Testing an Adapted Auditory Verbal Learning Test Paradigm for fMRI to Lateralize Verbal Memory in Patients with Epilepsy.

BACKGROUND AND PURPOSE: fMRI is a noninvasive tool for predicting postsurgical deficits in candidates with pharmacoresistant temporal lobe epilepsy. We aimed to test an adapted paradigm of the Rey Auditory Verbal Learning Test to evaluate differences in memory laterality indexes between patients and healthy controls and its association with neuropsychological scores. MATERIALS AND METHODS: We performed a prospective study of 50 patients with temporal lobe epilepsy and 22 healthy controls. Participants underwent a block design language and memory fMRI. Laterality indexes and the hippocampal anterior-posterior index were calculated. Language and memory lateralization was organized into typical and atypical on the basis of laterality indexes. A neuropsychological assessment was performed with a median time from fMRI of 8 months and was compared with fMRI performance. RESULTS: We studied 40 patients with left temporal lobe epilepsy and 10 with right temporal lobe epilepsy. Typical language occurred in 65.3% of patients and 90.9% of healthy controls (P = .04). The memory fMRI laterality index was obtained in all healthy controls and 92% of patients. The verbal memory laterality index was bilateral (24.3%) more frequently than the language laterality index (7.69%) in patients with left temporal lobe epilepsy. Atypical verbal memory was greater in patients with left temporal lobe epilepsy (56.8%) than in healthy controls (36.4%), and the proportion of bilateral laterality indexes (53.3%) was larger than right laterality indexes (46.7%). Atypical verbal memory might be associated with higher cognitive scores in patients. No relevant differences were seen in the hippocampal anterior-posterior index according to memory impairment. CONCLUSIONS: The adapted Rey Auditory Verbal Learning Test paradigm fMRI might support verbal memory lateralization. Temporal lobe epilepsy laterality influences hippocampal memory laterality indexes. Left temporal lobe epilepsy has shown a higher proportion of atypical verbal memory compared with language, potentially to memory functional reorganization.

PET/MRI and PET/MRI/SISCOM coregistration in the presurgical evaluation of refractory focal epilepsy.

We aimed to investigate the usefulness of coregistration of positron emission tomography (PET) and magnetic resonance imaging (MRI) findings (PET/MRI) and of coregistration of PET/MRI with subtraction ictal single-photon emission computed tomography (SPECT) coregistered to MRI (SISCOM) (PET/MRI/SISCOM) in localizing the potential epileptogenic zone in patients with drug-resistant epilepsy. We prospectively included 35 consecutive patients with refractory focal epilepsy whose presurgical evaluation included a PET study. Separately acquired PET and structural MRI images were coregistered for each patient. When possible, ictal SPECT and SISCOM were obtained and coregistered with PET/MRI. The potential location of the epileptogenic zone determined by neuroimaging was compared with the seizure onset zone determined by long-term video-EEG monitoring and with invasive EEG studies in patients who were implanted. Structural MRI showed no lesions in 15 patients. In these patients, PET/MRI coregistration showed a hypometabolic area in 12 (80%) patients that was concordant with seizure onset zone on EEG in 9. In 7 patients without MRI lesions, PET/MRI detected a hypometabolism that was undetected on PET alone. SISCOM, obtained in 25 patients, showed an area of hyperperfusion concordant with the seizure onset zone on EEG in 7 (58%) of the 12 of these patients who had normal MRI findings. SISCOM hyperperfusion was less extensive than PET hypometabolism. A total of 19 patients underwent surgery; 11 of these underwent invasive-EEG monitoring and the seizure onset zone was concordant with PET/MRI in all cases. PET/MRI/SISCOM coregistration, performed in 4 of these patients, was concordant in 3 (75%). After epilepsy surgery, 13 (68%) patients are seizure-free after a mean follow-up of 4.5 years. PET/MRI and PET/MRI/SISCOM coregistration are useful for determining the potential epileptogenic zone and thus for planning invasive EEG studies and surgery more precisely, especially in patients without lesions on MRI.

Impact of radiotherapy delay on survival in glioblastoma

BACKGROUND: Previous studies in glioblastoma have concluded that there is no decrease in survival with increasing time to initiation of RT up to 6 weeks after surgery. Unfortunately, the number of glioblastoma patients who start RT beyond 6 weeks is not small in some countries. The aim of our study was to evaluate the effect of RT delay beyond 6 weeks on survival of patients who have undergone completed resection of a glioblastoma. METHODS: We reviewed 107 consecutive glioblastoma patients who had a complete surgical resection at our hospital. Clinical data, including delay in initiation of RT, were prospectively collected. The impact of single parameters on overall survival was determined by univariate and multivariate analyses. RESULTS: According to univariate analysis, variables that had a prognostic influence on survival were age (p = 0.036), KPS (p = 0.031), additional treatment with CHT (p < 0.0001), and initiation of RT before 42 days (p = 0.009). Multivariate analysis indicated that Karnofsky performance scale, additional treatment with chemotherapy, and initiation of RT before 6 weeks after surgery were favorable, independent prognostic factors of survival. CONCLUSIONS: Survival is significantly reduced in glioblastoma patients if RT is not initiated within the 6 weeks after complete resection of the tumor (AU)

Simple fMRI postprocessing suffices for normal clinical practice.

BACKGROUND AND PURPOSE: Whereas fMRI postprocessing tools used in research are accurate but unwieldy, those used for clinical practice are user-friendly but are less accurate. We aimed to determine whether commercial software for fMRI postprocessing is accurate enough for clinical practice. METHODS: Ten volunteers underwent fMRI while performing motor and language tasks (hand, foot, and orolingual movements; verbal fluency; semantic judgment; and oral comprehension). We compared visual concordance, image quality (noise), voxel size, and radiologist preference for the activation maps obtained by using Neuro3D software (provided with our MR imaging scanner) and by using the SPM program commonly used in research. RESULTS: Maps obtained with the 2 methods were classified as "partially overlapping" for 70% for motor and 72% for language paradigm experiments and as "overlapping" in 30% of motor and in 15% of language paradigm experiments. CONCLUSIONS: fMRI is a helpful and robust tool in clinical practice for planning neurosurgery. Widely available commercial fMRI software can provide reliable information for therapeutic management, so sophisticated, less widely available software is unnecessary in most cases.

Does gender matter in glioblastoma?

BACKGROUND The clinical outcome of glioblastoma (GBM) patients who receive radiotherapy alone or with chemotherapy is well established. However, little is known about how many patients do not receive this treatment. We consider it is important to investigate why a proportion of operated patients do not receive further treatment after surgery. METHODS We reviewed all consecutive GBM patients operated on in our hospital between January 2000 and December 2008. RESULTS A total of 216 patients with GBM were identified. Fifty-five (25%) did not receive any treatment after surgery. Univariate analysis showed that factors associated with no further treatment after surgery were older than 60 years (p=0.002), of female gender (p=0.03), had a KPS<70 (p<0.001) and had had a biopsy (p<0.001). Multivariate analysis indicated that age =60 years and KPS <70 were independent predictors of no further treatment after surgery. Gender was not an independent variable. However, women in the whole series were older than 60 years (p=0.01), and they had a worse KPS (p=0.02) and more biopsies (p=0.04) than men. In the whole group, median survival time was 10.4 months for men (n=125) vs. 7.2 months for women (n=91), log rank p<0.04. This difference was not observed in the group that was treated after surgery. CONCLUSIONS One out of four patients could not be treated after surgery. Independent predictors were older age and low KPS. These poor risk variables were more frequent in women and their survival was therefore lower than men in our series.

Does gender matter in glioblastoma?

BACKGROUND The clinical outcome of glioblastoma (GBM) patients who receive radiotherapy alone or with chemotherapy is well established. However, little is known about how many patients do not receive this treatment. We consider it is important to investigate why a proportion of operated patients do not receive further treatment after surgery. METHODS We reviewed all consecutive GBM patients operated on in our hospital between January 2000 and December 2008. RESULTS A total of 216 patients with GBM were identified. Fifty-five (25%) did not receive any treatment after surgery. Univariate analysis showed that factors associated with no further treatment after surgery were older than 60 years (p=0.002), of female gender (p=0.03), had a KPS<70 (p<0.001) and had had a biopsy (p<0.001). Multivariate analysis indicated that age =60 years and KPS <70 were independent predictors of no further treatment after surgery. Gender was not an independent variable. However, women in the whole series were older than 60 years (p=0.01), and they had a worse KPS (p=0.02) and more biopsies (p=0.04) than men. In the whole group, median survival time was 10.4 months for men (n=125) vs. 7.2 months for women (n=91), log rank p<0.04. This difference was not observed in the group that was treated after surgery. CONCLUSIONS One out of four patients could not be treated after surgery. Independent predictors were older age and low KPS. These poor risk variables were more frequent in women and their survival was therefore lower than men in our series (AU)

Intraoperative warming and post-operative cognitive dysfunction after total knee replacement.

BACKGROUND: Post-operative cognitive dysfunction (POCD) can affect 30% of orthopedic surgery patients. We hypothesized that perioperative temperature has an impact on POCD. METHODS: We included 150 patients over 65 years of age scheduled for total knee replacement under spinal anesthesia. They were randomized to receive standard care (sheet cover) or active warming. Neurocognitive assessment (11 subtests) was performed pre-operatively and at day 4 (three subtests) and 3 months (10 subtests). A control group of 55 nonsurgical patients took the same tests at equivalent times. POCD was defined as an individual score decrease of more than 2 standard deviations (SDs) below the baseline on at least two subtests or 2 SDs in the combined z-score, in both cases using control-adjusted changes. RESULTS: Tympanic temperature declined below 35 °C in 88% of standard-care patients; 25.3% of warmed patients had a temperature ≥36 °C. On day 4, 3.2% of standard-care patients and 19.4% of warmed patients had POCD (P=0.0058). At 3 months, there were no between-group differences (standard care, 14.3%; warmed, 6.5%) (P=0.2440). CONCLUSIONS: Perioperative warming was associated with a higher incidence of cognitive dysfunction at 4 days after total knee replacement in patients >65 years of age.

La hemisferectomía funcional también es eficaz en pacientes adultoscon epilepsia catastrófica / Successful functional hemispherectomy in adult patients with refractory epilepsy

Introducción. La hemisferectomía es una técnica quirúrgica empleada para tratar epilepsias farmaco resistentes en el contexto de síndromes hemisféricos difusos. La mayoría de las series de pacientes hemisferectomizados incluyen preferentemente pacientes en edad pediátrica. Métodos. Presentamos nuestra serie de cuatro pacientes adultos sometidos a hemisferectomía funcional para el tratamiento de su epilepsia refractaria tras realizarse una evaluación prequirúrgica completa. En tres pacientes la epilepsia era secundaria a un infarto dela arteria cerebral media y en uno a una encefalitis de Rasmussen. Resultados. Tras la cirugía tres pacientes permanecieron libres de crisis a lo largo del período de seguimiento (13-26 meses) y en el cuarto se consiguió una reducción >75% en su frecuencia de crisis. En todos los pacientes hubo una mejoría en su calidad de vida. Las complicaciones precoces tras la cirugía fueron una crisis tónico clónica aislada en un paciente y un estatus epiléptico precoz probablemente secundario a fiebre y meropenem que dismunuye el umbral convulsivo. El único déficit neurológico permanente que se produjo fue una hemianopsia en un paciente. Conclusión. La hemisferectomía funcional debe considerarse una opción quirúrgica en pacientes con epilepsia refractaria secundaria a lesiones hemisféricas extensas y que estén afectos previamente de hemiparesias graves (AU)

Introduction. Functional hemispherectomy is a surgical technique used to treat refractory epilepsies in the setting of extensive unilateral hemispheric lesions. Most series of hemispherectomies include mainly pediatric patients. Methods. We report our series of four adult patients that have undergone functional hemispherectomy for their refractory epilepsy. Each one had a complete presurgical evaluation including video EEG, neuropsychological testing and anatomical and functional neuroimaging. In three of them, the epilepsy was secondary to a middle cerebral artery infarction. One patient had Rasmussen encephalitis. Results. After surgery, three patents have become completely seizure free (follow up 13-26 months). The fourth patient has had more than 75% reduction in seizure frequency. All of them have had significant improvement in their quality of life. Early complications included an isolated tonic-clonic generalized seizure(one patient), and status epilepticus in another patients related to infection and use of meropenem. Only one patient has presented hemianopia as a permanent neurological deficit after surgery. Conclusions. Functional hemispherectomy is a good surgical option in the setting of large unilateral hemispheric lesions causing hemiparesis and intractable seizures, even in adult patients (AU)

[Successful functional hemispherectomy in adult patients with refractory epilepsy]. / La hemisferectomía funcional también es eficaz en pacientes adultos con epilepsia catastrófica.

INTRODUCTION: Functional hemispherectomy is a surgical technique used to treat refractory epilepsies in the setting of extensive unilateral hemispheric lesions. Most series of hemispherectomies include mainly pediatric patients. METHODS: We report our series of four adult patients that have undergone functional hemispherectomy for their refractory epilepsy. Each one had a complete presurgical evaluation including video EEG, neuropsychological testing and anatomical and functional neuroimaging. In three of them, the epilepsy was secondary to a middle cerebral artery infarction. One patient had Rasmussen encephalitis. RESULTS: After surgery, three patents have become completely seizure free (follow up 13-26 months). The fourth patient has had more than 75% reduction in seizure frequency. All of them have had significant improvement in their quality of life. Early complications included an isolated tonic-clonic generalized seizure (one patient), and status epilepticus in another patients related to infection and use of meropenem. Only one patient has presented hemianopia as a permanent neurological deficit after surgery. CONCLUSIONS: Functional hemispherectomy is a good surgical option in the setting of large unilateral hemispheric lesions causing hemiparesis and intractable seizures, even in adult patients.

Parry Romberg syndrome and linear scleroderma in coup de sabre mimicking Rasmussen encephalitis.

We present one patient with Parry Romberg syndrome and another with linear scleroderma in coup de sabre, with focal neurologic deficits and intractable seizures arising from the hemisphere ipsilateral to the cutaneous lesion. Brain MRI showed progressive hemispheric atrophy. Pathology after functional hemispherectomy showed chronic inflammatory features suggestive of Rasmussen encephalitis.

Diferencias de género en las funciones cognitivas e influencia de las hormonas sexuales / Gender differences in cognitive functions and influence of sex hormones

Objetivo. Revisar las evidencias científicas sobre las diferencias cognitivas en función del género y la posible influencia de las hormonas sexuales en el rendimiento cognitivo. Método. Se realizó una búsqueda sistemática de la bibliografía a través del sistema Medline sobre artículos relacionados con el tema. Resultados. Las mujeres presentan un mayor rendimiento con respecto a los hombres en fluencia verbal, velocidad perceptiva, habilidad motora fina, tareas de memoria verbal y aprendizaje verbal. Los hombres superan a las mujeres en tareas visuoespaciales, resolución de problemas matemáticos y memoria visual. No se encuentran diferencias en función del género en atención y memoria de trabajo. Los estudios que evalúan la influencia de factores hormonales se han realizado en diversos grupos: a) pacientes con trastornos hormonales; b) pacientes sometidos a neuroimagen tras la administración hormonal; c) en mujeres sanas en función del ciclo menstrual, y d) en pacientes sometidos a tratamiento hormonales (hipogonadismo hipogonadotrófico, mujeres posmenopáusicas y trastorno de la identidad de género). Estos estudios en su mayoría encuentran una influencia de los niveles hormonales en diversas capacidades cognitivas, aunque los resultados no son del todo concluyentes por las limitaciones y escasez de estos estudios. Conclusiones. Existen diferencias cognitivas en función del género y las hormonas sexuales parecen ejercer una influencia en estas funciones cognitivas

Objective. To review scientific evidence on gender differences in cognitive functions and influence of sex hormones on cognitive performance. Method. Systematical search of related studies identified in Medline. Results. Women outperform men on verbal fluency, perceptual speed tasks, fine motor skills, verbal memory and verbal learning. Men outperform women on visuospatial ability, mathematical problem solving and visual memory. No gender differences on attention and working memory are found. Researchers distinguish four methods to investigate hormonal influence on cognitive performance: a) patient with hormonal disorders; b) neuroimaging in individuals during hormone administration; c) in women during different phases of menstrual cycle, and d) in patients receiving hormonal treatment (idiopathic hypogonadotropic hypogonadism, postmenopausal women and transsexuals). The findings mostly suggest an influence of sex hormones on some cognitive functions, but they are not conclusive because of limitations and scarcity of the studies. Conclusions. There are gender differences on cognitive functions. Sex hormones seem to influence cognitive performance

[Gender differences in cognitive functions and influence of sex hormones]. / Diferencias de género en las funciones cognitivas e influencia de las hormonas sexuales.

OBJECTIVE: To review scientific evidence on gender differences in cognitive functions and influence of sex hormones on cognitive performance. METHOD: Systematical search of related studies identified in Medline. RESULTS: Women outperform men on verbal fluency, perceptual speed tasks, fine motor skills, verbal memory and verbal learning. Men outperform women on visuospatial ability, mathematical problem solving and visual memory. No gender differences on attention and working memory are found. Researchers distinguish four methods to investigate hormonal influence on cognitive performance: a) patient with hormonal disorders; b) neuroimaging in individuals during hormone administration; c) in women during different phases of menstrual cycle, and d) in patients receiving hormonal treatment (idiopathic hypogonadotropic hypogonadism, postmenopausal women and transsexuals). The findings mostly suggest an influence of sex hormones on some cognitive functions, but they are not conclusive because of limitations and scarcity of the studies. CONCLUSIONS: There are gender differences on cognitive functions. Sex hormones seem to influence cognitive performance.

Indefensión aprendida y dependencia de sustancias / The learned helplessness and substance dependence

Objetivo. Realizar una revisión sistemáticade la teoría de la indefensión aprendida asícomo de la relación entre ésta y la dependencia desustancias.Material y métodos. Se realizó una búsqueda sistemáticade la bibliografía a través del sistemaMEDLINE y PSYCINFO sobre artículos relacionadoscon el tema.Resultados. La teoría de la indefensión aprendidapuede aplicarse al ámbito de las adiccionescomo modelo explicativo de la incontrolabilidad, ejecentral de estos trastornos. Concretamente, la indefensiónaprendida desempeñaría un papel relevantecomo variable predictora de consumo ycomo variable relacionada con la evolución de dichoconsumo, asociándose a alteraciones emocionalesy déficits neuropsicológicos.Conclusiones. La indefensión aprendida constituyeun paradigma válido aplicable a los trastornospor dependencia de sustancias. Se requiere de másestudios para determinar sus implicaciones clínicasy terapéuticas en las adicciones

Objectives. A systematic review of thetheory of learned helplessness as well as the relationbetween this paradigm of learning and substancedependence.Materail and methods. A systematic search of thearticles on the bibliography through MEDLINEand PSYCINFO systems were made.Results. The theory of learned helplessness can beapplied to the scope of addictions like an explanatorymodel of the uncontrollability experience, thatis the central axis of substance related disorders. Asa result, the learned helplessness becomes a predictingvariable of consumption and its evolution.Furthermore, the helplessness model is associatedto neuropsychological and emotional impairments.Conclusions. The learned helplessness paradigmbecomes a useful model for substance dependencedisorders although more research to determinateclinical and therapeutic implications of the theoryin the field of addictions is required

Cortical laminar necrosis related to prolonged focal status epilepticus.

Cortical laminar necrosis (CLN) is radiologically defined as high intensity cortical lesions on T1 weighted MRI images following a gyral distribution. Histopathologically, CLN is characterised by pannecrosis of the cortex involving neurones, glial cells, and blood vessels. It has been reported to be associated with hypoxia, metabolic disturbances, drugs, and infections. We present two patients who developed CLN and permanent neurological deficits after prolonged and repeated focal status epilepticus. The possible mechanisms leading to CLN in these patients are discussed, together with the implications of prompt and aggressive treatment in similar cases.

Complex motor behaviors in temporal lobe epilepsy.

Complex motor behaviors differing from typical automatisms were found in 12 of 502 patients with temporal lobe epilepsy. Movements involved proximal limb segments (6) or body axis (6) and were often preceded by auras and followed by automatisms. Seven of 12 patients are seizure free after surgery. The other 5 patients declined surgery.

Can the Wada test evaluate mesial temporal function? A SPECT study.

OBJECTIVE: To assess the value of SPECT during intracarotid amobarbital procedure (IAP) to discriminate which patients performed the test with the hippocampus inactivated and correlate it with the risk of amnesia after anterior temporal lobectomy (ATL). METHODS: The authors studied 40 consecutive patients undergoing ATL for refractory epilepsy. SPECT was performed after IV injection of 99mTc-HMPAO during the IAP (IAP-SPECT). Interictal SPECT and IAP-SPECT were realigned to obtain the perfusion change percentage (PCP), allowing a quantitative measurement. Wechsler Memory Scale Revised (WMS-R) before and during the first year of follow-up was used to assess memory impairment after surgery. RESULTS: A decrease between 10 and 12% of the mean PCP values was observed in the frontal, parietal, and lateral temporal lobes of the injected side and in the contralateral cerebellum. However, no significant PCP changes were observed in the occipital or mesial temporal lobes. Thirty-eight passed the memory evaluation of the IAP and in 6 of those 38 patients a decline in memory was demonstrated 1 year after ATL. However, high preoperative neuropsychological score (in two patients) and IAP asymmetry scores (in other three patients) predicted postoperative memory risk in five of these six patients. Fourteen of the 38 patients (40%) had hypoperfusion of the hippocampus during the IAP-SPECT (i.e., the hippocampus was inactivated) and only 1 of these 14 patients (2.5%) developed memory impairment after temporal lobectomy. On the other hand, 5 of the 24 patients (13%) who had a functional hippocampus on IAP-SPECT developed memory impairment. CONCLUSIONS: The results suggest that the combination of SPECT, intracarotid amobarbital procedure, and neuropsychological testing predicted risk for all patients who had postoperative memory decline, indicating that risk prediction should be based on multiple factors. IAP-SPECT results demonstrated that the hippocampus is not inactivated in over 60% of patients and that the lack of accuracy of the IAP alone in predicting the risk of amnesia is probably related to an insufficient inactivation of the ipsilateral hippocampus during the test.

Pattern of cognitive dysfunction in depressive patients during maintenance electroconvulsive therapy.

BACKGROUND: Objective data regarding adverse cognitive deficits associated with maintenance electroconvulsive therapy (M-ECT) are lacking. This study examined the cognitive state of depressive patients during M-ECT. METHOD: A cross-sectional study was carried out in 11 depressive patients in remission, all with a DSM-IV diagnosis of major depressive disorder. The mean number of previous ECT sessions was 36.1, and the mean intersession interval was 52.7 days. A group of 11 patients who had not received ECT was selected for comparison and matched for diagnosis, sex, age and years of schooling. All subjects were assessed using a complete neuropsychological battery including memory, attention and frontal function tests. RESULTS: Groups did not present differences in long delay verbal recall. Encoding of new information and results on the frontal function tests were significantly lower in the M-ECT patients. CONCLUSION: Depressed patients preserve long-term memory, but suffer short-term memory impairment and frontal function alteration during M-ECT. Further longitudinal studies are necessary to determine the influence of M-ECT on non-memory functions and different memory subtypes.

Neuropsicobiología de la relación entre la experiencia sensitiva posnatal y el desarrollo de la precisión en las conexiones neuronales / Neuropsychobiology of the relationship between postnatal sensory experience and development of precision in neuronal connections

No disponible

Could the hypofrontality pattern in schizophrenia be modified through neuropsychological rehabilitation?

OBJECTIVE: The effects of neuropsychological treatment on cognitive hypofrontality were examined in schizophrenic patients through the score activation. METHOD: Eight subjects (six men and two women) with persistent negative symptoms and cognitive impairments were evaluated with single photon emission computed tomography (SPECT) procedures and neuropsychological battery before and after a neuropsychological treatment group. RESULTS: After treatment an enhancement in neuropsychological performance was found, especially in executive functions. The activation score showed an increase over baseline levels and no cognitive-dependent hypofrontality after treatment was found. Although the prefrontal blood flow changes were small and non-specific, they suggest a reduction of the cognitive hypofrontality after neuropsychological treatment. CONCLUSION: Cognitive improvements after neuropsychological treatment would possibly be related with the diminution of the functional hypoactivity in the prefrontal areas.