Preoperative neuropsychological presentation of patients with refractory frontal lobe epilepsy.

BACKGROUND: This study investigated whether certain cognitive deficits are associated with frontal lobe epilepsy (FLE) aiming to contribute with localization data to the preoperative assessment of epilepsy surgery candidates. METHODS: We evaluated 34 patients with refractory FLE, 37 patients with refractory medial temporal lobe epilepsy (MTLE), and 22 healthy individuals in attention, psychomotor speed, motor function, verbal memory span, verbal fluency, response inhibition/interference, concept formation and set shifting, anticipation and planning, global memory. RESULTS: Neuropsychological performances of FLE and MTLE were similar, with the only exception the WCST-number of categories index, measuring mental flexibility, in which MTLE patients performed significantly worse than FLE patients. Left-FLE patients presented more perseverative responding compared to both other patient groups and healthy controls (HCs), while left-MTLE patients showed worse sorting abilities than the other epilepsy groups. CONCLUSIONS: Our findings suggest a weak cognitive differentiation between FLE and MTLE, probably attributed to the intricate nature of fronto-temporal connectivity frequently resulting in overlapping deficits as well as the confounding effects of seizure-related variables. In clinical practice, a highly individualized (idiographic) neuropsychological approach along with the inclusion of concurrent EEG recordings (e.g., interictal coupling) may be of help for neuropsychologists in identifying FLE patients from those with medial temporal pathology presenting frontal dysfunction as a secondary cognitive symptom.

Arousal deregulation in the co-shaping of neuropsychological dysfunction in frontal and mesial temporal lobe epilepsy.

OBJECTIVE: Our work aims to investigate the role of physiological arousal in the expression of neuropsychological deficits in frontal lobe epilepsy (FLE) and mesial temporal lobe epilepsy (mTLE), by drawing on the Lurian theory of brain function. METHODS: For this study a total of 43 patients with focal onset epilepsy has been taken; twenty-four patients with FLE, 19 patients with mTLE and 26 healthy controls, all matched for age and education. Participants underwent a comprehensive neuropsychological assessment including various cognitive domains, such as attention, episodic memory, speed of information processing, response inhibition and mental flexibility, working memory, verbal fluency (phonological & semantic). RESULTS: There were no significant differences between FLE and mTLE patients in terms of neuropsychological performance. However, both FLE and mTLE patients showed significantly worse performance in several cognitive domains than HCs. The results seem to support our hypothesis that aberrant physiological arousal, as reflected in patients' worse performance in vigilance and attention, response inhibition, and processing speed, along with other disease-specific variables, may co-determine neuropsychological dysfunction and/or impairment in both FLE and mTLE. CONCLUSION: Identifying a differential arousal-related neuropsychological affection in FLE and mTLE, among the known deleterious effects of the functional deficit zone and other disease-related variables, may further our understanding of the underlying cognitive-pathophysiological mechanisms in focal epilepsy syndromes.

Health-Related Quality of Life after Coronary Revascularization: A systematic review with meta-analysis.

OBJECTIVE: To conduct a systematic review and meta-analysis to summarize evidence and determine the impact of coronary revascularization (CR) on cardiac patients' Health-Related Quality of Life (HRQoL), highlighting factors that may affect this outcome in patients. METHODS: A systematic search of Medline (Pubmed), EMBASE, Cochrane Library, Sciverse (Science Direct and Scopus) and PsycInfo was conducted to identify studies published from January 2000 to December 2012. Data were analyzed using MIX 2.0 Pro and SPSS 20. RESULTS: Thirty-four longitudinal studies met the inclusion criteria; these studies included 15,992 patients, of whom 8,027 had undergone PCI, 6,348 had undergone CABG and 1,617 had received medication treatment. Moderate long-term effect sizes were revealed for both CR procedures. Both percutaneous coronary interventions (PCI) and coronary artery bypass graft surgery (CABG) had significantly greater effects on HRQoL than did medication; however, the CR procedures did not differ significantly from each other. Moderators included the type of instrument used to assess HRQoL and the study quality. Benefits related to physical functioning were greater than those related to psychosocial functioning in patients treated with CABG. CONCLUSIONS: Empirical research highlights the positive effect of CR on patient HRQoL. Researchers should carefully select the instrument they use to measure HRQoL, as this may affect the results and thus conclusions. More RCTs and between-group studies employing pre-post designs should be conducted before clear conclusions can be drawn.

Translation, adaptation and validation of the Coronary Revascularization Outcome Questionnaire into Greek.

BACKGROUND AND AIMS: Evaluating the impact of coronary revascularization on patients' health related quality of life with a patient-based and disease-specific tool is important for drawing conclusions about treatment and outcomes. This study reports on the translation, adaptation and psychometric evaluation of a Greek version of the Coronary Revascularization Outcome Questionnaire (CROQ-Gr). METHODS: A total of 609 (81.7% male) patients who had undergone coronary revascularization (percutaneous coronary intervention or coronary artery bypass grafting) were recruited from four hospitals in Athens. After translating the CROQ into Greek, a preliminary qualitative study and a pilot quantitative study were conducted. A full psychometric evaluation was carried out on the main study's data. RESULTS: The psychometric evaluation demonstrated that the CROQ-Gr is acceptable to patients (high response rate, low missing data) and has a good level of reliability (internal consistency >0.70, test-retest reliability >0.90) and validity (both content and construct validity). CONCLUSIONS: The results of this study show the CROQ-Gr to be a psychometrically rigorous patient-based measure of outcomes of coronary revascularization. It would be appropriate for use in evaluative research as well as a routine clinical tool to aid cardiologists in monitoring the outcomes of care.