Hippocampal recording via the RNS system reveals marked ipsilateral activation of epileptiform activity during Wada testing.

Wada testing remains an important component of pre-surgical testing to assess the feasibility of temporal lobectomy for patients with intractable epilepsy. In this procedure, an anesthetic is injected into either internal carotid artery while memory and language testing is performed, simulating the effect of temporal lobe resection. The mechanism remains poorly understood because the hippocampal vasculature is predominantly via the posterior circulation. We recorded hippocampal EEG during bilateral methohexital Wada testing in three patients who had previously been implanted with a responsive neurostimulation system (RNS) to determine the effect of the injections on hippocampal activity. In all six injections from three patients, methohexital caused immediate, transient increases in hippocampal spikes. With at least two of these injections, the electrographic changes were consistent with electrographic seizures. In all cases, the epileptiform activity was not apparent on scalp EEG and was without obvious clinical correlate other than the negative findings expected from the anesthetic. The results demonstrate the utility of intracranial EEG during Wada testing and suggest that the elicitation of seizures or continuous spiking might contribute to dysfunction of the hippocampus during the Wada test. We hypothesize that this effect is due to disconnection and disinhibition of medial temporal structures.

Long-term Quality of Life in Survivors of Brain Metastases: A Roller Coaster of Perspective.

Longevity in cancer patients with brain metastases is increasingly being observed. This raises discussions about how best to maintain a good quality of life for these patients. Recent data suggest that post-treatment quality of life (QoL) can be maintained using new treatment options, but little data exist regarding the QoL in long-term survivors. This study of 19 patients surviving greater than two years from the initial treatment of brain metastases suggests that long-term QoL can be better than at the start of treatment and perhaps even better than normal, especially between three and five years post-treatment. This improved QoL seems mostly attributable to improved functional and social well-being and is possible as long as emotional and physical well-being are maintained within the normal range.

Comparison of the Computer and Hand Administered Versions of the Brown Location Test (BLT).

OBJECTIVE: The Brown Location Test (BLT) was developed to remedy some of the problems in existing visual-based memory tests. The hand version has demonstrated good psychometric properties, the ability to provide lateralization information for mesial temporal lobe epilepsy patients, and has normative data. The purpose of this study was to compare the hand administered format to the more recently developed computer administered format. METHODS: We used Generalizability Theory analyses to assess the degree of variability in scores across the hand and computer versions of the test, and across alternate test forms, A and B. We also compared the means and standard deviations for the different versions and forms using paired t-tests, and Pearson correlation coefficients. RESULTS: There was minimal variability and high levels of score similarity across the various test administration formats and forms. CONCLUSIONS: The high degree of comparability between versions allows one to apply the validity findings and normative data collected using the hand administered version to the computer version of the BLT.

Spatial memory for asymmetrical dot locations predicts lateralization among patients with presurgical mesial temporal lobe epilepsy.

This study examined the ability of an asymmetrical dot location memory test (Brown Location Test, BLT) and two verbal memory tests (Verbal Selective Reminding Test (VSRT) and California Verbal Learning Test, Second Edition (CVLT-II)) to correctly lateralize left (LTLE) or right (RTLE) mesial temporal lobe epilepsy that was confirmed with video-EEG. Subjects consisted of 16 patients with medically refractory RTLE and 13 patients with medically refractory LTLE who were left hemisphere language dominant. Positive predictive values for lateralizing TLE correctly were 87.5% for the BLT, 72.7% for the VSRT, and 80% for the CVLT-II. Binary logistic regression indicated that the BLT alone correctly classified 76.9% of patients with left temporal lobe epilepsy and 87.5% of patients with right temporal lobe epilepsy. Inclusion of the verbal memory tests improved this to 92.3% of patients with left temporal lobe epilepsy and 100% correct classification of patients with right temporal lobe epilepsy. Though of a limited sample size, this study suggests that the BLT alone provides strong laterality information which improves with the addition of verbal memory tests.

Allocentric but not egocentric visual memory difficulties in adults with ADHD may represent cognitive inefficiency.

Attention Deficit Hyperactivity Disorder (ADHD) has often been conceptualized as arising executive dysfunctions (e.g., inattention, defective inhibition). However, recent studies suggested that cognitive inefficiency may underlie many ADHD symptoms, according to reaction time and processing speed abnormalities. This study explored whether a non-timed measure of cognitive inefficiency would also be abnormal. A sample of 23 ADHD subjects was compared to 23 controls on a test that included both egocentric and allocentric visual memory subtests. A factor analysis was used to determine which cognitive variables contributed to allocentric visual memory. The ADHD sample performed significantly lower on the allocentric but not egocentric conditions. Allocentric visual memory was not associated with timed, working memory, visual perception, or mental rotation variables. This paper concluded by discussing how these results supported a cognitive inefficiency explanation for some ADHD symptoms, and discussed future research directions.

The relationship of self-reported subclinical obsessive-compulsive symptoms and impulsivity among adults with AD/HD.

This study examined the degree to which subclinical obsessive-compulsive symptoms (SOCS) among individuals with Attention Deficit/Hyperactivity Disorder (AD/HD) were associated with response inhibition difficulties on a performance-based test. Participants consisted of 64 adults with AD/HD who completed the Conner׳s Continuous Performance Test, Second Edition (CPT-II), Symptom Checklist-90-Revised (SCL-90-R), and the Brown Attention Deficit Disorder Scale (ADD Scale). Individuals with higher scores on the Obsessive-Compulsive Scale from the SCL-90-R made significantly more commission errors on the CPT-II; whereas other SCL-90-R scores did not demonstrate such a relationship. We did not find that SOCS were related to severity of AD/HD. These results supported the hypothesis that individuals with AD/HD with response inhibition difficulties tend to report more subclinical obsessive symptoms.

Influence of anxiety on memory performance in temporal lobe epilepsy.

This study examined the degree to which anxiety contributed to inconsistent material-specific memory difficulties among 243 patients with temporal lobe epilepsy from the Multisite Epilepsy Study. Visual memory performance on the Rey Complex Figure Test (RCFT) was poorer for those with high versus low levels of anxiety but was not found to be related to the TLE side. The verbal memory score on the California Verbal Learning Test (CVLT) was significantly lower for patients with left-sided TLE than for patients with right-sided TLE with low anxiety levels but equally impaired for those with high anxiety levels. These results suggest that we can place more confidence in the ability of verbal memory tests like the CVLT to lateralize to left-sided TLE for those with low anxiety levels, but that verbal memory will be less likely to produce lateralizing information for those with high anxiety levels. This suggests that more caution is needed when interpreting verbal memory tests for those with high anxiety levels. These results indicated that RCFT performance was significantly affected by anxiety and did not lateralize to either side, regardless of anxiety levels. This study adds to the existing literature which suggests that drawing-based visual memory tests do not lateralize among patients with TLE, regardless of anxiety levels.

Processing speed and working memory performance in those with both ADHD and a reading disorder compared with those with ADHD alone.

In previous studies, children with both Attention-Deficit Hyperactivity Disorder (ADHD) and a Reading Disorder were found to have more difficulties with processing speed, working memory, and timed as opposed to non-timed executive functioning (EF) measures when compared with those with either disorder alone. The current study found that older adolescents and adults with both disorders also had more difficulties on processing speed and working memory measures than individuals who only had ADHD. There were no differences among non-timed EF scores. These results add support to the premise that common underlying features may be contributing to the high co-morbidity between these disorders and associated cognitive weaknesses.

Visual memory in patients after anterior right temporal lobectomy and adult normative data for the Brown Location Test.

Several large meta-analytic studies have failed to support a consistent relationship between visual or "nonverbal" memory deficits and right mesial temporal lobe changes. The Brown Location Test (BLT), a recently developed dot location learning and memory test, uses a nonsymmetrical array and provides control over many of the confounding variables (e.g., verbal influence and drawing requirements) inherent in other measures of visual memory. In the present investigation, we evaluated the clinical utility of the BLT in patients who had undergone left or right anterior mesial temporal lobectomy. We also provide normative data of 298 healthy adults for standardized scores. Results revealed significantly worse performance on the BLT in the right as compared to the left lobectomy group and the healthy adult normative sample. The present findings support a role for the right anterior mesial temporal lobe in dot location learning and memory.

A new measure of visual location learning and memory: development and psychometric properties for the Brown Location Test (BLT).

There are a variety of well-established neuropsychological tests that are helpful in identifying global and specific verbal memory deficits. In contrast, tests of visual memory have produced less consistent results likely due in part to confounding variables such as verbal encodability, administration difficulties, and insufficient differentiation of among types of visual memory. The Brown Location Test (BLT) was designed to specifically measure visual memory for location of identical objects (dots) and address limitations found in commonly employed visual memory tests. This paper describes the empirical basis for the BLT and reports the psychometric properties of the test. Results indicate good internal and alternate form reliabilities. Factor analysis of a brief test battery confirmed that BLT performance is generally independent of verbal memory and global intellectual abilities. BLT performance declined with age, but there was no association between performance and gender, education, or intellectual functioning. In view of the favorable psychometric properties observed during preliminary studies, additional normative and validation studies in healthy and patient populations are warranted.

Development and evaluation of the Sleep Treatment and Education Program for Students (STEPS).

University students report significantly worse sleep quality than the general population. Sleep problems are related to increased health concerns, irritability, depression, fatigue, and attention and concentration difficulties, along with poor academic performance. Clinical research indicates that psychoeducational interventions are among the most effective methods for improving sleep quality in the general population. Similar studies for university students are lacking. In this study, the authors describe the development of the Sleep Treatment and Education Program for Students (STEPS) and evaluate its effectiveness with a double blind, experimental design. Students in the treatment group reported significantly improved sleep quality and sleep hygiene behaviors at 6 weeks posttreatment.

Relationship of sleep hygiene awareness, sleep hygiene practices, and sleep quality in university students.

College students are known for their variable sleep schedules. Such schedules, along with other common student practices (e.g., alcohol and caffeine consumption), are associated with poor sleep hygiene. Researchers have demonstrated in clinical populations that improving sleep hygiene knowledge and practices is an effective treatment for insomnia. However, researchers who have examined relationships between sleep hygiene and practices in nonclinical samples and overall sleep quality have produced inconsistent findings, perhaps because of questionable measures. In this study, the authors used psychometrically sound instruments to examine these variables and to counter the shortcomings in previous investigations. Their findings suggest that knowledge of sleep hygiene is related to sleep practices, which, in turn, is related to overall sleep quality. The data from their regression modeling indicated that variable sleep schedules, going to bed thirsty, environmental noise, and worrying while falling asleep contribute to poor sleep quality.