Cognitive impairment associated with antiepileptic drug (AED) therapy in children is an important concern given the potential negative effects of treatment on school learning and performance. Unfortunately, there have been few studies examining the cognitive effects of AEDs in this population and no adequate studies of newer AEDs. This article will discuss the effects of the traditional and newer AEDs on neuropsychological function in children. Because of various limitations in the designs of these studies, however, many of the studies report inconclusive findings. Although it will be necessary to overcome many programmatic and procedural hurdles, well-designed randomized prospective studies that are of adequate length to determine how AEDs ultimately relate to school performance and social adjustment are needed to firmly establish the cognitive and behavioral effects of AEDs in children.
Abstract This article reviews the shared history of epilepsy and neuropsychology and highlights the clinical and scientific progress in both disciplines. It considers the role of neuropsychology in understanding the impact of the epilepsies and how cognitive studies of epilepsy and epilepsy surgery helped elucidate human brain function. It begins by focusing on the late 1800s/early 1900s, when intelligence testing became available and widely used in epilepsy and neuropsychology, before turning to the 1920s–1950s, when a clearer picture of the different epilepsy syndromes and their associated EEG and clinical seizure features emerged. It then examines surgical treatment of the epilepsies in the period beginning in the late 1940s, along with the conflict between the eugenics movement and the goal of providing better care of people with epilepsy within specialized epilepsy institutions. It also looks at the risk factors for cognitive impairment and the effects of EEG abnormalities on neuropsychological function.
AbstractDeath rates for Parkinson's Disease (PD) in the U.S.A. and the state of Georgia were investigated for the period 1979–83. Age adjusted death rates for the U.S.A. were greater in whites than blacks and greater in men and women. No differences were found in Georgia between urban and rural counties. Death rates were not higher in counties containing paper mills.Keywords: Neuroepidemiology-Parkinson'sDisease-MortalityRate
Abstract Objective: The Mayo Normative Studies (MNS) represents a robust dataset that provides demographically corrected norms for the Rey Auditory Verbal Learning Test. We report MNS application to an independent cohort to evaluate whether MNS norms accurately adjust for age, sex, and education differences in subjects from a different geographic region of the country. As secondary goals, we examined item-level patterns, recognition benefit compared to delayed free recall, and derived Auditory Verbal Learning Test (AVLT) confidence intervals (CIs) to facilitate clinical performance characterization. Method: Participants from the Emory Healthy Brain Study (463 women, 200 men) who were administered the AVLT were analyzed to demonstrate expected demographic group differences. AVLT scores were transformed using MNS normative correction to characterize the success of MNS demographic adjustment. Results: Expected demographic effects were observed across all primary raw AVLT scores. Depending on sample size, MNS normative adjustment either eliminated or minimized all observed statistically significant AVLT differences. Estimated CIs yielded broad CI ranges exceeding the standard deviation of each measure. The recognition performance benefit across age ranged from 2.7 words ( SD = 2.3) in the 50–54-year-old group to 4.7 words ( SD = 2.7) in the 70–75-year-old group. Conclusions: These findings demonstrate generalizability of MNS normative correction to an independent sample from a different geographic region, with demographic adjusted performance differences close to overall performance levels near the expected value of T = 50. A large recognition performance benefit is commonly observed in the normal aging process and by itself does not necessarily suggest a pathological retrieval deficit.
The present study examined the clinical utility of the Weschsler Memory Scale-Revised (WMS-R) Verbal and Visual Memory Indexes to predict laterality of previous temporal lobectomy (TL) in 13 left and 20 right patients. Three verbal-visual index discrepancy criteria were used
We prospectively evaluated performance of 63 referrals to a memory disorders clinic who received the Medical Symptom Validity Test (MSVT) as part of their standard neuropsychological evaluation. The patients were grouped based on independent medical diagnoses and presence or absence of a potential financial incentive to under-perform. Twenty-seven patients (42.9%) scored below cutoffs on the MSVT symptom validity indices. Two individuals in the potential financial incentive group showed clear signs of invalid responding (18.2%). Twenty-two of the remaining 25 patients who failed the symptom validity indices corresponded to the dementia profile. Three individuals did not correspond to the dementia profile but are thought to have performed validly representing a 4.8% false positive rate. When considering all MSVT indices, the base rate of invalid responding in the potential financial incentive to under-perform group increased to 27.3%. Combining all groups our base rate of invalid responding was 4.8%. Specific performances are presented.
Administration of antiepileptic drugs to pregnant animals in lower doses than those that produce congenital malformations is associated with cognitive and behavioral deficits and other poor neurodevelopmental outcomes. However, the effect of exposure of human fetuses to antiepileptic drugs on cognitive and behavioral abnormalities is unclear, and there are little data to guide the physician in choice of antiepileptic drugs in women who are pregnant or may become pregnant. This study is a planned interim analysis of data from the Neurodevelopmental Effects of Antiepileptic Drugs (NEAD) study, a prospective observational multicenter cohort study of the neurodevelopmental outcome at age 3 years of children who had been exposed in utero to one of several antiepileptic drugs. This study enrolled pregnant women with epilepsy who had been treated with carbamazepine, lamotrigine, phenytoin, or valproate between 1999 and 2004. The primary study outcome was cognitive performance of the children at 6 years of age. Of the 309 live births, cognitive assessments were conducted in 258 children. Children who had in utero exposure to valproate had significantly lower IQ scores than children exposed to the other antiepileptic drugs. After adjustment for maternal IQ, maternal age at delivery, drug dose, gestational age at birth, and maternal use of folate before conception, the mean IQ was 92 for children exposed to valproate, compared to 98 for those exposed to carbamazepine, 101 for those exposed to lamotrigine, and 99 for those exposed to phenytoin. The effect of in utero valproate exposure on IQ was dose dependent. Maternal IQ was strongly related to child IQ for each antiepileptic drug taken during pregnancy except valproate. The investigators conclude from these findings that valproate should not be a first-line antiepileptic in women of childbearing potential not only because of its known association with neural tube defects, but also because of its negative effect on cognitive impairment.
