Clinical Comparison of Two Confrontation Naming Measures in Spanish-Speaking People with Epilepsy.

OBJECTIVE: Research on the lateralizing value of neuropsychological tests is limited among Latino people with epilepsy (PWE). This study aims to evaluate the utility of two confrontation naming measures in laterality determination. METHOD: Data were collected from 71 Latino PWE who completed the Vocabulario Sobre Dibujos (VSD) and the Pontón-Satz Modified Boston Naming Test (MBNT). Raw and standardized scores were examined to determine diagnostic accuracy for predicting left hemisphere (LH) epilepsy for the full sample and using a sample-specific median split of educational attainment. RESULTS: The MBNT demonstrated adequate classification accuracy (65.7%, 77.1%) as did the VSD (54.3%, 74.3%) for predicting LH seizure laterality using raw and standardized scores, respectively. For participants with ≥ 9 years of education (HEdu), receiver operator characteristic curve analyses showed a raw/percentile cutoff of ≤ 26/≤ 5th on the VSD, yielding 53%-58% sensitivity/87%-83% specificity. A raw score cutoff of ≤ 17 on MBNT produced 47% sensitivity/78% specificity for HEdu participants. CONCLUSIONS: The VSD was found to have greater flexibility in determining cutoff scores using either raw or standardized scores for predicting seizure laterality. This study provides interpretation guidance, emphasizing education as a pertinent variable, to optimize lateralization accuracy for Latino PWE.

Improving neuropsychological seizure lateralization in Spanish-speaking people with epilepsy in the US: The need to account for education and demographic differences.

OBJECTIVE: The objective of the study was to investigate the predictive seizure lateralization ability of the Neuropsychological Screening Battery for Hispanics (NeSBHIS) in an optimally, demographically matched cohort of primarily immigrant Spanish-speaking people with epilepsy (PWE) living in the US. Linguistically and culturally appropriate neuropsychological measures for Spanish-speaking people are increasingly needed in the US, especially as this diverse, international population grows. The NeSBHIS was developed to meet this need. Previous studies were inconclusive regarding its utility in epilepsy lateralization with PWE. Sample size and demographic variables, particularly educational levels, which anchor neuropsychological normative data and guide clinical use, limited the conclusions of earlier studies. METHODS: A retrospective study, the NeSBHIS battery's ability to predict seizure lateralization in a large cohort of Spanish-speaking PWE (n = 108) was conducted using normative data based on refined, smaller education ranges suggested by the author of the NeSBHIS, Pontón. RESULTS: Regression analysis revealed that four NeSBHIS subtests representing different cognitive domains produced the best model for predicting lateralization: 1) language, 2) attention/mental control, 3) visual memory recall, and 4) verbal memory recall. Prediction accuracy overall was 62% (67.3% for left hemisphere (LH) and 55.8% for right hemisphere (RH)). CONCLUSION: This study demonstrated the clinical utility of the NeSBHIS in seizure lateralization in a large cohort of Spanish-speaking PWE by analyzing standardized scores based on refined, education-based normative samples. These results also highlight that demographic variables, in particular, education, which varies greatly across Spanish-speaking nations in terms of compulsory educational opportunity and quality, must be accounted for more carefully in clinical and research practice.

Cognitive process scores associated with self-reported behavioral dysfunction on the Frontal Systems Behavior Scale (FrSBe) in chronic traumatic brain injury.

Introduction: Individuals with traumatic brain injury (TBI) often experience long-term cognitive impairment that affects daily functioning, but neuropsychological tests are often not associated with functional outcomes in chronic TBI. To identify better neuropsychological test predictors of functional outcomes, we identified process-oriented neuropsychological test scores associated with behavioral dysfunction in chronic TBI.Method: Adults (N = 65, age = 49.9 years, education = 14.6 years, 80% male, 97% white) with a > 6-month (median = 55 months) history of TBI (31% complicated mild, 20% moderate, 49% severe) completed the self-reported Frontal Systems Behavior Scale (FrSBe) and a battery of neuropsychological tests. Cognitive scores significantly associated with FrSBe domain scores (Apathy, Disinhibition, Executive Dysfunction) were included in hierarchical linear regression analyses.Results: Pearson correlations were significant (|r| = .25 - .41, p < .05) between FrSBe Disinhibition and Executive Dysfunction domains and numerous cognitive scores, particularly cognitive process scores, including California Verbal Learning Test II (CVLT-II) and Letter (FAS) Fluency Intrusions and Repetitions. In the regression analyses, gender, injury severity, premorbid intelligence, time since injury, self-awareness, and depression status accounted for less than 1% (Disinhibition) and 6.1% (Executive Dysfunction) of the total adjusted variance in respective FrSBe domains. Cognitive process scores were the strongest factors associated with behavioral dysfunction, explaining an additional 22.9% of the total adjusted variance in Disinhibition [F(3, 50) = 6.28, p = .001]. For Executive Dysfunction, traditional scores explained 2.6% added variance on top of the base model, with cognitive process scores explaining an additional 17.2% [F(4, 48) = 6.79, p = .003] of the total adjusted variance.Conclusions: Less frequently utilized cognitive process scores from well-known neuropsychological tests may be better predictors of behavioral dysfunction in chronic TBI, as measured by the FrSBe. Future prospective study is required to validate these findings and test the sensitivity and specificity of these cognitive process scores for identifying risk for behavioral dysfunction.

Epilepsy surgery in the underserved Hispanic population improves depression, anxiety, and quality of life.

OBJECTIVE: The objective of this study was to investigate the effect of epilepsy surgery on depression, anxiety, and quality of life (QOL) in a Hispanic, primarily immigrant, Spanish-speaking population with intractable epilepsy (IE). METHODS: Patients with IE from a comprehensive epilepsy treatment center in an urban, public healthcare setting who underwent resective brain surgery between 2008 and 2014 (N=47) and completed presurgical and postsurgical neuropsychological evaluation were retrospectively identified. Presurgical and 1-year postsurgical Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), and QOLIE-31 ratings were analyzed as postsurgical outcome measures. One-tailed paired sample t-tests were used to evaluate whether scores improved postoperatively. Established severity level classifications of depression and anxiety (i.e., minimal, mild, moderate, or severe) were used to analyze changes in occurrence of depression and anxiety. RESULTS: Medium to large improvements on the BDI-II and most QOLIE-31 subscales, with a smaller effect on the BAI and remaining QOLIE-31 subscales, were noted 1-year postsurgery. Levels of depression and anxiety were significantly reduced 1-year postsurgery. Depression, anxiety, and QOL improvements were robust and unaffected by gender, levels of education, or hemisphere of surgery. CONCLUSIONS: This study supports the positive benefits of epilepsy surgery on depression, anxiety, and QOL in Hispanic, primarily undocumented immigrant, Spanish-speaking people with epilepsy (PWE) in the US. These results are useful for educating this particular population about the possible benefits of surgery for IE and can enhance presurgical counseling.