to understand better the experience of seizures by studying differences in the subjective experience of being in an earthquake between patients with epileptic (EP) and nonepileptic (NES) seizures.

Methods: Forty-eight patients with CCTV/EEG-documented EP or NES who were in the Seattle metropolitan area during the February 28, 2001 Nisqually earthquake were randomly selected for telephone interviews on their earthquake experiences, including whether they thought they were having a seizure during the event.

Results: Twenty-three percent of EP patients spontaneously volunteered that they initially thought they were having a seizure during the earthquake as compared with none of the NES individuals (p = 0.