Neuropsychology of Epilepsy and Epilepsy Surgery

First Edition

Gregory P. Lee

AACN Workshop Series

This book brings together material that is widely dispersed across the medical and neuropsychological literature into one handy volume. Much of the book is intended to be used as a reference resource for busy clinicians. Thus, it is general enough to be useful to neuropsychologists who are not epilepsy specialists, but also sufficiently specific to be beneficial for practicing epilepsy neuropsychologists.

Neuropsychology of Epilepsy and Epilepsy Surgery

First Edition

Gregory P. Lee

Description

This book provides essential information about the variety of seizure disorders and serves as a basic epilepsy reference guide for students and practicing clinical neuropsychologists. In addition to epilepsy neuropsychological assessment issues, the book provides an overview of the known cognitive effects of seizures as well as the adaptive, emotional, and psychiatric consequences of epilepsy including a chapter on psychogenic nonepileptic seizures. Diagnostic tests, such as EEG and structural neuroimaging, are described and the leading treatment options are detailed with a chapter on pharmacologic therapies which reviews the known cognitive and behaivoral side effects of specific antiepileptic drugs. Many of the more rare epilepsy disorders have been included in the appendices for quick and easy reference.

The book also details the role of neuropsychology within the epilepsy surgery process including pre-and post-surgery cognitive evaluations, cortical stimulation mapping, functional neuroimaging, and intracarotid amobarbital (Wada) procedures and reviews the major surgical treatment options used in the intractable epilepsies. Case examples are dispersed throughout the text with neuropsychological results as heuristic aids. The book concludes with a glossary of epilepsy terms.

Neuropsychology of Epilepsy and Epilepsy Surgery

First Edition

Gregory P. Lee

AACN Workshop Series

PREFACE

ACKNOWLEDGMENTS

PART ONE

MEDICAL ASPECTS OF EPILEPSY FOR NEUROPSYCHOLOGISTS

Chapter 1
Introduction

Definitions

Epidemiology

Etiology

Role of Neuropsychologist in Epilepsy

Role of Neuropsychologist in Epilepsy Surgery

Chapter 2
Classification of Epilepsy Disorders

Tradition Classification of Seizure Disorders

Partial Seizure Disorders

Simple Partial Seizures

Complex Partial Seizures

Generalized Seizure Disorders

Absence Seizures

Tonic-Clonic Seizures

Epidemiology of Seizure Disorders

Etiology of Seizure Disorders

Chapter 3
Epilepsy Syndromes

Localization-Related Epilepsies

Idiopathic Localization-Related

Symptomatic Localization-Related

Symptomatic Reflex Epilepsies

Temporal Lobe Epilepsies

Frontal Lobe Epilepsies

Parietal Lobe Epilepsies

Occipital Lobe Epilepsies

Crytogenic Localization-Related Epilepsies

Generalized Epilepsy Syndromes

Idiopathic Generalized Syndromes

Childhood Absence Epilepsy

Juvenile Absence Epilepsy

Cryptogenic Generalized Epilepsy Syndromes

Lennox-Gastaut Syndrome

Symptomatic Generalized Epilepsy Syndromes

Undetermined Epilepsy Syndromes

Acquired Epileptic Aphasia

Continuous Spike-Waves during Slow Sleep

Special Syndromes

Febrile Convulsions

Isolated Status Epilepticus

Epidemiology of Epilepsy Syndromes

Etiology of Epilepsy Syndromes

Non-Epileptic Seizures

Sudden Unexplained Death in Epilepsy (SUDEP)

Chapter 4
Diagnostic Tests in Epilepsy

Electrophysiology

Interictal Scalp Recordings

EEG Patterns in Partial Epilepsies

EEG Patterns in Generalized Epilepsies

Structural Neuroimaging in Epilepsy

Chapter 5
Medical (Non-Surgical) Treatment of Epilepsy

Pharmacological Therapies

Older Antiepileptic Drugs

Newer Antiepileptic Drugs

Antiepileptic Drug Adverse Effects

Antiepileptic Drugs in Women

Pregnancy / Teratogenic Effects

AED Treatment in Children

Cognitive & Behavioral Effects

Review of Specific Antiepileptic Drugs

Use of AEDs in Bipolar Disorder

Suicidality and Antiepileptic Drugs

Ketogenic Diet

Chapter 6
Neuropsychological Assessment in Epilepsy

Selection of Neuropsychological Tests

Factors Contributing to Cognitive Decline

Confounding Factors in Test Interpretation

Cognitive Deficits in Epilepsy

Attention

ADHD

Memory

Intelligence

Language

Visual-Perceptual & Spatial Functions

Executive Functions

Childhood Learning Disabilities

Quality of Life Assessment

Driving Issues in Epilepsy

Case Example: Preoperative Cognitive Testing

Chapter 7
Psychological and Psychiatric Disorders in Epilepsy

Risk Factors

Mood Disorders

Anxiety Disorders

Psychotic Disorders

Personality Disorders

Interictal Behavioral Syndrome of TLE

Epilepsy-Specific Psychological Disorders

Chapter 8
Psychogenic Nonepileptic Seizures (PNES)

Diagnosis2

Prevalence

Etiology

Symptoms

Assessment

Treatment

PART TWO
SURGICAL TREATMENT OF EPILEPSY

Chapter 9
Neuropsychological Assessment in Epilepsy Surgery

Preoperative Neuropsychological Assessment

Purposes of Preoperative Assessment

Lateralization & Localization

Risk for Postoperative Impairment

Establish a Baseline

Prediction of Seizure Control

Postoperative Neuropsyhological Assessment

Case Example: Right Temporal Lobectomy

Chapter 10
Other Neuropsychological Procedures in Epilepsy Surgery

Intracarotid Amobarbital (Wada) Procedure

Wada Testing in Children

Functional Magnetic Resonance Imaging

Electro-Cortical Stimulation Mapping

Case Example: Wada Predicts Amnesia

Chapter 11
Medical Aspects of Epilepsy Surgery

Criteria for Surgical Evaluation

Diagnostic Evaluation for Epilepsy Surgery

Noninvasive Video-EEG Monitoring

Magnetic Resonance Iimaging (MRI)

Functional Neuroimaging

Monitoring with Intracranial Electrodes

Epilepsy Surgery Procedures

Vagus Nerve Stimulation

Anterior Temporal Lobectomy

Frontal Lobectomy

Parietal Lobecotomy

Occipital Lobectomy

Lesionectomy

Hemispherectomy

Corpus Callosotomy

Multiple Subpial Transection

Selective Amygdalohippocampectomy

Implanted Brain Stimulators

Case Example: Brain Stimulator Candidate

Appendix I:
Traditional Classification of Epileptic Seizures - Description of Seizure Types Not Covered in Text

Simple partial seizures with motor signs

Simple partial seizures with somatosensory or special sensory symptoms

Simple partial seizures with autonomic symptoms or signs

Simple partial seizures with psychic signs

Simple partial seizures with cognitive signs

Simple partial seizures with affective signs

Simple partial seizures with illusions

Simple partial seizures with hallucinations

Generalized seizure disorders

Atypical absence seizures

Myoclonic Seizures

Clonic Seizures

Tonic Seizures

Atonic Seizures

Appendix II:
Classification of Epilepsy Syndromes - Description of Seizure Types Not Covered in Text

Idiopathic Localization-Related

Benign childhood epilepsy with centrotemporal spikes

Childhood epilepsy with occipital paroxysms

Reading epilepsy

Hot water epilepsy

Autosomal dominant nocturnal frontal lobe epilepsy

Symptomatic Localization-Related

Rasmussen's syndrome

Reflex epilepsies

Photosensitive seizures

Musicogenic epilepsy

Eating epilepsy

Startle epilepsy

Frontal lobe epilepsies

Precentral frontal lobe seizures

Premotor frontal lobe seizures

Supplementary motor area (SMA) seizures

Dorsolateral prefrontal lobe seizures

Orbitofrontal lobe seizures

Medial frontal lobe seizures

Frontal opercular seizures

Parietal lobe epilepsies

Postcentral gyrus seizures

Superior parietal lobule seizures

Inferior parietal lobule seizures

Paracentral parietal lobe seizures

Idiopathic Generalized Epilepsy Syndromes

Benign neonatal familial convulsions

Benign neonatal convulsions (non-familial)

Benign myoclonic epilepsy of childhood

Juvenile myoclonic epilepsy (JME)

Epilepsy with tonic-clonic seizures upon awakening

Cryptogenic or Symptomatic Generalized Epilepsy Syndromes

West syndrome (infantile spasms)

Myoclonic-astatic seizures

Epilepsy with myoclonic absences

Appendix III:Wada Assessment Procedures and Rating Criteria at the Medical College of Georgia (MCG)

Procedure for measuring Wada language at MCG

Procedure for measuring Wada memory at MCG

MCG Wada Evaluation scoring form

Glossary of Common Epilepsy Terms

Neuropsychology of Epilepsy and Epilepsy Surgery

First Edition

Gregory P. Lee

AACN Workshop Series

Author Information

After earning a Ph.D. in Clinical Psychology, Dr. Gregory P. Lee completed postdoctoral fellowships in Neuropsychology at the University of Houston, in conjunction with Baylor College of Medicine, and University of Wisconsin Medical School. He is board-certified in Clinical Neuropsychology by the American Board of Professional Psychology and American Board of Clinical Neuropsychology and is a fellow of the American Psychological Association and National Academy of Neuropsychology. Dr. Lee is a tenured Professor of Neurology in the School of Medicine, School of Allied Health, and School of Graduate Studies at the Medical College of Georgia where he is Director of the Adult Neuropsychology Service, Director of Training for the postdoctoral fellowship program in clinical neuropsychology, and Director of Research in the School of Allied Health. In addition to overseeing neuropsychological services for general neurology, epilepsy, and neurosurgery patients, Dr. Lee performs cortical stimulation mapping, functional magnetic resonance imaging, and intracarotid amobarbital (Wada) procedures for the Epilepsy Surgery Program. Professor Lee is also an active researcher (> 150 publications) primarily in the areas of epilepsy and epilepsy surgery. Dr. Lee has been elected to the Board of Directors of the American Board of Clinical Neuropsychology and serves on the executive committee of the Amercian Board of Professional Psychology.

Neuropsychology of Epilepsy and Epilepsy Surgery

First Edition

Gregory P. Lee

AACN Workshop Series

Reviews and Awards

"Overall, I recommend this book for neuropsychologists who see epilepsy patients. Its use as a reference will be facilitated after an initial read of the whole book, which will also provide clinicians with a solid overview of the field... the strength of this volume lies in its brevity. I very much liked the short, half to one-page descriptions of syndromes provided in the appendix, and found myself reaching for this book more than once during the review process to familiarize myself with a specific surgical procedure or refresh my memory of a specific seizure type." -- Christian von Thomsen, Psy.D., Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA

"The book Neuropsychology of Epilepsy and Epilepsy Surgery provides a fabulous overview of epilepsy and seizures that includes diagnosis, etiology, and treatment, with a focus on neuropsychological aspects of the epilepsies and their management. The book is easy to read, and includes tables that nicely summarize a wealth of information...This volume is sure to become a core reference and teaching guide for the neuropsychology of epilepsy for years to come." -- Mike R. Schoenberg, The Clinical Neuropsychologist