Faculty Bibliography

The goals of this work were to: (1) determine the prevalence of clinically significant obsessive-compulsive (OC) symptoms in patients with temporal lobe epilepsy (TLE), (2) characterize the differences in self-reported OC symptoms in patients with TLE and a normative control group, and (3) compare the severity of OC symptoms in right and left hemisphere TLE patients. Patients with TLE (n=30) were administered the Obsessive-Compulsive Inventory (OCI). As a group, patients with TLE had a higher prevalence of OC symptoms than the nonpatient normative sample. In addition, TLE patients exhibited elevated scores on all but 3 of the 16 OCI scales and subscales. There were no reliable differences in OC symptoms in patients with right versus left hemisphere seizure foci, although the right hemisphere patients tended to score higher on both scales of the OCI

OBJECTIVE: To characterize cognitive status in a sample of individuals with late-onset GM2 gangliosidosis (commonly referred to as late-onset Tay-Sachs disease). METHODS: Seventeen subjects (13 men, 4 women) diagnosed with GM2 gangliosidosis were evaluated. Subjects ranged in age from 18 to 56 years and were in various stages of disease progression. Subjects underwent comprehensive neuropsychological assessment. Impairment was defined as performance more than 1.6 SD below the normative mean. RESULTS: Group mean performance was within the denoted normal range on all measures except on a task assessing visual sequencing and set shifting. Approximately one-half of the sample scored in the impaired range on measures of processing speed, visual sequencing, and set shifting. One-third of the sample also scored in the impaired range on measures of delayed verbal recall. Impairment tended to be restricted to a subset of the sample, as 5 of the 14 subjects able to undergo formal testing accounted for 70% of the total number of impaired scores. If the three subjects unable to participate in formal testing are also considered impaired, 47% of the current sample exhibited significant cognitive impairment in at least one cognitive domain. CONCLUSION: In late-onset GM2 gangliosidosis, there is a risk of impairment in executive functioning and memory as well as cerebellar dysfunction. Dementia was not present in any subjects in the current sample

OBJECTIVE: Depression, anxiety, and psychosis are the most frequent psychiatric disorders after epilepsy surgery. The only new-onset somatoform disorder reported postoperatively is conversion disorder. We identified 10 patients who developed somatoform disorder other than nonconversion epileptic seizures after anterior temporal lobectomy. METHOD: We retrospectively reviewed the charts of 325 anterior temporal lobectomy and 125 extratemporal surgeries between 1991 and 2000. RESULTS: Seven of the patients developed undifferentiated somatoform disorder after anterior temporal lobectomy, 1 had pain and body dysmorphia, another had pain disorder, and another had body dysmorphia alone, but none were found after extratemporal surgeries (chi-square = 3.93; P < or = 0.05). Somatoform disorder was significantly more common in right anterior temporal lobectomy (n = 9) than left anterior temporal lobectomy (n = 1) (chi-square = 6.5; P < or = 0.025). CONCLUSIONS: Our findings suggest that right temporal resection contributes to the development of somatoform disorders in our patients and that right temporal dysfunctions may contribute to idiopathic somatoform disorders

Many commonly used measures of figural reproduction have been found to be relatively insensitive to the effects of right temporal lobe dysfunction. More positive findings are present in studies using measures of figural learning over repeated trials. This study examined the use of a commercially available measure of figural learning in a sample of epilepsy patients undergoing presurgical neuropsychological testing. The Brief Visuospatial Memory Test-Revised (BVMT-R) was administered to 47 subjects undergoing comprehensive presurgical workups with video and EEG monitoring. Groups with left (N = 25) and right (N = 22) temporal lobe seizures did not differ on BVMT-R measures of learning, delayed recall, or yes/no recognition. Approximately 29% of the sample exhibited 'impaired' performance in comparison to published norms. The results of receiver operating curve analyses revealed little discrimination in performance between groups. The BVMT-R does not appear to have the sensitivity required for assessing nonverbal memory in this population

The cognitive effects of subthalamic nucleus (STN) stimulation in Parkinson's disease (PD) have been examined. However, there are no reported studies that evaluate, by incorporating a disease control group, whether neuropsychological performance in surgical patients changes beyond the variability of the assessment measures. To examine this issue, 17 PD patients were tested before and after bilateral STN stimulator implantation, both on and off stimulation. Eleven matched PD controls were administered the same repeatable neuropsychological test battery twice. Relative to changes seen in the controls, the surgery for electrode placement mildly adversely affected attention and language functions. STN stimulation, per se, had little effect on cognition. The STN DBS procedure as a whole resulted in a mild decline in delayed verbal recall and language functions. There were no surgery, stimulation, or procedure effects on depression scale scores. In contrast to these group findings, one DBS patient demonstrated significant cognitive decline following surgery

Findings from previous research have argued for the dissociation of two visual-perceptual tasks traditionally thought to be mediated by the nondominant hemisphere (i.e. perceptual closure and facial discrimination). This, primarily methodological, study examined the extent to which the facial closure measure (Mooney closure faces test) involves 'closure' and/or facial discrimination. A factor analysis of six visual perceptual measures, carried out separately for left brain damaged (LBDs, n=33) and right brain damaged (RBDs, n=30) patients, resulted in two relatively independent factors (i.e. a closure factor and a facial discrimination factor), with the Mooney closure faces test loading on both. The mixed factorial structure did not aid the facial closure measure's sensitivity to right-sided brain disease. Moreover, age and education intercorrelated differently with the two factors. Results argue for the use of more discrete visual-perceptual measures when examining perceptual functioning and/or right hemisphere integrity, and imply the existence of at least two discrete cortical level visual-perceptual neural systems