Empirical Techniques for Determining the Reliability, Magnitude, and Pattern of Neuropsychological Change After Epilepsy Surgery

Hermann, Bruce P.; Seidenberg, Michael; Schoenfeld, Jen; Peterson, Jacqueline; Leveroni, Catherine L.; Wyler, Allen R.

doi:10.1111/j.1528-1157.1996.tb00531.x

Cited by 202 publications

(162 citation statements)

References 23 publications

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“…They are based on retest reliabilities of data obtained from a group of controls. Additionally the practice effect is considered; that is, an increase of performance due to test repetition (30). With regard to the surgical group, we decided for each patient whether the change score (1 2 months postoperative minus preoperative score) was within or beyond the 90% confidence intervals obtained from the nonsurgical children with epilepsy.…”

Section: Discussionmentioning

confidence: 99%

Pre‐ and Postoperative Neuropsychological Profiles in Children and Adolescents with Temporal Lobe Epilepsy

Lendt¹,

Helmstaedter²,

Elger³

1999

Epilepsia

125

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Summary: Purpose:To evaluate the neuropsychological performance of children before and after temporal lobe resection (TLR).Methods: Memory, attention, language, and visuoconstructive abilities were examined in 20 children (age 10-16 years) before, and 3 and 12 months after TLR (right, n = 10; left, n = 10; two-thirds anterior resection, n = 16; amygdalohippocampectomy, n = 4). Preoperative performance was compared with data of 30 age-matched healthy children; changes in performance after surgery were determined by repeatedmeasurement multivariate analysis of variance (MANOVA) and by use of reliable change indices (RCI).Results: Preoperatively, no differences were observed between patients and controls in verbal and figural memory performance. Children with temporal lobe epilepsy (TLE), however, and particularly those with a left temporal focus, showed significantly reduced language performance. Repeatedmeasurement statistics indicated that memory performance did not change after surgery, whereas language performance and attention significantly improved 3 months and 1 year after surgery, respectively. Individual evaluations of memory showed gains in five children and deterioration in four children. Poor seizure control appeared the decisive variable characterizing children with losses in memory.Conclusions: Compared with adults, pre-and postoperative memory data suggest less pronounced hemispheric differences in school-age children with TLE. The results raise the possibility that children have a lower risk of memory deterioration after TLR, which may be due to their larger potential for cerebral plasticity.

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Section: Discussionmentioning

confidence: 99%

Pre‐ and Postoperative Neuropsychological Profiles in Children and Adolescents with Temporal Lobe Epilepsy

Lendt¹,

Helmstaedter²,

Elger³

1999

Epilepsia

125

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“…Changes exceeding the RCI are considered reliable and statistically meaningful, but the level at which a change becomes clinically significant has not been determined. For T5, a decline a 1 1 represents the value needed to exceed the RCI 90th centile, 3 7 and 3 5 for the 80th and 70th centiles, respectively (34). A logistic regression analysis, again with backward elimination, was performed to estimate the power of prediction of the independent variables for preto postoperative T5 score decline exceeding RCI at each centile level.…”

Section: Discussionmentioning

confidence: 99%

“…For determination of the significance of memory score decline, we used the RCI, an estimate of the degree of variability due to measurement error inherent in the test, and derived from assessment of patients tested twice with no intervening surgery (34). Changes exceeding the RCI are regarded as meaningful and reliable, although the decline that would be considered clinically significant has not been determined.…”

Section: Discussionmentioning

confidence: 99%

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Prediction of Verbal Memory Loss in Individuals After Anterior Temporal Lobectomy

et al. 1998

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Summary:Purpose: Decreased memory function represents the area of greatest neuropsychological morbidity after anterior temporal lobectomy (ATL), particularly for left ATL candidates. We wished to identify easily derived demographic and neuropsychological predictors of risk of pre-to postoperative memory decline using only information available preoperatively.Methods: We assessed decline in memory as measured by the California Verbal Learning Test (CVLT) by deriving multiple regression equations using the following measures as independent variables: age at onset, chronological age at time of surgery, sex, Full Scale IQ (FSIQ), level of education, and preoperative memory scores. In all, 203 patients (93 males, 110 females), undergoing ATL (107 left, 96 right) with preoperative and 6-month postoperative testing, were examined.Results: The combination of age, FSIQ, sex, side of surgery and preoperative score was highly predictive (p-values < 0.0001) of postoperative memory scores. Higher postoperative scores were associated with higher preoperative score, younger chronological age, higher FSIQ, female sex, and right side of resection. Reliable change index (RCI) values were used to estimate meaningful decline on the total score across five trials. Logistic regression analysis showed preoperative score and age to be predictors of RCI decline for left-sided resections. Sensitivity of decline (290th centile RCI) prediction was 56%, and specificity was 95%. Validation in 30 patients from a separate population of patients undergoing left ATL produced similar figures. Conclusions:The derived regression equations can accurately predict verbal memory decline on a list-learning task in -50% of individual patients undergoing ATL, and falsepositive prediction errors are very rare. Key Words: Epilepsy-Memory-Surgery-Temporal lobectomy.Decreased memory function represents the greatest potential neuropsychological morbidity after performance of anterior temporal lobectomy (ATL), particularly for verbal memory measures in patients undergoing left-sided resection (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Right-sided resections pose less consistent risk of memory impairment, possibly reflecting the absence of currently available adequate measures of nonverbal memory. Verbal memory deficit in association with right temporal lobe epilepsy (RTLE) is relatively rare and may be due to the presence of concomitant left mesial temporal abnormality, as demonstrated by magnetic resonance imaging (MRI) spectroscopy (21). Identified risk factors for postoperative memory decline after left ATL are older age at time of surgery, later age at onset of unprovoked seizures, and better preoperative memory performance (1)(2)(3)11,22 Males have been shown to be at greater risk than females in some series (23,24). Better preoperative memory performance is also a risk factor for post-ATL decline for right-sided resections ( I 1). For left-sided resections, the principal risk factor is the absence of hippocampal sclerosis (HS...

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“…These indicated significant improvements in letter cancellation ( t = 4, p = 0.003), response inhibition ( t = 2.5, p = 0.03), and language comprehension ( t = 3.9, p = 0.003). The significance of individual postoperative changes (33,34) was judged based on testretest data in the 65 nonsurgical patients who had done all tests except comprehension, naming, and visuoconstruction. The 90% confidence intervals for the before and after difference scores were calculated by taking into account the retest reliabilities in nonsurgical patients and correcting for retest effects (estimated by the difference in scores for the nonsurgical group) ( Table 7).…”

Section: Neuropsychological Outcomementioning

confidence: 99%

Surgical Outcome in a Group of Low‐IQ Patients with Focal Epilepsy

et al. 1999

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Patients with focal epilepsy frequently show specific, circumscribed cognitive impairments that mirror the site of the epileptogenic area or the underlying morphologic lesion. However, general intelligence scores of those patients are most often within normal range (1). Several authors claim that a low IQ is associated with a poor seizure outcome, and they therefore consider a low IQ score as a contraindication for resective epilepsy surgery (2,3). Falconer (4), for instance, noted that an IQ <70 contraindicates surgery, and Rasmussen claimed that patients with an IQ level 4 0 points should not be considered for surgery except under certain exceptional circumstances ( 5 ) . The underlying assumption is that low intel-

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Empirical Techniques for Determining the Reliability, Magnitude, and Pattern of Neuropsychological Change After Epilepsy Surgery

Abstract: RCIs and regression-based norms are complementary indexes and can be particularly useful in examining the test-retest performance of individual patients who undergo epilepsy surgery as well as in the more general investigation of cognitive outcome after epilepsy surgery.

Cited by 202 publications

References 23 publications

Pre‐ and Postoperative Neuropsychological Profiles in Children and Adolescents with Temporal Lobe Epilepsy

Pre‐ and Postoperative Neuropsychological Profiles in Children and Adolescents with Temporal Lobe Epilepsy

Prediction of Verbal Memory Loss in Individuals After Anterior Temporal Lobectomy

Surgical Outcome in a Group of Low‐IQ Patients with Focal Epilepsy

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