Behavioral effects of antiepileptic drugs.
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Anticonvulsants↗
Biomedical subjects
C B Dodrill
Publications and source records attributed to C B Dodrill.
Intellectual impairment as an outcome of status epilepticus.
Mental ability changes following status epilepticus (SE) are explored. With respect to the studies reviewed, it is noted that (1) most dealt with children, (2) few utilized any formal psychologic assessment, (3) most were retrospective, (4) earlier studies tended to disclose greater losses in mental ability than later studies, and (5) most investigators described at least a few adverse changes attributable to SE rather than to underlying neurologic disease. An original prospective study is also reported.
Adult↗
Analysis of errors on the Trail Making Test.
This study was designed to determine whether the number and/or types of errors on the Trail Making Test differentiated head-injured and normal control subjects. Errors on Part B were categorized into two types of shifting errors (from number to letter and from letter to number) and two types of sequencing errors (number and letter). Subjects consisted of 133 head-injured patients and 145 normal controls. Analysis showed that the frequency of errors on Parts A and B did not differ significantly between the groups nor did the percentage of subjects making errors. Total shifting and sequencing errors also did not differentiate between the two groups. Although head-injured subjects were more likely than controls to err in shifting from letters to numbers, this finding was of no apparent clinical usefulness. The discriminative value of time scores was confirmed.
Brain Damage, Chronic↗
Brain injury, handedness, and speech lateralization in a series of amobarbital studies.
Data on handedness and speech lateralization in patients selected for amobarbital studies have frequently been extrapolated to the normal population, despite the high frequency of brain injuries which might alter lateralization in these patients. To achieve a better definition of the relationships between brain injury, handedness, and speech lateralization, we reviewed the records of 237 consecutive patients who underwent amobarbital testing. Brain injuries sufficient to cause right hemiparesis were strongly associated with left handedness and atypical (right hemisphere or bilateral) speech representation. Among nonhemiparetic patients, abnormal extratemporal radiological findings were associated with an increased incidence of left handedness and atypical speech lateralization. It was not possible to demonstrate any alteration in handedness or speech representation resulting from abnormalities restricted to the temporal lobes, although such alterations could not be excluded. Handedness and speech lateralization established using amobarbital studies in neurosurgical patients may not be representative of the normal population.
Adolescent↗
Further studies of the Wonderlic Personnel Test as a brief measure of intelligence.
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Adult↗
Effects of antiepileptic drugs on abilities.
The selection of antiepileptic drugs depends not just on efficacy considerations but on psychological side effects, including their effects on abilities. In general, investigations show that antiepileptic drugs have slight to mild adverse effects on abilities. Of the major agents, carbamazepine is frequently associated with fewer of these effects. There are, however, a number of confounding factors which complicate the interpretation of these studies. These include procedures pertaining to subject selection, statistical analysis, seizures, co-medication, test selection, and the use of the active agent versus placebo study design. The importance of each of these factors is briefly discussed, with emphasis on their relevance to interpretation of existing studies.
Anticonvulsants↗
The role of psychosocial and financial factors in medication noncompliance in epilepsy.
Noncompliance in the taking of medication for a chronic disorder was related to emotional adjustment, psychosocial adjustment, ability to assume responsibility in life generally, and financial factors. Of 282 adults with epilepsy, eighty were identified by physicians' ratings as definitely compliant and forty-two as noncompliant. Results showed: 1) there were no differences between compliers and noncompliers in emotional adjustment; 2) noncompliance is not related to the cost of medications or to whether or not they are free; 3) noncompliance is more likely when patients report general financial distress, regardless of actual financial status; 4) persons with regular responsibilities in life also tend to take their medication regularly; and, 5) when reported financial distress and ability to assume responsibilities are considered simultaneously, the likelihood of noncompliance is four times as great in some patient groups as in others.
Adolescent↗
Emotional and intellectual correlates of unsuccessful suicide attempts in people with epilepsy.
This study evaluated the emotional and intellectual correlates of unsuccessful suicide attempts in persons with seizure disorders. Psychosocial evaluations were completed on 198 adults with epilepsy, of whom 32 had made one or more suicide attempts. The MMPI demonstrated increased anxiety and decreased ego strength among those with histories of suicide attempts in comparison to those without such a history. Intellectual abilities as evaluated by the WAIS were slightly lower among the suicide attempters, especially on language-related tasks. Unsuccessful suicidal behavior in epilepsy is probably the product of multiple conditions and circumstances, including seizures themselves, decreased adaptive abilities, increased emotional problems, and the continual availability of agents (antiepileptic medications) with which a suicide attempt may be undertaken.
Adolescent↗
Multidisciplinary prediction of seizure relief from cortical resection surgery.
Preoperative variables from a full range of medical specialties were used to predict degree of seizure relief from cortical resection surgery as treatment for epilepsy in 100 patients. General, seizure history, electroencephalographic (EEG), radiological, surgical, and psychological/neuropsychological data were considered. The patients were divided into one large predictive group (n = 75) and a smaller independent cross-validation sample (n = 25). Eight predictive variables emerged: single EEG focus; anterior-midtemporal lobe discharges; discharges only from the side of surgery; rate of occurrence of discharges in surgical area; Wechsler Adult Intelligence Scale Digit Symbol subtest; Marching Test, preferred hand, time; Minnesota Multiphasic Personality Inventory (MMPI) Hysteria scale score; and MMPI Paranoia scale score. By use of multivariate procedures, increased predictability of surgical outcome was obtained not only with the predictive group but with the independent cross-validation sample. The results demonstrate that predictions of seizure relief from epilepsy surgery can be made with 80% accuracy using multiple, rather than single, predictors.
Adolescent↗
Interictal behavioral features of patients with epilepsy.
Three questions are dealt with in this paper. (1) Do patients with epilepsy differ behaviorally from normal control groups and from persons with other medical and neurological conditions with respect to emotional adjustment, and if so, in what ways? (2) Are patients with temporal lobe epilepsy different emotionally or behaviorally from patients with other types of epilepsy? (3) To what degree does underlying brain dysfunction create a substrate for abnormal and maladaptive behavior? A review of the literature reveals the following. Persons with epilepsy demonstrate more emotional and psychiatric problems than normal individuals and more difficulties than other patient groups having nonneurological disorders, but have about the same incidence of these problems as persons with other neurological disorders. Increased emotional and psychiatric problems are not found among patients with temporal lobe epilepsy in comparison to patients with other types of epilepsy, although there are some behavioral peculiarities which appear in a small proportion of these patients. There is a mild tendency for impairment on neuropsychological tests to be associated with emotional and psychiatric problems in epilepsy.
Behavior↗
Incidence and doubtful significance of nonstandard orientations in reproduction of the key from the Aphasia Screening Test.
Nonstandard key orientations (reversed, vertical, diagonal, indeterminant) were studied for 138 normal control subjects and in 1,235 patients obtained from three sources. Keys in nonstandard orientations were slightly but not significantly more frequent in the patient groups. The vast majority of nonstandard keys were reversed. Comparisons with persons having normal key orientations on biodata, neuropsychological, intellectual, and personality variables gave negative results. Retesting a portion of the sample showed that the tendency to reproduce the key in irregular orientations was consistent over time in only about half the cases. In contrast to occasional reports in the literature, it appears that nonstandard orientations in the drawing of the key in the Aphasia Screening Test are infrequent, somewhat inconsistent in appearance, and likely of little or no demonstrable clinical significance.
Adolescent↗
Verbal memory deficits after left temporal lobectomy for epilepsy. Mechanism and intraoperative prediction.
Verbal memory deficits remain a major complication of dominant hemisphere temporal lobectomy for epilepsy. The extent of this deficit was assessed preoperatively and 1 month and 1 year postoperatively with the Wechsler Verbal Memory Scale (WMSV) in 14 adults undergoing left temporal lobectomy. Intraoperative localization of language and verbal memory was also performed by electrical stimulation mapping. The WMSV score decreased an average of 22% at 1 month (13 cases), and 11% at 1 year (10 cases), even though in the majority of cases the medial extent of the resections had been significantly modified as a result of preoperative memory changes in response to intracarotid amobarbital perfusion testing. Memory decline was greater in patients who were not seizure-free, and correlated with the lateral (but not the medial) extent of the resection. The memory deficit could be predicted intraoperatively with 80% accuracy from the relationship of the resection to sites identified by electrical stimulation mapping as essential to naming or input or storage aspects of memory. This technique was applied prospectively in two additional cases with left temporal epileptic foci and complete verbal memory loss with left hemisphere amobarbital inactivation. These resections were tailored to avoid the essential naming and memory sites; the WMSV score increased 1 month postoperatively in both cases. This study identifies a lateral cortical component for verbal memory. Sites essential for that component can be localized intraoperatively with stimulation mapping; when they are spared in a resection, verbal memory deficit following dominant hemisphere temporal lobectomy can be prevented even in high-risk cases.
Adolescent↗
Use of neuropsychological tests to identify high school students with epilepsy who later demonstrate inadequate performances in life.
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Adolescent↗
Neuropsychological and emotional correlates of marital status and ability to live independently in individuals with epilepsy.
Studies from several countries have reported that fewer people with epilepsy marry, but the reasons for this are not clear. In the present investigation, 178 adults with epilepsy were divided into married, separated/divorced, and never married groups. The never married group was subdivided into persons living in dependent versus independent settings. The groups did not differ with respect to seizure type, age at onset of seizures, and related variables. All were administered a complete battery of neuropsychological tests and the Minnesota Multiphasic Personality Inventory. On all tests of abilities, the married and the never married independent groups had the best scores, the separated/divorced group was intermediate, and the never married dependent group had by far the lowest scores. In the emotional area, however, the separated/divorced group had the poorest scores and the other groups were indistinguishable from each other. It appears that marital status is more related to emotional adjustment than to mental abilities, and that independent living skills are more related to mental abilities than to emotional adjustment.
Activities of Daily Living↗
Intensive EEG monitoring and psychological studies of patients with pseudoepileptic seizures.
EEG/closed-circuit television long-term monitoring was used as a definitive diagnostic tool to identify and characterize 25 patients with pseudoepileptic seizures and a similar group of subjects with epilepsy, confirming the value of the procedure. The groups did not differ with respect to intelligence, neuropsychological impairment, or incidence of potential etiological factors for seizures. Scores on the Minnesota Multiphasic Personality Inventory (MMPI) and the Hypochondriasis, Hysteria, and Schizophrenia Scales were significantly higher for the pseudoepileptic group than for the other subjects. As a whole, the former patients exhibited an MMPI profile pattern frequently seen in the conversion form of hysteria. A set of three rules derived from the MMPI profiles was used to classify the patients correctly in 80-90% of cases. As evaluated by the Washington Psychosocial Seizure Inventory, psychosocial problems of patients with pseudoepileptic seizures were more severe in certain areas, and appeared to reflect early family background problems and inappropriate management of their disorders.
Adult↗
Psychosocial problems among adults with epilepsy.
The psychosocial functioning of adults with epilepsy was evaluated by the administration of the Washington Psychosocial Seizure Inventory, which was given to five groups of patients across the United States. In four of the five samples, the results were indistinguishable from one another, with similar psychosocial problems suggested despite substantially different patient characteristics and referral sources. Emotional, interpersonal, vocational, and financial concerns were most commonly found, as well as difficulties in dealing with seizures. Persons in the fifth sample were selected somewhat differently; they had fewer vocational and financial problems, but were otherwise similar. The results have implications for the study of psychosocial problems in epilepsy and for the establishment of treatment programs.
Adolescent↗
Psychosocial problems in adults with epilepsy: comparison of findings from four countries.
Psychosocial problems in groups of adults with epilepsy from Canada, Finland, the German Democratic Republic, and the United States were evaluated by the Washington Psychosocial Seizure Inventory. A number of similarities in psychosocial concerns were found across the four countries. At the forefront for each group were emotional problems, followed by concerns pertaining to adjustment to the seizures themselves. Where far-reaching governmental support of a financial and vocational nature was lacking, difficulties in these areas were also noted. In all cases, few problems were found in matters pertaining to family relationships and to medical care. Hypotheses to account for differences between the groups were discussed.
Adolescent↗
Development of intelligence and neuropsychological impairment scales for the Washington Psychosocial Seizure Inventory.
The Washington Psychosocial Seizure Inventory (WPSI) was used to evaluate the relative extent of psychosocial problems in 379 adults with epilepsy, having differing levels of intelligence and neuropsychological impairment. In general, there were more psychosocial problems when abilities were decreased. Two new scales for the WPSI were developed, one of which provides an index of intelligence and the other an index of neuropsychological impairment. When groups of patients are considered, these scales correlate well with the Wechsler Adult Intelligence Scale and with the Neuropsychological Battery for Epilepsy, respectively, but less well when there is consideration of individual cases. The uses and limitations of the new scales in research and clinical contexts are discussed.
Adolescent↗