Quantitative and Qualitative Interpretation of Neuropsychological Data in the Assessment of Temporal Lobectomy Candidates

Abstract

Neuropsychologists who serve as members of an epilepsy surgery team are often asked to provide information regarding localized cerebral dysfunction that may relate to the seizure focus in patients with intractable temporal lobe epilepsy (TLE). However, the rate at which neuropsychological (NP) assessment results correspond with the side of seizure focus (i.e., left vs. right) in TLE patients is unknown. The majority of literature in this area has focused on the ability of single NP tests to detect lateralized cognitive dysfunction in groups of TLE patients, with mixed findings and few consistent replications. The primary purpose of this study was to examine the rate at which qualitative clinician interpretations of NP profiles agree with seizure lateralization as determined by a multidisciplinary surgery team in temporal lobectomy candidates. Quantitative analyses of single NP test scores and groups of test scores (i.e., cognitive domain composite scores) were also conducted to examine their effectiveness in discriminating left from right TLE groups. Only four of the 19 NP test variables and three of the nine composite cognitive domain scores significantly differed between the groups. However, clinician interpretation of NP profiles agreed with the surgery conference team's determination of seizure laterality in two-thirds of cases. These findings suggest that qualitative aspects of NP performance play an important role in identifying lateralized cerebral dysfunction in TLE patients, and provide additional support for the use of NP assessment results in the selection of temporal lobectomy candidates.

Clinical utility of the Wechsler Memory Scale—Fourth Edition (WMS-IV) in predicting laterality of temporal lobe epilepsy among surgical candidates

“…Perhaps the most established memory test to be associated with side of seizure and ultimate side of surgery is the Rey Auditory Verbal Learning Test (RAVLT) [6]. There is limited evidence for the Rey-Osterrieth Complex Figure Test [3,7]. Confrontation-naming measures, particularly the Boston Naming Test (BNT), have also been shown to predict seizure laterality and ultimate side of surgical resection [8][9][10][11].…”

Predictors of unfavorable outcomes following deep brain stimulation for movement disorders and the effect of hospital case volume on outcomes: an analysis of 33, 642 patients across 234 US hospitals using the National (Nationwide) Inpatient Sample from 2002 to 2011

“…As beneficial effects of DBS in movement disorders became widespread, the need to establish good practices, better outcomes with minimal adverse events, and enhanced ability to effectively deal with complex cases led to the emergence of multidisciplinary patient management approach, incorporating cross-disciplinary expertise. 30,38,40 The cross-disciplinary model involved before concluding a case deemed for DBS, in addition to evolving technology, and equipped infrastructure could possibly explain the rise in hospital charges over time. In our analysis, this increase was most notable for LVCs, re- flecting a 463% rise in the mean hospital charges in 2011 compared with 2002, despite inflation adjustments.…”

Semantic descriptor ranking: a quantitative method for evaluating qualitative verbal reports of visual cognition in the laboratory or the clinic

“…Thus, while the test outcomes are rich in qualitative information, it is hard to measure this information. This is a well-documented shortcoming of qualitative tests in general (Gainotti et al, 1985, 1989; Milberg et al, 1996; Glozman, 1999; Ogden-Epker and Cullum, 2001; Pachalska et al, 2008). …”

“…At the other end of visual testing spectrum, qualitative tests of visual function have a roughly complementary set of strengths and weaknesses, in that while they are much better at capturing the nuances of high-level vision under real-world conditions, the outcomes of these tests are hard to quantify (Miles and Huberman, 1994; Poreh, 2000; Ogden-Epker and Cullum, 2001). Imagine, for instance, a clinical provider trying to quantify the visual deficit in a patient with agnosia, or inability to recognize objects.…”