Clustering and switching strategies during verbal fluency performance differentiate Alzheimer's disease and healthy aging.

Clustering and switching strategies during phonemic and semantic verbal fluency tasks as defined by Troyer et al. (1997), Abwender et al. (2001), and Lanting et al. (2009) were compared using archival data to determine which scoring procedures best differentiate healthy older adults (n = 26) from individuals with early-stage Alzheimer's disease (AD, n = 26). Total word production showed the largest group difference, especially for semantic fluency. The AD group produced fewer switches when compared to the healthy control group, whereas the groups did not differ in cluster size. The AD group also accessed fewer novel semantic subcategories, presumably due to reduced access to semantic memory storage rather than lower processing speed. Clustering and switching scores on the phonemic task did not add information above total words produced, consistent with previous research indicating these variables are most informative in relation to semantic fluency.

A male advantage for spatial and object but not verbal working memory using the n-back task.

Sex-related differences have been reported for performance and neural substrates on some working memory measures that carry a high cognitive load, including the popular n-back neuroimaging paradigm. Despite some evidence of a sex effect on the task, the influence of sex on performance represents a potential confound in neuroimaging research. The present study investigated sex-related differences in verbal, spatial, and common object versions of the high cognitive load "n-back" working memory task. Eighteen male and 18 female undergraduates completed all 3 versions of the task. A mixed ANOVA, with Sex (male and female) as the between-subjects factor and Condition (verbal, spatial, and object) as the within-subjects repeated measure revealed that males were significantly more accurate than females on the spatial and object versions of the n-back task and performed equivalently to females on the verbal version of the task. Although the expected female advantage for verbal working memory was not found using this effortful n-back task, these results support a male advantage for high cognitive load spatial and object working memory. Future research should take into account the influence of sex on performance of the n-back task, and examine sex-related differences in working memory using other paradigms.

The Concept of an Epilepsy Brain Bank.

Epilepsy comprises more than 40 clinical syndromes affecting millions of patients and families worldwide. To decode the molecular and pathological framework of epilepsy researchers, need reliable human epilepsy and control brain samples. Brain bank organizations collecting and supplying well-documented clinically and pathophysiologically tissue specimens are important for high-quality neurophysiology and neuropharmacology studies for epilepsy and other neurological diseases. New development in molecular mechanism and new treatment methods for neurological disorders have evoked increased demands for human brain tissue. An epilepsy brain bank is a storage source for both the frozen samples as well as the formaldehyde fixed paraffin embedded (FFPE) tissue from epilepsy surgery resections. In 2014, the University of Saskatchewan have started collecting human epilepsy brain tissues for the first time in Canada. This review highlights the necessity and importance of Epilepsy Brain bank that provides unique access for research to valuable source of brain tissue and blood samples from epilepsy patients.

The female advantage in object location memory is robust to verbalizability and mode of presentation of test stimuli.

This study extends Duff and Hampson's [Duff, S., & Hampson, E. (2001). A sex difference on a novel spatial working memory task in humans. Brain and Cognition,47, 470-493] finding of a sex-related difference in favor of females for an object location memory task. Twenty female and 20 male undergraduate students performed both manual and computer-generated versions of the task using stimuli that varied in degree of verbalizability. A 2x2x3 ANOVA with Sex as a between-subjects factor, and Presentation (manual or computer) and Stimuli (common objects, common shapes, and novel shapes) as within-subjects repeated measures revealed a significant main effect for Sex. Females made fewer errors than males regardless of presentation and across the three levels of verbalizability (i.e., stimulus types); moreover, the effect size was considered "large" [Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Berlin: Springer]. These findings are interpreted within the context of the current literature that demonstrates a female advantage for object location memory (e.g., [Voyer, D., Postma, A., Brake, B., & Imperato-McGinley, J. (2007). Gender differences in object location memory: A meta-analysis. Psychonomic Bulletin and Review, 14, 23-38]).

Safety and yield of early cessation of AEDs in video-EEG telemetry and outcomes.

BACKGROUND: Video-electroencephalography (VEEG) telemetry is the simultaneous recording of ictal and interictal EEG pattern and paroxysmal behavior to investigate the nature of paroxysmal events. METHODS: This is a prospective study performed to asses the safety and yield of early discontinuation of antiepileptic drugs (AEDs) in the telemetry unit. Over a 2.5-year period, 50 patients that met the indications for VEEG monitoring were admitted by an epileptologist to neuro-observation units with continuous monitoring, nursing coverage and EEG technicians support during working hours and on-call thereafter. In most cases AEDs (except Phenobarbital) were discontinued in 24h. We prospectively assessed the yield and safety of the telemetry investigation as well as epilepsy surgery outcomes. RESULTS: Our monitoring answered the study question in 88% of the patients. The question was not answered in 12% of cases due to the lack of recorded events. Our results changed the management in 74% of cases and potentially improved quality of life by decreasing the AEDs consumption and number of seizures per month. Over all, 22% received epilepsy surgery and became either seizure free or their seizures became non-disabling. Our method significantly decreased the duration of hospital admission for monitoring and minimal complications occurred only in 8% of patients. CONCLUSIONS: In conclusion, our method for short VEEG monitoring has a high yield for diagnosis, minimal complications and is cost effective. These qualities, together with good surgery results validate our method for the investigation and treatment of refractory seizure cases.

Epilepsy surgery in the elderly: an unusual case of a 75-year-old man with recurrent status epilepticus.

BACKGROUND: Epilepsy surgery is increasingly well-supported as an effective treatment for patients with intractable epilepsy. It is most often performed on younger patients and the safety and efficacy of epilepsy surgery in elderly patients are not frequently described. CASE REPORT: We report a case of a 75-year-old right-handed man who underwent a left fronto-temporal craniotomy for resection of a suprasellar meningioma in 2002. Immediately following hospital discharge, he began to experience complex partial seizures. He continued to have frequent seizures despite treatment with multiple combinations of antiepileptic medications. He presented with status epilepticus every two or three months, and required long periods of hospitalization on each occasion for post-ictal confusion and aphasia. Scalp EEG showed continuous spikes and polyspikes and persistent slowing in the left temporal area, as well as spikes in the left frontal area. EEG telemetry recorded multiple seizures, all with a clear focus in the left temporal area. MRI scan showed an area of encephalomalacia in the left temporal lobe, as well as post-surgical changes in the left frontal area. Neuropsychological testing showed bilateral memory impairment with no significant cognitive decline expected after unilateral temporal lobe resection. A left anteromesial temporal lobectomy was performed with intraoperative electrocorticography. Since surgery, the patient was not seizure-free (Engel class II-b), but had no further episodes of status epilepticus in one year and two months of follow-up. CONCLUSIONS: This is one of the oldest patients reported in the literature with epilepsy surgery and supports the possibility of epilepsy surgery in elderly patients for particular cases. In addition, few cases with such a malignant evolution of temporal lobe epilepsy have been described in this age group.

Experience of psychogenic nonepileptic seizures in the Canadian league against epilepsy: A survey describing current practices by neurologists and epileptologists.

PURPOSE: Psychogenic nonepileptic seizures (PNES) are one of the most common differential diagnoses of epilepsy. Our objective is to describe current medical care in Canada and identify patterns of practice and service gaps. METHODS: In 2015, a 36-question survey was sent via email to the 131 members of the Canadian League Against Epilepsy. The questions were designed after literature review and discussion with the ILAE PNES Task Force. Questions were separated into 5 sections: 1) the role of the respondent and their exposure to PNES, 2) diagnostic methods, 3) management of PNES, 4) etiological factors, and 5) problems accessing health care. RESULTS: Sixty-two questionnaires were analyzed (response rate: 47%). Most respondents were epileptologists (76%). The majority of respondents personally diagnosed PNES and communicated the diagnosis to the patient, but only 55% provided follow-up within their practice and only 50% recommended or arranged treatment. Many (35%) were either unfamiliar with the diagnosis of PNES or inexperienced in arranging or offering treatment. Most (79%) provided follow-up to patients with concomitant epilepsy, but when PNES was the sole diagnosis follow-up rates were low. Although 84% of respondents felt that individualized psychological therapy was the most effective treatment, 40% of patients were not referred to psychotherapy and in most cases availability such therapy was low (30-60%). CONCLUSIONS: Canadian health professionals' understanding of PNES mostly reflects current international expert opinion. Once diagnosis is made however, the majority of patients are discharged from neurological services without appropriate psychological care.

A Mozart effect for women on a mental rotations task.

During the past decade, there have been numerous reports of a brief, but statistically significant, improvement in immediate spatial-temporal performance after listening to 10 min. of Mozart's Sonata K.448, known as the "Mozart effect." The purpose of the present study was to assess whether production of the effect is influenced by length of listening conditions or sex. Each of 52 right-handed participants (26 females, 26 males) completed a paper-folding and cutting task and a Mental Rotations task following a listening condition in which the Mozart sonata was played and a silent condition (no music was played). A significant 3-way interaction among sex, listening condition, and task indicated that an effect was present only for women on the Mental Rotations task. As such, researchers should investigate the role of sex in production of the Mozart effect.

Epilepsy and homicide.

PURPOSE: We report the rare case of a patient with intractable epilepsy and escalating aggression, resulting in murder, who had complete resolution of her seizures and explosive behavior following a right temporal lobectomy. PATIENTS AND METHODS: We searched the available literature from 1880 to 2013 for cases of epilepsy being used as a court defense for murder and collected information regarding the final sentencing outcomes. We selected 15 papers with a total of 50 homicides. RESULTS: We describe the case of a 47-year-old woman with drug-resistant right temporal epilepsy who developed increasing emotional lability, outbursts of anger and escalating violent behavior culminating in a violent murder. The patient was imprisoned while awaiting trial. In the interim, she underwent a successful temporal lobectomy with full resolution of seizures, interictal rage and aggressive behaviors. After the surgery, her charges were downgraded and she was transferred to a psychiatric facility. CONCLUSION: The aggressive behavior associated with epilepsy has been described in the literature for over a century. A link between epilepsy and aggression has been disproportionally emphasized. These patients share some common characteristics: they are usually young men with a long history of epilepsy and lower than average intelligence. The violent act is postictal, sudden-onset, more likely to occur after a cluster of seizures and is usually related with alcohol abuse.

Endocrine therapy is associated with low performance on some estrogen-sensitive cognitive tasks in postmenopausal women with breast cancer.

This study investigated the effects of endocrine therapy (i.e., tamoxifen and anastrozole) on cognitive functioning by comparing 28 postmenopausal women with breast cancer to 37 healthy age-equivalent controls. Participants completed neuropsychological tests previously shown to be estrogen sensitive (e.g., verbal memory, letter fluency). A significant treatment effect was observed on speeded measures of letter fluency, complex visuomotor attention, and manual dexterity, but not on measures of verbal or object-location memory, or on tests presumed to be estrogen insensitive (e.g., spatial ability). In partial support of previous research, these results indicate that endocrine therapy can have detrimental effects on speeded higher brain functions but not necessarily on memory.

Learning, retention and generalization of a mirror tracing skill in Alzheimer's disease.

The present study examined the ability of 12 patients with probable Alzheimer's disease (AD) and 12 age- and education-matched normal control (NC) subjects to learn and retain the visuomotor skills necessary to efficiently trace a pattern (e.g., a 4- or 6-pointed star) seen only in mirror-reversed view. Those AD (N=6) and NC (N=7) subjects who were able to initially perform the basic mirror tracing task did not differ significantly in initial level of performance, learning over trials, retention of the skill over a 30-min delay interval, and generalization of the skill to a new figure or to the opposite direction of tracing. The AD patients who were unable to initially perform the mirror tracing task were significantly worse than those who could perform the task on several neuropsychological measures sensitive to deficits in problem solving and executive functions, but not on tests of global cognitive decline, memory, language, or visuoperceptual functioning. These results indicate that acquisition and retention of a complex visuomotor skill can proceed normally in the early stages of AD in those individuals who can initially perform the basic task, and that inability to perform the basic task may be related to the frontal lobe dysfunction that is often prominent in the disorder.