The purpose of this study was to investigate the validity of the Revised Optimism-Pessimism Scale (PSMR) as a measure of attributional style, and the incremental utility of optimism and pessimism as predictors of seizure group, in an intractable seizure disorder sample. Participants included adult patients with epileptic seizures (ES; n = 151) and psychogenic nonepileptic seizures (PNES; n = 173) whose diagnoses were confirmed by prolonged video/EEG monitoring (PVEM). Optimism and pessimism scores were computed from abbreviated versions of the MMPI for all participants. Analyses were conducted to examine the relationships between optimism, pessimism, and MMPI clinical scale scores. Logistic regression analyses were conducted to generate a model for the prediction of seizure group. Results supported the validity of the PSM-R as a measure of attributional style in an intractable seizure disorder sample. Both optimism and pessimism provided significant incremental predictive utility over and above other predictors of seizure group. There are advantages of using the proposed prediction model over other alternative differential diagnostic procedures, including lower cost, greater availability, and increased standardization. Overall, results indicated that attributional style is a clinically relevant index of personality and cognitive response to stress among an intractable seizure disorder sample. (c) 2023 Elsevier Inc. All rights reserved.

SUMMARY Introduction. The traditional view of cognition in idiopathic or genetic generalized epilepsy (GGE) is that “one size fits all” i.e. only very mild generalized impairment might be detected, if any. This paper describes four case studies of cognitive functioning in GGE patients with photosensitivity and reflexive seizures. Aim. The aim was to discover whether each individual’s set of cognitive deficits varied in accordance with his/her other clinical phenomena such as photosensitivity and kinds of reflexive seizures. Method. Neurological and cognitive performance was assessed by comprehensive evaluation of each patient based on interviews, neurologist’s EEG reports and neuropsychological tests. Assessment of cognitive domains included estimated pre-morbid I.Q. based on reading ability and demographic norms, current I.Q., attention factors, verbal memory, visual memory and executive functions. Results. Clinical signs and investigative studies indicated that two cases typically began reflexive seizure episodes with facial myoclonia which evolved into tonic-clonic convulsions or generalized myoclonic seizures. These patients had widespread attention and working memory deficits, some severe, together with lowered intelligence scores. In contrast, two other cases (with no history of myoclonus) had generalized reflexive seizures originating in the occipital lobes, very mild localized visual dysfunction and high intelligence. Conclusions. The systematic variation in extent and nature of cognitive dysfunction illustrated in these cases with reflexive seizures (preceded by myoclonia or visual phenomena) would be explained by a more recent conceptualization of GGE as encompassing regional differences in variable hyperexcitability located at cortical levels or functional neural networks.

Behavioral studies have shown that verbal information is better retained when it is self-generated rather than read (learned passively). We used fMRI and a paired associates task to examine brain networks underlying self-generated memory encoding. Subjects were 49 healthy English speakers ages 19–62 (30 female). In the fMRI task, related word pairs were presented in a “read” condition, where subjects viewed both words and read the second word aloud, or a “generate” condition, where the second word was presented with only the first letter and the subject was required to generate the word. Thirty word pairs were presented in each condition. After the fMRI scan, words that were read or generated were presented, each with two foils, in a forced-choice recognition task. On the recognition post-test, words from the “generate” condition were more correctly recognized than from the “read” condition (80.0% for generated words versus 72.0% for read words; t(48)=5.17, p<0.001). FMRI revealed increased activation for generate>read in inferior/middle frontal gyri bilaterally (L>R), anterior cingulate, and caudate nucleus and the temporo-parietal–occipital junction bilaterally. For the “read” condition, better subsequent memory performance across individual subjects was positively correlated with activation in the cuneus bilaterally. In the “generate” condition, better subsequent memory performance was positively correlated with activation in the left superior temporal gyrus. These results suggest that self-generation improves memory performance, that enhanced cortical activation accompanies self-generated encoding, and that recruitment of a specific brain network underlies self-generated encoding. The findings may have implications for the development of procedures to enhance memory performance.

Stress is a commonly reported seizure precipitant among individuals with epilepsy. Yet, the relationship between stress and seizure susceptibility remains unclear. This study examined the relationship between emotional distress and lifetime seizure load in individuals with temporal lobe epilepsy (TLE), as well as the potential moderating effect of explanatory style on this relationship. Data were collected from 148 individuals with TLE. Scales 2 and 7 of the Minnesota Multiphasic Personality Inventory were used as a measure of emotional distress, and explanatory style was measured using the Revised Optimism–Pessimism Scale. Elevated Scale 2 scores were associated with an increase in seizure load only in subjects with Full Scale IQ scores≥92. An interaction between emotional distress and explanatory style was not observed. Thus, for individuals with higher levels of intelligence, depression may be an important pathway in linking emotional distress to poor seizure control.

The aim of this study was to assess whether duration of seizure disorder and lifetime seizure load are associated with deficits in higher cognitive functions in patients with temporal lobe epilepsy (TLE) (N=207) or psychogenic nonepileptic seizures (PNES) (N=216). Multivariate regression analyses revealed that age at onset, duration, and group assignment were significant predictors of neuropsychological performance (all P<or=0.02), with group having a moderating relationship. Univariate analyses revealed different patterns of predictor effects on cognitive functioning within each diagnostic group. An impairment index was calculated for each individual, and univariate analyses revealed that age at TLE but not PNES onset was the only significant predictor of impairment (b=-0.005, P<0.001). The results suggest that earlier age at seizure onset, longer duration, and higher lifetime seizure frequency affect cognitive functioning in both the TLE and PNES groups, but differently within each group. These results have implications for early diagnosis and intervention in both groups.

We evaluated the potential moderating effect of emotional distress (Minnesota Multiphasic Personality Inventory 2, scales D and Pt) on language functioning (i.e., Boston Naming Test, phonemic paraphasic error production on the Boston Naming Test, Controlled Oral Word Association Task, Animal Naming, Token Test) in patients with left (N=43) and right (N=34) mesial temporal lobe epilepsy (MTLE) and frontal lobe epilepsy (FLE) (N=30). Video/EEG and brain imaging results confirmed localization. Logistic regression models revealed that perceived emotional distress moderated language performance. Performance of patients with left MTLE and that of patients with FLE were equally poor across language measures. Performance of patients with right MTLE was intact. Depression and anxiety differentially moderated performance. Anxiety was associated with better performance in patients with FLE on classically temporal lobe-mediated tasks (Boston Naming Test). Depression was associated with worse language performance on measures for which impaired performance was traditionally intrinsic to the underlying epileptogenic lesion (word fluency in FLE). Emotional distress influences language performance. Adequate treatment of mood should be considered when managing pharmacoresistant epilepsy.

The classic receptive (temporal lobe)/generative (frontal lobe) dissociation of language function may be inadequate in characterizing language function in epilepsy. The relative impact of temporal versus frontal lobe epileptogenic foci on language function is also unknown. Individuals with mesial temporal lobe epilepsy (MTLE), have higher rates of psychopathology relative to the general and other chronically ill populations, as well as structural hippocampal abnormalities associated independently with the MTLE syndrome and the effects of high levels of emotional distress. Therefore, cognitive dysfunction may result from some combination of the intrinsic epileptogenic lesion or damage associated with chronic high levels of emotional distress, or both. The present study evaluted the diagnostic utility of the Boston Naming Test, phonemic paraphasic error production on the BNT, Controlled Oral Word Association Task, Animal Naming, and Token Test in terms of their ability to predict frontal lob epilepsy (FLE), left MTLE, or right MTLE focus, as well as the potentially moderating effects of perceived emotional distress. Seventy-seven individuals with MTLE (43 left and 34 right) and 30 individuals with FLE were included. Binary logistic regression models evaluated the predictive ability of each language measure to differentiate diagnostic group. Main effect and interaction terms for scales D and Pt on the MMPI-2 were added to each model to assess the possible moderating effects of perceived emotional distress. The results did not explicitly support a receptive/generative dichotomy, but rather a continuum of language function with some tasks more or less reliant on receptive and generative language components. Left MTLE and FLE patients performed equally poorly on all language measures, while right MTLE patient performance was largely unimpaired. Performance was moderated by perceived emotional distress; however, depression and anxiety were found to 3 differentially moderate performance with both suppressive and faclitatory effects relative to seizure focus. Anxiety facilitated FLE patient performance on tasks more reliant on temporal lobe integrity, while depression tended to suppress language performance on measures for which impaired performance was intrinsic to the underlying epiltogenic lesion (e.g., BNT performance in left MTLE). Perceived emotional distress is an important treatment consideration in the management of intractable epilepsy patients.

We sought to determine significant predictors of seizure and cognitive outcome following surgery for epilepsy. Participants included 41 patients who had undergone anterior temporal lobectomy (ATL). Higher presurgical verbal/language scores and lower nonverbal memory scores were predictive of seizure-free status following ATL. Overall, the presurgical predictors were 93% accurate in discriminating between seizure-free and non-seizure-free patients postsurgery. Surgery in the nondominant-for-language hemisphere was predictive of higher postsurgical verbal/language and verbal memory scores. Higher presurgical visual/construction, nonverbal memory, and verbal/language scores were predictive of better postsurgical verbal/language functioning. Better presurgical verbal/language functioning was predictive of the same skills postsurgically as well as visual/construction outcomes. Exploratory analyses in a subset of participants (n=25) revealed that dominant and nondominant intracarotid amobarbital (Wada) memory scores added unique variance only for predicting nonverbal memory following ATL. Presurgical neuropsychological testing provides significant and unique information regarding postsurgical seizure freedom and cognitive outcome in patients who have undergone ATL.

Purpose: Noninvasive tests that accurately localize seizure onset provide great value in the presurgical evaluation of patients with intractable epilepsy. This study examined the diagnostic utility of three expressive language disturbances in lateralizing language-dominant (DOM) temporal lobe complex partial seizures: (1) the postictal language delay (PILD; time taken to correctly read a test phrase out loud immediately following seizures); (2) the production of postictal phonemic paraphasic errors (PostPE); and (3) interictal phonemic paraphasic errors (InterPE).Methods: All 60 subjects underwent inpatient video/EEG monitoring and had surgically confirmed temporal lobe epilepsy (TLE). We determined the presence and number of PostPE and, PILD times (in s) for 212 seizures, and InterPE on the Boston Naming Test (BNT). Each technique's diagnostic usefulness was evaluated via logistic regression and ROC curve analysis. Sensitivity, specificity, positive predictive value and negative predictive values were computed.Results: PILD, PostPE and InterPE production were equally effective and accurate in lateralizing DOM seizure onset. Patients with DOM TLE had a longer PILD and committed more PostPE and InterPE than those with nondominant (NDOM) TLE. Respective sensitivity and specificity values were as follows: PILD (84%, 86%), PostPE (94%, 64%), and InterPE (97%, 86%). No single predictor was significantly better but a combination model yielded enough incremental utility to collectively outperform each separate predictor model.Conclusions: Interictal language testing is as accurate as postictal language testing in predicting DOM lateralization of TLE. Clinicians should also attend to the quality of errors produced during interictal and postictal language testing.

The efficacy of a self-generation encoding procedure in facilitating the encoding and retrieval of verbal memories was compared with the didactic presentation of information in individuals with seizure disorders. Through a within-subject design, 87 patients (25 left temporal seizure onset, 29 right temporal, 8 frontal, and 25 psychogenic nonepileptic seizures) received a self-generation learning condition and a didactic learning condition and were subsequently tested for verbal paired associate free recall, cued recall, and recognition memory. All patient groups benefited from the use of the self-generation condition relative to the didactic condition. Better performance occurred with the self-generation procedure for cued recall and recognition memory test performance, but not free recall. Individuals with a left temporal seizure onset (patients with the poorest memory performance on the didactic condition) benefited the most from the self-generation condition. A memory encoding strategy that actively involves patient participation enhances memory performance.

The generation effect refers to the theory that optimal acquisition and retention of information is achieved by active participation rather than by passive observation. The efficacy of a self-generation memory encoding strategy was tested using a verbal paired-associate task for free recall, cued recall, and recognition memory in 40 traumatically brain-injured outpatients in two studies. In study #1, self-generation encoding procedures improved recognition memory, but not free recall, compared with the didactic presentation of information. In study #2, self-generation procedures improved cued recall test performance, but the results demonstrated that the type of cue that is provided moderates the efficacy of self-generation procedures. Results provide preliminary empirical support for the use of self-generation encoding procedures in improving upon verbal memory and learning abilities in individuals with TBI.

Many studies have reported on the pattern of neuropsychological test performance across varied seizure diagnosis populations. Far fewer studies have evaluated the accuracy of the clinical neuropsychologist in formulating an impression of the seizure diagnosis based on results of neuropsychological assessment, or compared the accuracy of clinical neuropsychological judgment to results of statistical prediction. Accuracy of clinical neuropsychological versus statistical prediction was investigated in four seizure classification scenarios. While both methods outperformed chance, accuracy of clinical neuropsychological classification was either equivalent or superior to statistical prediction. Results support the utility and validity of clinical neuropsychological judgment in epilepsy treatment settings.

Memory difficulties are a frequent cognitive complaint of patients with chronic epilepsy. Previous studies have suggested that the presence of a seizure focus causes reorganization of brain mechanisms underlying memory function. Here we examine whether seizure onset in the left hemisphere and onset in the right hemisphere have different effects on memory lateralization and whether longer duration of epilepsy is associated with increased lateralization of memory functions to the unaffected hemisphere. We hypothesized that hemisphere of onset and duration of epilepsy would influence plasticity of memory mechanisms, similar to the plasticity observed for language mechanisms. Healthy controls (HC, N = 10) and patients with epilepsy (N = 23, 11 with a left- and 12 with a right-hemisphere focus) performed a scene-encoding fMRI task at 4 T. Active voxels (relative to scrambled image viewing) were identified for each participant. Memory laterality indices (LIs) were calculated in three regions of interest (ROIs) designed on the basis of HC group data: a functional ROI, an anatomical–hippocampal ROI, and an anatomical–medial temporal ROI encompassing hippocampus and parahippocampal gyrus. In healthy controls, LIs were suggestive of slight left lateralization of encoding memory for pictures. Patients with right hemisphere epilepsy showed a nonsignificant increase in degree of left lateralization. In contrast, patients with left hemispheric epilepsy showed right-lateralized activation, differing significantly from controls and from patients with right hemispheric epilepsy. Neuropsychological measures of memory (WMS-III Story Recall) across epilepsy patients predicted LIs in the anatomical ROIs: higher scores were associated with more left-lateralized medial temporal fMRI activation. Neither age of onset nor duration of epilepsy was significantly related to LI. These results indicate that focal epilepsy may influence the functional neuroanatomy of memory function.

Past research has suggested that pessimistic attributional style may be a risk factor for psychopathology among patients with seizure disorders. In addition, classifying psychogenic nonepileptic seizures (PNES) into subtypes has been found to be clinically relevant. However, very few studies have addressed differences in optimism, pessimism, or neuropsychological performance among PNES subtypes. We previously classified adults with PNES into semiology-based subtypes (catatonic, minor motor, major motor). In the study described here, we compared subtypes on optimism, pessimism, depressive symptoms, and neuropsychological performance. We found that patients with PNES with low optimism had significantly greater depressive symptoms than patients with high optimism, F(2, 39)=36.49, P<0.01). Moreover, patients with high pessimism had significantly greater depressive symptoms than patients with low pessimism, F(2, 39)=13.66, P<0.01. We also found that the catatonic subtype was associated with fewer depressive symptoms and better verbal memory than the other PNES subtypes. Our results support relationships between optimism, pessimism, and depressive symptoms and extend these findings to a PNES sample. Overall, the results of the present study suggest that classification into semiology-based subtypes and study of normal personality traits among patients with PNES may have clinical significance.

Purpose: Patients with psychogenic nonepileptic seizures (PNES) rate their health-related quality of life (HRQOL) more poorly than those with epileptic seizures (ES). This has been explained in part by mood state. We sought to investigate whether HRQOL differences between diagnostic groups (PNES vs. ES) can be explained by additional, perhaps chronic, aspects of mood and personality. An understanding of these relationships may inform treatment designed to improve HRQOL in ES or PNES.Methods: One-hundred fourteen individuals (69 ES and 45 PNES) completed the quality of life in Epilepsy-89. The profile of mood states (POMS) and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) were employed to measure current and chronic mood symptoms, respectively. Multiple regression analyses determined the contribution of chronic mood symptoms to HRQOL beyond the variance accounted for by current mood state and seizure diagnosis.Results: Similar to previous reports, individuals with PNES reported poorer HRQOL than those with ES. Current mood state was strongly related to HRQOL and appeared to moderate the relationship between seizure diagnosis and HRQOL. However, when more chronic psychological symptoms, such as somatization and emotional distress, were included in a model, the moderating role of mood state was not significant.Conclusion: Analyzed independently, mood state is related to HRQOL, but when chronic indicators of psychological symptoms are included in a model mood is related to HRQOL, but, the moderating effect of mood is no longer significant. Treatments designed to improve HRQOL among individuals with intractable seizures should also address chronic psychological distress and symptoms associated with high levels of somatization.