Neuropsychology of Epilepsy and Epilepsy Surgery (Oxford Workshop Series American Academy of Clinical Neuropsyshology)

373 Pages·2010·2.37 MB·English

by  Gregory Lee

NEUROPSYCHOLOGY OF EPILEPSY AND EPILEPSY SURGERY
OXFORD WORKSHOP SERIES:
AMERICAN ACADEMY OF CLINICAL NEUROPSYCHOLOGY
Series Editors
SusanMcPherson,Editor-in-Chief
IdaSueBaron
RichardKaplan
SandraKoffler
Greg J.Lamberty
JerrySweet
Volumes in the Series
NeuropsychologyofEpilepsyandEpilepsySurgery
GregoryP.Lee
TheBusinessofNeuropsychology
MarkT.Barisa
AdultLearningDisabilitiesandADHD
RobertL.Mapou
BoardCertificationinClinicalNeuropsychology
KiraE.Armstrong,DeanW.Beebe,RobinC.Hilsabeck,MichaelW.Kirkwood
UnderstandingSomatizationinthePracticeofClinicalNeuropsychology
GregJ.Lamberty
MildTraumaticBrainInjuryandPostconcussionSyndrome
MichaelA.McCrea
EthicalDecisionMakinginClinicalNeuropsychology
ShaneS.Bush
NEUROPSYCHOLOGY OF EPILEPSY
AND EPILEPSY SURGERY
Gregory P. Lee
Department of Neurology
School of Medicine
Medical College of Georgia
Augusta, Georgia
&&&
OXFORD WORKSHOP SERIES
1
2010
1
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LibraryofCongressCataloging-in-PublicationData
Lee,GregoryP.
Neuropsychologyofepilepsyandepilepsysurgery/byGregoryP.Lee.
p. ; cm.—(Oxfordworkshopseries)
Includesbibliographicalreferences.
ISBN-13:978-0-19-537250-2
ISBN-10:0-19-537250-6
1. Epilepsy. 2. Epilepsy—Psychologicalaspects. 3. Epilepsy—Surgery.
I. AmericanAcademyofClinicalNeuropsychology. II. Title. III. Series:Oxfordworkshopseries.
[DNLM:1. Epilepsy. 2. Epilepsy—surgery. 3. Neurophysiology—methods.WL385L478n2010]
RC372.L432010
616.8053—dc22
2009040355
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Preface
Psychologists in North America have been studying the cognitive and beha-
vioral consequences of epilepsy surgery since the technique was introduced
over three-quarters of a century ago. As surgical treatments for intractable
seizureshavegainedwidespreadacceptanceasahighlysuccessfultreatment
option,neuropsychologistsandclinicalpsychologistshavebeencalledupon
inever-increasingnumberstoparticipateintheassessmentandtreatmentof
all patients with epilepsy. Epilepsy and seizures affect approximately three
millionAmericansacrossallagegroups,andthereareover200,000newcases
ofseizuresandepilepsyeachyear.Becauseneuropsychologistsarefrequently
called upon to evaluate patients with brain tumors, stroke, traumatic brain
injury,andtoxicexposure(allofwhichmaycauseepilepsy),mostneuropsy-
chologistswillencounterpatientswithseizuresatsomepointintheirpractice
career. Moreover, psychologists may be among the first to recognize an
undiagnosed seizure disorder that may require referral for further medical
work-upandpossibletreatment. Thus,neuropsychologistsandclinicalpsy-
chologistsshouldbefamiliarwiththeimportantaspectsofepilepsy(namely,
its causes, presentations, cognitive and emotional implications, treatments,
andprognosis),andthisbookwaswrittentoservethispurpose.
Although several excellent comprehensive reference books describe the
multiplicityofseizuredisordersandepilepsysyndromes,andahostoftexts
deal with neuropsychological assessment, there is a scarcity of books dis-
cussing the overlap between the two subjects. Similarly, there are many
excellentchaptersdevotedtoneuropsychologicalassessmentandintracarotid
amobarbital (Wada) testing in epilepsy surgery books, but for the most part
theydonotcoverthemoregeneral(nonsurgical)epilepsytopics.Theaimof
this volume is, therefore, to provide a reference resource for neuropsycho-
logists, clinical psychologists, allied health professionals, and graduate stu-
dents that covers the classification of epileptic disorders, medical diagnostic
andtreatmentmethodsusedinepilepsy,thecognitiveandpsychiatriceffects
ofepilepsy,neuropsychologicalassessmentofpatientswithseizuredisorders,
epilepsy surgery procedures, and the neuropsychologist’s role in these
endeavors.
Much of the material in this book (such as, the classification of seizures,
side effects of particular medications, or certain surgical procedures) is not
intendedtobereadthroughallinonesitting,butrathertoserveasareference
for looking up specific information as the need arises; for example, when
information is needed about your patient’s particular seizure type or the
cognitive side effects of the antiepileptic medications they are taking. Brief
descriptions of the less common epilepsies are located in the Appendix for
quick reference. In contrast, other sections of the book may be valuable for
neuropsychologiststoreadintheirentiretysuchasthosesectionsdealingwith
assessment of epilepsy patients, depression in epilepsy, psychogenic
nonepilepticseizures,orhowneuropsychologistsestimateriskforpostopera-
tive cognitive decline in seizure surgery patients. The book ends with a
glossary of commonly used epilepsy terms that may be helpful when a brief
dictionarydefinitionofanunfamiliartechnicalwordisrequired.
viii Preface
Acknowledgments
Aswithallacademicendeavors,whetherresearchorclinical,thisworkrests
onabroadunderlyingfoundationconsistingofthementorship,collaboration,
influence,andsupportofagenerousgroupofcoworkersandsupporters.The
day-to-dayworkwithinacomprehensiveepilepsysurgeryprogramdepends
uponahostofhealthcareprofessionalsincludingepileptologists,neurosur-
geons,neuropsychologists,nurses,EEGtechnicians,andavarietyofsupport
staff,andIhavebeenprivilegedtohaveworkedamongthemforthepast24
yearsattheMedicalCollegeofGeorgia.
Althoughtheyhavegoneontobroaderhorizonsatdifferentinstitutions,I
owe an enormous debt of gratitude to my two long-term friends and colla-
borators, Drs.KimfordJ. MeadorandDavid W.Loring. These twowere the
instigators and motivators of many different research projects and clinical
innovations. Their ideas never stopped flowing, and I am indebted to their
unceasingpursuitofproductivityandexcellencethatcontinuetothisday.
The Epilepsy Surgery Program at the Medical College of Georgia was
established in 1981 by Dr. Herman F. Flanigin, a neurosurgeon trained by
Dr. Wilder Penfield at the Montreal Neurologic Institute, with whom he
published the early landmark paper on temporal lobectomy (Penfield W &
FlaniginH.Surgicaltherapyoftemporallobeseizures.ArchivesofNeurology&
Psychiatry1950;64:491–500).IamgratefultoDr.Flanigin,firstforhiringme
andthenforguidingmethroughthevariousrolesaneuropsychologistserves
in an epilepsy surgery program; as well as to his postdoctoral fellow and
successor, Dr. Joseph R. Smith, for his commitment to exacting detail and
indulgenceindealingwithmyfauxpasintheoperatingroom;andfinallyto
ourcurrentfearlessleader,Dr.ColeA.Giller—anepilepsyneurosurgeonwho
obtained his Ph.D. in mathematics from UC-Berkeley but is nevertheless
willingtolistentowhattheimperfectscienceofneuropsychologyhastooffer.
Additional appreciation goes to all the epileptologists and electrophy-
siology fellows, past and present, at the Medical College of Georgia (MCG),
whohavetaughtmesomuchaboutpatientswithepilepsyovertheyears,but
particularly to Drs. Anthony Murro, Kim Meador, Ki Lee, Jeff Politsky, Don
King, Brian Gallagher, and especially to Dr. Yong D. Park for his constant