Biomedical subjects

C B Dodrill

Publications and source records attributed to C B Dodrill.

88 records · Page 5Linked to original sources

PubMed1976

Neuropsychological correlates of the electroencephalogram in epileptics: I. Topographic distribution and average rate of epileptiform activity.

In 57 male and 33 female uncontrolled adult epileptics treated solely by diphenylhydantoin, scores on a broad battery of neuropsychological tests were compared with the separate and simultaneous consideration of the topographic distribution and average rate of occurrence of their EEG epileptiform discharges. These studies were given within a median of 1.24 days of each other. In the battery of tests, it was statistically significant that the group with generalized discharges did the poorest, patients with focal epileptiform activity were intermediate, and those without discharges did the best. When the rates of occurrence of discharges were compared to the neuropsychological test scores, results were less often significantly correlated with the EEG findings. In general, however, individuals with discharges occurring at the rate of more than 1/min did worse than those with fewer discharges. When the topographic distribution and average rate variables were considered in combination, their impacts on psychological performance were cumulative. The results suggest that EEG epileptiform discharges serve as an index of brain function having a bearing upon neuropsychological performance of epileptics.

Adult↗

PubMed1976

Neuropsychological correlates of the electroencephalogram in epileptics: II. The waking posterior rhythm and its interaction with epileptiform activity.

Relationships between psychological functions and waking dominant posterior rhythm frequency (DPRF) of the EEG were evaluated with and without simultaneous evaluation of epileptiform discharges. Ninety adult epileptics with uncontrolled seizure disorders treated solely by diphenylhydantoin underwent EEGs during wakefulness and administrations of an extensive battery of neuropsychological tests. The DPRF was particularly related to abilities simultaneously requiring attention an complex mental manipulations. Rhythms slower than 7.5-8.0 Hz were accompanied by relatively poorer performance than rhythms which were faster. When epileptiform discharges were considered in combination with the DPRF, larger differences in abilities were demonstrated, and the psycholoigcal correlates tended to be more substantial for the epileptiform discharge variable than for the DPRF variable. The selection of tests employed and the range of rhythms assessed are critical to these findings, and the substantial construction of these variables by many previous investigators is believed to be related to the negative findings often reported.

Alpha Rhythm↗

PubMed1976

Mephenytoin: a reappraisal.

Serum levels of mephenytoin (Mesantoin) and its metabolite nirvanol were correlated with effectiveness and side effects in 93 patients. Mean mephenytoin level was 8% of the combined mephenytoin plus nirvanol levels. "Total mephenytoin" level should be used clinically, as neither individual component is as well correlated with clinical phenomena. Serum levels of 25 to 40 mug/ml usually yield improvement in seizure control without discomfort, and three-quarters of patients had fewer seizures. Side effects frequently associated with phenytoin were absent, but drowsiness, an occasional rash, and a single, fatal case of aplastic anemia were found. Performance on psychological tests of cognitive-attentional skills showed a modest improvement during mephenytoin administration. The drug merits wider employment in refractory seizure problems, but vigilant follow-up is required.

Adolescent↗

PubMed1976

Relationships between intelligence and electroencephalographic epileptiform activity in adult epileptics.

Intellectual correlates of electroencephalographic epileptiform activity were examined by administering the Wechsler Adult Intelligence Scale to epileptic patients divided into groups on the basis of presence or absence, average rate, and topographic distribution of discharges. The results showed that lower intelligence levels were associated with the presence of discharges, especially when they were generalized rather than focal and when they occurred at an average rate of more than one per minute. An examination of patients having discharges ipsilateral and contralateral to their handedness showed few findings, as did an analysis based on an assessment of strengths and weaknesses within individuals. The results suggest that electroencephalographic epileptiform activity is significantly related to the intellectual functioning of epileptics.

Adult↗

PubMed1975

Effects of repeated administrations of a comprehensive neuropsychological battery among chronic epileptics.

Effects of repeated administrations of the neuropsychological battery originated by Halstead and developed by Reitan were assessed by administration of the battery on four occasions at 6- to 12-month intervals to 17 epileptics with stable neurological dysfunction. Changes in drug regimen complicated interpretation to some degree, but it appeared that: a) the majority of the neuropsychological measures did not demonstrate significant practice effects; and b) there were statistically and clinically significant practice effects on some of Halstead's most sensitive measures (Category Test, Tactual Performance Test--Localization, Impairment Index). In addition, the question was raised as to whether or not the Wechsler Adult Intelligence Scale may be more effected by the administration of anticonvulsants than are many of the other neuropsychological procedures. Caution was urged in interpretation when the battery is used on a repeated basis.

Adult↗

PubMed1975

Diphenylhydantoin serum levels, toxicity, and neuropsychological performance in patients with epilepsy.

The neuropsychological effects of diphenylhydantoin were assessed in 70 adults having primarily psychomotor and major motor seizures. All patients were stabilized on diphenylhydantoin alone, and assessment of this drug by gas-liquid chromatography provided a basis for dichotomizing the group into High and Low drug groups, both with and without toxic patients. In addition, patients showing signs of toxicity were contrasted with those not showing such signs. In each of these comparisons, control was maintained with respect to the variables of age, education, age at onset of disorder, and duration of disorder. Neuropsychological assessment was by means of the test battery originated by Halstead and developed by Reitan. Results showed that the High and Toxic Groups rather consistently did more poorly on all tasks than the Low and Nontoxic Groups. However, differences which were statistically significant appeared only in connection with tasks which had a heavy motor component. Possible reasons for the lack of statistically significant differences on the higher level mental tasks were presented.

Adult↗

PubMed1975

Effects of sulthiame upon intellectual, neuropsychological, and social functioning abilities among adult epileptics: comparison with diphenylhydantoin.

This report presented results of psychological studies done during a double-blind study which compared sulthiame with diphenylhydantoin as primary agents in the treatment of uncontrolled epileptics. Assessments of intellectual, neuropsychological, and social functioning abilities were made with 22 adult epileptic patients. The results showed significantly less impairment with treatment by diphenylhydantoin than by sulthiame, and substantial differences were revealed on intellectual tasks, on tasks calling for sustained concentration and attention, and on psychomotor problem-solving tasks. The results could not be explained on the basis of increased tonic-clonic seizures while on sulthiame. However, an increase in other types of seizures was noted, as was an increase in EEG epileptiform discharges. Possible mechanisms for the decrement in performance were discussed, and the value of an objective assessment of the psychological effects of anticonvulsant agents was noted.

Adult↗

PubMed1975

Intrauterine rubella, head size, and intellect.

The assumption that congenital rubella is commonly associated with microcephaly and mental retardation was examined. Among a rubella clinic population of 111 children, 92 children had vision sufficient to allow testing by the Leiter International Scale. The mean IQ for this group was 99.46 (SD, 19.5). Head circumference in this group correlated well with stature but poorly with intellect. The authors conclude that children with intrauterine rubella should be viewed as small children rather than children with small heads and that such children are poorly served if mental subnormality is assumed without careful study.

Body Height↗

PubMedDate not supplied

Zonisamide in epilepsy: a pilot study.

We compared zonisamide monotherapy (12 weeks) to carbamazepine monotherapy (12 weeks) after phenytoin baseline monotherapy (8 weeks) in an open crossover pilot study of eight adults with uncontrolled partial seizures. Zonisamide had definite antiepileptic activity in five subjects. In two of these, response to zonisamide was superior to that to either phenytoin or carbamazepine. A third subject became seizure free on zonisamide, but had to be withdrawn after 18 days because of mild Stevens-Johnson syndrome. The other three subjects were withdrawn from the study because of drug toxicity, manifested mainly by impaired higher mental function and increased seizures. The best response to zonisamide was at doses approximating 6 mg/kg/day, with plasma levels of 20-30 mg/L. Plasma levels of greater than 30 mg/L usually were associated with toxicity. The pharmacokinetics of zonisamide are complex and nonlinear, with steady-state plasma levels being approximately three times higher than those predicted from a single-dose study.

Adolescent↗

PubMedDate not supplied

Neuropsychological abilities of children with epilepsy.

One hundred eighteen epileptic children, aged 6-15 years, underwent detailed neuropsychological testing including the Wechsler Intelligence Scale for Children-Revised and the age-appropriate Halstead-Reitan battery. Eight had classical absence seizures only, eight had classic absence seizures and generalized tonic-clonic seizures, 30 had generalized tonic-clonic seizures only, 31 had partial seizures only, 20 had partial seizures and generalized seizures, 15 had atypical absence seizures, and five had minor motor seizures. A control group of 100 children without seizures, matched to the general population for intelligence and matched to the seizure cases for age, underwent identical testing. The Wechsler full-scale intelligence quotient (FSIQ) of cases was significantly (p = 0.01) lower than that of controls and was related to seizure type. Children with minor motor or atypical absence seizures had the lowest average FSIQ (70 and 74, respectively). All seizure types were associated with below-control intelligence except classic absence only. Intelligence was also correlated with degree of seizure control. A highly significant inverse correlation between years with seizures and intelligence was found (p less than 0.0001). A rating of neuropsychological impairment, derived from all measures of brain function, was assigned to each child. Epileptic children had significantly more impairment than controls (p less than 0.0001). Children with seizures had been placed in special education or had repeated a grade in school almost twice as frequently as controls (p less than 0.001). Even though often placed in a class of younger children, their academic achievement was behind grade placement more often than in controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMedDate not supplied

The difficult-to-employ in epilepsy rehabilitation: predictions of response to an intensive intervention.

In this prospective study, 46 adult seizure outpatients with suspected brain impairment were referred for vocational services at the University of Washington Regional Epilepsy Center and counseled for job placement. Among the demographic, intellectual, neuropsychological, and psychosocial variables considered, the Wechsler Adult Intelligence Scale (WAIS) Digit Symbol subtest and the name-writing procedure from the neuropsychological battery by Dodrill (1978) were the best discriminators of later employability. Using discriminant function analysis, these two tests correctly classified 75.0% of the group which ultimately became employed (n = 22) and 73.9% of the group which did not attain employment (n = 26). Implications of these findings are discussed in relation to rehabilitation planning.

Adolescent↗

PubMedDate not supplied

Correlates of generalized tonic-clonic seizures with intellectual, neuropsychological, emotional, and social function in patients with epilepsy.

Relationships between generalized tonic-clonic seizures and indicators of psychological functioning were evaluated in 94 adults with epilepsy who had exceptionally clear seizure histories. Patients were divided according to lifetime numbers of attacks and the presence or absence of a history of major motor status epilepticus. History of status epilepticus or history of more than 100 individual convulsions was associated with decreased functioning in all areas. Abilities were poorest for the group with a history of status, whereas emotional and psychosocial adjustment were worst in persons having large numbers of single convulsions. Possible reasons for the decreased test scores other than seizures were explored in great detail, but none could account for the differences in performance across the groups.

Adolescent↗

PubMedDate not supplied

Factors affecting the outcome of MMPI and neuropsychological assessments of psychogenic and epileptic seizure patients.

The literature reveals conflicting information regarding the extent to which psychogenic seizure patients have emotional disorders and neuropsychological deficits as compared with patients with epileptic seizures. Among groups matched for numbers of subjects, age, sex, and years of education, we observed that patients who had solely psychogenic seizures with either a major component of affectual expression or relatively minor motor activity were more disturbed emotionally than epileptic patients with partial seizures. In contrast, the personality characteristics of psychogenic seizure patients whose attacks had either little affectual display or prominent motor expression could not be distinguished from those of epileptic patients with convulsive generalized seizures. Closely matched groups of patients with solely psychogenic seizures, partial seizures, or generalized seizures did not differ in neuropsychological performance. However, psychogenic seizure patients performed much better on neuropsychological measures than a less-well-educated, but otherwise matched group of patients with generalized epileptic seizures.

Epilepsy↗

PubMedDate not supplied

Motor speed is a contaminating factor in evaluating the "cognitive" effects of phenytoin.

Many studies suggestive of adverse effects of phenytoin (PHT) on mental abilities have used testing procedures which have timed or motor speed elements. Therefore, to what degree the motor speed element alone may have resulted in attributing adverse higher level intellectual or cognitive effects to PHT instead of the identified construct to be measured (e.g., memory, abstraction, decision making) is not clear. To help distinguish "motor" effects from these more complex "cognitive" effects, neuropsychological data on 70 adult PHT monotherapy patients were reanalyzed. Initially, a series of statistically significant differences favored the low serum level group over the high serum level group in neuropsychologic performance. However, when a simple measure of motor speed (Finger Tapping Test) was covaried out, all statistically significant differences between the groups disappeared. Thus, losses in cognitive abilities could not be associated with PHT even though markedly elevated blood levels had been achieved.

Adult↗

PubMedDate not supplied

An objective method for the assessment of psychosocial problems in adolescents with epilepsy.

Psychosocial problems in adolescents with epilepsy have been of concern for many years, but have been difficult to assess. This article presents the multicenter development of the Adolescent Psychosocial Seizure Inventory (APSI), an empirically based self-report test patterned after the Washington Psychosocial Seizure Inventory, which is used to evaluate psychosocial problems in adults. After pilot work, 120 adolescents with epilepsy from five centers in North America took the APSI and were interviewed by professionals with respect to adequacy of adjustment in eight psychosocial areas. At least one parent or guardian was also interviewed. Interrater reliability of professional ratings in each area was established. Using an item-by-item, empirically based technique, eight psychosocial scales were developed as well as three validity scales. Reliability of the scales was established by both internal consistency and test-retest procedures. Results for each adolescent are presented in profile form. These results give a visual display of the types and extent of problems that likely would be identified in a detailed professional assessment. It is anticipated that the APSI will be of value in a variety of treatment and research contexts.

Adaptation, Psychological↗

PubMedDate not supplied

Neuropsychological abilities before and after 5 years of stable antiepileptic drug therapy.

Detailed neuropsychological evaluations were conducted on 198 adults with epilepsy before and after a 5-year study period. Of these, three groups of 11 persons each were formed in which the patients did not change their medication: (a) phenytoin (PHT) monotherapy; (b) PHT and other drug(s); (c) drug regimens exclusive of PHT. The typical patient had few seizures during the study period. Examination of data from 20 neuropsychological and intellectual variables obtained at the beginning and end of the 5-year study period revealed few statistically significant changes in mental abilities and no losses. Thus, we were unable to find evidence for insidious cognitive losses with PHT and other drugs over time with normal therapeutic serum levels and in the absence of active seizure disorders.

Adult↗