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Biomedical subjects

R Rausch

Publications and source records attributed to R Rausch.

At least 19 recordsLinked to original sources
PubMed1999

Karyological and dental identification of Microtus limnophilus in a large focus of alveolar echinococcosis (Gansu, China).

A study of voles (Arvicolidae, Rodentia) from Gansu (China) designed to identify a potential host of Echinococcus multilocularis, responsible for human alveolar echinococcosis, leads to a general analysis of Microtus limnophilus population karyotypes, M1 of M. oeconomus populations from all of Eurasia and of M. limnophilus of Mongolia. The Microtus of Gansu belonging to the nominal subspecies M. limnophilus limnophilus (2n = 38; NF = 58) differs markedly in size and shape of M1 from the M. limnophilus of Mongolia, which must therefore be considered as a new subspecies M. limnophilus of malygini nov. ssp. (2n = 38; NF = 60) and the M. oeconomus of Mongolia should be ranked as M. oeconomus kharanurensis nov. ssp. (2n = 30; NF = 60).

Animals↗
PubMed1999

Temporal lobe epilepsy, temporal lobectomy, and major depression.

Sixty-two patients with medically intractable complex partial seizures who had either surgical or no surgical intervention were followed up at a mean of 10.9 years after surgery or initial evaluation. Of the 49 surgical patients, 45% had a life-time history of depression, versus 15% of the 13 patients in the nonsurgical comparison group. In the surgical group, 77% had prior history of depression; of these, 47% experienced no further episodes after surgery. Depression occurred de novo after lobectomy in 5 surgical patients (approximately 10%), 4 developing depression within 1 year. Presurgical presence of depressive episodes predicted continued postoperative depressive episodes. The significantly higher depression rate in patients with temporal lobe seizure foci suggests limbic system dysfunction in the increased risk for depression. Postsurgical resolution of episodes in almost 50% of these patients supports the tenet that depression per se is not a contraindication for surgery in patients with intractable seizures.

Adult↗
PubMed1997

Effects of hemisphere speech dominance and seizure focus on patterns of behavioral response errors for three types of stimuli.

We used a protocol consisting of a continuous presentation of stimuli with associated response requests during an intracarotid sodium amobarbital procedure (IAP) to study the effects of hemisphere injected (speech dominant vs. nondominant) and seizure focus (left temporal lobe vs. right temporal lobe) on the pattern of behavioral response errors for three types of visual stimuli (pictures of common objects, words, and abstract forms). Injection of the left speech dominant hemisphere compared to the right nondominant hemisphere increased overall errors and affected the pattern of behavioral errors. The presence of a seizure focus in the contralateral hemisphere increased overall errors, particularly for the right temporal lobe seizure patients, but did not affect the pattern of behavioral errors. Left hemisphere injections disrupted both naming and reading responses at a rate similar to that of matching-to-sample performance. Also, a short-term memory deficit was observed with all three stimuli. Long-term memory testing following the left hemisphere injection indicated that only for pictures of common objects were there fewer errors during the early postinjection period than for the later long-term memory testing. Therefore, despite the inability to respond to picture stimuli, picture items, but not words or forms, could be sufficiently encoded for later recall. In contrast, right hemisphere injections resulted in few errors, with a pattern suggesting a mild general cognitive decrease. A selective weakness in learning unfamiliar forms was found. Our findings indicate that different patterns of behavioral deficits occur following the left vs. right hemisphere injections, with selective patterns specific to stimulus type.

Adult↗
PubMed1996

Word-finding deficits persist after left anterotemporal lobectomy.

OBJECTIVE: To determine the incidence and extent of exacerbation of word-finding difficulty following anterotemporal lobectomy and to identify predictors of change. DESIGN: Case-series study of qualitative and quantitative changes in confrontation naming ability before surgery and 1 year after surgery. Stepwise multiple regression analysis of predictors of postoperative naming change. SETTING: A university epilepsy surgery program. PARTICIPANTS: Fifty-nine consecutive patients. INTERVENTION: Standard, en bloc anterotemporal lobectomy. MAIN OUTCOME MEASURE: Raw scores and types of errors on the 85-item Boston Naming Test. RESULTS: A significant exacerbation of word-finding difficulty was noted that persisted at least 1 year after surgery in 25% of patients with left, speech-dominant anterotemporal lobectomy (Laterality x Time interaction [F = 24.5; P < .0005]). "Tip-of-the-tongue"-type errors were most frequent (F = 54.66; P < .001), as opposed to paraphasic-type errors seen more frequently among patients with aphasia or dementia. Word-finding decline was worse among patients who underwent a left anterotemporal lobectomy and who were left-hemisphere speech dominant, older, or evaluated earlier in the postoperative course. CONCLUSIONS: Significant, persisting worsening of word-finding difficulties is not a rare consequence of a left anterotemporal lobectomy, as suggested by previous studies. Differences between these results and those of previous studies may reflect differences in extent of surgical resection and/or differential sensitivity of psychometric measures of naming to word-finding problems. Information regarding extent, frequency, and predictors of word-finding declines may be used in counseling surgical candidates about the potential cognitive side effects of anterotemporal lobectomy.

Adult↗
PubMed1995

Outcomes in 248 patients who had diagnostic evaluations for epilepsy surgery.

Surgery for intractable epilepsy is a widely used treatment that is not readily assessed by randomised trials. We evaluated the impact of epilepsy surgery on seizures, medication use, employment, and the quality of life in 248 adults and adolescents consecutively referred to one medical centre between 1974 and 1990. Outcomes were determined through self-administered questionnaire and medical record review for 202 surgery and 46 non-surgery patients whose treatment was usually determined by the presence or absence of an epileptogenic focus. Surgery and non-surgery patients differed at baseline only in median monthly seizure frequency (surgery lower than non-surgery). After adjustment for baseline covariates, surgery patients at follow-up had greater decline in average monthly seizure frequency (-11.9 vs - 1.5; difference -10.4, 95% CI -20.5, -0.3) and took fewer antiepileptic medications (average number 1.4 vs 2.0; difference -0.67, 95% CI -0.94, -0.40). Although quality-of-life scores were higher (p < 0.05) with surgery on 5 of 11 scales that were administered only at follow-up, there were no significant differences in employment status or prospectively assessed quality of life. Relative to a non-surgery group, patients treated surgically had better seizure control with less antiepileptic medication. The impact of epilepsy surgery on quality of life and employment needs to be assessed in larger prospective studies.

Adolescent↗
PubMed1995

Outcome assessment for epilepsy surgery: the impact of measuring health-related quality of life.

Epilepsy surgery is an increasingly common treatment for intractable epilepsy; yet there is no clear consensus among experts on how to report epilepsy surgery outcome. Most published outcome reporting systems focus on seizure frequency and type but differ in how they define clinically distinct outcome categories. We used a reliable and valid measure of self-reported health-related quality of life (HRQOL), the Epilepsy Surgery Inventory (ESI)-55, as an external standard by which to evaluate seven previously published, seizure-based outcome classification systems. The ESI-55 was administered to 133 adults who had previously undergone surgery for intractable epilepsy, and results were linked to data on their seizure occurrence before and after surgery (over the year prior to their HRQOL reports). These 133 patients were classified according to each seizure-based outcome system, and variation in HRQOL across outcome groups was evaluated using analysis of variance. Results reveal noteworthy variation in the extent to which different systems reflect patients' HRQOL at follow-up. We modified existing systems to derive a seizure-based surgery outcome system that most closely reflects HRQOL when applied over the latest 1-year postoperative interval.

Adolescent↗
PubMed1994

Asymmetric interictal glucose hypometabolism and cognitive performance in epileptic patients.

OBJECTIVE: To relate hemispheric metabolic asymmetries to cognitive performance in patients with unilateral mesial temporal lobe epilepsy. DESIGN: Asymmetrical cerebral glucose metabolisms on interictal fludeoxyglucose F 18 positron emission tomograms (FDG-PET) were correlated with cognitive measures. Analyses included partial correlations that controlled for the correlation between metabolic asymmetries of the lateral temporal lobe and other brain regions and the correlation of IQ scores with affected cognitive scores. SETTING: A university epilepsy surgery center. PATIENTS: Subjects included 13 patients who had intractable complex partial seizures originating from a mesial temporal lobe. INTERVENTION: Patients underwent FDG-PET scanning as part of their diagnostic work-up. Asymmetry indexes for cerebral metabolic rates were determined for whole hemisphere, lateral temporal lobe, mesial temporal lobe, frontal lobe, thalamus, and parietal lobe. MAIN OUTCOME MEASURES: The following cognitive domains were assessed: psychometric intelligence, mental control/attention, language, and verbal and nonverbal memory. Neuropsychological measures were obtained within 14 days of FDG-PET scanning. RESULTS: Relative reductions in glucose metabolism of the left hemisphere and left lateral temporal lobe correlated with a lower verbal IQ score and a lower score on a verbal memory task, recall of logical prose. Relative reduction in metabolism of the left side of the thalamus also correlated with lower scores for recall of logical prose. CONCLUSION: Relative hypometabolism of the left hemisphere correlates with lower cognitive performance. Hypometabolism of the left lateral temporal lobe and thalamus independently correlates with the verbal memory difficulties seen in this epileptic patient population.

Adult↗
PubMed1993

Hippocampal neuron loss and memory scores before and after temporal lobe surgery for epilepsy.

OBJECTIVE: To assess the relationship of hippocampal neuron loss to intellectual and memory measures before and after temporal lobe surgery. DESIGN: Pyramidal cell loss, as determined on the resected tissue, of hippocampal subregion CA1 correlated highest with other subregional cell loss and thus was used as the primary indicator of hippocampal neuron loss. Groups of patients with left and right temporal lobe seizures were subdivided according to degree of CA1 neuron loss. Behavioral performances of patient groups were compared before and after surgery. SETTING: Patient data were obtained from a university program of surgery for epilepsy. CASES: Twenty-five patients who had intractable epilepsy. MAIN OUTCOME MEASURES: Wechsler Adult Intelligence Scale IQ scores, verbal and nonverbal memory measures adapted from the Wechsler Memory Scale, and the Rey-Osterrieth recall score. RESULTS: Degree of hippocampal cell loss selectively related to learning of unrelated word pairs, both preoperatively and postoperatively, in patients with left but not right temporal lobe seizures. Patients with severe loss of left hippocampal neurons performed worse than those with mild-moderate neuron loss both before and after surgery. Immediate recall of logical prose did not relate to hippocampal neuron loss, although scores decreased following left temporal lobe surgery. CONCLUSION: These findings support a role for the left hippocampus in rote verbal memory, ie, learning of unrelated word pairs. Semantically complex verbal learning, ie, recall of logical prose, is more dependent on extrahippocampal temporal lobe regions. Finally, patients with severe as compared with minimal left hippocampal neuron loss may be at risk for lower memory functioning postoperatively.

Adult↗
PubMed1992

Reliability and validity of the Katz Adjustment Scales in an epilepsy sample.

Development of quality of life measures de novo is time-consuming and expensive, and a number of instruments are already available for general use. Reevaluation and refinement of quality of life tools are needed to improve the existing pool of measures. In this study, data from a sample of 328 epilepsy patients were used to revise a measure of social adjustment and emotional status developed in the 1960s, the 127-item form R1 of the Katz Adjustment Scales (KAS-R1). Using a comprehensive item analysis procedure, we increased the number of items used in scoring the KAS-R1 from 76 to 113 and substantially improved the reliability of scales in both the original sample of 328 epilepsy patients and in a second administration to a 'cross-validation' sample of 193 epilepsy patients. Support for the validity of the revised KAS-R1 scoring system was obtained in a known groups analysis of patients who had previously undergone surgery for epilepsy: mean scores were significantly higher (p < 0.05) on 11 out of 14 scales in the revised KAS-R1 for patients who were completely seizure-free compared to patients who were having seizures with loss of consciousness, after adjusting for age, gender, and anticonvulsant medication use.

Adaptation, Psychological↗
PubMed1992

A health-related quality of life instrument for patients evaluated for epilepsy surgery.

The goals of surgery in treating intractable epilepsy are to eliminate seizures and improve quality of life. This report describes the development of the Epilepsy Surgery Inventory (ESI)-55, a 55-item measure of health-related quality of life for epilepsy patients. The ESI-55 includes the following scales (number of items in parentheses): health perceptions (9), energy/fatigue (4), overall quality of life (2), social function (2), emotional well-being (5), cognitive function (5), physical function (10), pain (2), and three separate scales of role limitations due to emotional, physical, or memory problems (5 items each). Also included is one change in health item. The ESI-55 was completed by 89% of 224 adults who had undergone a protocol evaluation for epilepsy surgery since 1974. Alpha internal consistency reliability coefficients ranged from 0.76 to 0.88 except for social function (alpha = 0.68). Multitrait scaling analyses supported item discrimination across scales. Factor analysis confirmed previously identified mental and physical health factors, and yielded a third factor defined by cognitive function and role limitations scales. Construct validity was supported by correlations of the ESI-55 with a mood profile instrument. Analysis of ESI-55 scale scores by seizure classification showed that the 44 patients who were seizure-free following surgery scored higher than did 55 patients who continued to have seizures (P less than 0.05 for all comparisons); 43 patients having seizures without loss of consciousness scored in between. Results of this study indicate that the ESI-55 is reliable, valid, and sensitive to differences in seizure status.

Adult↗
PubMed1991

Right-hemisphere language dominance in temporal lobe epilepsy: clinical and neuropsychological correlates.

Prior to and following temporal lobe surgery, patients with right-hemisphere language dominance and focal left temporal lobe epilepsy (RHLD-LTLSz) were compared to right-handed patients with left-hemisphere language dominance and either left temporal lobe epilepsy (LHLD-LTLSz) or right temporal lobe epilepsy (LHLD-RTLSz). The group of RHLD-LTLSz patients had a more consistent history of brain involvement before the age of 5 years and had a higher seizure frequency rating than did either LHLD patient group. Cognitively, RHLD-LTLSz patients did not show significant deficits in psychometric intellectural scores. In addition, they did not demonstrate comparable degrees of verbal memory loss as found either pre- or postoperatively in LHLD-LTLSz patients. The right-handed RHLD-LTLSz and the right-handed LHLD-LTLSz groups both appeared to exhibit bilaterally depressed fine-motor coordination. The left-handed RHLD-LTLSz patients did not show the same motor deficiencies. These latter findings suggest that hemispheric dominance for bilateral motor control may exist independent of language dominance, but not independent of handedness.

Adolescent↗
PubMed1990

Supraspan learning in patients with unilateral anterior temporal lobe resections.

The present data addresses the role of the anterior temporal lobe in verbal and visual supraspan learning. Patient subjects had either a left or right standardized temporal lobe resection, which involved extensive removal of mesial temporal lobe structures. Neither patient group showed marked deficits on either the verbal or visual supraspan learning tasks, although an unexpected performance variation occurred. A tendency to mild depression of performance on the verbal supraspan learning task was observed among right temporal-lobectomy patients. Nevertheless, the overall results indicate that anterior temporal lobe structures are not independently critical for supraspan learning. These findings are consistent with a previous report that posterior brain regions are involved in mediating such tasks.

Adult↗
PubMed1990

Performance of patients with unilateral temporal lobectomy on selective reminding procedures using either related or unrelated words.

The present study compared the performance of patients with right (RTL) and left temporal lobectomy (LTL) with normal controls on two selective reminding procedures using either unrelated or semantically-related word-lists. LTL patients were found to be impaired relative to normal controls and RTL patients on both types of lists. The LTL patients entered fewer words into long-term storage (LTS) on each trial and showed a reduced ability to consistently recall such words on subsequent trials. The impaired initial learning of words and reduced subsequent recall of such words may reflect a unitary underlying deficiency. In addition, on the unrelated word-list, the LTL patients made significantly more intrusion errors than the other subject groups. Analyses of performance pattern indicate that LTL patients were able to benefit from the semantic-relatedness of words. RTL patients were impaired relative to normal controls on only the semantically-related word-list, both in entering words into LTS and the subsequent recall. These findings indicate that further studies of the semantic organization or its utilization of both RTL and LTL patients are warranted.

Adult↗
PubMed1989

Memory following intracarotid amobarbital injection contralateral to hippocampal damage.

We examined the relationship between memory performance and hippocampal damage in temporal lobe epileptics undergoing the intracarotid amobarbital sodium procedure (IAP). Overall memory performance in the course of IAP was correlated with seizure lateralization. The hemisphere of seizure focus had impaired IAP memory in 63% (19/30) of the patients. The IAP memory performance following perfusion of the hemisphere contralateral to severe hippocampal lesions was impaired in five of six patients. These patients also exhibited hypometabolism of the impaired temporal lobe as determined independently by positron emission tomography. The single patient with a severely damaged hippocampus who did not demonstrate IAP memory impairment with contralateral hemisphere injection did not exhibit perfusion of the ipsilateral posterior cerebral artery with amobarbital. Memory performance following intracarotid amobarbital injection contralateral to a less severely damaged hippocampus was impaired in 14 of 24 patients and was not related to extent of hippocampal damage, temporal lobe hypometabolism of labeled glucose, perfusion of the ipsilateral posterior cerebral artery, hemispheric language dominance, or order of injection. These results indicate that impaired memory performance during IAP may reflect severe hippocampal damage and/or epileptogenic abnormality.

Adult↗
PubMed1989

Seashore Rhythm Test performance in patients with unilateral temporal lobe damage.

The Seashore Rhythm Test has been reported to be sensitive to right hemisphere dysfunction and, in particular, right temporal lobe integrity. However, several reports have appeared that have failed to support these earlier findings. In the latter studies, the confounding effects of possible bilateral or extratemporal lobe dysfunction in the patient groups could not be ruled out. The present study investigated the Seashore Rhythm Test performance of 38 right-handed seizure patients with evidence of glucose hypometabolism restricted to the right (n = 23) or left (n = 15) temporal lobe on positron computed tomography. Patients were studied prior to and subsequent to unilateral anterior temporal lobectomy for control of medically intractable seizures. No significant difference was found between right and left temporal lobe dysfunctional patients, either pre- or post-lobectomy, which further corroborates that the Seashore Rhythm Test does not discriminate between patients with right vs. left temporal lobe damage.

Adult↗
PubMed1984

Right-hemisphere language dominance in right-handed epileptic patients.

Hemispheric language dominance, as determined by intracarotid amobarbital sodium injections, and handedness, as reflected by writing and drawing preference, were evaluated in a select group of patients with intractable seizures who had documented focal epilepsy originating from one temporal lobe. Of the patients with left temporal lobe seizure focus, an unusually high percentage of right-handed patients (4/26 [15%]) had right hemisphere language dominance. Pathologic findings of the resected temporal lobe in these patients revealed microscopic damage (hippocampal sclerosis) of the hippocampus in three of three cases; one patient also had a small hamartoma in the midtemporal gyrus. We hypothesize that crossed dominance resulted from disruption by epileptiform activity during early development of selective areas of the left hemisphere.

Adolescent↗