Faculty Bibliography

OBJECTIVE: To examine the relationship between the degree of handedness and hemispheric language dominance in patients with epilepsy. METHODS: The authors examined the relationship between degree of handedness and hemispheric language dominance in 174 epilepsy surgery candidates using the intracarotid amobarbital procedure and results from a modified version of the Edinburgh Handedness Inventory. RESULTS: The incidence of atypical language dominance increased linearly with the degree of left-handedness, from 9% in strong right-handers (laterality quotient [LQ] = +100) to 46% in ambidextrous individuals and 69% in strong left-handers (LQ = -100). CONCLUSIONS: The incidence of atypical language dominance depends not only on the direction but also on the degree of handedness. In addition, direction of language dominance varies with hemisphere of seizure focus and degree of handedness. A familial history of sinistrality may have an additional effect on the likelihood of atypical dominance

CONTEXT: Establishing psychometric and measurement properties of concussion assessments is important before these assessments are used by clinicians. To date, data have been limited regarding these issues with respect to neurocognitive and postural stability testing, especially in a younger athletic population. OBJECTIVE: To determine the test-retest reliability and reliable change indices of concussion assessments in athletes participating in youth sports. A secondary objective was to determine the relationship between the Standardized Assessment of Concussion (SAC) and neuropsychological assessments in young athletes. DESIGN: We used a repeated-measures design to evaluate the test-retest reliability of the concussion assessments in young athletes. Correlations were calculated to determine the relationship between the measures. All subjects underwent 2 test sessions 60 days apart. SETTING: Sports medicine laboratory and school or home environment. Patients or Other Participants: Fifty healthy young athletes between the ages of 9 and 14 years. MAIN OUTCOME MEASURE(S): Scores from the SAC, Balance Error Scoring System, Buschke Selective Reminding Test, Trail Making Test B, and Coding and Symbol Search subsets of the Wechsler Intelligence Scale for Children were used in the analysis. RESULTS: Our test-retest indices for each of the 6 scores were poor to good, ranging from r = .46 to .83. Good reliability was found for the Coding and Symbol Search tests. The reliable change scores provided a way of determining a meaningful change in score for each assessment. We found a weak relationship ( r < .36) between the SAC and each of the neuropsychological assessments; however, stronger relationships ( r > .70) were found between certain neuropsychological measures. CONCLUSIONS: We found moderate test-retest reliability on the cognitive tests that assessed attention, concentration, and visual processing and the Balance Error Scoring System. Our results demonstrated only a weak relationship between performance on the SAC and the selected neuropsychological tests, so it is likely that these tests assess somewhat different areas of cognitive function. Our correlational findings provide more evidence for using the SAC along with a more complex neuropsychological assessment battery in the evaluation of concussion in young athletes

BACKGROUND AND PURPOSE: Patients with nonlesional temporal lobe epilepsy have long been known to have abnormalities of memory. Recently, these patients have been shown to have increased diffusivity in the hippocampus. We hypothesized that in these patients, a negative correlation would exist between diffusivity measures of the mesial temporal lobe and performance on neuropsychological tests. METHODS: Twenty presurgical patients with temporal lobe epilepsy and 20 age- and sex-matched healthy controls underwent MR imaging of the brain. Apparent diffusion coefficient region of interest measures were taken in both hippocampi and parahippocampal gyri by 2 independent observers. Mean whole brain diffusivity was calculated. All patients completed neuropsychological testing. Electroencephalogram and pathology results were collected. Patients and controls were compared with respect to each apparent diffusion coefficient measure. In patients, apparent diffusion coefficients ipsilateral and contralateral to the seizure focus were compared. Associations were assessed between diffusivity measures and neuropsychological scores. RESULTS: Eleven patients had right-sided seizure foci and 9 had left-sided seizure foci. Patients demonstrated higher apparent diffusion coefficient values than controls over the whole brain, in the hippocampi, and in the parahippocampal gyri (P < .05). Patients demonstrated higher apparent diffusion coefficient within the ipsilateral hippocampus (1.19 +/- 0.22 x 10(-3) s/mm2) and parahippocampal gyrus (1.02 +/- 0.12 x 10(-3) s/mm2) compared with the contralateral side (1.02 +/- 0.16 x 10(-3) s/mm2 and 0.96 +/- 0.09 x 10(-3) s/mm2, respectively) (P < .05). Negative correlations were seen between hippocampal apparent diffusion coefficients and multiple memory tests (P < .05). CONCLUSION: Quantitative diffusion measurements in the hippocampus correlate with memory dysfunction in patients with temporal lobe epilepsy

Clinical decision making about an athlete's return to competition after concussion is hampered by a lack of systematic methods to measure recovery. We applied standard regression-based methods to statistically measure individual rates of impairment at several time points after concussion in college football players. Postconcussive symptoms, cognitive functioning, and balance were assessed in 94 players with concussion (based on American Academy of Neurology Criteria) and 56 noninjured controls during preseason baseline testing, and immediately, 3 hr, and 1, 2, 3, 5, and 7 days postinjury. Ninety-five percent of injured players exhibited acute concussion symptoms and impairment on cognitive or balance testing immediately after injury, which diminished to 4% who reported elevated symptoms on postinjury day 7. In addition, a small but clinically significant percentage of players who reported being symptom free by day 2 continued to be classified as impaired on the basis of objective balance and cognitive testing. These data suggest that neuropsychological testing may be of incremental utility to subjective symptom checklists in identifying the residual effects of sport-related concussion. The implementation of neuropsychological testing to detect subtle cognitive impairment is most useful once postconcussive symptoms have resolved. This management model is also supported by practical and other methodological considerations