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Biomedical subjects

B P Hermann

Publications and source records attributed to B P Hermann.

At least 19 recordsLinked to original sources
PubMed1992

Adequacy of language function and verbal memory performance in unilateral temporal lobe epilepsy.

We examined adequacy of language functions, their influence on verbal learning and memory performance, and the relative effects of language function and laterality of seizure focus on the memory performance of 99 left-hemisphere dominant patients with invasively verified epilepsy of left (N = 47) or right (N = 52) temporal lobe origin. Patients with left temporal lobe epilepsy (TLE) scored significantly lower than the right TLE group on several aphasia battery subtests (Visual Naming, Sentence Repetition, Token Test, Reading Comprehension, Aural Comprehension). Adequacy of language function (nominal speech) was significantly related to verbal learning and memory performance for both left and right TLE groups. Finally, comparison of the predictive significance of laterality of TLE and adequacy of language function indicated that language functions (Visual Naming and Aural Comprehension), but not laterality of TLE, were significant predictors for verbal learning and memory performance. It is concluded that: 1) adequacy of basic language functions is particularly compromised in left TLE, 2) there is a significant relationship between adequacy of language function and several aspects of verbal learning and memory ability in both left and right temporal lobe groups, and 3) clinical assessment and theoretical models of memory need to consider these relationships.

Adolescent↗
PubMed1992

Preoperative psychological adjustment and surgical outcome are determinants of psychosocial status after anterior temporal lobectomy.

This investigation evaluated the role of preoperative psychological adjustment, degree of postoperative seizure reduction, and other relevant variables (age, education, IQ, age at onset of epilepsy, laterality of resection) in determining emotional/psychosocial outcome following anterior temporal lobectomy. Ninety seven patients with complex partial seizures of temporal lobe origin were administered the Minnesota Multiphasic Personality Inventory (MMPI), Washington Psychosocial Seizure Inventory (WPSI), and the General Health Questionnaire (GHQ) both before and six to eight months after anterior temporal lobectomy. The data were subjected to a nonparametric rank sum technique (O'Brien's procedure) which combined the test scores to form a single outcome index (TOTAL PSYCHOSOCIAL OUTCOME) that was analysed by multiple regression procedures. Results indicated that the most powerful predictors of patients' overall postoperative psychosocial outcome were: 1) The adequacy of their preoperative psychosocial adjustment, and 2) A totally seizure-free outcome. Additional analyses were carried out separately on the MMPI, WPSI, and GHQ to determine whether findings varied as a function of the specific outcome measure. These results were related to the larger literature concerned with the psychological outcome of anterior temporal lobectomy.

Adaptation, Psychological↗
PubMed1992

Pathological status of the mesial temporal lobe predicts memory outcome from left anterior temporal lobectomy.

This investigation tested the hypothesis that the degree of impairment to memory function caused by an anterior temporal lobectomy (ATL) is inversely related to the pathological status of the resected hippocampus. Specifically, the greatest risk to postoperative memory function should be to patients with no or minimal hippocampal sclerosis, i.e., those with a functional hippocampus. Forty patients who underwent a partial resection of the left (n = 21) or right (n = 19) anterior temporal lobe were administered tests of immediate and delayed verbal and figural memory, both preoperatively and 6 months postoperatively. The degree of postoperative impairment in memory function was then investigated as a function of the degree of hippocampal sclerosis, as determined by a standardized procedure. For a left ATL, an absence or mild degree of hippocampal sclerosis was associated with significantly greater postoperative impairment of both verbal and figural memory, compared with patients with moderate or marked sclerosis. No statistically significant relationship was noted for patients who underwent a right ATL, but the findings were in the same direction for five of six memory measures. It may be possible to predict and avoid surgically induced impairment of memory function among patients who undergo left ATL through the use of preoperative hippocampal volumetric magnetic resonance imaging. Better clinical tests of right hippocampal function are needed to predict the outcome for patients who undergo a right ATL.

Adult↗
PubMed1991

Mood state in unilateral temporal lobe epilepsy.

The purpose of this investigation was to reexamine the relationship between self-reported depression and laterality of temporal lobe epilepsy and to determine the contribution of associated frontal lobe dysfunction in predisposing patients to depression. Sixty-four patients with complex partial seizures of left (n = 26) or right (n = 38) temporal lobe origin were administered several self-report measures of mood state (Beck Depression Inventory, Center for Epidemiological Studies-Depression scale, Beck Anxiety Inventory), and a test of frontal lobe function [Wisconsin Card Sorting Test (WCST)]. There were no overall differences between the left and right temporal lobe groups on the measures of depression and anxiety. However, the left temporal lobe group exhibited a significant relationship between the degree of associated frontal lobe dysfunction (as indicated by increased perseverative responding on the WCST) and dysphoric mood state. For the right temporal lobe group there was a nonsignificant inverse relationship between mood state and indices of frontal lobe dysfunction. These results (1) are consistent with the broader psychiatric literature, which has implicated a relationship between depression and left frontal lobe dysfunction, (2) suggest that previous conflicting reports of depression/left temporal lobe epilepsy relationships are due in part to variations in the intactness of frontal lobe function, and (3) suggest that the presence of associated frontal lobe dysfunction may be a consideration in understanding interictal psychopathology in epilepsy.

Adult↗
PubMed1991

Language function following anterior temporal lobectomy.

The authors report the results of a prospective investigation that evaluated postoperative changes in language function after dominant (29 cases) or nondominant (35 cases) anterior temporal lobectomy for treatment of complex partial seizures. These patients received conservative resection of lateral temporal cortex but aggressive resection of medial temporal cortex. None of the patients underwent functional mapping of cortical language ability. All patients were assessed with a standardized aphasia battery (Multilingual Aphasia Examination) before and 6 months after surgery. Postoperatively, the dominant anterior temporal lobectomy group did not show any significant losses in language function compared to patients who underwent nondominant anterior temporal lobectomy. In addition, the dominant temporal lobectomy group showed significant postoperative improvement in complex receptive language comprehension compared to the nondominant group. These results suggest that patients with complex partial seizures of medial temporal lobe onset can undergo a conservative resection of lateral temporal cortex without language mapping. Such surgery carries little risk to language function and provides an excellent postoperative surgical outcome.

Adolescent↗
PubMed1991

Seizure outcome from anterior and complete corpus callosotomy.

Eighty patients underwent anterior corpus callosotomy for treatment of generalized seizures. The patients' mean age was 18.3 years (range 4 to 53 years); the mean age at seizure onset was 5.27 years (range 0.1 to 27 years). The mean intelligence quotient (IQ) of 41 testable patients was 71.12 (range less than 30 to 114). The seizure outcome was as follows: 13% were seizure-free, 65% were significantly improved, and 22% were unchanged. Ten patients subsequently underwent a second operation to complete the callosal sectioning which resulted in additional seizure improvement in only five of them. Five complications resulted from 90 operations: two epidural hematomas, one delayed subdural hematoma, one bone-flap infection, and one postcallosotomy disconnection syndrome; two patients died. A younger age at onset of seizures, a higher IQ, and generalized tonic-clonic, atonic, complex-partial, and mixed seizure types were associated with improved seizure outcome.

Adolescent↗
PubMed1990

Psychosocial predictors of psychopathology in epilepsy.

The 30-item version of the GHQ was administered to 102 adults with epilepsy, and four sets of variables (neurological, psychosocial, medication, demographic) were used to predict psychiatric distress. Psychopathology was found to be associated with increased perceived stigma, elevated number of stressful life events during the past year, poor adjustment to epilepsy, financial stress, vocational problems, external locus of control, and an earlier onset of epilepsy. Multiple regression procedures reduced this list to three independent predictors of psychopathology: an increased number of stressful life events in the past year, poor adjustment to epilepsy, and financial stress.

Adaptation, Psychological↗
PubMed1989

Short-term psychological outcome of anterior temporal lobectomy.

The purpose of this investigation was to determine the short-term behavioral and emotional effects of anterior temporal lobectomy (ATL). Forty-one patients who underwent ATL were administered a standardized measure of emotional adjustment (Mental Health Inventory) on four occasions: preoperatively, and 1, 3, and 6 months postoperatively. Patients who were rendered totally seizure-free by ATL showed significant improvements on multiple indices of psychological distress and psychological well-being, improvement that continued up to 3 months after surgery and remained constant at 6 months postoperatively. Patients who were significantly improved (greater than 75% reduction in seizure frequency) but continued to experience some seizure activity showed no significant improvements in behavioral or emotional adjustment. The clinical and theoretical significance of these findings is discussed, and it is suggested that functional outcome (for instance, mental health) following ATL may be best predicted by a binary seizure outcome classification (seizure-free or not seizure-free).

Epilepsy↗
PubMed1989

Results of reoperation for failed epilepsy surgery.

A total of 37 patients who failed epilepsy surgery were evaluated with magnetic resonance imaging and long-term scalp electroencephalographic monitoring before reoperation. Repeat surgery involved focal resections after initial focal resections (30 cases) or stereotactic lesions (one case), or focal resections following anterior corpus callosotomy (six cases). Patients with initial focal resections followed by enlargement of the original operative site had the most successful outcome, especially those with complex partial seizures of temporal lobe origin. The most common cause for poor outcome of the original operation in patients with temporal lobe epilepsy was insufficient hippocampal resection. Patients who were most likely to benefit from reoperation were: 1) those with initially incompletely resected structural lesions; 2) those who were initially evaluated with invasive ictal monitoring; and 3) those who underwent further resection of the initial operative site rather than resection of a different cortical region.

Adolescent↗
PubMed1988

The MacAndrew Alcoholism Scale in epilepsy: a high false positive error rate.

A substantial proportion of patients with epilepsy seen in a large medical center were found to be incorrectly classified as possible substance abusers by the MacAndrew Alcoholism Scale (MAC) of the MMPI. Demographic variables, IQs, and MAC scale raw scores were compiled for a sample of 29 male and 33 female seizure patients. No significant or meaningful differences were found between the sexes; therefore, the sample was treated as a single group. False positive error rates on the MAC scale were 48.39% when MacAndrew's originally proposed raw score cut-off of 24 was used; 30.65% with a cut-off of 26; 20.97% with a cut-off of 28; and 9.68% with a cut-off of 30. A similarity of experiential and behavioral characteristics between seizure patients and substance abusers is suggested as a possible reason for the findings. A greater awareness of this high false positive rate for epilepsy patients is needed to differentiate drug-/alcohol-induced from non-induced seizures and to prevent inappropriate labeling of seizure patients by the various professional groups who utilize the MMPI. Suggestions are made for future research.

Adult↗
PubMed1988

Effects of anterior temporal lobectomy on language function: a controlled study.

This study represents the first prospective controlled investigation of preoperative versus postoperative (6 months) language function in patients who underwent partial resection of the dominant (n = 15) or nondominant (n = 14) anterior temporal lobe for treatment of medically refractory epilepsy. Language dominance was confirmed by intracarotid sodium amytal test. Thirteen of the 15 patients undergoing anterior temporal lobectomy of the dominant hemisphere were operated on under local anesthesia in order to map language and memory functions intraoperatively. Using a standardized language/aphasia battery, we found a significant trend of worse preoperative language function in patients with dominant hemisphere temporal lobe foci in comparison to patients with nondominant foci. Following anterior temporal lobectomy, neither group showed any significant losses in language function, whereas the dominant hemisphere temporal lobe group showed significant improvement in receptive language comprehension and associative verbal fluency.

Adult↗
PubMed1988

The interrelationship between language function and verbal learning/memory performance in patients with complex partial seizures.

The purpose of this investigation was to inquire into the relationship between demographic, seizure related, and language factors with the adequacy of verbal learning and memory function in 25 patients with complex partial seizures of dominant temporal lobe origin. Language function in general, and measures of verbal comprehension (aural and reading) and retrieval ability (naming and associative fluency) in particular, emerged as the most robust predictors of verbal learning and memory performance in this sample. Our findings both supported and extended the hypothesis of Mayeux et al. (1980) of a relationship between adequacy of language function and verbal learning and memory performance in patients with complex partial seizures. The implications of these findings for studies investigating the relationship between complex partial seizures/temporal lobe pathology and memory function are discussed.

Epilepsy, Temporal Lobe↗
PubMed1988

Wisconsin Card Sorting Test performance in patients with complex partial seizures of temporal-lobe origin.

Wisconsin Card Sorting Test (WCST) performance was investigated in patients with complex partial seizures (CPS) of dominant (n = 16) or nondominant (n = 19) temporal-lobe origin as well as in an epilepsy control group (n = 6) which consisted largely of patients with primary generalized epilepsies. Fifty seven percent of the CPS group (39% of dominant and 74% of nondominant temporal-lobe patients) performed in a manner suggestive of frontal-lobe pathology compared to 17% of the epilepsy controls. There were no differences among the groups in the number of categories achieved, but there were substantial qualitative differences in problem-solving efficiency. Nondominant temporal patients manifested more total errors and perseverative errors relative to both dominant temporal and epilepsy controls, and more perseverative responses relative to epilepsy controls. Dominant temporal-lobe patients showed more perseverative errors than epilepsy controls. Finally, a consecutive series of patients who underwent partial temporal-lobe resection were examined 6 months post-surgically and they were found to manifest significantly fewer perseverative responses. The possible reasons for "frontal-like" performance in CPS patients with documented temporal-lobe pathology are discussed and a specific hypothesis is suggested.

Adult↗
PubMed1988

The neurological, psychosocial and demographic correlates of hypergraphia in patients with epilepsy.

The multiaetiological determinants and correlates of interictal hypergraphia in patients with epilepsy were studied. A variety of neurological, psychosocial and demographic variables were examined in order to determine their relationship to experimental and clinically derived measures of hypergraphia in a sample of 50 patients with epilepsy. The results indicate that hypergraphia is of multifactorial origin in general, with especially strong relationships with measures of psychopathology. These results are related to the larger literature concerned with interictal behavioural change in patients with epilepsy.

Adult↗
PubMed1985

Identification of neuropsychological deficits in epilepsy using the Luria-Nebraska Neuropsychological Battery: a replication attempt.

Using the Luria-Nebraska Neuropsychological Battery (LNNB), Berg and Golden (1981) assessed 40 patients with epilepsy and reported a hit rate of 77.3% for idiopathic epilepsy and 88.9% for symptomatic epilepsy (82.5% overall). The purpose of this investigation was to attempt to replicate their important findings. A consecutive series of 31 patients with epilepsy was administered the LNNB and we obtained a hit rate of 47% for idiopathic epilepsy and 30% for symptomatic epilepsy (41% overall). Four possible methodological reasons for these disparate findings were offered.

Adolescent↗