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N R Varney

Publications and source records attributed to N R Varney.

9 recordsLinked to original sources

The phenomenology of multiple partial seizure-like symptoms without stereotyped spells: an epilepsy spectrum disorder?

Consistent with previous reports by neuropsychiatrists, the results of the present investigation confirmed the existence of a neurobehavioral disorder characterized by the subjective experiencing of multiple cognitive, affective, and psychosensory phenomena similar to those associated with more classic partial seizure disorders. According to the literature, such patients typically respond favorably to anticonvulsants although they lack the customary motor manifestations of complex partial seizure (CPS) disorders and typically do not have stereotyped spells. This neuropsychiatric syndrome has recently been termed epilepsy spectrum disorder (ESD). In the present study, 30 patients with ESD were matched with equal numbers of treatment-refractory CPS patients and normal controls. All subjects were administered a standardized interview consisting of 35 cognitive, affective, and psychosensory partial seizure-like symptoms. The results indicated that ESD patients endorsed significantly more partial seizure-like symptoms than did CPS patients and controls. Relatively low levels of symptom endorsement by an unmatched psychiatric comparison sample indicated that the high levels of symptom endorsement by ESD patients could not be attributed to the presence of psychiatric dysfunction per se. Analysis of responding to 'foil' items unrelated to partial seizures indicated that high levels of symptom endorsement by ESD patients did not merely reflect a deviant response. Although ESD patients seldom present themselves at tertiary care epilepsy centers, the study of such patients is likely to be of relevance to mainstream epileptology.

Adult

Dichotic listening failure in dysphoric neuropsychiatric patients who endorse multiple seizure-like symptoms.

In the present investigation, the dichotic word listening performance of a sample of 25 dysphoric neuropsychiatric patients who endorsed multiple partial seizure-like symptoms was compared with that of matched samples of normal controls and patients with mood disorders who did not endorse multiple seizure-like symptoms. Eighty percent of the patients who endorsed multiple episodic phenomena failed the dichotic listening task, compared with 8% of normal controls and 28% of patients with typical mood disorders. After treatment with carbamazepine, a subsample of polysymptomatic patients manifested significantly fewer seizure-like symptoms. This clinical improvement was typically associated with markedly improved dichotic listening performance in most cases. The results are consistent with our previous hypothesis that "subclinical" electrophysiological dysfunction may severely disrupt the normal transmission and processing of auditory information. Because it is sensitive to this type of presumed cerebral dysfunction and relatively specific, impaired dichotic listening performance is likely to be a useful clinical marker for this complex neuropsychiatric syndrome.

Adult

Visuospatial judgment. A clinical test.

We constructed and developed a brief test assessing capacity for discriminating the direction of lines. Application of the test to patients with unilateral brain disease disclosed a remarkably high frequency of defective performance in those with right hemisphere lesions. The performance of patients with left hemisphere lesions was comparable to that of control patients. Brevity and ease of administration make the test convenient for clinical use.

Adolescent

Linguistic correlates of pantomime recognition in aphasic patients.

Aphasic patients were given tests assessing pantomime recognition, reading comprehension, aural comprehension, and naming ability to determine whether defective pantomime recognition could be the result of a disturbance of symbolic thinking also affecting linguistic functioning. Defects in pantomime recognition always occurred in conjunction with reading defects of at least comparable severity, but reading defects sometimes occurred without comparable defects in pantomime recognition. The relationship of pantomime recognition with both aural comprehension and naming ability was significantly weaker than that between pantomime recognition and reading comprehension. The implications of the findings with regard to other nonverbal aphasic symptoms and the role of sensory modality factors are discussed.

Aphasia

Visual localization in patients with unilateral brain disease.

The accuracy of localization of briefly exposed single dots and pairs of dots was assessed in patients with lesions of the left and right hemispheres and in control patients without history or evidence of brain disease. A remarkably high frequency of impaired performance was found in the patients with right hemisphere lesions. The performance of the patients with left hemisphere lesions was comparable with that of the control patients. Visual field defect was associated with defective localization in the right hemisphere group but not in the left hemisphere group. Aphasic disorder and age were not related to performance level. The relationship of the findings to those of previous studies of visual localization in patients with unilateral brain disease is discussed.

Adult

Visual perception of line direction in patients with unilateral brain disease.

The accuracy of identifying the slope of briefly exposed lines was assessed in patients with lesions of the left or right hemisphere and in a group of control patients without history or evidence of brain disease. The frequency of impaired performance was remarkably high in the patients with right hemisphere lesions. In contrast, the patients with left hemisphere lesions did not perform differently from the control group. Visual field defect, aphasic disorder, and age were not related to performance level. The striking interhemispheric difference in performance on this visuospatial task suggests its further development for clinicodiagnostic purposes.

Adult

Neuropsychiatric correlates of theta bursts in patients with closed head injury.

Twenty-five head-injured patients with localized theta bursts on standard or 24 h ambulatory EEG were administered a standardized interview for neuropsychiatric symptoms associated with complex partial seizures (e.g. olfactory hallucinations, memory gaps) and a battery of neuropsychological tests. Although the formal neuropsychological test performances of these patients were relatively normal they reported an abundance of seizure-like behavioural symptoms. While the frequency of these symptoms was high, they did not occur in a stereotyped complex or sequence. These findings suggest that localized theta bursts may be diagnostic of an underlying neuroelectrical disorder.

Adolescent