Biomedical subjects

Sarah J Wilson

Publications and source records attributed to Sarah J Wilson.

7 recordsLinked to original sources

PubMed2006

Neurological control of human sexual behaviour: insights from lesion studies.

We review the human literature examining the effects of neurological insult on human sexual behaviour. We provide a synthesis of the findings to date, and identify key brain regions associated with specific aspects of human sexual behaviour. These include subcortical and cortical regions, with the mesial temporal lobe and the amygdala in particular being a crucial structure in the mediation of human sexual drive.

Amygdala↗

PubMed2005

Characterizing psychosocial outcome trajectories following seizure surgery.

PURPOSE: We have developed a new approach to characterizing psychosocial outcome after seizure surgery that allows us to identify diverse individual trajectories as well as subgroups of patients with similar outcomes. METHODS: Eighty-nine anterior temporal lobectomy (ATL) patients were recruited through our Seizure Surgery Follow-up and Rehabilitation Program. The Austin CEP Interview was used to measure psychosocial adjustment presurgery, at discharge, and 1, 3, 6, 12, and 24 months postsurgery. Patient outcome trajectories were characterized across this time frame using a profile-focused form of dual clustering that leads to a lattice representation. RESULTS: Two major, distinct outcome subgroups were identified. Fifty-eight percent (58%) of patients reported good outcomes, characterized by improved family dynamics, enhanced vocational and social functioning, and driving by 24 months postsurgery. A range of trajectories led to these outcomes, including the experience of early postoperative adjustment difficulties. In contrast, 31% of patients perceived their outcomes as poor, reporting affective disturbance at 12 months and difficulties discarding sick role behaviors. Early anxiety served as a marker of poor outcomes, while resolution of early anxiety and vocational change at 12 months were indicators of good outcomes at 24 months. The remaining 11% of patients reported minimal adjustment features. CONCLUSIONS: For the majority of patients, seizure surgery gives rise to an evolving process of postoperative adjustment that leads to distinct outcome trajectories. Our approach questions the clinical sensitivity of health-related quality of life measures that average across patients to provide a unitary measure of outcome. Although preliminary, the findings have implications for postoperative treatment, including the identification of markers of longer-term outcomes.

Adaptation, Psychological↗

PubMed2004

The amygdala and sexual drive: insights from temporal lobe epilepsy surgery.

The aim of this study was to explore the relationship between the amygdala and human sex drive. We compared amygdalar volume in groups of patients with or without sexual changes after temporal lobe resection and in age-matched neurologically normal subjects. Forty-five patients with intractable temporal lobe epilepsy who underwent surgical resection in the Comprehensive Epilepsy Program at the Austin and Repatriation Medical Centre completed a semistructured interview and questionnaire relating to sexual outcome after surgery. Volumetric analyses of both amygdalae were conducted on the patients' preoperative T(1)-weighted magnetic resonance imaging scans and those of 46 neurologically normal controls. Patients who reported a postoperative sexual increase had a significantly larger amygdalar volume contralateral to the site of their resective surgery than patients with a sexual decrease or no change than control subjects. There was a significant positive relationship between contralateral amygdalar volume and the maximum degree of sexual change. We have demonstrated a relationship between contralateral amygdalar volume and sexual outcome in patients undergoing temporal lobe resection. This finding provides evidence for an important role of the amygdala in regulating human sexual behavior. A larger contralateral amygdala may contribute to the expression of increased or improved sexuality after temporal lobe resection.

Adult↗

PubMed2004

Paradoxical results in the cure of chronic illness: the "burden of normality" as exemplified following seizure surgery.

Little has been written about processes of recovery following life-changing medical interventions for chronic illness. This article reviews our research with chronic epilepsy patients undergoing neurosurgery for the relief of intractable partial seizures. This research has given rise to a new conceptualization of adjustment and outcome following effective treatment of chronic illness, representing the first, detailed characterization of this process from a psychological and psychosocial perspective. Crucial to outcome are patient and family expectations prior to treatment, and learning to discard roles associated with chronic illness after treatment. These and the posttreatment affective functioning of the patient temper the view of medical outcome, and can account for paradoxical clinical effects, such as worsening patient psychosocial functioning in the context of medical treatment success. Our results have clear implications for the clinical management of chronically ill patients and their families to optimize treatment outcome.

Adaptation, Psychological↗

PubMed2004

Mood disturbance before and after seizure surgery: a comparison of temporal and extratemporal resections.

PURPOSE: Mood disturbance is a common comorbid condition of temporal lobe epilepsy before and after seizure surgery. Few studies have examined mood disturbance in patients undergoing resections outside the temporal lobe (extratemporal resections). This study aimed to compare the early, postoperative evolution of mood disturbance in temporal and extratemporal lobe epilepsy patients to examine the effect of site of surgical resection on mood outcome. METHODS: The study used a longitudinal design and was qualitative in nature. Sixty seizure surgery patients (43 temporal resections, 17 extratemporal resections) were assessed before surgery and at discharge, 1 month, and 3 months after surgery, by using the Austin CEP Interview. Psychosocial adjustment, psychiatric difficulties, including depression and anxiety, and seizure frequency were assessed. RESULTS: Before surgery, both temporal and extratemporal patients had significant psychiatric histories with similarly high rates of depression (33 and 53%, respectively) and anxiety (23 and 18%, respectively). After surgery, significantly more temporal patients were seizure free at each of the reviews compared with extratemporal patients. Temporal patients also reported significantly higher levels of depression (26%), anxiety (42%), and psychosocial adjustment difficulties (64%) at the 1-month review than did extratemporal patients. Mood disturbance was significantly associated with adjustment difficulties in both groups, but was not related to seizure outcome at any review period. CONCLUSIONS: A general increase in mood disturbance was evident after surgery, particularly in temporal resection patients at the 1-month review. Site of surgery and psychosocial adjustment showed significant associations with postoperative mood disturbance, supporting the role of both neurobiological and psychosocial factors in mood outcome.

Adaptation, Psychological↗

PubMed2003

Sexual outcome after epilepsy surgery.

The aim of this study was to provide a description of patient-perceived sexual change after temporal lobe resection (TLR) and extratemporal resection (ETR). Fifty-eight TLR and sixteen ETR patients completed a semistructured interview and questionnaire assessing sexual change after epilepsy surgery. Five areas of sexual functioning were addressed: sexual drive, thoughts/fantasies, interest, masturbation, and activity. Each patient's perception of sexual changes relative to perceived levels of normal functioning was assessed. Characteristically, the onset of sexual change occurred in the first three postoperative months and persisted to the time of interview. A postoperative sexual change was significantly more likely to be reported by patients who had undergone TLR (64%) than ETR (25%). In the TLR group, sexual change was significantly more frequent following right-sided resections. Marked sexual change occurred more frequently in females than males. Postoperative sexual change is an important outcome feature after epilepsy surgery. The predisposition of TLR patients to postoperative change provides further evidence for a temporal lobe contribution to sexual function.

Adolescent↗

PubMed2002

Modelling rhythmic function in a musician post-stroke.

The aim of this study was to model the components of rhythmic function in a case (H.J.) of acquired rhythmic disturbance. H.J. is a right-handed, amateur male musician who acquired arrhythmia in the context of a global amusia after sustaining a right temporoparietal infarct. His rhythmic disturbance was analysed in relation to three independent components using an autoregressive extension of Wing and Kristofferson's model of rhythmic timing. This revealed preserved error-correction and motor implementation capacities, but a gross disturbance of H.J.'s central timing system ("cognitive clock"). It rendered him unable to generate a steady pulse, prevented adequate discrimination and reproduction of novel metrical rhythms, and partly contributed to bi-manual co-ordination difficulties in his instrumental performance. The findings are considered in relation to the essential components of the cognitive architecture of rhythmic function, and their respective cerebral lateralisation and localisation. Overall, the data suggested that the functioning of the right temporal auditory cortex is fundamental to 'keeping the beat' in music. The approach is presented as a new paradigm for future neuropsychological research examining rhythmic disturbances.

Aged↗