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The Utility of the Repeatable Battery of Neuropsychological Status in Patients with Temporal and Non-temporal Lobe Epilepsy

Maiman, Moshe; Del Bene, Victor A; Farrell, Eileen; MacAllister, William S; Sheldon, Sloane; Rentería, Miguel Arce; Slugh, Mitchell; Gazzola, Deana M; Barr, William B
OBJECTIVE:The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a brief neuropsychological battery that has been validated in the assessment of dementia and other clinical populations. The current study examines the utility of the RBANS in patients with epilepsy. METHODS:Ninety-eight patients with epilepsy completed the RBANS as part of a more comprehensive neuropsychological evaluation. Performance on the RBANS was evaluated for patients with a diagnosis of temporal lobe epilepsy (TLE; n = 51) and other epilepsy patients (non-TLE, n = 47) in comparison to published norms. Multivariate analysis of variance compared group performances on RBANS indices. Rates of impairment were also compared across groups using cutoff scores of ≤1.0 and ≤1.5 standard deviations below the normative mean. Exploratory hierarchical regressions were used to examine the relations between epilepsy severity factors (i.e., age of onset, disease duration, and number of antiepileptic drugs [AEDs]) and RBANS performance. RESULTS:TLE and non-TLE patients performed below the normative sample across all RBANS indices. Those with TLE performed worse than non-TLE patients on the Immediate and Delayed Memory indices and exhibited higher rates of general cognitive impairment. Number of AEDs was the only epilepsy severity factor that significantly predicted RBANS total performance, accounting for 14% of the variance. CONCLUSIONS:These findings suggest that the RBANS has utility in evaluating cognition in patients with epilepsy and can differentiate TLE and non-TLE patients. Additionally, number of AEDs appears to be associated with global cognitive performance in adults with epilepsy.
PMID: 31761928
ISSN: 1873-5843
CID: 4215572

Is formal scoring better than just looking? A comparison of subjective and objective scoring methods of the Rey Complex Figure Test for lateralizing temporal lobe epilepsy

LeMonda, Brittany C; MacAllister, William; Morrison, Chris; Vaurio, Linnea; Blackmon, Karen; Maiman, Moshe; Liu, Anli; Liberta, Taylor; Bar, William B
OBJECTIVE/UNASSIGNED:Findings highlight concerns regarding the usefulness of the RCFT in TLE lateralization, regardless of scoring approach.
PMCID:8236070
PMID: 33356888
ISSN: 1744-4144
CID: 4954292

The use of the MSVT in children and adolescents with epilepsy

MacAllister, William S; Désiré, Naddley; Vasserman, Marsha; Dalrymple, Jessica; Salinas, Lilian; Brooks, Brian L
Pediatric neuropsychologists are increasingly recognizing the importance of performance validity testing during evaluations. The use of such measures to detect insufficient effort is of particular importance in pediatric epilepsy evaluations, where test results are often used to guide surgical decisions and failure to detect poor task engagement can result in postsurgical cognitive decline. The present investigation assesses the utility of the Medical Symptom Validity Test (MSVT) in 104 clinically referred children and adolescents with epilepsy. Though the overall failure rate was 15.4% of the total group, children with 2nd grade or higher reading skills (a requirement of the task) passed at a very high rate (96.6%). Of the three failures, two were unequivocally deemed true positives, while the third failed due to extreme somnolence during testing. Notably, for those with ≥2nd grade reading levels, MSVT validity indices were unrelated to patient age, intellectual functioning, or age of epilepsy onset, while modest relations were seen with specific memory measures, number of epilepsy medications, and seizure frequency. Despite these associations, however, this did not result in more failures in this population of children and adolescents with substantial neurologic involvement, as pass rates exceeded 92% for those with intellectual disability, high seizure frequency, high medication burden, and even prior surgical resection of critical memory structures.
PMID: 32297798
ISSN: 2162-2973
CID: 4415502

Cortical gray-white matter blurring and declarative memory impairment in MRI-negative temporal lobe epilepsy

Blackmon, Karen; Barr, William B; Morrison, Chris; MacAllister, William; Kruse, Michelle; Pressl, Christina; Wang, Xiuyuan; Dugan, Patricia; Liu, Anli A; Halgren, Eric; Devinsky, Orrin; Thesen, Thomas
Magnetic resonance imaging (MRI)-negative temporal lobe epilepsy (TLE) may be a distinct syndrome from TLE with mesial temporal sclerosis (TLE-MTS). Imaging and neuropsychological features of TLE-MTS are well-known; yet, these features are only beginning to be described in MRI-negative TLE. This study examined whether a quantitative measure of cortical gray and white matter blurring (GWB) was elevated in the temporal lobes ipsilateral to the seizure onset zone of individuals with MRI-negative TLE relative to TLE-MTS and healthy controls (HCs) and whether GWB elevations were associated with neuropsychological comorbidity. Gray-white matter blurring from 34 cortical regions and hippocampal volumes were quantified and compared across 28 people with MRI-negative TLE, 15 people with TLE-MTS, and 51 HCs. Declarative memory was assessed with standard neuropsychological tests and the intracarotid amobarbital procedure (IAP). In the group with MRI-negative TLE (left and right onsets combined), hippocampal volumes were within normal range but GWB was elevated, relative to HCs, across several mesial and lateral temporal lobe regions ipsilateral to the seizure onset zone. Gray-white matter blurring did not differ between the groups with TLE-MTS and HC or between the groups with TLE-MTS and MRI-negative TLE. The group with MRI-negative TLE could not be distinguished from the group with TLE-MTS on any of the standard neuropsychological tests; however, ipsilateral hippocampal volumes and IAP memory scores were lower in the group with TLE-MTS than in the group with MRI-negative TLE. The group with left MRI-negative TLE had lower general cognitive abilities and verbal fluency relative to the HC group, which adds to the characterization of neuropsychological comorbidities in left MRI-negative TLE. In addition, ipsilateral IAP memory performance was reduced relative to contralateral memory performance in MRI-negative TLE, indicating some degree of ipsilateral memory dysfunction. There was no relationship between hippocampal volume and IAP memory scores in MRI-negative TLE; however, decreased ipsilateral IAP memory scores were correlated with elevated GWB in the ipsilateral superior temporal sulcus of people with left MRI-negative TLE. In sum, GWB elevations in the ipsilateral temporal lobe of people with MRI-negative TLE suggest that GWB may serve as a marker for reduced structural integrity in regions in or near the seizure onset zone. Although mesial temporal abnormalities might be the major driver of memory dysfunction in TLE-MTS, a loss of structural integrity in lateral temporal lobe regions may contribute to IAP memory dysfunction in MRI-negative TLE.
PMID: 31181427
ISSN: 1525-5069
CID: 3927662

Reliable Digit Span: Does it Adequately Measure Suboptimal Effort in an Adult Epilepsy Population?

Maiman, Moshe; Del Bene, Victor A; MacAllister, William S; Sheldon, Sloane; Farrell, Eileen; Arce Rentería, Miguel; Slugh, Mitchell; Nadkarni, Siddhartha S; Barr, William B
Objective/UNASSIGNED:Assessment of performance validity is a necessary component of any neuropsychological evaluation. Prior research has shown that cutoff scores of ≤6 or ≤7 on Reliable Digit Span (RDS) can detect suboptimal effort across numerous adult clinical populations; however, these scores have not been validated for that purpose in an adult epilepsy population. This investigation aims to determine whether these previously established RDS cutoff scores could detect suboptimal effort in adults with epilepsy. Method/UNASSIGNED:Sixty-three clinically referred adults with a diagnosis of epilepsy or suspected seizures were administered the Digit Span subtest of the Wechsler Adult Intelligence Scale (WAIS-III or WAIS-IV). Most participants (98%) passed Trial 2 of the Test of Memory Malingering (TOMM), achieving a score of ≥45. Results/UNASSIGNED:Previously established cutoff scores of ≤6 and ≤7 on RDS yielded a specificity rate of 85% and 77% respectively. Findings also revealed that RDS scores were positively related to attention and intellectual functioning. Given the less than ideal specificity rate associated with each of these cutoff scores, together with their strong association to cognitive factors, secondary analyses were conducted to identify more optimal cutoff scores. Preliminary results suggest that an RDS cutoff score of ≤4 may be more appropriate in a clinically referred adult epilepsy population with a low average IQ or lower. Conclusions/UNASSIGNED:Preliminary findings indicate that cutoff scores of ≤6 and ≤7 on RDS are not appropriate in adults with epilepsy, especially in individuals with low average IQ or below.
PMID: 29659666
ISSN: 1873-5843
CID: 3042972

The WISC-V in children and adolescents with epilepsy

MacAllister, William S; Maiman, Moshe; Vasserman, Marsha; Fay-Mcclymont, Taryn; Brooks, Brian L; Sherman, Elisabeth M S
Despite its popularity in the neuropsychological evaluation of children, the utility of the Wechsler Intelligence Scale for Children - Fifth Edition (WISC-V) has not yet been investigated in children with epilepsy. Eighty clinically referred children and adolescents with epilepsy were administered the WISC-V as part of a comprehensive assessment and scores were compared to matched controls from the WISC-V standardization sample. T tests compared WISC-V indices and subtests between patients and controls and Chi-square analyses compared the rates of low scores. Correlational analyses assessed the relationships between epilepsy severity variables (e.g., age of onset, duration of epilepsy, number of antiepileptic drugs, seizure frequency). All WISC-V composites and subtests were significantly lower in patients versus controls and the rate of low scores was higher in patients than controls for all composites and subtests with the exception of Figure Weights. The Working Memory Index and Processing Speed Index were most sensitive to impairment, while the Verbal Comprehension Index and Fluid Reasoning Index were least sensitive. Of the epilepsy severity variables, age of seizure onset and number of antiepileptic drugs were strong predictors of deficits, whereas seizure frequency was the weakest predictor. Importantly, no significant differences were seen in children with right hemisphere epilepsy versus left on the five WISC-V composites, though a trend was seen towards a lower Visual-Spatial Index in those with right-sided focal seizures.
PMID: 30676259
ISSN: 1744-4136
CID: 3610632

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

MacAllister, William S; Vasserman, Marsha; Armstrong, Kira
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.
PMID: 30676252
ISSN: 1744-4136
CID: 3610622

Noninvasive identification of seizure lateralization in children: Name that thing

Hamberger, Marla J; MacAllister, William S; Seidel, William T; Busch, Robyn M; Salinas, Christine M; Klaas, Patricia; Smith, Mary Lou
OBJECTIVE:With this prospective, observational study, we aimed to determine whether noninvasive language tasks, developed specifically for children, could reliably identify the hemisphere of seizure onset in pediatric epilepsy. METHODS:analyses and odds ratios were used to examine classification of left vs right hemisphere epilepsy for individual patients based on test performance. RESULTS:= 0.004). The odds of left hemisphere epilepsy were 4.2 times higher (95% confidence interval 1.4-11.7) than the odds of right hemisphere epilepsy with poor auditory naming performance. In the subset of patients with temporal lobe epilepsy (TLE), the odds of left TLE were 11.3 times higher (95% confidence interval 2.00-63.17) than the odds of right TLE with poor auditory naming performance. CONCLUSION/CONCLUSIONS:Contrary to previous findings, naming performance can lateralize hemisphere of seizure onset in children with epilepsy, thereby assisting in the preoperative workup for pediatric epilepsy surgery.
PMCID:6336167
PMID: 30518557
ISSN: 1526-632x
CID: 3796882

Memory in children with epilepsy: Utility of the WRAML-2 in generalized and focal epilepsy syndromes

Salinas, Lilian; Dalrymple, Jessica; MacAllister, William S
The material-specific model for memory impairment predicts that verbal memory deficits are seen with left temporal seizures, and visual memory deficits are seen with right temporal seizures (Henkin et al., 2005). In pediatric epilepsy, seizure pathology has not always yielded the expected material-specific memory profiles. This study used the Wide Range Assessment of Memory and Learning-Second Edition (WRAML-2) to assess memory functioning among pediatric patients with epilepsy. The WRAML-2 was administered to 180 youth with epilepsy during their neuropsychological evaluations. Memory and recognition scores correlated significantly with epilepsy severity variables. There were no significant differences in verbal and visual memory and recognition index scores among patients with generalized epilepsy or among those with lateralized or localized electroencephalography (EEG) patterns and lesions on imaging. However, clinically meaningful verbal versus visual discrepancy scores were significantly related to lateralized abnormalities on EEG and magnetic resonance imaging (MRI) results. Most patients with right hemisphere pathology showed the expected material-specific visual memory deficits, while fewer than 15% of the left hemisphere cases showed the expected verbal memory deficits. Over one-third of those with identified left-sided pathology showed clinically significant deficits in visual memory. Findings are incongruent with the material-specific memory model and reflect the fact that early developmental neurological insults can lead to functional reorganization/crowding effects in children with left hemisphere epilepsy. On exploratory analyses, there were no significant differences in discrepancy scores among participants with left, right, and bilateral languages on Wada and functional MRI (fMRI). However, those with right and bilateral language dominance were more likely to show discrepancies that were incongruent with the material-specific model.
PMID: 30384096
ISSN: 1525-5069
CID: 3401142

Auditory and visual naming tests for children

Hamberger, Marla J; Seidel, William T; MacAllister, William S; Smith, Mary Lou
Assessment of naming in children has been hampered by the use of tests that were developed, either to assess naming in adults or to assess related verbal functions in children. We developed comparable visual naming test (VNT) and auditory description naming (ANT) specifically for children. We collected normative data, not only for accuracy, typically the sole performance measure, but also for response time (RT) and reliance on phonemic cuing. The normative sample consisted of 200 typically developing children, ages 6-15, with 40 children per 2-year age group (6-7, 8-9, 10-11, 12-13, and 14-15). Children were tested individually by a trained examiner. Based on item analysis, naming tests were finalized at 36 items for ages 8-15 and 28 items for ages 6-7. Age-stratified normative data are provided for accuracy, mean RT, tip-of-the-tongues (i.e., delayed but accurate responses plus items named following phonemic cueing), and a summary score, which incorporates all performance measures. Internal and test-retest reliability coefficients for both tests were reasonable. Accuracy scores were high across age groups, indicating that item names were within the mental lexicon of most typically developing children. By contrast, time and cue-based scores improved with age, reflecting greater efficiency in word retrieval with development. These complementary auditory naming and visual naming tests for children address a longstanding clinical need, improving upon the current standard with respect to the sensitivity of performance measures and the addition of an auditory verbal component to the assessment of naming in children.
PMID: 29258379
ISSN: 1744-4136
CID: 3218772