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Psychological functioning and seizure outcome following temporal lobectomy
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Abstracts /Archives of Clinical Neuropsychology 15 (2000) 653450
evaluation. Additional demographic and medical history data were available. Regression analyses were used to predict diagnosis using clinical symptoms, MMPI-2 data, and demographic variables. MMPI-2s were classified as NES or ES profiles based on scoring rules suggested by Den-y and McLachlan (1996). MMPI-2 profile was the single best predictor of diagnosis (R2= 0.76). However, the addition of clinical symptoms of preparatory movements and stiffening and presence of psychological treatment history increased the R to 0.88. Thus, the results of this preliminary study suggest that detailed clinical symptom description combined with the MMPI-2 data maybe an effective tool in the diagnosis of NES.
Psychological functioning and seizure outcome following temporal lobectomy Lacritz LH, Epker MO, Van Ness 8 Agostini M, Cullurn CM. Psychological functioning was examined in 22 patients with intractable temporal lobe epilepsy (right = 9, left = 13) before and after temporal lobectomy for seizure control. Subjects were divided into 2 groups based on seizure outcome (seizure-free n = 15, non-seizure-free n = 7). Repeated measures analyses on pre/post MMPI-2 results revealed significant Group x Time interactions for scales F, 1,3,4,7,8, and 0. A similar trend was seen for Scale 2 (Depression), but did not reach statistical significance. Alternatively, no significant changes were observed on some of the more characterological subscales of the MMPI-2 including scales 5, 6, and 9. Therefore, subjects who did not achieve complete amelioration of their seizure disorder after surgery (despite a reduction in seizure frequency in most cases) demonstrated significantly greater psychological distress, health concerns, irritability, anxiety, and withdrawal after surgery, while seizure-free subjects showed an improvement in psychological functioning. Psychological outcome did not appear to be affected by cognitive variables, as no statistically significant changes on measures of memory, language or other cognitive domains were observed following surgery in either group. These results highlight the potential for differential psychological effects of epilepsy surgery depending on seizure outcome. Furthermore, they support the need to provide pre- and post-surgical psychological intervention for many of these patients, including discussion of expectations for surgery, possible outcomes, and risks (including exacerbation of psychological problems).
Qualitative scoring of the Rey-Osterrieth epilepsy patients Schwartz TJ Peters CE, Stein A.
Complex Figure proves useful in evaluating
Although it is customary to use a single, quantitative summary score for each condition for the ReyOsterrieth Complex Figure (ROCF; Osterrieth, 1944), this system fails to recognize the wealth of process features captured by this task. The Boston Qualitative Scoring System (BQSS; Stem et al., 1994), was developed to provide both a comprehensive set of qualitative ratings and important quantitative summary scores. In the present study, nine epilepsy patients’ ROCF were assessed with the BQSS as part of a comprehensive pre-surgical neuropsychological evaluation. Six of the patients had medial temporal seizure foci (TLE) and 3 had frontal foci (FLE). Using the quantitative summary scores, half of the TLEs and none of the FLEs showed impairments. In contrast, all but 1 of the patients demonstrated significant impairments on the qualitative ratings. These ratings revealed decreased presence and placement of figural features over delays for all of the TLEs. For the FLEs, the qualitative ratings helped to reveal impairments in synthesizing and integrating the information. These process scores were clinically useful, in many cases revealing deficits that were too subtle to be captured by
Abstracts /Archives of Clinical Neuropsychology 15 (2000) 653450
evaluation. Additional demographic and medical history data were available. Regression analyses were used to predict diagnosis using clinical symptoms, MMPI-2 data, and demographic variables. MMPI-2s were classified as NES or ES profiles based on scoring rules suggested by Den-y and McLachlan (1996). MMPI-2 profile was the single best predictor of diagnosis (R2= 0.76). However, the addition of clinical symptoms of preparatory movements and stiffening and presence of psychological treatment history increased the R to 0.88. Thus, the results of this preliminary study suggest that detailed clinical symptom description combined with the MMPI-2 data maybe an effective tool in the diagnosis of NES.
Psychological functioning and seizure outcome following temporal lobectomy Lacritz LH, Epker MO, Van Ness 8 Agostini M, Cullurn CM. Psychological functioning was examined in 22 patients with intractable temporal lobe epilepsy (right = 9, left = 13) before and after temporal lobectomy for seizure control. Subjects were divided into 2 groups based on seizure outcome (seizure-free n = 15, non-seizure-free n = 7). Repeated measures analyses on pre/post MMPI-2 results revealed significant Group x Time interactions for scales F, 1,3,4,7,8, and 0. A similar trend was seen for Scale 2 (Depression), but did not reach statistical significance. Alternatively, no significant changes were observed on some of the more characterological subscales of the MMPI-2 including scales 5, 6, and 9. Therefore, subjects who did not achieve complete amelioration of their seizure disorder after surgery (despite a reduction in seizure frequency in most cases) demonstrated significantly greater psychological distress, health concerns, irritability, anxiety, and withdrawal after surgery, while seizure-free subjects showed an improvement in psychological functioning. Psychological outcome did not appear to be affected by cognitive variables, as no statistically significant changes on measures of memory, language or other cognitive domains were observed following surgery in either group. These results highlight the potential for differential psychological effects of epilepsy surgery depending on seizure outcome. Furthermore, they support the need to provide pre- and post-surgical psychological intervention for many of these patients, including discussion of expectations for surgery, possible outcomes, and risks (including exacerbation of psychological problems).
Qualitative scoring of the Rey-Osterrieth epilepsy patients Schwartz TJ Peters CE, Stein A.
Complex Figure proves useful in evaluating
Although it is customary to use a single, quantitative summary score for each condition for the ReyOsterrieth Complex Figure (ROCF; Osterrieth, 1944), this system fails to recognize the wealth of process features captured by this task. The Boston Qualitative Scoring System (BQSS; Stem et al., 1994), was developed to provide both a comprehensive set of qualitative ratings and important quantitative summary scores. In the present study, nine epilepsy patients’ ROCF were assessed with the BQSS as part of a comprehensive pre-surgical neuropsychological evaluation. Six of the patients had medial temporal seizure foci (TLE) and 3 had frontal foci (FLE). Using the quantitative summary scores, half of the TLEs and none of the FLEs showed impairments. In contrast, all but 1 of the patients demonstrated significant impairments on the qualitative ratings. These ratings revealed decreased presence and placement of figural features over delays for all of the TLEs. For the FLEs, the qualitative ratings helped to reveal impairments in synthesizing and integrating the information. These process scores were clinically useful, in many cases revealing deficits that were too subtle to be captured by