Faculty Bibliography

We examined the sensitivity of the Rey Auditory Verbal Learning Test (AVLT), California Verbal Learning Test (CVLT), Boston Naming Test (BNT), and Multilingual Aphasia Examination Visual Naming subtest (MAE VN) to lateralized temporal lobe epilepsy (TLE) in patients who subsequently underwent anterior temporal lobectomy. For the AVLT (n = 189), left TLE patients performed more poorly than their right TLE counterparts [left TLE = 42.9 (10.6), right TLE = 47.7 (9.9); p < .002 (Cohen's d = .47)]. Although statistically significant, the CVLT group difference (n = 212) was of a smaller magnitude [left LTE = 40.7 (11.1), right TLE = 43.8 (9.9); (p < .03, Cohen's d = .29)] than the AVLT. Group differences were also present for both measures of confrontation naming ability [BNT: left LTE = 43.1 (8.9), right TLE = 48.1 (8.9); p < .001 (Cohen's d = .56); MAE VN: left TLE = 42.2, right TLE = 45.6, p = .02 (Cohen's d = .36)]. When these data were modeled in independent logistic regression analyses, the AVLT and BNT both significantly predicted side of seizure focus, although the positive likelihood ratios were modest. In the subset of 108 patients receiving both BNT and AVLT, the AVLT was the only significant predictor of seizure laterality, suggesting individual patient variability regarding whether naming or memory testing may be more sensitive to lateralized TLE

Temporal lobe epilepsy (TLE) can impair interictal cognitive function. In the perceptual domain, previous psychophysical studies demonstrated specific deficits in auditory and tactile perception in patients with TLE. This study compared performance of 25 TLE subjects and 27 controls on two low-level, visual tasks: luminance discrimination and frequency discrimination. Both tasks were performed under a relatively easy and a relatively difficult condition, by adjusting the stimulus duration. TLE subjects performed as well as controls on both tasks at both stimulus durations. These results imply that interictal occipital lobe function, as reflected in performance on low-level visual tasks, is not impaired in TLE, consistent with functional imaging data. Furthermore, since TLE subjects performed normally while taking therapeutic doses of multiple AEDs, the data suggest that these AEDs do not impair visual perception

BACKGROUND:Surgery for intractable temporal lobe epilepsy usually controls seizures and improves health-related quality of life (HRQOL), but some patients experience continued seizures, memory decline, or both. The relative impact of these unfavorable outcomes on HRQOL has not been described. METHODS:We studied seizure control, memory change, and HRQOL among 138 patients in the Multicenter Study of Epilepsy Surgery (MSES), an ongoing, prospective study of epilepsy surgery outcomes. Seizure remission at 2 years and 5 years was prospectively determined based upon regularly scheduled follow-up calls to study patients throughout the follow-up period. HRQOL was assessed annually using the Quality of Life in Epilepsy Inventory (QOLIE-89). Memory decline was determined by change in verbal delayed recall from baseline to the 2- or 5-year follow-up. RESULTS:HRQOL improved in patients who were in remission at the 2-year or 5-year follow-up, regardless of memory outcome. Among those not in remission at both 2 and 5 years (25/138, 18%), HRQOL remained stable when memory did not decline (14/138, 10%), but HRQOL declined when memory did decline (11/138, 8%). These 11 patients had baseline characteristics predictive of poor seizure or memory outcome. Declines were most apparent on HRQOL subscales assessing memory, role limitations, and limitations in work, driving, and social activities. CONCLUSIONS:After temporal resection, health-related quality of life (HRQOL) improves or remains stable in seizure-free patients despite memory decline, but HRQOL declines when persistent seizures are accompanied by memory decline. These results may be useful in presurgical counseling and identifying patients at risk for poor psychosocial outcome following surgery.

The ecological validity of neuropsychological instruments has become an important topic in recent decades, as neuropsychologists are asked to address real-world outcomes with increasing frequency. Although novel instruments that tap skills required for everyday functioning have been developed, it is unclear whether these instruments are migrating from research laboratories into the applied settings of clinical neuropsychologists. The current study surveyed assessment practices of neuropsychologists with regard to their utilization of instruments designed with ecological concerns in mind. Respondents included 747 North American, doctorate-level psychologists (40% usable response rate) affiliated with Division 40 of the American Psychological Association, National Academy of Neuropsychology, or the International Neuropsychological Society. Results indicated that approximately one-third of respondents reported use of ecologically oriented instruments (EOIs), and these instruments were generally utilized with much less frequency than traditional measures. Additionally, certain practice demographics affected usage rates of EOIs. Study findings are interpreted in the context of a growing body of literature that calls attention to the importance of developing and utilizing instruments that are able to handle the complex, real-world issues increasingly addressed during the neuropsychological assessment process