Faculty Bibliography

BACKGROUND AND PURPOSE/OBJECTIVE:The main clinical indication for functional MR imaging (fMRI) has been to preoperatively map the cortex. Motor paradigms to activate the cortex are simple and robust; however, language tasks show greater variability and difficulty. The aim of this study was to develop a language task with an adequate control task to engage the areas of the posterior temporal lobe responsible for sentence comprehension. METHODS:We performed a cloze paradigm requiring silent reading of a visually presented sentence-completion task based on semantic meaning versus a letter-scanning epoch requiring the completion of nonlinguistic strings or a rest period. Before this task was clinically used in two patients epilepsy and cavernous angioma, its feasibility and accuracy were tested in 14 healthy right-handed participants. RESULTS:Results showed significant activation of the posterior temporal cortex, including a broad area across the posterior left temporal cortex extending into the inferior parietal lobule. When the sentence completion-minus-letter string task was compared with the sentence completion-minus-rest task, increased activation was present in the posterior temporal lobe. CONCLUSION/CONCLUSIONS:Decreased significant activation during the sentence completion-minus-rest contrast may be attributed to increased noise from intersubject variability in the rest period. Our results suggest that this task elucidates areas important to reading comprehension in the posterior and inferior temporal regions that verbal fluency and auditory discrimination tasks do not. Data from two cases are summarized to exemplify the input of this task for neurosurgery.

OBJECTIVE:To estimate the comparative prevalence of bipolar symptoms in respondents with epilepsy vs other chronic medical conditions. METHODS:The Mood Disorder Questionnaire (MDQ), a validated screening instrument for bipolar I and II symptoms, in conjunction with questions about current health problems, was sent to a sample of 127,800 people selected to represent the US adult population on selected demographic variables. A total of 85,358 subjects (66.8%) aged 18 or older returned the survey and had usable data. Subjects who identified themselves as having epilepsy were compared to those with migraine, asthma, diabetes mellitus, or a healthy comparison group with regard to relative lifetime prevalence rates of bipolar symptoms and past clinical diagnoses of an affective disorder. RESULTS:Bipolar symptoms, evident in 12.2% of epilepsy patients, were 1.6 to 2.2 times more common in subjects with epilepsy than with migraine, asthma, or diabetes mellitus, and 6.6 times more likely to occur than in the healthy comparison group. A total of 49.7% of patients with epilepsy who screened positive for bipolar symptoms were diagnosed with bipolar disorder by a physician, nearly twice the rate seen in other disorders. However, 26.3% of MDQ positive epilepsy subjects carried a diagnosis of unipolar depression, and 25.8% had neither a uni- nor bipolar depression diagnosis. CONCLUSION/CONCLUSIONS:Bipolar symptoms occurred in 12% of community-based epilepsy patients, and at a rate higher than in other medical disorders. One quarter were unrecognized.

This study assessed the impact of comorbid depression on health care utilization and health care coverage by people with epilepsy in US communities using a postal survey questionnaire. People with untreated depression used significantly more health resources of all types assessed with and without adjustment for seizure type, seizure recency, and days with epilepsy symptoms. The number of visits to medical doctors and psychiatrists differed significantly among people with no (N = 443), mild to moderate (N = 58), and severe (N = 148) symptoms of depression who were not receiving antidepressant treatment (all P < 0.001). People with current symptoms treated with antidepressants had more medical visits than people with no current symptoms ( P=0.016 ). People with current symptoms but not treated for depression had more medical and psychiatric visits than people with no current symptoms (both P = 0.001). These data highlight the impact of comorbid depression on health care utilization by people with epilepsy.