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Query: UMLS:C0036572 (seizures)
 80,221 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Neurologic manifestations, afflicting up to 70% of SLE patients, include psychosis, seizures, chorea, neuropathies, and stroke. MRI is useful in evaluation of lupus patients and several reports have documented cerebral atrophy or focal hyperintensities. We report an unusual MRI appearance in a 56-year-old woman with SLE, diagnosed on the basis of pleuritis, lymphopenia, anti-DNA antibodies, and neurologic involvement. She reported recent onset of Raynaud's phenomenon and generalized macular rash. She presented after two months of gradual deterioration with memory loss, flattened affect, dysphagia, dysarthria, anomia, and somnolence, without focal neurologic signs. Investigations included elevated ESR, reduced complement, normal CSF without oligoclonal bands, negative viral serology, normal hormone and vitamin levels, normal renal and hepatic function. Neuropsychologic testing showed widespread impairment (WAIS-R: FSIQ-63; WMS-69; DRS-98; RCPM-14; WAB AQ-78.8). CT was normal but MRI showed strikingly symmetric, confluent hyperintensities extensively involving cerebral and cerebellar white matter on T1 and T2 weighted scans. Basal ganglia and subependymal and subcortical white matter were spared. Treated with prednisone, the patient made a gradual, but incomplete, recovery. These MRI findings may reflect widespread vasculopathy or direct immunologic brain insult with or without immunologic blood-brain barrier disruption.
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PMID:Dementia with leukoencephalopathy in systemic lupus erythematosus. 191 71

Laterality and age of onset effects on semantic and figural memory were evaluated in 30 right-handed, left speech dominant (amobarbital test) patients with epilepsy before and after temporal lobectomy. There were no effects of focus on WAIS-R IQ scores. Early onset (less than or equal to 5 years) was associated with lower IQ and memory (WMS). Left Temporal (LT) patients showed worse semantic than figural memory preoperatively. Unexpectedly, early onset LT had marked postoperative decline of figural memory, whereas late onset LT patients showed the previously reported worsening of semantic memory. Right Temporal (RT) lobectomy patients, in contrast, improved in both semantic and figural memory regardless of age of onset. A "crowding effect" was suggested by the decline in figural memory following surgery in the early onset LT patients who remained stable or improved in semantic memory. Results indicate the need to incorporate age of onset of seizures into laterality models of memory function following unilateral temporal-hippocampal resection.
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PMID:Memory deficits before and after temporal lobectomy: effect of laterality and age of onset. 292 10

Neuropsychological assessment has been extensively used in the presurgical evaluation of temporal lobe epilepsy (TLE) patients to assist in determining lateralization of seizure onset. Very few studies have examined the accuracy with which commonly used neuropsychological instruments provide this information in the individual patient. In 81 patients (49 right-, 32 left-TLE) without space-occupying lesions in whom correct seizure lateralization was inferred on the basis of postsurgical seizure-free status, we compared the frequency with which discrepancies between the Wechsler Memory Scale-Revised (WMS-R; Wechsler, 1987) Verbal and Visual Memory Indices, Warrington Recognition Memory Test (WRMT; Warrington, 1984) Words and Faces scaled scores, and Intracarotid Amobarbital Procedure (IAP) hemispheric memory scores correctly predicted seizure lateralization in the individual patient. Using both clinical analysis and discriminant function analyses (DFA), the IAP was found to be a clearly superior predictor of seizure laterality to the neuropsychological measures, whether used individually or in combination with one another. Using clinical analysis the WRMT was found to be a superior predictor to the WMS-R, which frequently gave false lateralizing information. Using all 3 measures in combination with one another, 87.1% of patients were correctly lateralized using DFA. Correctly lateralized patients were older and had longer durations of seizure disorder.
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PMID:Individual patient prediction of seizure lateralization in temporal lobe epilepsy: a comparison between neuropsychological memory measures and the Intracarotid Amobarbital Procedure. 912 57

We examined whether differences between the expanded standardization protocol (SP) used to derive norms for the final published version (PB) of the Wechsler Memory Scale - Third Edition (WMS-III; Wechsler, 1997a) would result in differences on the Primary Indexes in a neurologic sample. Specifically, we examined the comparability of the performances of 63 patients with temporal lobectomy (TL) who were administered either the expanded SP protocol (n = 33: 22 left TL and 11 right TL) or the PB battery (n = 30: 11 left TL and 19 right TL). Patients who were administered the SP or PB were comparable in terms of age, sex, education, seizure duration, postsurgical seizure status, and Full Scale IQ. Postoperative intervals were significantly longer for the SP group, although correlational analyses demonstrated no significant relationship between postoperative follow-up interval and WMS-III performance. A series of t tests revealed no significant differences on any of the eight Primary Index scores between patients taking the two versions of the WMS-III for either left or right TL groups. Furthermore, repeated measures analyses of variance failed to show significant differences on modality-specific memory scores between the SP and PB for the left and right TL groups. The current study indicates that temporal lobectomy patients obtained comparable scores on the two versions of the WMS-III.
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PMID:Comparability of the expanded WMS-III standardization protocol to the published WMS-III among right and left temporal lobectomy patients. 1126 16

Several investigators have reported on the relationship between metabolism, using magnetic resonance spectroscopy (MRS), and function, using neuropsychological tests in temporal lobe epilepsy (TLE) patients, but the opinions regarding the results remain in contention. The aim of this study is to examine the relationship between metabolism, using proton MRS ((1)H-MRS), and function using several neuropsychological tests in the temporal lobes of TLE patients. We studied 29 TLE patients at our hospital using(1)H-MRS and neuropsychological tests. We used a clinical 1.5 T MR unit. We conducted five neuropsychological tests to examine the function of the left or right temporal lobe. There were significant correlations between the N-acetylaspartate/creatine + phosphocreatine (NAA/Cr) ratios and the scores of almost all of the neuropsychological tests for the temporal lobe function ipsilateral to the spike focus. However, in two Wechsler Memory Scale-Revised (WMS-R) subtests we found no significant correlation in the ipsilateral side. These findings suggest that the NAA/Cr ratios, which reflect neural metabolism, are closely related to function in the temporal lobes of TLE patients. The disparity between the results in two subtests of WMS-R show that several tests may be necessary in order to assess temporal lobe function.
Seizure 2001 Apr
PMID:A study of the relationship between metabolism using 1H-MRS and function using several neuropsychological tests in temporal lobe epilepsy. 1143 17

For seizure control in temporal lobe epilepsy, the head of the hippocampus to the choroidal point, parahippocampal gyrus, entorhinal area, uncus, and at least the basolateral nucleus of the amygdala should be completely removed. The subtemporal approach should be selected for removal of these structures, and it does not interrupt the temporal stem and optic radiation. Pre- and postoperative neuropsychological examinations revealed that there is no significant decline of scores of various examinations including WAIS, WMS, Randt memory, and verbal associates learning tests, even if the resection were performed on the language dominant side. Seizure control for the 20 non-lesional patients operated with this approach is 60% (Class I and II), without definite permanent complications.
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PMID:Microanatomy of medial temporal area and subtemporal amygdalohippocampectomy. 1237 76

To determine the utility of the Wechsler Memory Scale-Revised (WMS-R) in measuring material-specific memory changes, within-subject comparisons of the Verbal-Visual Memory Index discrepancy and discrepancy scores using short-term and delayed Logical Memory and Visual Reproduction subtests from the WMS-R were studied prior to and following temporal lobectomy among 30 patients with left temporal lobectomy, 30 with right temporal lobectomy, and 50 epileptic, non-surgical controls. The groups were matched on age, sex, handedness, age at seizure onset, duration of epilepsy, and presurgical Verbal and Performance IQ; the right temporal group had a higher mean educational level (p <.05). All surgical patients were left hemisphere dominant for speech; those who had persistent postoperative seizures were excluded from study. On retesting, left temporal lobectomy was associated with a marked change in short-term and delayed memory discrepancy scores primarily due to a drop in verbal memory. Right temporal lobectomy was not associated with a drop in visual memory, suggesting that the WMS-R appears to reflect decrements in material-specific memory following left but not right temporal lobectomy. The nonsurgical controls showed increases in both short-term and delayed memory discrepancy scores due to increases in short-term and delayed verbal memory. Relative to these controls, the absence of comparable increases in verbal memory among the right temporal patients suggests that right temporal lobectomy may be associated with risk to verbal memory.
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PMID:Detection of changes in material-specific memory following temporal lobectomy using the Wechsler Memory Scale-Revised. 1458 8

We report on a 22 year-old woman with left temporal lobe epilepsy who had suffered complex partial seizures since childhood. At 19 years 10 months of age she underwent selective amygdalohippocampectomy, which resulted in a complete cessation of seizures. Preoperatively, the Logical Memory II section of the WMS-R revealed poor logical memory function. Postoperatively, the patient's scores on several neuropsychological tests had deteriorated, namely, the Miyake Paired-Associate Word Learning Test (related and unrelated pairs), several sections of the WMS-R (Figural Memory, Logical memory I, Visual Reproduction II, Visual Paired Associates I, and Verbal Paired Associates I and II), and the BVRT-R. In particular, her scores on the Visual Paired Associates I, Verbal Paired Associates I and II sections of the WMS-R, and the BVRT-R not only declined at one and three months post-surgery, but also showed progressive deterioration at 16 and 18 months post-surgery. It should be kept in mind that selective amygdalohippocampectomy can result in progressive postoperative, deterioration in some aspects of memory function.
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PMID:Memory function decline over 18 months after selective amygdalohippocampectomy. 1524 56

Memory difficulties are a frequent cognitive complaint of patients with chronic epilepsy. Previous studies have suggested that the presence of a seizure focus causes reorganization of brain mechanisms underlying memory function. Here we examine whether seizure onset in the left hemisphere and onset in the right hemisphere have different effects on memory lateralization and whether longer duration of epilepsy is associated with increased lateralization of memory functions to the unaffected hemisphere. We hypothesized that hemisphere of onset and duration of epilepsy would influence plasticity of memory mechanisms, similar to the plasticity observed for language mechanisms. Healthy controls (HC, N = 10) and patients with epilepsy (N = 23, 11 with a left- and 12 with a right-hemisphere focus) performed a scene-encoding fMRI task at 4 T. Active voxels (relative to scrambled image viewing) were identified for each participant. Memory laterality indices (LIs) were calculated in three regions of interest (ROIs) designed on the basis of HC group data: a functional ROI, an anatomical-hippocampal ROI, and an anatomical-medial temporal ROI encompassing hippocampus and parahippocampal gyrus. In healthy controls, LIs were suggestive of slight left lateralization of encoding memory for pictures. Patients with right hemisphere epilepsy showed a nonsignificant increase in degree of left lateralization. In contrast, patients with left hemispheric epilepsy showed right-lateralized activation, differing significantly from controls and from patients with right hemispheric epilepsy. Neuropsychological measures of memory (WMS-III Story Recall) across epilepsy patients predicted LIs in the anatomical ROIs: higher scores were associated with more left-lateralized medial temporal fMRI activation. Neither age of onset nor duration of epilepsy was significantly related to LI. These results indicate that focal epilepsy may influence the functional neuroanatomy of memory function.
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PMID:Medial temporal fMRI activation reflects memory lateralization and memory performance in patients with epilepsy. 1816 41

Distinguishing psychogenic nonepileptic seizures (PNES) from epileptic seizures (ES) is a difficult task that is often aided by neuropsychological evaluation. In the present study, signal detection theory (SDT) was used to examine differences between these groups in neuropsychological performance on the Wechsler Memory Scale, Third Edition, Word List Test (WMS-III WLT). The raw WMS-III WLT scores on this task failed to discriminate the two groups; however, with the use of SDT, patients with PNES were found to have a negative response bias and increased memory sensitivity as compared with patients with ES. When patients with left (LTLE) and right (RTLE) temporal lobe epilepsy were compared, the patients with LTLE demonstrated decreased memory sensitivity but a similar response bias as compared with the patients with RTLE. Memory impairment in patients with PNES may be related to faulty decision-making strategies, rather than true memory impairment, whereas memory performance differences between the LTLE and RTLE groups are likely related to actual differences in memory abilities.
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PMID:Application of signal detection theory to verbal memory testing to distinguish patients with psychogenic nonepileptic seizures from patients with epileptic seizures. 1943 89


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