It is not clear whether the blind are generally superior to the sighted on measures of tactile sensitivity or whether they excel only on certain tests owing to the specifics of their tactile experience. Wecompared the discrimination performance of blind Braille readers and age-matched sighted subjects on three tactile tasks using precisely specified stimuli. Initially, the blind significantly outperformed the sighted at a hyperacuity task using Braille-like dot patterns, although, with practice, both groups performed equally well. On two other tasks, hyperacute discrimination of gratings that differed in ridge width and spatial-acuity-dependent discrimination of grating orientation, the performance of the blind did not differ significantly from that of sighted subjects. These results probably reflect the specificity of perceptual learning due to Braille-reading experience.301

The intrarater and interrater reliability (I&IR) of EEG interpretation has significant implications for the value of EEG as a diagnostic tool. We measured both I&IR of EEG interpretation based on interpretation of complete EEGs into standard diagnostic categories and rater confidence in their interpretations, and investigated sources of variance in EEG interpretations. During two distinct time intervals six board-certified clinical neurophysiologists classified 300 EEGs into one or more of seven diagnostic categories, and assigned a subjective confidence to their interpretations. Each EEG was read by three readers. Each reader interpreted 150 unique studies, and 50 studies twice to generate intrarater data. A generalizability study assessed the contribution of subjects, readers, and the interaction between subjects and readers to interpretation variance. Five of the six readers had a median confidence of ≥ 99%, and the upper quartile of confidence values was 100% for all six readers. Intrarater Cohen’s kappa (κc) ranged from 0.33 to 0.73 with an aggregated value of 0.59. κc ranged from 0.29 to 0.62 for the 15 reader pairs, with an aggregated Fleiss kappa of 0.44 for interrater agreement. The κc were not significantly different across rater pairs (Chi-Square = 17.3, df=14, p = 0.24). Variance due to subjects (i.e. EEGs) was 65.3%, to readers was 3.9%, and to the interaction between readers and subjects was 30.8%. Experienced epileptologists have very high confidence in their EEG interpretations and low to moderate I&IR, a common paradox in clinical medicine. A necessary but insufficient condition to improve EEG interpretation accuracy is to increase intrarater and interrater reliability. This goal could be accomplished, for instance, with an automated on-line application integrated into a continuing medical education module that measures and reports EEG I&IR to individual users.

Data from lesion studies suggests that the ability to perceive speech sounds, as measured by auditory comprehension tasks, is supported by temporal lobe systems in both the left and right hemisphere. For example, patients with left temporal lobe damage and auditory comprehension deficits (i.e., Wernicke's aphasics), nonetheless comprehend isolated words better than one would expect if their speech perception system had been largely destroyed (70-80% accuracy). Further, when comprehension fails in such patients their errors are more often semantically-based, thanphonemically based. The question addressed by the present study is whether this ability of the right hemisphere to process speech sounds is a result of plastic reorganization following chronic left hemisphere damage, or whether the ability exists in undamaged language systems. We sought to test these possibilities by studying auditory comprehension in acute left versus right hemisphere deactivation during Wada procedures. A series of 20 patients undergoing clinically indicated Wada procedures were asked to listen to an auditorily presented stimulus word, and then point to its matching picture on a card that contained the target picture, a semantic foil, a phonemic foil, and an unrelated foil. This task was performed under three conditions, baseline, during left carotid injection of sodium amytal, and during right carotid injection of sodium amytal. Overall, left hemisphere injection led to a significantly higher error rate than right hemisphere injection. However, consistent with lesion work, the majority (75%) of these errors were semantic in nature. These findings suggest that auditory comprehension deficits are predominantly semantic in nature, even following acute left hemisphere disruption. This, in turn, supports the hypothesis that the right hemisphere is capable of speech sound processing in the intact brain.

The current study examined beliefs about medication and their association with adherence to antiepileptic drugs (AEDs) among predominantly ethnic minority, low-income patients with epilepsy (PWE). Seventy-two PWE completed standardized questionnaires. The Beliefs about Medicines Questionnaire was used to assess perceptions about AEDs and medications in general. Adherence was measured with the Morisky 4-item scale and via participant self-rating. On the Morisky scale, 63% of patients endorsed at least one item for nonadherence. There was a significant relationship between seizure frequency and adherence (Morisky: r= 0.33, p= 0.006; Self-rating: r =−0.35; p= 0.003). Patients with lower self-rated adherence expressed greater concerns about AEDs (r= −0.25, p= .036) and beliefs that medications, in general, may be intrinsically harmful (r= −0.26; p= 0.032) and minimally beneficial (r= 0.36; p< 0.002), as compared to more adherent patients. These findings inform future educational interventions in this population of PWE.

In experienced hands, stenting for symptomatic VAS can be accomplished with a very high success rate (100%), with few periprocedural complications, and is associated with durable symptom resolution in the majority (approximately 80%) of patients. We conclude that endovascular stenting of vertebral artery atherosclerotic disease is safe and effective compared with surgical controls and should be considered first-line therapy for this disease.