Subthalamic deep brain stimulation: neurobehavioral concerns.
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Cognition↗
Biomedical subjects
V M Soukup
Publications and source records attributed to V M Soukup.
Heterogeneity affecting outcome from acute stroke therapy: making reperfusion worse.
BACKGROUND: Stroke patients are heterogeneous not only with respect to etiology but also in terms of preexisting clinical conditions. Approximately one fifth of patients with acute stroke are hyperglycemic and/or have had a recent infectious or inflammatory condition. Summary of Review-- Experimental research indicates that these factors can alter and accelerate the evolution of stroke and reperfusion injury, although these effects are complex and some may have a favorable impact. Both conditions involve activation of inflammatory and reactive oxygen mechanisms. In addition, hyperglycemia has concomitant deleterious vascular and metabolic effects that worsen infarct size and encourage hemorrhagic transformation in reperfusion models. Clinical data are less extensive but in general support an adverse impact on outcome. CONCLUSIONS: After examining these data in detail, we concluded that the presence of these clinical conditions could assist in identification of those at increased risk for complications of reperfusion therapy. Furthermore, consideration of these factors may provide a rational basis for combination therapy and improve the clinical relevance of experimental stroke models.
Acute Disease↗
Punctate midline myelotomy for the relief of visceral cancer pain.
OBJECT: This study offers clinical support for the concept that neurosurgical interruption of a midline posterior column pathway by performing a punctate midline myelotomy (PMM) provides significant pain relief without causing adverse neurological sequelae in cancer patients with visceral pain refractory to other therapies. METHODS: A PMM of the posterior columns was performed in six cancer patients in whom visceral pain had been refractory to other therapies. The cause of the visceral pain was related to residual, progressive, or recurrent local cancer or postirradiation effects. Clinical efficacy of the procedure was examined by comparing patient pain ratings and narcotic usage pre- and post-PMM. Follow-up periods ranged from 3 to 31 months. Examination of the results indicates a significant reduction in pain ratings as well as a significant reduction in daily narcotic use. No adverse neurological effects were observed. One spinal cord has been recovered for postmortem examination. CONCLUSIONS: These findings provide corroborating clinical evidence for the existence of a newly recognized midline posterior column pathway that mediates the perception of visceral pelvic and abdominal pain. Preliminary data indicate that significant pain relief can be obtained following PMM with minimal neurological morbidity and suggest that the procedure may provide an alternative treatment modality for cancer-related pain in patients in whom adequate pain control with narcotics cannot be achieved or narcotic side effects cannot be tolerated.
Abdominal Neoplasms↗
Temporal stability of the Wisconsin Card Sorting Test in an untreated patient sample.
This study evaluates the temporal stability of the Wisconsin Card Sorting Test (WCST). The only previous similar study found unacceptably low test-retest stability in a non-patient elderly sample. In contrast, the present study utilizes 29 untreated obstructive sleep apnea patients who are more typical of persons likely to receive the WCST clinically. The 11 WCST scores examined demonstrated test-retest correlations from .34 to .83 (mean = .64). Six of 11 correlations were within .10 of the .80 criterion for clinical utility and there was minimal change across sessions. The current findings justify greater optimism regarding the test-retest reliability of the WCST.
Adult↗
Cognitive improvement despite minimal arachnoid cyst decompression.
There are relatively few reports that evaluate the cognitive functions of patients with arachnoid cysts. Presumably, these 'silent cysts' are regarded as incidental findings with no functional significance. Although postoperative clinical improvement is well documented in patients with significant reduction in cystic volume, the current report describes a patient who underwent cystoperitoneal shunting due to mass effect, with minimal postoperative decompression. Neuropsychological testing indicated significant cognitive improvement in verbal learning, memory, visual-perceptual abilities, constructional skills, conceptual shifting, and psychomotor speed after shunt placement, despite marginal evidence of decompression. These findings suggest that (1) significant cognitive changes can occur in these patients, despite minimal postoperative regression of the lesion, (2) cognitive measures may provide an alternative, functional index of outcome efficacy, and (3) reliance on traditional outcome measures (i.e. anatomical decompression or resolution of clinical symptoms) may underestimate the efficacy of surgical intervention for these patients.
Adult↗
Trail Making Test: issues in normative data selection.
The Trail Making Test (TMT) is one of the most frequently administered neuropsychological instruments, having been used in the evaluation of cognitive dysfunction for over 50 years. Despite the measure's extensive clinical use and proliferation of research, no comprehensive review of the adult TMT normative literature is available. This report examines the available TMT normative reports and provides a summary of the sample characteristics. Significant variability between studies precludes the use of metanorms. Clinically, these findings indicate that biased results may be obtained if the most appropriate normative data set is not used and underscore the importance of identifying the normative comparison group that approximates the relevant patient characteristics. To assist the clinician, selected normative reports (based on certain exclusionary parameters) have been compiled for three nonclinical comparison groups: (a) an adolescent and young adult group (ages 15-24), (b) an adult group (ages 20-54), and (c) an older adult group (ages 55-85). Results are discussed in terms of the influence of moderator variables on TMT performance and other factors, such as procedural differences in administration, that may account for the significant variability between normative samples.
Journal Article↗
Cognitive sequelae of unilateral posteroventral pallidotomy.
OBJECTIVE: To examine the cognitive sequelae of unilateral posteroventral pallidotomy. DESIGN: Single-group pretest and posttest methodologic assessment with baseline evaluation performed 1 to 2 days prior to surgery and follow-up conducted 3 months after pallidotomy. SETTING: Movement disorder clinic at a university medical center. PATIENTS: Fourteen patients (age range, 43-82 years) with Parkinson disease (average disease duration, 7.4 years). INTERVENTION: Unilateral posteroventral pallidotomy procedures were performed on the right (n=8) and left (n=6) side of the brain. MAIN OUTCOME MEASURES: The protocol consisted of a range of neuropsychological instruments sensitive to subcortical dysfunction, including measures of bi-manual coordination, simple-complex reaction time, visual attention, naming, verbal fluency, learning, recognition memory, and problem solving. RESULTS: No significant deterioration in specific cognitive abilities was observed as a function of the procedure. Patients showed a significant improvement in motor coordination speed for both contralateral and ipsilateral upper extremities. CONCLUSIONS: Stereotactic unilateral posteroventral pallidotomy is associated with minimal risk of adverse neuropsychological effects or cognitive decline. Additional research is warranted, with an increased sample size and extended follow-up, to assess any potential lateralized effects of the procedure.
Adult↗
The Medical College of Georgia Complex Figures: reliability and preliminary normative data using an intentional learning paradigm in older adults.
Reliability and preliminary normative data are provided for the Medical College of Georgia Complex Figures (MCGCF). Forms A and B were examined in 77 healthy older adults, aged 55-75, and found to be of comparable difficulty. Despite the use of parallel forms, there was a practice effect on retesting for each of the recall trials of the MCGCF. There was no effect of gender on performance, but a correction factor is recommended for those aged 65 and older. Preliminary age-adjusted normative tables are available, as is information to facilitate the interpretation of intrasubject (i.e., idiographic) performances within and between trials. The latter data are particularly relevant for clinical practice, but are rarely reported in the literature. Still lacking for the MCGCF is independent validation of their utility in the evaluation of clinical populations. Whereas examination of the various complex figures reveals no prima facie evidence to suggest a lack of congruence in clinical utility between the MCGCF and the Taylor figure, this key question can only be addressed through independent empirical validation.
Aged↗
Right hemispace presentation and left cueing on Raven's Coloured Progressive Matrices among right brain-damaged neglect patients.
Despite the substantial experimental literature that has accrued on factors associated with a reduction in neglect, few empirical studies have attempted to extrapolate these findings to clinical assessment and evaluate the efficacy of neglect-reducing strategies on patient performance. The current study developed a modified version of the Raven's Coloured Progressive Matrices (RCPM) by aligning the response alternatives in a column, in the right hemispace. Three groups of patients (right brain-damaged (RBD) with neglect, RBD without neglect, and orthopaedic controls) were administered abbreviated versions of the revised format, and performance was compared to the standard presentation format. The efficacy of left cues with the revised format was also investigated. Presence of neglect was assessed via the Schenkenberg Line Bisection Task and the Bells Test. Results showed a significant performance decrement among RBD neglect patients under all conditions. However, contrary to predictions, RBD neglect patients did not reveal significantly better performance on the revised version as compared to the standard presentation format. No significant effects associated with left side cueing were observed. The finding that no significant performance changes emerged as a function of stimulus modification and verbal prompts suggests that, although these manipulations may be employed by clinicians to maximize patient performance, empirical support for the efficacy of these procedures is lacking.
Adult↗
Stress, coping style, and problem solving ability among eating-disordered inpatients.
Stress levels, coping style, and problem solving ability among bulimic and anorexic individuals were explored. Bulimics (n = 33) reported a greater number of negative life events and feelings of being pressured than did a non-eating-disordered group. Anorexics (n = 12) reported higher levels of anxiety and depression than the other groups. Both anorexics and bulimics reported higher levels of stress, lower levels of confidence in their ability to solve problems, a tendency to avoid confronting problems, a reluctance to share personal problems, and feelings of being driven. Implications are suggested.
Adaptation, Psychological↗