Pomegranate supplementation improves cognitive and functional recovery following ischemic stroke: A randomized trial.

Objectives: We tested whether supplementing with pomegranate polyphenols can enhance cognitive/functional recovery after stroke. Methods: In this parallel, block-randomized clinical trial, we administered commercially-available pomegranate polyphenol or placebo pills twice per day for one week to adult inpatients in a comprehensive rehabilitation setting starting approximately 2 weeks after stroke. Pills contained 1 g of polyphenols derived from whole pomegranate, equivalent to levels in approximately 8 oz of juice. Placebo pills were similar to the pomegranate pills except that they contained only lactose. Of the 163 patients that were screened, 22 were eligible and 16 were randomized (8 per group). We excluded one subject per group from the neuropsychological analyses since they were lost to follow-up, but we included all subjects in the analysis of functional data since outcome data were available. Clinicians and subjects were blinded to group assignment. Neuropsychological testing (primary outcome: Repeatable Battery for the Assessment of Neuropsychological Status) and functional independence scores were used to determine changes in cognitive and functional ability. Results: Pomegranate-treated subjects demonstrated more neuropsychological and functional improvement and spent less time in the hospital than placebo controls. Discussion: Pomegranate polyphenols enhanced cognitive and functional recovery after stroke, justifying pursuing larger clinical trials.

Epilepsy Surgery for Skull-Base Temporal Lobe Encephaloceles: Should We Spare the Hippocampus from Resection?

The neurosurgical treatment of skull base temporal encephalocele for patients with epilepsy is variable. We describe two adult cases of temporal lobe epilepsy (TLE) with spheno-temporal encephalocele, currently seizure-free for more than two years after anterior temporal lobectomy (ATL) and lesionectomy sparing the hippocampus without long-term intracranial electroencephalogram (EEG) monitoring. Encephaloceles were detected by magnetic resonance imaging (MRI) and confirmed by maxillofacial head computed tomography (CT) scans. Seizures were captured by scalp video-EEG recording. One case underwent intraoperative electrocorticography (ECoG) with pathology demonstrating neuronal heterotopia. We propose that in some patients with skull base temporal encephaloceles, minimal surgical resection of herniated and adjacent temporal cortex (lesionectomy) is sufficient to render seizure freedom. In future cases, where an associated malformation of cortical development is suspected, newer techniques such as minimally invasive EEG monitoring with stereotactic-depth EEG electrodes should be considered to tailor the surrounding margins of the resected epileptogenic zone.

The NAB shape learning subtest as a predictor of lateralized seizure onset.

This study presents the first empirical evaluation of the predictive value of the Neuropsychological Assessment Battery Shape Learning (NAB-SL) subtest in a sample of patients with unilateral temporal lobe epilepsy. Stimulus characteristics of the NAB-SL may improve predictive ability over other commonly used visual memory tests. Forty-nine patients with unilateral temporal lobe epilepsy were compared on measures of non-verbal and verbal memory (NAB-SL and Wechsler Memory Scale-III subtests). Univariate and forward conditional logistic regressions identified predictive values for each memory test individually and in combination. The NAB-SL delayed memory demonstrated consistently stronger predictive power over visual reproduction at the univariate and multivariate levels. The NAB-SL was a good predictor (80% range) of lateralized seizure onset when combined with a verbal memory measure. These preliminary results provide support for the use of the NAB-SL in preoperative epilepsy evaluations as a predictor of non-dominant temporal lobe dysfunction. Potential benefits of this test are discussed.

Motivation, psychopathology, locus of control, and quality of life in women with epileptic and nonepileptic seizures.

To examine factors that may potentially aid in the differential diagnosis and subsequent tailoring of treatment for patients with epileptic (ES) and psychogenic nonepileptic (PNES) seizures, thirty female patients with PNES and 51 female patients with temporal lobe epilepsy were assessed in the areas of motivation, psychopathology, health-related locus of control (HRLOC), and health-related quality of life (HRQOL). The two groups demonstrated equivalent levels of motivation, clinically elevated yet comparable mood symptoms, and no general differences in HRLOC. Despite similar mood disturbances in both groups, the participants with PNES had a later age of seizure onset, exhibited greater personality disturbances, attributed more control over their condition to nonphysicians, and endorsed a greater negative impact of their seizures on physical and emotional aspects of HRQOL. Preliminary analyses suggest that chronic anxiety and overall HRQOL may be core discriminators between these seizure groups. Addressing such issues may prove useful in tailoring more specific treatments for these etiologically disparate conditions.

A comprehensive neuropsychological profile of women with psychogenic nonepileptic seizures.

The purpose of this study was to compare the neuropsychological profile of women with VEEG-confirmed diagnoses of psychogenic nonepileptic seizures (PNES) with that of an age- and education-matched group of women with left temporal lobe epilepsy (LTLE). Results indicate that in a relatively homogenous PNES sample, no severe neurocognitive impairments were present, further supporting a psychologically versus neurologically driven pathology of PNES. In comparison to age-stratified normative data, the PNES group demonstrated only a modest deficiency across neuropsychological domains and a relative area of weakness in attention and working memory, and generally outperformed their counterparts with LTLE. Although the attentional deficits in the PNES group may have been influenced by their elevated levels of emotional distress, symptoms of depression and anxiety were significant and common in both patients with PNES and those with LTLE, and therefore, the utility of psychological factors in discriminating these groups is limited. The present findings warrant the use of longitudinal research with patients with PNES to identify changes in the presentation of this condition as well as its subsequent neurocognitive and emotional impairments.