| 1. |
- Engman, Elisabeth, 1942, et al.
(författare)
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Non-parametric evaluation of memory changes at group and individual level following temporal lobe resection for pharmaco-resistant partial epilepsy
- 2004
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Ingår i: J Clin Exp Neuropsychol. - 1380-3395 .- 1744-411X. ; 26:7, s. 943-54
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Tidskriftsartikel (refereegranskat)abstract
- Group versus individual verbal and visuospatial memory outcome following epilepsy surgery was evaluated by a non-parametric method in 25 left and 29 right temporal lobectomy patients. Twenty-five controls were assessed twice. Analyses of change at an individual level evaluated by this statistical approach based on paired-ranks were compared to results with a method based on distances (Reliable Change). The left temporal lobectomy group deteriorated in the two verbal memory variables (p < 0.01 and 0.05). High levels of individual changes unexplained by group patterns were disclosed in the three memory variables analyzed in the patients. Significant individual change, although less pronounced, also occurred in the controls. Group versus individual outcome was adequately distinguished by the non-parametric method. To properly analyze memory change after epilepsy surgery, evaluation at group and individual level ought to combined.
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| 2. |
- Andersson-Roswall, Lena, 1965, et al.
(författare)
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Cognitive outcome 10 years after temporal lobe epilepsy surgery: a prospective controlled study
- 2010
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Ingår i: Neurology. - 0028-3878. ; 74:24, s. 1977-1985
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore late effects of temporal lobe resection (TLR) for epilepsy on general cognitive level and memory. Methods: Fifty-one patients who had undergone TLR (23 in the speech-dominant temporal lobe [DTL] and 28 in the nondominant temporal lobe [NDTL]) were assessed preoperatively and 2 and 10 years postoperatively. Twenty-three healthy controls were assessed at baseline and at corresponding intervals. A battery of standardized tests for assessment of general cognitive level and memory was analyzed using a linear mixed model of between-subjects treatment effect and within-subject time effect. Results: The main result was cognitive stability from 2 to 10 years after TLR. The DTL group had declined in verbal memory at the 10-year follow-up compared to the NDTL group and to the controls. However, this decline was detected already 2 years postoperatively, with no further decline from 2 to 10 years. The memory decline was not related to seizure outcome or AED treatment. The NDTL group showed less improvement in performance IQ (PIQ) at the 10-year follow-up compared to the controls. The most important correlate to inferior PIQ scores was continuing seizures, which was more frequent in the NDTL group. Conclusions: In this study, the main finding was cognitive stability from 2 to 10 years after temporal lobe resection. There was no further decline in verbal memory from 2 to 10 years after surgery, lending no support to the notion of an ongoing progressive decline in verbal memory after temporal lobe resection. The verbal memory course was not dependent on seizure outcome or antiepileptic drug treatment.
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| 3. |
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| 4. |
- Andersson-Roswall, Lena, 1965, et al.
(författare)
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Verbal cognition and attention deficits do not explain the verbal memory decline associated with pharmacoresistant partial epilepsy
- 2007
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Ingår i: Epilepsy & Behavior. - : Elsevier BV. - 1525-5050. ; 11:3, s. 413-420
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to explore whether change in verbal memory with time in patients with epilepsy is influenced by performance on tasks assessing verbal cognition or attention/processing speed. Thirty-six patients and twenty-five healthy controls were tested twice with median retest intervals of 4.8 and 3.1 years, respectively. Aspects of verbal memory, verbal cognition, and attention/processing speed were assessed. Decline in one verbal memory variable (Cronholm–Molander Memory Test Paired Associates—Delayed Recall) was the strongest correlate of epilepsy. The second strongest correlate was a decrease in one attention/processing speed variable (Digit Symbol). The relationship between decline in verbal memory and epilepsy was not influenced by the decline in attention/processing speed, and the results did not support the notion that limited mental reserves as reflected in impaired verbal cognition or attention/processing speed can explain the relationship between verbal memory and epilepsy.
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| 5. |
- Andersson-Roswall, L, et al.
(författare)
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Verbal memory decline and adverse effects on cognition in adult patients with pharmacoresistant partial epilepsy: A longitudinal controlled study of 36 patients
- 2004
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Ingår i: Epilepsy & Behavior. ; 5:5, s. 677-686
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to delineate possible longitudinal cognitive changes in adult patients with a long history of pharmacoresistant partial epilepsy. Thirty-six patients and thirty healthy controls were investigated at baseline. A reassessment was conducted, with median test intervals of 4.8 years for the patients and 3.1 years for controls. A standardized battery was used for assessment of general cognitive level and memory. At baseline, patients performed at a significantly lower level on general cognition, immediate recall of pairs of associated words, and retention of learned words and visuospatial stimuli, compared with controls. Analyses of change over time in the patients disclosed significant verbal memory decline in retention of pairs of associated words. Group comparisons of change over time revealed adverse effects in the performance aspect of general cognition on the patients. Also, group comparisons indicated impaired performance across time for the patients in retention of pairs of associated words and retention of visuospatial stimuli. The adverse effect on memory and general cognition in this patient group over the period was clear-cut when compared with the longitudinal changes in an adequate control group.
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| 6. |
- Andersson-Roswall, Lena, 1965, et al.
(författare)
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Verbal memory decline is less frequent at 10 years than at 2 years after temporal lobe surgery for epilepsy
- 2012
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Ingår i: Epilepsy & Behavior. - : Elsevier BV. - 1525-5050. ; 24:4, s. 462-467
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Tidskriftsartikel (refereegranskat)abstract
- We investigated individual short-and long-term verbal memory changes after temporal lobe resection for epilepsy. Fifty-one patients (23 operated on the speech-dominant temporal lobe, DTL and 28 on the non-dominant temporal lobe, NDTL) were tested on learning/immediate recall and delayed recall of word-list and word-pairs preoperatively, 2 years postoperatively and 10 years postoperatively. Changes were defined using reliable change indices of 23 healthy controls assessed at corresponding intervals. Fewer patients had reliable declines at 10 years than at 2 years (DTL: 13-35% vs 35-44%; NDTL: 0-4% vs 7-21%). Four DTL patients (17%) had reliable declines in >= 2 tests at 10-year follow-up. More NDTL patients had improvement at 10 years than at 2 years (18-30% vs 4-22%). The only risk factor for decline both short and long term was DTL resection. In conclusion, most patients had stable verbal memory postoperatively. A few DTL patients had a lasting decline at long-term follow-up, but more patients showed partial recovery, especially in the NDTL group. (C) 2012 Elsevier Inc. All rights reserved.
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| 7. |
- Engman, Elisabeth, 1942
(författare)
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A longitudinal study of cognitive changes after surgical treatment for epilepsy
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Epilepsy surgery is a valuable therapeutic option for some patients with pharmaco-resistant partial epilepsy, but resection of cortical tissue carries a risk of creating or worsening a dysfunction. Therefore pre-and postoperative levels of cognitive function are systematically monitored in epilepsy surgery programs. One aim of the present neuropsychological study was to describe general cognitive function and memory preoperatively, and change two years postoperatively, in adults in the Göteborg epilepsy surgery series. For this purpose data were analysed for 70 consecutive patients in Study I. In study II the purpose was to explore the hypothesis that analysis with appropriate methods would yield more knowledge about the individual variability separately from group patterns in a more homogeneous group of 54 temporal lobectomy patients. In study III the long-term change (10 years) after surgery was studied in a subgroup of 25 temporal lobectomy patients. In study IV the purpose was to investigate cognitive changes across time in 36 patients with pharmaco-resistant partial epilepsy who had not been operated and to explore the hypothesis that a cognitive decline over time would be disclosed. A control group of 30 neurologically healthy persons was matched to the patients and 25 of these participated in a follow-up. Results in Study I showed that preoperatively the general cognitive level (Full Scale IQ and Impairment Index) was lower in patients than in controls (p<0.01). Performance in aspects of verbal and visual memory was more impaired in the temporal lobe subgroups than in controls (p<0.01). The impairment was congruent with the lateralisation of seizure origin (verbal in the speech-dominant and visual in the non-dominant group). Postoperatively a slight increment in general intellectual status was found (p<0.01) for the total patient group and for the frontal lobe group (p<0.05). In Study II a significant (p<0.05) postoperative impairment in verbal associative memory was found in the left temporal lobectomy group. Individual heterogeneity (declines as well as improvements) unexplained by group patterns was significant in both verbal and visuospatial memory variables and was measurable with the non-parametric relative rank variance parameter. In Study III cognitive stability was the main finding at long-term follow-up together with patterns of residual decrement and increment at an individual level in 28% versus 16% of the patients. In Study IV, deterioration was found in the non-operated patients in delayed recall of verbal associative memory (p<0.05) as well as adverse change in aspects of general cognition (p<0.01) across time.Cognitive stability was the main postoperative result at group level together with a significant postoperative impairment in verbal associative/episodic memory after left temporal lobectomy at the two year follow-up. There were no long-term changes in cognition at group level. Impairment in verbal associative/episodic memory was also found in the group of non-operated patients at follow-up. However, with comprehensive evaluation methods important patterns of change with decrements as well as increments at an individual level could be discerned. Factors relevant for the interpretation of this heterogeneity, such as practice effects, regression toward the median and reliability issues related to memory tests, are discussed. Other aspects may have to be studied in larger series. At present prediction of memory outcome after epilepsy surgery can to some extent be made at group level, but not at an individual level.
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| 8. |
- Engman, Elisabeth, 1942, et al.
(författare)
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A longitudinal study of psychological features in patients before and two years after epilepsy surgery
- 2012
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Ingår i: Epilepsy & Behavior. - : Elsevier BV. - 1525-5050. ; 24:2, s. 221-226
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Tidskriftsartikel (refereegranskat)abstract
- This study aimed at investigating psychological features before and two years after epilepsy surgery. Fifty patients, 39 with temporal lobe epilepsy (TLE) and 11 with frontal lobe epilepsy (FLE), were assessed at baseline and two years postoperatively with the Karolinska Scales of Personality (KSP). Baseline group level outcome was normal while individual level analyses delineated some mild to moderate degrees of psychological problems exceeding the normal range in subsets of patients. Features of hostility characterized half of the FLE and one-fourth of the TLE patients. Above 1/3 in each group had dependency features. About 1/3 of the TLE patients suffered from psychasthenia. In conclusion, even though group levels were normal, several patients had psychological problems. The main longitudinal result was that the personality features were stable and did not change after epilepsy surgery. (C) 2012 Elsevier Inc. All rights reserved.
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| 9. |
- Engman, Elisabeth, 1942, et al.
(författare)
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Serial cognitive change patterns across time after temporal lobe resection for epilepsy
- 2006
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Ingår i: Epilepsy Behav. - : Elsevier BV. - 1525-5050. ; 8:4, s. 765-72
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Tidskriftsartikel (refereegranskat)abstract
- Longitudinal cognitive outcome with respect to general cognitive status and memory at the group and individual levels was studied 10 years after temporal lobe resection for epilepsy. Twenty-five patients who had undergone a medium-term follow-up (T2, median = 2.7 years) also underwent a long-term follow-up (T3, median = 9.8 years). At the group level, there was a significant increment across time, partly due to practice, in IQ (P value from 0.049 to <0.0001) but not in memory variables. On the basis of the normative interval of reassessed matched controls, the analysis at the individual level of change from baseline to T2 disclosed decrements in 12-29% of the patients and increments in 8-21%. These proportions diminished at T3 (0-12 and 0-16%) and the dominating pattern of Performance IQ and verbal memory was a return toward baseline. These findings make the interpretation of an initial (T2) postoperative increment or decrement more problematic and underline the need for a comprehensive evaluation across time, including both at the group and individual levels.
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| 10. |
- Malmgren, Kristina, 1952, et al.
(författare)
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Seizure outcome after resective epilepsy surgery in patients with low IQ.
- 2008
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Ingår i: Brain : a journal of neurology. - : Oxford University Press (OUP). - 1460-2156 .- 0006-8950. ; 131:Pt 2, s. 535-42
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Tidskriftsartikel (refereegranskat)abstract
- Epilepsy surgery has been questioned for patients with low IQ, since a low cognitive level is taken to indicate a widespread disturbance of cerebral function with unsatisfactory prognosis following resective surgery. The prevalence of epilepsy in patients with cognitive dysfunction is, however, higher than in the general population and the epilepsy is often more severe and difficult to treat. It is therefore important to try to clarify whether IQ predicts seizure outcome after resective epilepsy surgery. The Swedish National Epilepsy Surgery Register, which includes data on all epilepsy surgery procedures in Sweden since 1990, was analysed for all resective procedures performed 1990-99. Sustained seizure freedom with or without aura at the 2-year follow-up was analysed as a function of pre-operative IQ level categorized as IQ <50, IQ 50-69 and IQ >or=70 and was also adjusted for the following variables: age at epilepsy onset, age at surgery, pre-operative seizure frequency, pre-operative neurological impairment, resection type and histopathological diagnosis. Four hundred and forty-eight patients underwent resective epilepsy surgery in Sweden from 1990 to 1999 and completed the 2-year follow-up: 72 (16%) had IQ <70, (18 with IQ <50 and 54 with IQ 50-69) and 376 IQ >or=70. There were 313 adults and 135 children or=70 group. There was a significant relation between IQ category and seizure freedom [odds ratio (OR) 0.41, 95% confidence interval (CI) 0.27-0.62] and this held also when adjusting for clinical variables [OR 0.58 (95% CI 0.35-0.95)]. In this population-based epilepsy surgery series, IQ level was shown to be an independent predictor of seizure freedom at the 2-year follow-up. However, many of the low-IQ patients benefit from surgery, especially patients with lesions. Low IQ should not exclude patients from resective epilepsy surgery, but is an important prognostic factor to consider in the counselling process.
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