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PubMed2005

Educational problems with underlying neuropsychological impairment are common in children with Benign Epilepsy of Childhood with Centrotemporal Spikes (BECTS).

INTRODUCTION: Benign Epilepsy of Childhood with Centrotemporal Spikes (BECTS) is one of the most common childhood epilepsies with a good prognosis regarding the seizure and neuropsychological outcomes. However, recent reports indicate the presence of neuropsychological problems in a significant percentage of children with BECTS. Our study was aimed to examine the educational performance and neuropsychological functions along with clinical and electrographic characteristics in a cohort of children with BECTS. METHODS: We identified a cohort of children with BECTS by screening medical and EEG recordings of patients attending our institute. Data were collected with a standard protocol. Their educational performance was evaluated by an interview with the parents. Neuropsychological and language tests were administered to children who had educational problems. Statistical analysis was done using the chi2-test. RESULTS: Fifty children (29 boys and 21 girls; mean age of onset of epilepsy 7.84+/-2.87 years) who met the criteria for BECTS were included in this study. Atypical seizure characteristics for BECTS were observed in 26 (52%) children. EEG showed typical centrotemporal spike and wave discharges in all children, 42% of them had a tangential dipole in the frontocentral region. An additional extra-rolandic focus in the EEG was found in seven children (14%). Educational problems were identified in 27 children (54%); 19 of them had neuropsychological or language impairment (p=0.003). We found a statistically significant correlation between the occurrence of educational problems and the absence of a tangential dipole in the EEG (p<0.001). Abnormal language function had a significant correlation with atypical seizure semiology (p=0.021). CONCLUSION: This study shows that a significant number of children with BECTS have neuropsychological impairment and educational problems.

Adolescent↗
PubMed1983

The functional assessment of verbal impairment.

Standard measures do not generally account for functional communication performance. Traditionally the measures used to assess verbal impairment in the brain-damaged patient generally sample performance under artificial conditions rather than the unforced , voluntary, and habitual utterances which characterize natural language use. An awareness of the potential for functional communication in even the most severely brain-damaged patients requires enlightened medical management. Man is a social being capable of communicating in many ways other than the verbal mode. Under appropriate circumstances, with guidance and encouragement, he can and does accommodate and adjust. Communication assessment must go beyond the restricted information derived from standardized language tests. In practical terms, this means that rehabilitation evaluations must incorporate observations of the aphasic or dysarthric patient in his natural environment as a part of the overall communication assessment or using an established measure of functional communication. It is hard to imagine that a functional philosophy is not universally implemented. The speech pathology literature is a clear case in point.

Aphasia↗
PubMed1989

Performance of university students on the Fullerton subtest of idioms.

The study examined the performance of 71 university students on the Fullerton Language Test for Adolescents subtest on Idioms. The subjects were assigned to one of three age categories, and the performances of the groups were compared. The results demonstrated that 51% of the 18-21-year-old group fell within the "Competence Range" for this subtest, while 84% of the 22-29-year-old group and 91% of the 30+ year-old group fell within this range. As chronological age increased, performance improved.

Adolescent↗
PubMed1979

[Activation of supplementary motor areas during voluntary movements in man studied by measurement of focal cerebral blood flow (author's transl)].

Focal activation in the cerebral cortex during different motility and language tests in 52 patients examined by arteriography was studied by measuring focal cerebral blood flow (fCBF) by means of an apparatus of high resolution. A sterotactic or functional approach demonstrated that the upper premotor activation previously noted in certain types of movement, corresponds to supplementary motor area (SMA). A retrospective study of 157 maps of fCBF recorded during motor or verbal behaviour, compared to 90 recordings in subjects at rest, showed that SMA is involved in most voluntary movements, either verbal or non-verbal. An analysis of the results suggests that SMA acts during the establishment of new motor programs, and in the control of pre-established automatic activities, in response to internal and external stimuli.

Brain Mapping↗
PubMed2002

Aphasia following left putaminal hemorrhage. Statistical analysis of factors affecting prognosis.

Multivariate and single variable analyses were employed to investigate the recovery mode of aphasia in right-handed patients with putaminal hemorrhage on the left side. Speech disturbance was evaluated using the standard language test for aphasia (SLTA) at intervals of 1, 3 and 6 months after the ictus. Recovery was assessed in relation to age, gender, volume and location of hematoma, and treatment modalities. Extension of the hematoma into the corona radiata was the factor that dominated the prognosis of aphasia at all intervals during the follow-up period. Good recovery was documented in patients with less than 2 cm2 of the hematoma volume located in the corona radiata. Recovery was poor, however, in patients with more than 12 cm2 of the hematoma in the corona radiata. While aphasia continued to improve over 6 months after the ictus, recovery was more prominent in the first 3 months. Our study precisely demonstrated that the extension into the corona radiata independently and strongly influenced the outcome of aphasia in patients with left putaminal hemorrhage.

Aphasia↗
PubMed1985

[Recovery in aphasia (Part 1)].

In order to elucidate the factors which have an influence on the prognosis of aphasia, a correlation was studied in 76 right-handed aphasic patients between recovery rates and various factors: i.e. aphasia type, age, educational level, time between onset of aphasia and institution of therapy and initial severity. Initial evaluations on Standard Language Test of Aphasia (SLTA) were obtained within 5 months after the cerebrovascular accident and reevaluations were obtained 3 months after the initial evaluation. Recovery rates were determined by comparing scores of these 2 tests in order to coincide with clinical impression. The results obtained were as follows: Aphasia type: The highest recovery rates were seen in conduction aphasics, followed by amnestic, Wernicke, and Broca aphasics. Global aphasics had significantly lower recovery rates. It was suggested that anarthria in Broca's aphasia and jargon in Wernicke's aphasia had a significant ratarding effect on recovery rates. Age: Age and recovery rates showed a significant negative correlation: younger patients recovered better, and this trend was remarkable in Wernicke aphasics but not Broca aphasics. Education: Patients with more education tended to improve more, and this trend was most remarkable in amnestic aphasics. Time between onset of aphasia and institution of therapy: Time elapsed from onset and recovery rates showed a significant negative correlation; recovery rates decreased as the time interval from onset increased. Initial severity: Correlation between the initial severity of aphasia, measured by the initial SLTA scores and recovery rates was very high; severily affected aphasics recovered to a lesser extent than mildly affected ones and this trend was remarkable in Wernicke and Broca aphasics.

Adult↗
PubMed2005

Depression and anxiety disorders in pediatric epilepsy.

PURPOSE: This study examined affective disorders, anxiety disorders, and suicidality in children with epilepsy and their association with seizure-related, cognitive, linguistic, family history, social competence, and demographic variables. METHODS: A structured psychiatric interview, mood self-report scales, as well as cognitive and language testing were administered to 100 children with complex partial seizures (CPSs), 71 children with childhood absence epilepsy (CAE), and 93 normal children, aged 5 to 16 years. Parents provided behavioral information on each child through a structured psychiatric interview and behavior checklist. RESULTS: Significantly more patients had affective and anxiety disorder diagnoses (33%) as well as suicidal ideation (20%) than did the normal group, but none had made a suicide attempt. Anxiety disorder was the most frequent diagnosis among the patients with a diagnosis of affective or anxiety disorders, and combined affective/anxiety and disruptive disorder diagnoses, in those with suicidal ideation. Only 33% received some form of mental health service. Age, verbal IQ, school problems, and seizure type were related to the presence of a diagnosis of affective or anxiety disorder, and duration of illness, to suicidal ideation. CONCLUSIONS: These findings together with the high rate of unmet mental health underscore the importance of early detection and treatment of anxiety disorders and suicidal ideation children with CPSs and CAE.

Adolescent↗
PubMed2006

The stability of marker characteristics across tests of the same subject and across subjects.

This research investigates the stability of marker characteristics within a very short period of time for both tests on the same subject as well as tests on different subjects. It reports on the scoring of the scripts of the whole cohort of students that took three high stakes tests in 2003 in a European country: a Language test consisting of a Literacy and a Literature paper and a History test. The many-facets Rasch model was used to study marker severity and marking consistency and it was found that some markers had more stable characteristics than others. Although the stability of marker characteristics was generally weak, it was non-negligible (correlation indices as indicators of stability ranged up to 0.707). This study, however, is not absolutely accurate due to the small sample sizes employed and it can be added that more research is needed to reach definite results.

Europe↗
PubMed1983

Brain organization for language: clues from sign aphasia.

Since sign language conveys many grammatical relations by manipulating spatial relations, its study provides a unique opportunity to investigate cerebral specialization for language. Three deaf signers with damage to the left hemisphere were administered an array of formal sign language tests and a linguistic analysis of their spontaneous signing was performed. All three signers showed aphasia for sign language. Strikingly, in these patients, differential damage within the left hemisphere appeared to lead to selective impairment of the structural layers of sign language (e.g. lexicon versus grammar). These data provide the first demonstration of grammatical breakdown in sign language. Importantly, the language impairments of these patients stood in marked contrast to their relatively intact capacities to process nonlanguage visual-spatial relationships. These results suggest that the two cerebral hemispheres of deaf signers can develop separate specializations for linguistic and for visual-spatial processing, even for a visual-spatial language. They further suggest that the left hemisphere has an innate predisposition for language.

Adult↗
PubMed1996

Pediatric Rasmussen encephalitis: social communication, language, PET and pathology before and after hemispherectomy.

This prospective case study examined social communication (i.e., formal thought disorder, cohesion), language, positron emission tomography glucose utilization, and neuropathology in four children with Rasmussen encephalitis who achieved seizure control following right hemispherectomy. Prior to hemispherectomy, all four children had illogical thinking, loose associations, cohesive deficits, and impaired performance on formal language tests. Their postoperative improvement in social communication and language appeared to be related to age of onset, duration of illness, and postsurgical reversibility of hypometabolism in the nonresected prefrontal cortex. These changes were not associated with increase in IQ scores. The variability in the type and extent of pathologic change across subjects reflected the severity and duration of the illness. The study's findings imply that early surgical intervention might have mitigated certain aspects of the social communication and linguistic deficits found in these children.

Adolescent↗
PubMed1999

Neuropsychological characteristics of adolescents with conduct disorder: association with attention-deficit-hyperactivity and aggression.

The purpose of this study was to determine whether an association exists between neuropsychological deficits and conduct disorder (CD) with and without concurrent attention-deficit-hyperactivity disorder (ADHD). In addition, we explored the differential neuropsychological performance of aggressive and nonaggressive CD adolescents and the combined effect of this behavioral status and ADHD on performance. Fifty-nine adolescents (mean age of 15.4 years) who met the criteria for CD were compared with 29 controls comparable in age, gender, and socioeconomic status. A neuropsychological battery of current tests measuring executive functions and a battery of language tests were used in the study. Multivariate analyses showed that, compared with controls, CD adolescents had significantly lower verbal skills but did not differ on executive function measures. However, the lower verbal performance of CD adolescents is not explained by the existence of a CD subgroup with concomitant ADHD or aggressiveness. The study confirms with a sample of CD adolescents the association between verbal deficits and antisocial behavior when socioeconomic status is controlled. Our results also demonstrate that CD per se can be a sufficient condition for such deficits.

Adolescent↗
PubMed2001

An Investigation of Language Impairment in Autism: Implications for Genetic Subgroups.

Autism involves primary impairments in both language and communication, yet in recent years the main focus of research has been on the communicative deficits that define the population. The study reported in this paper investigated language functioning in a group of 89 children diagnosed with autism using the ADI-R, and meeting DSM-IV criteria. The children, who were between 4- and 14- years-old were administered a battery of standardized language tests tapping phonological, lexical, and higher-order language abilities. The main findings were that among the children with autism there was significant heterogeneity in their language skills, although across all the children, articulation skills were spared. Different subgroups of children with autism were identified on the basis on their performance on the language measures. Some children with autism have normal language skills; for other children, their language skills are significantly below age expectations. The profile of performance across the standardized measures for the language-impaired children with autism was similar to the profile that defines the disorder specific language impairment (or SLI). The implications of this language impaired subgroup in autism for understanding the genetics and definition of both autism and SLI are discussed.

Journal Article↗
PubMed1992

Neuropsychological performance among agricultural pesticide applicators.

To assess the potential effects on neuropsychiatric performance of chronic occupational exposure to organophosphate insecticides, we performed a prospective longitudinal study of a cohort of apple orchard pesticide applicators and a comparison cohort of beef slaughter-house workers. The study group consisted of 49 applicators and 40 comparison subjects who completed both an initial evaluation (preseason) prior to the onset of the approximately 6-month pesticide spraying season and a follow-up evaluation (postseason) about 1 month following the end of spraying season. The applicator cohort had a greater number (n = 22, 45%) of individuals who identified primary preference for Spanish-language testing than did the comparison cohort (n = 5, 13%). Stratification by language preference revealed no significant differences in background characteristics between the two cohorts, except for fewer years of education in the Spanish-language preference applicators versus control subgroups (5.0 +/- 3.1 vs 7.8 +/- 3.7 years, respectively). After controlling for language preference, there were no statistically significant differences between the applicators and control cohorts on neuropsychological subtests of the computerized test battery. Preseason baseline performance on individual tests was a significant predictor of postseason test performance. After controlling for baseline performance, the only statistically significant exposure related across-season changes in neuropsychological performance was for one subtest (Symbol Digit Substitution) and was confined to the Spanish language preference subgroups, with worse adjusted postseason performance among applicators versus controls (P = 0.001). This study found no clear evidence of clinically significant decrements in neuropsychological performance following one 6-month season of pesticide exposure in a cohort of applicators who were felt to have generally low, intermittent, and well-controlled organophosphate exposures.

Adult↗
PubMed2003

Language skills of children with early cochlear implantation.

OBJECTIVE: This study investigated factors contributing to the comprehension and production of English language by children with prelingual deafness after 4 to 7 yr of multichannel cochlear implant use. The analysis controlled for the effects of child and family characteristics so that educational factors most conducive to maximum implant benefit could be identified. DESIGN: A battery of language tests were administered to 181 8- and 9 yr-old children from across the United States and Canada who received a cochlear implant by age 5. Tests of comprehension, verbal reasoning, narrative ability and spontaneous language production were administered either in speech and sign or in the child's preferred communication mode. These constituted the Total Language measures. Spoken Language measures were derived from a speech-only language sample. Type and amount of educational intervention since implantation constituted the independent variables. Characteristics of the child and the family were considered intervening variables. A series of multiple regression analyses determined the amount of variance in Total Language and Spoken Language ability accounted for by the intervening variables and the amount of additional variance attributable to the independent variables. RESULTS: More than half of the children (with performance intelligence quotients in the average range) exhibited language skills that were similar to those of hearing 8 to 9 yr olds on measures of verbal reasoning, narrative ability, utterance length, and lexical diversity. Significant predictors of language ability were similar for Total and for Spoken Language outcomes and included greater nonverbal intelligence, smaller family size, higher socio-economic status and female gender. Age at receiving an implant did not affect language outcome. After the variance due to these variables was controlled, the primary rehabilitative factors associated with linguistic outcome were amount of mainstream class placement and an educational emphasis on speech and auditory skills. CONCLUSIONS: Use of a cochlear implant has had a dramatic impact on the linguistic competence of profoundly hearing-impaired children. More than half of the children in this sample with average learning ability produced and understood English language at a level comparable with that of their hearing age mates. Such mature language outcomes were not typical of children with profound hearing loss who used hearing aids. Use of a visual (i.e., sign) language system did not provide the linguistic advantage that had been anticipated. Children educated without use of sign exhibited a significant advantage in their use of narratives, the breadth of their vocabulary, in their use of bound morphemes, in the length of their utterances and in the complexity of the syntax used in their spontaneous language. An oral educational focus provided a significant advantage for both spoken and total language skills.

Canada↗
PubMed2002

[A case of crossed aphasia in a dextral patient with polycythemia].

We report a 72-year-old right-handed man who was diagnosed as having crossed aphasia. He had polycythemia, hypertension and an old cerebral infarction in the right occipital lobe. He was admitted to our hospital because of muscle weakness in the left extremities at the age of 71. In the laboratory data, red blood cells(689 x 10(4)/microliter) and platelets(87.6 x 10(4)/microliter) were increased in number. Brain CT detected a right putaminal hematoma and an old infarct in the occipital lobe on the right. After admission, he developed non-fluent speech, and impairments of auditory comprehension, writing and naming due to the infarction in his right cerebral hemisphere including the middle cerebral artery distribution. The standard language test of aphasia(SLTA) revealed marked impairments in the language function, except for reading kana and kanji words. This writing was severely impaired compared with other language dysfunctions. Auditory comprehension, repetition and reading were impaired at the sentence level rather than at the kana word level. Furthermore, he suffered from left hemiparesis and left unilateral spatial neglect. We diagnosed his impairments of language function as crossed aphasia based on his right-handedness, CT findings and the results of SLTA. His language center was considered to be located in both cerebral hemispheres. Compared with typical findings in reported cases of crossed aphasia, the presence of both non-fluent speech and mutism were consistent with previous observations. However, the marked impairments of auditory comprehension, repetition and naming were different. Polycythemia and hypertension were considered to be the risk factors of cerebral infarction in our patient.

Aged↗
PubMedDate not supplied

Comparison of age- and dementia-dependent cognitive modifications: a cross sectional study with Alzheimer patients and normal 20-year-older controls.

Alzheimer's patients (DAT/pts) and 2 control groups (one matched for age and education and one for education but 20 years older) were given ten cognitive ability tasks suited to test language, memory and intelligence performances. The aim was to ascertain whether test score relationships changed between DAT/pts and the 20-year-older controls. Test profiles appeared to be similar for memory and intelligence but not for language tasks. This outcome, however, cannot be definitely accepted, and the experiment is discussed to define the methodological constraints that warn against a naive interpretation of the multivariate profiles.

Aged↗
PubMed2006

Safety and efficacy of rivastigmine in adolescents with Down syndrome: a preliminary 20-week, open-label study.

Individuals with Down syndrome (DS) exhibit a cholinergic deficiency similar to that found in Alzheimer's disease. Cholinesterase inhibitors, used to treat Alzheimer's disease, may improve cognitive function in individuals with DS. This is the first investigation of the safety and efficacy of rivastigmine (an acetyl and butyryl cholinesterase inhibitor) on specific cognitive domains in pediatric DS. Eleven subjects with DS (ages 10-17 years) were treated with a liquid formulation of rivastigmine. Four subjects experienced no adverse events (AEs). Seven subjects reported AEs that were mild, transient and consistent with adverse events typically noted with cholinesterase inhibitors. Significant improvements were found in overall adaptive function (Vineland Adaptive Behavior Scales and Clinician's Interview-Based Impression of Change), attention (Leiter Attention Sustained tests A and B), memory (NEPSY: Narrative and Immediate Memory for Names subtests) and language (Test of Verbal Expression and Reasoning and Clinical Evaluation of Language Fundamentals-Preschool) domains. Improved language performance was found across all functional levels. These results underscore the need for larger, controlled studies employing a carefully constructed test battery capable of measuring the full scope of performance across multiple domains and a wide range of functional levels.

Adaptation, Psychological↗
PubMed2004

A case of psychogenic fugue: I understand, aber ich verstehe nichts.

Psychogenic fugue is a disorder of memory that occurs following emotional or psychological trauma and results in a loss of one's personal past including personal identity. This paper reports a case of psychogenic fugue in which the individual lost access not only to his autobiographical memories but also to his native German language. A series of experiments compared his performance on a variety of memory and language tests to several groups of control participants including German-English bilinguals who performed the tasks normally or simulated amnesia for the German language. Neuropsychological, behavioral, electrophysiological and functional neuroimaging tests converged on the conclusion that this individual suffered an episode of psychogenic fugue, during which he lost explicit knowledge of his personal past and his native language. At the same time, he appeared to retain implicit knowledge of autobiographical facts and of the semantic or associative structure of the German language. The patient's poor performance on tests of executive control and reduced activation of frontal compared to parietal brain regions during lexical decision were suggestive of reduced frontal function, consistent with models of psychogenic fugue proposed by Kopelman and Markovitsch.

Adult↗