Verbal fluency in focal epilepsy: a systematic review and meta-analysis.

Testing of verbal fluency is currently part of standard presurgical neuropsychological assessment for patients with focal epilepsy. However, to date no systematic review has been conducted on semantic (SVF) and phonemic verbal fluency (PVF) in this patient group. The present review compares verbal fluency between healthy control subjects and subgroups of adult presurgical patients with focal epilepsy according to lateralisation and localisation of the dysfunction. PubMed was searched with a comprehensive search string. Abstracts of all studies and full-texts of potentially relevant studies were screened. Study quality was assessed by independent raters according to predefined criteria. 39 studies were included. Meta-analyses were performed to compare SVF and PVF across groups of patients with temporal (TLE) and frontal lobe epilepsy (FLE) as well as healthy controls (HC). Both patients with left- and right sided TLE were impaired on SVF and PVF compared to HC. Patients with left-sided TLE were slightly more impaired than patients with right-sided TLE. Patients with FLE showed a larger impairment in PVF than patients with TLE, whereas on SVF there was no difference between FLE and TLE. For TLE comparisons the study pool seems to have been sufficient, whereas more studies are needed to verify results for FLE. Semantic verbal fluency might not differentiate between FLE and TLE. While verbal fluency impairment was anticipated, especially in left-sided TLE and FLE patients, the impairment in patients with right-sided TLE was larger than expected. Results are discussed with regard to neuropsychological theory and practice.

Flashbulb memories in patients with temporal lobe epilepsy.

PURPOSE: Flashbulb memories (FMs) are vivid and stable autobiographical memories associated with learning surprising news of high emotional impact. Patients with temporal lobe epilepsy (TLE) can have autobiographical memory deficits. This is the first investigation of FMs in TLE applying a consistency measure of FM quality controlling for confabulation. METHOD: A sample of 12 patients with TLE and a matched group of 15 healthy controls (HCs) were tested on an FM test including a retest procedure. Scores of FM consistency were obtained by comparing answers across both testing occasions. RESULTS: In patients with TLE, FM consistency scores were significantly lower than in HCs. Exploratory subgroup analyses revealed FM deficits in both patients with left TLE and patients with right TLE compared with HCs. CONCLUSION: The present study indicates that the FMs of patients with TLE are less consistent than those of healthy control subjects. Future investigations with larger samples are desirable, especially regarding separate analyses of patients with left TLE and patients with right TLE.

The impact of extratemporal epilepsy surgery on quality of life.

Quality of life (QOL) with respect to seizure outcome, cognitive performance, and depressive symptoms was analyzed in 21 adult patients undergoing extratemporal epilepsy surgery (EXTLE). The Subjective Handicap of Epilepsy questionnaire was administered before and 1 year after surgery. Additionally, cognitive performance, depressive symptoms (Beck Depression Inventory), and seizure frequency were assessed. After surgery, seizure frequency decreased and various aspects of QOL significantly improved. Improvements in the domain of Work and Activities correlated with a reduction in complex partial seizure frequency. Alterations in the subscale change correlated with a decrease in simple partial seizure frequency. The present results provide detailed evidence that patients with extratemporal epilepsy benefit from epilepsy surgery.

Ribbon synapses of the mammalian retina contain two types of synaptic bodies--ribbons and spheres.

The present paper reports that the synaptic bodies of the retinal ribbon synapses in rat, guinea pig, golden hamster and mouse are a heterogeneous population of organelles. In addition to the well-known synaptic ribbons sensu stricto which consist of a platelike electron-dense central structure surrounded by electron-lucent synaptic vesicles, there are what is termed synaptic spheres, in which the core is not platelike, but round to oval. In rat retinae procured at day, ribbons outnumbered spheres by a factor of 4. At night spheres were not seen in photoreceptor cells. Spheres, like ribbons, may lie some distance from the synaptic site, perhaps indicating transit from their site of origin to the synapse. At night ribbons are longer than at daytime. In addition to the previously described connecting stalks between synaptic vesicles and the electron-dense ribbons, the presence of filamentous stalks between adjacent synaptic vesicles is described. The latter stalks, depending on their presence or absence, may influence the position of the synaptic vesicles in relation to the synaptic body and/or the presynaptic membrane. It is concluded that the plasticity of retinal synapses cannot be fully appreciated unless the temporal changes of ribbons, spheres and the connecting stalks are taken into consideration.