Neuropsychology of Childhood Epilepsy (Advances in Behavioral Biology)

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A recent review 4 concluded that progressive cognitive decline does occur in a proportion of patients and appears to be associated with markers of a difficult epilepsy course e. In summary, the neurobehavioral status of persons with epilepsy is affected by factors unassociated with seizures or their treatment per se—given that there is evidence of abnormalities prior to the onset of the disorder, factors that are associated with the course or consequences of the disorder and its treatment, as well as general neurobiological factors that affect cognition in all of us.

The literature on cognition and epilepsy is largely one of characterization and description, not treatment or remediation—a glaring omission in such a long and rich tradition. National Center for Biotechnology Information , U. Journal List Epilepsy Curr v. This article has been cited by other articles in PMC. Abstract It is well known that neuropsychological impairment can be associated with chronic epilepsy. Cognitive Problems May Antedate the Diagnosis of Epilepsy As investigators seek to determine the onset and timing of neurocognitive disruptions, children with new-onset epilepsy can help provide an early window on the process.

Open in a separate window. Structural Brain Abnormality One factor that may underlie cognitive pathology in children with epilepsy is structural brain abnormality. Progressive Cognitive Impairment Recent investigations have focused on the cumulative neurobiological burden associated with chronic epilepsy and the risk of progressive cognitive impairment Cognition and Temporal Lobe Epilepsy Temporal lobe epilepsy has been of special interest from a neuropsychological perspective, as it is a common syndrome, frequently with onset in childhood or adolescence and a prolonged and intractable course 66 , A Taxonomic Approach to Cognitive Evaluation Presentation and Course A yet untapped approach to understanding cognitive morbidity in epilepsy is taxonomic in nature.

Chronic epilepsy and cognition. Lateralization of verbal memory and unilateral hippocampal sclerosis: J Clin Exp Neuropsychol. Aldenkamp A, Arends J. The relative influence of epileptic EEG discharges, short nonconvulsive seizures, and type of epilepsy on cognitive function. Neuropsychological effects of seizures. Helmstaedter C, Kurthen M. Clinical neuropsychology and neocortical epilepsies.

Jokeit H, Ebner A. Effects of chronic epilepsy on intellectual functions. Neuropsychology of childhood epilepsy: Intelligence in childhood epilepsy syndromes. Pitkanen A, Sutula TP. Is epilepsy a progressive disorder? Prospects for new therapeutic approaches in temporal-lobe epilepsy. Neuropsychological functioning among 32 patients with temporal lobe epilepsy and their discordant siblings. Cognitive skills in children with intractable epilepsy: Benign childhood epilepsy with occipital paroxysms: Neuropsychological abilities of children with epilepsy.

Neuropsychological and behavioral status of children with complex partial seizures. Dev Med Child Neurol. Children with new-onset epilepsy: Not only a matter of epilepsy: Neurocognitive development of children with congenital unilateral brain lesion and epilepsy. Psychological effects of sodium valproate and carbamazepine in epilepsy. Does short-term antiepileptic drug treatment in children result in cognitive or behavioral changes? Special education needs of children with newly diagnosed epilepsy.

Factors associated with academic achievement in children with recent-onset seizures. Behavior problems in children before first recognized seizures. Teacher assessment of behaviour in children with new-onset seizures. ADHD as a risk factor for incident unprovoked seizures and epilepsy in children. Psychiatric co-morbidity in children with newly diagnosed epilepsy. Major depression is a risk factor for seizures in older adults. Depression and suicide attempt as risk factors for incident unprovoked seizures. Progressive hippocampal and extrahippocampal atrophy in drug resistant epilepsy.

Quantitative MR imaging of the neocortex. Neuroimaging Clin N Am. The relationship between quantitative MRI and neuropsychological functioning in temporal lobe epilepsy. Disproportion in the distribution of gray and white matter: Cognitive consequences of coexisting temporal lobe developmental malformations and hippocampal sclerosis.

What is a Biological Psychologist?

Significance of fornix atrophy in temporal lobe epilepsy surgery outcome. Relationship between information processing speed in temporal lobe epilepsy and white matter volume. Cerebellar atrophy in temporal lobe epilepsy affects procedural memory. Investigating temporal lobe contribution to confrontation naming using MRI quantitative volumetrics.

J Int Neuropsychol Soc. Quantitative MRI in outpatient childhood epilepsy. ILAE-defined epilepsy syndromes in children: Predictors of hippocampal, cerebral, and cerebellar volume reduction in childhood epilepsy. Cerebral and cerebellar volume reduction in children with intractable epilepsy. Extra-hippocampal grey matter density abnormalities in paediatric mesial temporal sclerosis. Voxel-by-voxel comparison of automatically segmented cerebral gray matter—A rater-independent comparison of structural MRI in patients with epilepsy.

Voxel-based morphometric comparison of hippocampal and extrahippocampal abnormalities in patients with left and right hippocampal atrophy. Voxel based morphometry of grey matter abnormalities in patients with medically intractable temporal lobe epilepsy: J Neurol Neurosurg Psychiatry. Voxel-based morphometry of unilateral temporal lobe epilepsy reveals abnormalities in cerebral white matter. Voxel-based morphometry reveals gray matter network atrophy in refractory medial temporal lobe epilepsy.

Voxel-based morphometry of the thalamus in patients with refractory medial temporal lobe epilepsy. The neurodevelopmental impact of childhood onset temporal lobe epilepsy on brain structure and function and the risk of progressive cognitive effects. Chronic epilepsy and cognition: Long-term prognosis of seizures with onset in childhood. N Engl J Med.

Biologic factors as predictors of social outcome of epilepsy in intellectually normal children: The effects of refractory epilepsy on intellectual functioning in children and adults A longitudinal study. Prospective follow-up of intellectual development in children with a recent onset of epilepsy. The impact of childhood intelligence on later life: J Pers Soc Psychol. Childhood mental ability and dementia. A year prospective study of the Framingham cohort. Visual memory predicts Alzheimer's disease more than a decade before diagnosis.

Cognitive Problems May Antedate the Diagnosis of Epilepsy

Cognitive functioning in community dwelling older adults with chronic partial epilepsy. Characteristics of medial temporal lobe epilepsy: Interictal and ictal scalp electroencephalography, neuropsychological testing, neuroimaging, surgical results, and pathology. These developments are covered in Chapter 4 , on Neuroimaging.

The present chapter begins with a review of historically important single-case studies that were crucial in establishing the field of neuropsychology. The issue of localisation of function via neuropsychological instruments will be addressed.

Neuropsychology

Major neuropsychological findings in relation to schizophrenia and depression will be summarised. Recent findings on memory for emotional material will be presented. The chapter concludes with a brief overview of psychometric issues, followed by a summary of the most commonly used neuropsychological instruments in clinical research and practice. Berlucchi, in Encyclopedia of Neuroscience , Although humankind has always been interested in this issue, the science of neuropsychology is relatively young.

Its traditional approach was the study of the associations between focal brain lesions and psychological defects, but today neuropsychology is in possession of refined methodologies and theoretical frameworks for understanding both how the mind works and how the brain works.

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It is hoped that progress on both fronts will take neuropsychology nearer the solution of the as yet intractable mind—brain problem, despite the feelings of some that neuropsychological research in cognition should be restricted preferentially to inquiring how the mind works, leaving the brain to cognitive neuroscience. The term neuropsychology has a long history, but it was only in the s that an autonomous field of scientific inquiry with that name was formally established on the occasion of the foundation of an international scientific journal called Neuropsychologia.

However the foundations of neuropsychology were laid down in the 19th century with the search for systematic relations between circumscribed brain lesions and the loss of particular mental abilities. The subsequent evolution of neuropsychology occurred by way of the refinement of the anatomo-clinical approach in brain-injured patients and the development of experiments aimed at establishing correlations between mental performances and brain organizations in healthy humans. While most neuropsychologists are interested in linking mind work to brain work, so-called cognitive neuropsychologists primarily focus on how the mind works.

Neuropsychology is the subspecialty of psychology that studies brain—behavior relationships. Neuropsychology is a diverse field that includes experimental neuropsychology , the study of brain—behavior relationships in nonhumans; cognitive neuropsychology , the study of normal cognition in humans; behavioral neuropsychology , the blending of behavioral theory and neuropsychological principles; and clinical neuropsychology , the study of brain—behavior relationships in humans.

When a physician requests neuropsychological testing for a patient, a clinical neuropsychologist will likely provide the assessment. The major role of clinical neuropsychologists is the assessment of cognitive function in individuals with known or suspected brain damage. Cognitive functions may be conceptualized as those processes by which an individual perceives both external and internal stimuli; selects pertinent stimuli and inhibits nonpertinent stimuli; records, retains, and recalls information; forms associations between stimuli and manipulates information in the pursuit of a goal; and outputs information through the expression of overt behavior.

Clinical neuropsychology is based on the premise that assessments of these overt behaviors provide information about the functional integrity of the central nervous system. Early theories of the relationship between neurological functioning and cognition proposed independent modules of function, demonstrated most clearly by the phrenologist Gall. According to this theory, specific brain regions, reflected by bumps on the skull, were associated with specific behavior. With the advances in localization of function, in part owing to patient case studies, Broca refined our understanding of language processing, specifically within the realm of expressive language functions.

The work of Lashley and Goldstein led to a better understanding of the relationship between brain localization and behavior in neurologically healthy and neurologically damaged individuals. Halstead and Luria, through differing methods, clearly demonstrated that the assessment of overt behaviors could be used to identify brain damage with accuracy. It is hypothesized that cognitive function depends on both localized areas of specific functions as well as recursive connections between multiple brain areas that contribute, in toto, to cognition.

In order to understand such a complex system, neuropsychology is a composite field of study integrating various disciplines including psychology, neurology, clinical neurosciences, psychiatry, statistics, and physiology. The role of clinical neuropsychology is to elucidate the effects of brain damage on behavior, and to be able to account for the influences of other factors such as genetic, developmental, emotional, and experiential contributions on cognitive functioning.

Two main approaches to neuropsychological assessment are typically used by clinicians: Not only do neuropsychologists use both quantitative and qualitative approaches to testing, they also test cognitive function in a multidimensional manner. For example, the assessment of verbal memory, a form of cognition, may be assessed by simply asking patients to remember a list of words.

This approach to testing is inadequate by itself, however, because verbal memory is more complex than simply remembering lists of words. Therefore, assessment of verbal memory entails testing memory for lists of words, pairs of words, sentences, and short stories, using both immediate recall, delayed recall, and recognition paradigms. Such an assessment strategy provides enough data to analyze fully specific deficits in cognitive abilities that may be shared by multiple processes and allows for a finer discrimination of abilities and impairments.

This chapter provides an overview of adult clinical neuropsychology with the aim of assisting practitioners in the use and interpretation of neuropsychological data. Neuropsychology in epilepsy is characterized by its close connection to neurophysiology, neuropathology and neuroradiology, and neuropharmacology. The synergy of these faculties has been stimulated decisively by epilepsy surgery. Neuropsychology traditionally is synonymous with the detection, lateralization, and localization of brain dysfunctions and associated behaviors.

However, today, in the presence of powerful high-resolution brain imaging techniques and sophisticated electroencephalographic EEG evaluation tools, the role of neuropsychology is changing Baxendale and Thompson, Apart from revealing cerebral dysfunctions related to epilepsy, neuropsychology is increasingly becoming a tool for the monitoring of epilepsy outcome and for quality control of the treatment of epilepsy Elger et al.

Standardized neuropsychological evaluation has become an integrated and essential tool in the diagnostic and clinical evaluation of surgical patients with epilepsy, and it will be extended to play a critical role in the routine care of patients with epilepsy on a more general level. This change of the diagnostic focus, however, does not supersede the examination of specific brain dysfunctions.

On the contrary, if the cognitive effects of epilepsies and underlying pathologies are to be detected, or if the cognitive consequences of pharmacological or surgical treatment are the focus of interest, then it is essential to have sensitive and specific measures that respond to the etiological factors involved and that reflect focal and systemic changes in affected brain regions and functional networks Hoppe and Helmstaedter, There is a diverse range of different test instruments available, leaving the examiner spoilt for choice Jones-Gotman et al.

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Based on this knowledge, test selection should be evidence-based and oriented to predefined criteria and clinically relevant questions. Concommitant with diagnostic and therapeutic improvements in epilepsy, neuropsychological instruments themselves should become the subject of ongoing quality control. The specific role of neuropsychology in epilepsy and the diagnostic options for clinicians are best illustrated on the basis of the following etiological model of cognitive impairments in epilepsy.

Neuropsychology is practiced within four different—frequently complementary—nosologic frameworks: Under the influence of neuropsychology , the interaction of these nosologic frameworks has led to a shift from an earlier characterization of learning disabilities, whereby deficits in children's functioning were characterized primarily as they were manifest in the school context, to a more encompassing label, learning disorders, which reflects the role of the brain in learning—or not learning—the full range of behaviors that it supports.

Learning disorders are framed in terms of biology structural anomalies, genetic syndromes, acquired brain injury , psychological processes disorders whose core symptoms suggest disruption of more or less specific behavioral systems that support attention, language, visuospatial functioning, social skills, and executive processes , behavioral clusters attention-deficit disorder with and without hyperactivity, nonverbal learning disorders, Asperger syndrome , and manifest symptoms in particular settings failure to acquire reading, math, organization, and social comportment skills as expected.

Lezak, in Handbook of Clinical Neurology , Neuropsychology is the study of brain—behavior relationships. Its history may be traced to an assertion by Hippocrates — bc relating brain and mind and then by Galen ad — , who first described brain anatomy. The practice of neuropsychology , as we know it today, owes much to the work of Alexander Luria — , who, in conjunction with his mentor, Lev Vygotsky — , postulated that each area in the central nervous system served one of three basic functions: Luria conceptualized brain—behavior relationships in terms of functional systems representing interactive patterns of brain operations between defined areas of the brain.

The findings from these examinations spurred brain research as wounds due to penetrating missile shrapnel allowed examiners to relate small areas of brain damage to specific behavioral and cognitive deficits. Seashore, and others that he thought would identify patients with frontal-lobe dysfunction. Ralph Reitan, then a psychologist working with Halstead, added to Halstead's battery a test of communication abilities developed by J.

From the early s on, other psychologists were developing tests important for neuropsychology in the USA and elsewhere. Arthur Benton, at the University of Iowa, devised many relatively brief tests of specific cognitive functions, as did Elizabeth Warrington and her colleagues McCarthy and Warrington, in England and Brenda Milner , in Canada.

In Australia, Kevin Walsh wrote about the necessity of going beyond test scores to include the qualitative aspects of patients' examination responses if a patient's condition is to be truly understood, an examination approach evolved independently by Edith Kaplan and her co-workers in Boston Kaplan, Before the days of sophisticated neuroimaging, neuropsychology was mostly used for the identification and localization of a cerebral lesion.

The first systematic applications of neuropsychologic assessment thus dealt with diagnosis.

Neuropsychology - an overview | ScienceDirect Topics

Over time, neuropsychologists not only became more skilled at localizing brain lesions on the basis of neuropsychologic test data, but developed specific criteria for predicting the nature of behavioral changes and functional loss. In their efforts to separate psychiatric patients from those who were neurologically impaired, some clinicians in the s and s created single tests or test scoring systems purporting to achieve this goal, i.

Neuropsychologic assessment procedures have developed rapidly during the last three decades, reflecting the growing appreciation of its value for neurodiagnostic questions and for the care and treatment of neurologically impaired patients, and for patients needing cognitive and behavioral rehabilitation Lezak et al. Moreover, neuropsychologic assessment has made significant contributions to basic science research and to clinical knowledge in the neurologic sciences, psychiatry, and in clinical and cognitive psychology Frackowiak et al.

The current integrated approach to neuropsychologic assessment is a complex undertaking requiring basic clinical psychology knowledge and training, knowledge of brain function and integration and how it relates to common and critical patterns of behavior, and an understanding of the tests and assessment techniques used to assess brain dysfunction. As noted by Vanderploeg ,. Regardless of the structure of the evaluation, the process neither begins nor ends with giving tests alone Vanderploeg, ; see Milberg et al.

Formal neuropsychology is based on science and hence the chapter reviews the nature of science.