Neuropsychology

The neuroanatomical basis of frontal lobe cognitive dysfunction in frontal lobe epilepsy (FLE) and idiopathic generalised epilepsy (IGE).

Jonothan O’ Muirchearthaigh, Pam Thompson, John Duncan, Mark Symms, Christian Vollmar, Matthias Koepp, Mark Richardson, Veena Kumari.

FLE and JME are two common types of epilepsy. We are undertaking brain scans in both groups to see if they have faulty brain function and connections and whether these are associated with decision making, concentration and other cognitive difficulties.

The first year of this collaborative study has resulted in the piloting and finalising of fMRI and out of scanner cognitive paradigms and the recruitment and testing of research subjects has commenced .

Temporal Lobe Surgery: Hippocampal Function & Memory

Sallie Baxendale, Pam Thompson

Temporal lobe surgery remains an effective treatment for many patients with medically intractable epilepsy but memory decline can be a worrying outcome. We have continued to explore the factors that govern the nature and extent of cognitive changes following surgery and to evaluate and develop assessment measures.

The Long Term Neuropsychological Effects of Epilepsy Surgery

Our surgical database continues to expand and develop. We now have presurgical data follow-up data on more than 600 patients seen one year after surgery. We are using these findings to modify our pre-operative counselling. We have now completed long term follow-up assessments (average 10 years) on 45 patients and are undertaking analysis on this group. Of particular interest is the impact of aging on the memory function of individuals post temporal lobe surgery.

Positive outcomes

Previously we have focussed on negative cognitive outcomes. This year we looked at positive outcomes and found a quarter of cases show improvements in verbal memory and identified right sided operations, short duration of epilepsy and a higher cognitive reserve as predictor variables.

The future of the Intracarotid Amobarbital Test

Pam Thompson, Sallie Baxendale

There continues to be much debate regarding the value of the intracarotid amobarbital protocol (IAP) in the assessment of cognitive risks. We have completed a comprehensive audit of the patients who have undergone surgery at the National Hospital. The evidence was limited to support the continued use of this procedure. These findings have been published. In addition we have undertaken a survey of the use of the IAP worldwide. Valid responses were received from 92 centres from 32 countries. This has demonstrated considerable variability ranging from 12% of surgical programmes never using the IAP to 12% who undertake it with every patient. These findings are soon to be published together with a broader debate concerning the procedure.

Learning disability & surgical outcome

Sallie Baxendale, Barbara Hurtado & Rebecca Davies

Temporal lobe surgery for those with learning disabilities has received scant attention. We have assessed the take up and outcome in our surgical series and have been looking at the predictive value of our current cognitive measures with the aim of developing measures more appropriate and useful in this population.

Epilepsy & the Media

Sallie Baxendale

The way that epilepsy is portrayed in the media is important as this affects the public view of people with epilepsy. We explored this further in a large internet survey which demonstrated that a number of myths are still widely held.

Our ongoing interest in the media portrayal and public perception of epilepsy continues. The findings were published from a large scale internet survey looking at the prevalence of epilepsy myths and misconceptions in the 21st century. More than 5000 responses were received and the publication triggered considerable media interest worldwide and debate among people with epilepsy. Sallie has also undertaken interviews this year with the media on her research work on the portayal of epilepsy and memory disorders in film. Together with film maker Sal Anderson she has been given funding from the Wellcome Trust’s ‘Engaging Science’ grant to produce a new film to address misperceptions about epilepsy.

Coping styles in non-epileptic attack disorder and epilepsy

Mary H. Stones, Annette O’Toole, Pam Thompson

Non-epileptic attacks look like epileptic seizures but are caused not by misfiring neurons in the brain but by psychological stresses. We are working to see how we can better help people with these socially disabling attacks.

The coping styles of patients with epilepsy and patients with non-epileptic attack disorder have been measured to assess whether they provide any pointers regarding appropriate treatment strategies. 117 inpatients undergoing investigations at the Sir William Gowers’ Centre at the Chalfont site have been recruited. All patients have undergone a semi-structured interview and have completed a standardised questionnaire and have been followed up at approximately six months. Data is currently being analysed.

Other collaborations

Members of the psychological team have collaborated during the year with other DCEE researchers on studies of fMRI memory and language paradigms and pre-surgical and post-surgical cognitive outcome. This has included the assessment of cognitive performance in 30 controls. Cognitive profiling of genetic mutations has continued and this year’s main focus has been KCNN2.