ORCID Profile
0000-0002-0747-3877
Current Organisations
Alfred Health
,
University of Melbourne and Department of Medicine - Austin Health
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Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 30-09-2016
Publisher: Elsevier BV
Date: 04-2023
Publisher: Elsevier BV
Date: 2019
DOI: 10.1016/J.YEBEH.2019.106636
Abstract: "My memory is terrible!" is a common refrain among people with epilepsy, but such complaints are not reliably linked to poor performances on standard tests of memory. Negative affect like depression and anxiety are the most robust predictor of these complaints however, neither do they entirely account for the phenomenon. The contribution of autobiographic memory impairment to subjective memory complaints in focal epilepsy has not been well-explored despite autobiographic memory impairments being common in patients with epilepsy, and the face validity of relating day-to-day memory failings to such a personally relevant form of memory. The current study sought to clarify whether autobiographic memory dysfunction contributes to subjective complaints in epilepsy, above and beyond negative affect, objective memory impairment, and epileptological factors in a large s le of patients with drug-resistant focal epilepsy relative to healthy controls (N = 135). Patients were stratified into groups with mesial temporal (MT n = 40) versus nonmesial temporal (NMT n = 46) foci. Compared to controls (n = 46), both patient groups reported more bitter subjective memory complaints (p < 0.001, large effect size), demonstrated poorer episodic (p = 0.001, large effect size) and semantic autobiographical recall (p = 0.004, medium effect size), and had higher levels of depressive symptomatology (p = 0.011, medium effect size), and trait neuroticism (p = 0.015, medium effect size). Contrary to expectations, multiple regression analyses revealed that autobiographic memory function was not an independent predictor of subjective memory complaints in either group with epilepsy. In people with epilepsy with MT foci, objective verbal memory dysfunction, neuroticism, and female gender predicted memory complaints (R
Publisher: SAGE Publications
Date: 03-2012
DOI: 10.5698/1535-7511-12.2.46
Abstract: At present there is considerable variability in the psychiatric evaluation and follow-up of patients in epilepsy surgery programs globally. There is a large body of research now demonstrating heightened risk for psychological disturbance in surgically remedial patients before and after surgery. This evidence provides a compelling case for the routine provision of psychiatric and psychological treatment to optimize the benefits of epilepsy surgery and patient outcomes. In a comprehensive model of care, presurgical psychiatric and psychosocial evaluation plays an integral role in shaping the team's understanding of surgical candidacy and the patient's capacity for informed consent. After surgery, efficacious treatment of psychiatric comorbidity increases the likelihood of seizure freedom as well as optimizes psychosocial functioning and quality of life. By contrast, failure to treat can allow psychiatric comorbidity to persist or psychological difficulties to develop as the patient adjusts to life after surgery.
Publisher: Elsevier BV
Date: 12-2019
DOI: 10.1016/J.EPLEPSYRES.2019.106234
Abstract: Similarities in clinical presentations between epileptic seizures (ES) and psychogenic non-epileptic seizures (PNES) produces a risk of misdiagnosis. Video-EEG monitoring (VEM) is the diagnostic gold standard, but involves significant cost and time commitment, suggesting a need for efficient screening tools. 628 patients were recruited from an inpatient VEM unit 293 patients with ES, 158 with PNES, 31 both ES and PNES, and 146 non-diagnostic. Patients completed the SCL-90-R, a standardised 90-item psychopathology instrument. Bayesian linear models were computed to investigate whether SCL-90-R domain scores or the overall psychopathology factor p differed between groups. Receiver operating characteristic (ROC) curves were computed to investigate the PNES classification accuracy of each domain score and p. A machine learning algorithm was also used to determine which subset of SCL-90-R items produced the greatest classification accuracy. Evidence was found for elevated scores in PNES compared to ES groups in the symptom domains of anxiety (b = 0.47, 95%HDI = [0.10, 0.80]), phobic anxiety (b = 1.32, 95%HDI = [0.98, 1.69]), somatisation (b = 0.84, 95%HDI = [0.49, 1.20]), and the general psychopathology factor p (b = 1.35, 95%HDI = [0.86, 1.82]). Of the SCL-90-R domain scores, somatisation produced the highest classification accuracy (AUC = 0.74, 95%CI = [0.69, 0.79]). The genetic algorithm produced a 6-item subset from the SCL-90-R, which produced comparable classification accuracy to the somatisation scores (AUC = 0.73, 95%CI = [0.64, 0.82]). Compared to patients with ES, patients with PNES report greater symptoms of somatisation, general anxiety, and phobic anxiety against a background of generally elevated psychopathology. While self-reported psychopathology scores are not accurate enough for diagnosis in isolation, elevated psychopathology in these domains should raise the suspicion of PNES in clinical settings.
Publisher: Wiley
Date: 22-03-2011
DOI: 10.1111/J.1528-1167.2011.03015.X
Abstract: Both neurobiologic and psychosocial factors have been proposed to account for the high prevalence of depression surrounding epilepsy surgery. Using a prospective longitudinal approach, this study aimed to profile the evolution of depression after epilepsy surgery at multiple time points, including early and longer-term follow-up. We also sought to identify neurobiologic and psychosocial predictors of depression before and after surgery, including whether patients undergoing mesial temporal lobe resection (MTR) were at greater risk of depression than patients undergoing nonmesial temporal lobe resection (NMTR). Sixty patients undergoing epilepsy surgery (38 MTR, 22 NMTR) for the treatment of medically intractable seizures were assessed preoperatively and at 1, 3, 6, and 12 months postoperatively in the Comprehensive Epilepsy Program of Austin Health. The diagnosis of depression was based on DSM-IV criteria for major depressive disorder, as assessed from a mental state examination. The Austin CEP Interview was used to obtain a detailed psychosocial assessment of each patient and family members. Before surgery, 43% of patients had a lifetime prevalence of depression, with no difference between the proportion of patients in the MTR (40%) and NMTR groups (50%). Predictive factors included a family history of psychiatric illness (p = 0.015) and financial dependence of either family members or government income benefits (p = 0.024). Discriminant function analysis indicated that these factors classified 69% of cases correctly (p = 0.006, partial η(2) = 0.06). In the 12 months following surgery, 37% of MTR and 27% of NMTR patients experienced major depression, with no significant difference between the two groups. The majority of depressed patients (70%) were diagnosed in the first 3 months and in 65% of diagnosed cases, the depression persisted for at least 6 months within the follow-up period. The pattern of recurrent and de novo depression differed significantly between the groups, with 13% of MTR patients developing de novo major depression in comparison to no NMTR patients (p = 0.05). A preoperative history of depression (p = 0.003) and poor postoperative family dynamics (1 month, p < 0.001 3 months, p = 0.007 6 months, p = 0.021 12 months, p = 0.097) were predictive of depression after surgery. These factors correctly classified 78% of cases (p = 0.000, partial η(2) = 0.19). The findings of this study confirm high rates of major depression before and after epilepsy surgery, the etiology of which is multifactorial. They highlight the need for thorough assessment and diagnosis before surgery, as well as the provision of routine follow-up and psychological support, particularly early after surgery. When estimating level of risk for depression, patients should be counseled about the role of both neurobiologic and psychosocial factors. Before surgery, these include a family history of psychiatric illness and financial dependence, whereas poor family adjustment to life after surgery and a patient preoperative history of depression were risk factors for postoperative depression. Finally, disruption to mesial temporal structures known to play a role in mood via MTR may place patients at increased risk of new-onset depression after surgery.
Publisher: Springer International Publishing
Date: 2016
Publisher: Wiley
Date: 07-11-2023
DOI: 10.1111/EPI.17449
Abstract: Childhood trauma has been implicated as a risk factor for the etiology of psychogenic nonepileptic seizures (PNES). Relatively little attention has been paid to whether profiles of specific trauma types differ between patients with epilepsy and PNES. Investigating childhood trauma profiles in these patient groups may identify psychological vulnerabilities that predispose to developing PNES, and aid early diagnoses, prevention, and treatment. Data were collected from two cohorts ( n Retrospective = 203 n Prospective = 209) admitted to video–electroencephalography (EEG) monitoring units in Melbourne Australia. The differences in Childhood Trauma Questionnaire domain score between patient groups were investigated using standardized effect sizes and general linear mixed‐effects models (GLMMs). Receiver‐operating characteristic curves were used to investigate classification accuracy. In the retrospective cohort, patients diagnosed with PNES reported greater childhood emotional abuse, emotional neglect, physical abuse, sexual abuse, and physical neglect relative to patients with epilepsy. These differences were replicated in the prospective cohort, except for physical abuse. GLMMs revealed significant main effects for group in both cohorts, but no evidence for any group by domain interactions. Reported sexual abuse showed the best screening performance of PNES, although no psychometric scores were adequate as isolated measures. Patients with PNES report a greater frequency of childhood trauma than patients with epilepsy. This effect appears to hold across all trauma types, with no strong evidence emerging for a particular trauma type that is more prevalent in PNES. From a practical perspective, inquiry regarding a history of sexual abuse shows the most promise as a screening measure.
Publisher: Elsevier BV
Date: 11-2016
DOI: 10.1016/J.YEBEH.2016.06.007
Abstract: Depression is common but underdiagnosed in epilepsy. A quarter of patients meet criteria for a depressive disorder, yet few receive active treatment. We hypothesize that the presentation of depression is less recognizable in epilepsy because the symptoms are heterogeneous and often incorrectly attributed to the secondary effects of seizures or medication. Extending the ILAE's new phenomenological approach to classification of the epilepsies to include psychiatric comorbidity, we use data-driven profiling of the symptoms of depression to perform a preliminary investigation of whether there is a distinctive symptom-based phenotype of depression in epilepsy that could facilitate its recognition in the neurology clinic. The psychiatric and neuropsychological functioning of 91 patients with focal epilepsy was compared with that of 77 healthy controls (N=168). Cluster analysis of current depressive symptoms identified three clusters: one comprising nondepressed patients and two symptom-based phenotypes of depression. The 'Cognitive' phenotype (base rate=17%) was characterized by symptoms taking the form of self-critical cognitions and dysphoria and was accompanied by pervasive memory deficits. The 'Somatic' phenotype (7%) was characterized by vegetative depressive symptoms and anhedonia and was accompanied by greater anxiety. It is hoped that identification of the features of these two phenotypes will ultimately facilitate improved detection and diagnosis of depression in patients with epilepsy and thereby lead to appropriate and timely treatment, to the benefit of patient wellbeing and the potential efficacy of treatment of the seizure disorder. This article is part of a Special Issue entitled "The new approach to classification: Rethinking cognition and behavior in epilepsy".
Publisher: Elsevier BV
Date: 05-2017
DOI: 10.1016/J.NEUROIMAGE.2017.02.088
Abstract: Higher cognitive functions depend upon dynamically unfolding brain network interactions. Autobiographical recollection - the autonoetic re-experiencing of context rich, emotionally laden, personally experienced episodes - is an excellent ex le of such a process. Autobiographical recollection unfolds over time, with different cognitive processes engaged at different times throughout. In this paper we apply a recently developed analysis technique - event related independent components analysis (eICA) - to study the spatiotemporal dynamics of neural activity supporting autobiographical recollection. Participants completed an in-scanner autobiographical recollection paradigm in which the recalled episodes varied in chronological age and emotional content. By combining eICA with these cognitive manipulations we show that the brain-wide response to autobiographical recollection comprises brain networks with (i) different sensitivities to psychological aspects of the to-be-recollected material and (ii) distinct temporal profiles of activity during recollection. We identified networks with transient activations (in language and cognitive control related regions) and deactivations (in auditory and sensorimotor regions) to each autobiographical probe question, as well as networks with responses that are sustained over the course of the recollection period. These latter networks together overlapped spatially with the broader default mode network (DMN), indicating subspecialisation within the DMN. The vividness of participants' recollection was associated with the magnitude of activation in left dorsolateral prefrontal cortex and deactivation in visual association cortices. We interpret our results in the context of current theories of the spatial and temporal organisation of the human autobiographical memory system. Our findings demonstrate the utility of eICA as a tool for studying higher cognitive functions. The application of eICA to high spatial and temporal resolution datasets identifies in a single experimental protocol spatially specific networks that are recruited during cognitive activity, as well as the temporal order of activation of these networks.
Publisher: Elsevier BV
Date: 03-2019
Publisher: Cambridge University Press (CUP)
Date: 30-01-2019
DOI: 10.1017/S1355617718001091
Abstract: Objectives: Autobiographical memory dysfunction is a marker of vulnerability to depression. Patients with obstructive sleep apnea (OSA) experience high rates of depression and memory impairment, and autobiographical memory impairments have been observed compared to healthy controls however, these groups were not age-matched. This study aimed to determine whether in iduals with untreated OSA have impaired autobiographical memory when compared to age-matched controls, and to assess the quality of autobiographical memories from three broad time points. Methods: A total of 44 participants with OSA ( M age=49.4±13.0) and 44 age-matched controls ( M age=50.0±13.1) completed the Autobiographical Memory Interview (AMI) to assess semantic and episodic memories from three different life stages, and 44 OSA participants and 37 controls completed the Autobiographical Memory Test (AMT) to assess overgeneral memory recall (an inability to retrieve specific memories). Results: OSA participants had significantly poorer semantic recall of early adult life on the AMI ( p .001), and more overgeneral autobiographical memories recalled on the AMT (=.001), than controls. Poor semantic recall from early adult life was significantly correlated with more depressive symptoms ( p =0.006) and lower education ( p .02), while higher overgeneral memory recall was significantly associated with older age ( p =.001). Conclusions: A specific deficit in semantic autobiographical recall was observed in in iduals with OSA. OSA patients recalled more overgeneral memories, suggesting that aspects of the sleep disorder affect their ability to recollect specific details of events from their life. These cognitive features of OSA may contribute to the high incidence of depression in this population. ( JINS 2019, 25 , 266–274)
Publisher: Elsevier BV
Date: 11-2019
DOI: 10.1016/J.YEBEH.2019.106530
Abstract: Psychopathology is common in patients undergoing investigation for seizure-related disorders. Psychometric examination using self-report instruments, such as the Symptom Checklist 90 - Revised (SCL-90-R), can assist diagnosis. The SCL-90-R, however, is a lengthy instrument and might not be tolerated by all patients. We assessed several abbreviated forms of the SCL-90-R in patients undergoing video encephalographic monitoring (VEM). Six hundred eighty-seven patients completed the SCL-90-R, and scores were computed for the full SCL-90-R and five abbreviated forms. Correlations and mean differences were computed between different forms. Classification accuracy was assessed via receiver operating characteristic (ROC) curves, and measurements models were examined using confirmatory factor analysis (CFA). All abbreviated forms were strongly correlated with the SCL-90-R for general psychopathology (r = 0.93-0.99), depression (r = 0.89-0.95), anxiety (r = 0.97-0.98), psychosis (r = 0.95-0.99), and obsessive-compulsive symptoms (r = 0.97). Classification performance was similar across forms for depression and anxiety, with high negative predictive values (0.90-0.94) and lower positive predictive values (0.34-0.38). Classification performance for psychotic and obsessive-compulsive disorders was poor. Differences were observed between the full SCL-90-R and its abbreviated forms across most domains (d = 0.00-0.65). The published measurement model was most strongly validated for the SCL-27, SCL-14, and the SCL-K-9. These five SCL-90-R abbreviated forms show high convergent validity with the full version. In patients undergoing investigation for seizure-related disorders, the Brief Symptom Inventory full form (BSI) or short form (BSI-18) is most appropriate where screening for both depression and anxiety is required. The SCL-K-9 is appropriate when only a single measure of global psychological distress is required. None of the instruments were able to detect psychotic or obsessive-compulsive symptoms with great accuracy. Caution should be exercised when making direct comparisons across the different forms.
Publisher: University of California Press
Date: 12-2012
Abstract: the skill of absolute pitch (ap) has been proposed as an ideal paradigm for investigating the complex relationships that exist between the genome and its expression at a cognitive and behavioral level (the phenotype). Yet despite this, we still have limited understanding of the early conditions that might be necessary or sufficient for development of this skill, and the influence of the current music environment has not been explored. To investigate these issues we undertook a detailed characterization of the early and current music environment of 160 musicians, and then identified factors predictive of varying extent of AP ability. The results demonstrate a similar contribution of past and present environmental influences, with a combination of factors (rather than any given factor) most salient in AP musicians. The novel finding for the role of the current environment suggests that auditory processing models emphasizing plasticity effects are relevant to AP ability.
Publisher: Cold Spring Harbor Laboratory
Date: 23-08-2022
DOI: 10.1101/2022.08.22.22278046
Abstract: Prenatal exposure to certain antiseizure medications (ASMs) has been associated with increased risk of adverse neurodevelopmental outcomes in offspring. While the cognitive and intellectual outcomes of ASM-exposed offspring have been well-described, the long-term behavioural and functional sequalae in these children have received less attention. This systematic review aims to synthesise evidence on the relationship between prenatal ASM exposure and postnatal adverse neurodevelopmental outcomes, focusing on non-cognitive and intellectual domains of neurodevelopment including reduced social, emotional, behavioural, and adaptive functioning, as well as the frequency of neurodevelopmental and psychiatric disorders. This will have meaningful clinical implications for how we counsel women taking ASMs in pregnancy. Studies reporting predefined neurodevelopmental outcomes will be identified by electronic searches of MEDLINE, PsychINFO, EMBASE, as well as additional manual and grey literature searches. Eligible studies will report outcomes of offspring exposed to ASMs in utero either prospectively or retrospectively from 1990 to present, with screening performed in duplicate. We will use the Newcastle-Ottawa Scale to conduct methodological quality assessments of included observational studies. A narrative synthesis will be used to report on the review findings. Meta-analysis is not anticipated. Ethics clearance is not required for the current study. The systematic review will be prepared as a journal article and published in a peer-reviewed journal upon completion. PROSPERO CRD42021281919 Strengths and limitations of this study This protocol was developed and written according to the PRISMA-P guidelines Publication of this protocol ensures transparency and reproducibility of the methods of the systematic review, as well as reduces the likelihood of review duplication Restricting publications to English only may introduce bias whereby some relevant data is not included Meta-analysis is not likely to be possible due to heterogeneity in study methodology, reducing the strength of the conclusions that can be drawn Targeting psychosocial and behavioural outcomes allows for a more nuanced understanding of the long-term clinical consequences of prenatal ASM-exposure
Publisher: Oxford University Press (OUP)
Date: 03-2022
DOI: 10.1093/BRAINCOMMS/FCAC062
Abstract: The ability to mentally travel forward through time allows humans to envisage a erse array of possible events taking place in the future, helping us to choose which pathway to take in life. In epilepsy, we assume that patients use this cognitive ability when deciding between various treatment options, but this assumption has not been robustly tested. The temporal lobes are key contributors to this ‘future thinking’ and its building blocks include cognitive functions commonly impaired in temporal lobe epilepsy such as memory and language, giving rise to a hypothesis that ‘future thinking’ is impaired in this patient cohort. Participants were 68 adults: 37 with neurosurgically-naïve, unilateral temporal lobe epilepsy (51% right lateralized) and 31 healthy controls of similar age, sex and intellectual ability to the participants with epilepsy. Future thinking was measured using an imagined experiences task validated in other neurological populations. Tools well-established in temporal lobe epilepsy were used to measure potential cognitive correlates of future thinking. Analysis of variance revealed significantly impoverished future thinking in both left and right temporal lobe epilepsy relative to controls (P = 0.001, ηp2=0.206), with no difference between temporal lobe epilepsy groups (P & 0.05). Future thinking deficits in left temporal lobe epilepsy were paralleled by deficits in scene construction, whereas impoverished future thinking in right temporal lobe epilepsy occurred in the setting of intact scene construction. Deficits in future thinking were associated with reductions in lexical access and episodic autobiographic memory in both epilepsy groups. In sum, future thinking is compromised in both left and right temporal lobe epilepsy. The deficit in left temporal lobe epilepsy is largely explainable by dysfunction in verbal cognitive processes including scene construction. While the basis of the deficits observed with right temporal foci shares features with that of left temporal lobe epilepsy, their intact scene construction raises questions about the role of the left and right temporal lobes in future thinking and scene construction and the relationship between these two constructs, including whether right temporal lobe might play a specific role in future thinking in terms of creative processing. Clinicians should take impaired future thinking into account when counselling temporal lobe epilepsy patients about various treatment options, as they may struggle to vividly imagine what different outcomes might mean for their future selves.
Publisher: Elsevier BV
Date: 07-2023
Publisher: Wiley
Date: 20-08-2012
DOI: 10.1111/J.1528-1167.2012.03632.X
Abstract: To assess the impact of childhood-onset temporal lobe epilepsy (TLE) on the attainment of normative developmental tasks and identify predictors of long-term developmental outcomes. In 1992-1993, a prospective longitudinal cohort study of childhood-onset TLE was commenced in the State of Victoria, Australia. At review in 2004-2006, we assessed developmental tasks, which are age-specific in idual psychosocial achievements tied to particular phases of the lifespan. The cohort comprised 54 in iduals (33 female) with a mean age of 20 years (range 12-29), and mean age at TLE onset of 6 years (range 0.2-15). In iduals were clustered into three groups representing distinct developmental trajectories: (1) a Normal group (52%) who achieved most of their developmental tasks, (2) an Altered group (37%) who achieved some, and (3) a Delayed group (11%) who achieved few. The groups showed significant cognitive differences, with the Normal group outperforming the Altered and Delayed groups on a range of measures (p < 0.05). Multiple discriminant function analysis indicated that membership of the groups was independently predicted by the chronicity of seizures, cognitive functioning, having surgically remediable epilepsy, and gender (p < 0.001). Seizure chronicity and cognition discriminated between all three trajectories, while surgical intervention and gender primarily discriminated between the Altered and Delayed trajectories. Childhood-onset TLE can disrupt achievement of normative developmental tasks that is independently predicted by medical, biologic, and cognitive factors. Assessment of developmental tasks across the lifespan provides a practical framework for guiding prognostic counseling of patients and families.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 16-09-2016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-01-2019
DOI: 10.1212/WNL.0000000000006905
Abstract: Patients with temporal lobe epilepsy (TLE) are similar in their epileptology regardless of whether they have a lesion evident on MRI this study aims to prospectively clarify whether they are also similar in their neuropsychological profiles. Participants comprised 152 adults: 79 patients with TLE and 73 healthy controls. Patients and controls did not differ in age, sex, or education ( p 0.05). Sixty-two percent of patients had an MRI-resolvable lesion (39% with presumed hippoc al sclerosis [HS-TLE], 61% with a lesion other than HS [MRI-positive TLE]) the remaining 38% of patients were lesion-negative. Psychometric measures well established in epilepsy were used. Relative to controls, all 3 patient subgroups showed significantly impaired autobiographical, verbal, and visual memory ( p 0.05–0.001) and significantly more depression and anxiety ( p 0.05–0.01). Yet, contrary to expectations, the 3 TLE subgroups did not differ in their severity of memory or mood impairment ( p 0.05). Lower Full-Scale IQ predicted memory impairments across all TLE subtypes, with early age at seizure onset a predictor unique to MRI-negative TLE. MRI-negative TLE is associated with memory and mood dysfunction equivalent to that seen in patients with hippoc al sclerosis and other MRI-resolvable pathologies. As such, neuropsychological impairments in TLE are not contingent on a macroscopic lesion and might be an intrinsic property of the underlying network disease.
Publisher: Wiley
Date: 27-02-2020
DOI: 10.1111/EPI.16455
Publisher: Wiley
Date: 06-08-2021
DOI: 10.1111/EPI.17027
Abstract: Following epilepsy surgery, patients can experience complex psychosocial changes. We recently described a longer term adjustment and reframing (“meaning‐making”) process 15–20 years following surgery for temporal lobe epilepsy, which could involve an ongoing sense of being a “different” person for some patients. Here, we quantitatively examine identity at long‐term follow‐up and how this relates to meaning‐making and postoperative seizure outcome. Eighty‐seven participants were included: 39 who underwent anterior temporal lobectomy (ATL) 15–20 years ago (59% female median age = 49.2 years, interquartile range [IQR] = 10 median follow‐up = 18.4 years, IQR = 4.4) and 48 surgically naïve focal epilepsy patients (56% female median age = 34.5 years, IQR = 19). We captured approach to meaning‐making by coding for key narrative features identified in our previous qualitative work. Nonparametric tests and correspondence analysis were then used to explore relationships between a quantitative measure of identity and meaning‐making, as well as seizure outcome, mood, and health‐related quality of life (HRQOL). Patients 15–20 years post‐ATL demonstrated a shift toward increasing identity commitment and exploration compared to the surgically naïve cohort, with this shift significantly linked to seizure outcome. Examining the relationship between identity and meaning‐making also revealed three groups: (1) those who embraced self‐change (29%), (2) those who continued to struggle with this process (60.5%), and (3) those who showed minimal engagement (10.5%). Those who "embraced change" were significantly younger at regular seizure onset and demonstrated a trend toward higher HRQOL. Findings suggest that ATL patients show a more developed identity profile compared to surgically naïve controls however, the majority still struggled with postoperative identity change at long‐term follow‐up. Approximately one third of patients demonstrated positive psychological growth following surgery, reflected in the ability to embrace change. Findings highlight the importance of understanding the impact of surgery on patient identity to maximize the psychosocial benefits.
Publisher: Wiley
Date: 18-03-2021
DOI: 10.1111/EPI.16871
Abstract: This study was undertaken to identify factors that predict discordance between the screening instruments Neurological Disorders Depression Inventory for Epilepsy (NDDI‐E) and Generalized Anxiety Disorder scale (GAD‐7), and diagnoses made by qualified psychiatrists among patients with seizure disorders. Importantly, this is not a validation study rather, it investigates clinicodemographic predictors of discordance between screening tests and psychiatric assessment. Adult patients admitted for inpatient video‐electroencephalographic monitoring completed eight psychometric instruments, including the NDDI‐E and GAD‐7, and psychiatric assessment. Patients were grouped according to agreement between the screening instrument and psychiatrists’ diagnoses. Screening was "discordant" if the outcome differed from the psychiatrist's diagnosis, including both false positive and false negative results. Bayesian statistical analyses were used to identify factors associated with discordance. A total of 411 patients met inclusion criteria mean age was 39.6 years, and 55.5% ( n = 228) were female. Depression screening was discordant in 33% of cases ( n = 136/411), driven by false positives ( n = 76/136, 56%) rather than false negatives ( n = 60/136, 44%). Likewise, anxiety screening was discordant in one third of cases ( n = 121/411, 29%) due to false positives ( n = 60/121, 50%) and false negatives ( n = 61/121, 50%). Seven clinical factors were predictive of discordant screening for both depression and anxiety: greater dissociative symptoms, greater patient‐reported adverse events, subjective cognitive impairment, negative affect, detachment, disinhibition, and psychoticism. When the analyses were restricted to only patients with psychogenic nonepileptic seizures (PNES) or epilepsy, the rate of discordant depression screening was higher in the PNES group ( n = 29, 47%) compared to the epilepsy group ( n = 70, 30%, Bayes factor for the alternative hypothesis = 4.65). Patients with seizure disorders who self‐report a variety of psychiatric and other symptoms should be evaluated more thoroughly for depression and anxiety, regardless of screening test results, especially if they have PNES and not epilepsy. Clinical assessment by a qualified psychiatrist remains essential in diagnosing depressive and anxiety disorders among such patients.
Publisher: Elsevier BV
Date: 2017
Publisher: Wiley
Date: 25-11-2015
DOI: 10.1111/EPI.13215
Abstract: Research suggests that in iduals with chronic epilepsy display differences in their self‐identity. The mechanisms by which self‐identity is altered, however, are not well understood. Neural networks supporting autobiographical memory retrieval in the mesial temporal ( MT ) lobe are thought to be fundamental to self‐identity processes. Thus, we examined differences in self‐identity and autobiographical memory in patients with either MT or non–mesial temporal ( NMT ) foci with early or late age of habitual seizure onset. Participants included 102 adults: 51 healthy in iduals and 51 patients with drug‐resistant focal seizures (19 MT , 32 NMT ). We used the Ego Identity Process Questionnaire to profile the identity development of participants, and examined how this related to memory function assessed using the Autobiographical Memory Test. Patients and controls had strikingly different self‐identity profiles, with early onset MT patients showing the least identity development compared to controls and other patient groups. In contrast, late‐onset NMT patients showed the highest level of identity development of the patient groups and closely resembled healthy controls (p 0.05 for all comparisons). For all MT patients, poor autobiographical memory retrieval was correlated with altered self‐identity (p 0.001). No associations between autobiographical memory and self‐identity were evident in the NMT group. Self‐identity in epilepsy may be modulated by the extent to which seizure foci impinge on the autobiographical memory network and the timing of seizure onset. Early disruption to MT regions of the autobiographical memory network may constitute a neurocognitive mechanism by which self‐identity is altered in chronic focal epilepsy.
Publisher: Elsevier BV
Date: 02-2016
DOI: 10.1016/J.NEUBIOREV.2015.09.022
Abstract: This systematic review sources the latest neuroimaging evidence for the role of cognition-related brain networks in depression, and relates their abnormal functioning to symptoms of the disorder. Using theoretically informed and rigorous inclusion criteria, we integrate findings from 59 functional neuroimaging studies of adults with unipolar depression using a narrative approach. Results demonstrate that two distinct neurocognitive networks, the autobiographic memory network (AMN) and the cognitive control network (CCN), are central to the symptomatology of depression. Specifically, hyperactivity of the introspective AMN is linked to pathological brooding, self-blame, rumination. Anticorrelated under-engagement of the CCN is associated with indecisiveness, negative automatic thoughts, poor concentration, distorted cognitive processing. Downstream effects of this imbalance include reduced regulation of networks linked to the vegetative and affective symptoms of depression. The configurations of these networks can change between in iduals and over time, plausibly accounting for both the variable presentation of depressive disorders and their fluctuating course. Framing depression as a disorder of neurocognitive networks directly links neurobiology to psychiatric practice, aiding researchers and clinicians alike.
Publisher: Cold Spring Harbor Laboratory
Date: 20-07-2019
DOI: 10.1101/19002717
Abstract: The primary aim of the study was to determine whether patients with psychogenic non-epileptic seizures (PNES) have different personality profiles compared to patients with epileptic seizures (ES). The secondary aim was to determine whether any such personality differences could be used to efficiently screen for PNES in clinical settings. PNES and ES are often difficult to differentiate, leading to incorrect or delayed diagnosis. While the current gold-standard investigation is video-EEG monitoring (VEM), it is resource intensive and not universally available. Although some research has investigated the differential psychological profiles of PNES and ES patients, most studies have focused on symptoms of psychopathology. The lack of research using modern personality models in PNES and ES presents a gap in knowledge that this study aimed to address. A retrospective collection of data was conducted on patients who completed the NEO-Five Factor Inventory questionnaire during a VEM admission to the Royal Melbourne Hospital between 2002-2017. Patients were classified as either ES or PNES based on clinical consensus diagnosis. For patients with ES, type of epilepsy and laterality of seizure focus were also recorded. Personality differences were investigated using Bayesian linear mixed effects models. Receiver operating characteristic curve analysis was also performed to generate sensitivities and specificities of in idual personality scores. 305 patients were included in the study. The ‘openness to experience’ domain was the only personality factor demonstrating strong evidence for a group difference (BF 10 = 21.55, d = −0.43 [95% CI −0.71, −0.17]), with patients in the PNES group having higher scores compared to the ES group. Within the openness to experience domain, only the ‘aesthetic interest’ facet showed evidence for a group difference (BF 10 = 7.98, d = −0.39 [95% CI −0.66, −0.12]). ES patients had lower scores on these measures compared to the normal population, while PNES patients did not. Both openness to experience and aesthetic interest, however, showed poor sensitivities (53%, 46% respectively) and specificities (69%, 46% respectively) for classifying PNES and ES patients. There were no differences between personality profiles in Temporal Lobe Epilepsy (TLE) and non-TLE patients, or in laterality in TLE. Patients with ES exhibit lower openness to experience and aesthetic interest compared to patients with PNES and compared to the general population. Despite these differences, the relatively low sensitivity and specificity of these instruments suggests their use is limited in a clinical setting. Nevertheless, these findings open up new avenues of research using modern personality models to further understand patients with epilepsy and related presentations.
Publisher: SAGE Publications
Date: 03-2017
DOI: 10.5698/1535-7511.17.2.78
Abstract: This review poses the question: Does disruption to cognitive brain networks in epilepsy contribute to the problem of comorbid depression? Initial evidence suggests that the network disease that gives rise to seizures has a predilection for the same cognition-related networks that regulate mood, with comorbidity reflective of more extensive disease. Framing both epilepsy and its psychiatric comorbidities in terms of dysfunction in overlapping (cognitive) networks raises the possibility that depression can be a primary feature of the disease in some cases and facilitates an epilepsy classification system where behavioral features of the disorder are embedded in a neurobiological mechanism.
Publisher: Wiley
Date: 16-07-2023
DOI: 10.1002/EPI4.12790
Abstract: Cortical stimulation is an important component of stereoelectroencephalography (SEEG). Despite this, there is currently no standardized approach and significant heterogeneity in the literature regarding cortical stimulation practices. Via an international survey of SEEG clinicians, we sought to examine the spectrum of cortical stimulation practices to reveal areas of consensus and variability. A 68‐item questionnaire was developed to understand cortical stimulation practices including neurostimulation parameters, interpretation of epileptogenicity, functional and cognitive assessment and subsequent surgical decisions. Multiple recruitment pathways were pursued, with the questionnaire distributed directly to 183 clinicians. Responses were received from 56 clinicians across 17 countries with experience ranging from 2 to 60 years ( M = 10.73, SD = 9.44). Neurostimulation parameters varied considerably, with maximum current ranging from 3 to 10 mA ( M = 5.33, SD = 2.29) for 1 Hz and from 2 to 15 mA ( M = 6.54, SD = 3.68) for 50 Hz stimulation. Charge density ranged from 8 to 200 μC/cm 2 , with up to 43% of responders utilizing charge densities higher than recommended upper safety limits, i.e. 55 μC/cm 2 . North American responders reported statistically significant higher maximum current ( P 0.001) for 1 Hz stimulation and lower pulse width for 1 and 50 Hz stimulation ( P = 0.008, P 0.001, respectively) compared to European responders. All clinicians evaluated language, speech, and motor function during cortical stimulation in contrast, 42% assessed visuospatial or visual function, 29% memory, and 13% executive function. Striking differences were reported in approaches to assessment, classification of positive sites, and surgical decisions guided by cortical stimulation. Patterns of consistency were observed for interpretation of the localizing capacity of stimulated electroclinical seizures and auras, with habitual electroclinical seizures induced by 1 Hz stimulation considered the most localizing. SEEG cortical stimulation practices differed vastly across clinicians internationally, highlighting the need for consensus‐based clinical guidelines. In particular, an internationally standardized approach to assessment, classification, and functional prognostication will provide a common clinical and research framework for optimizing outcomes for people with drug‐resistant epilepsy.
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.YEBEH.2019.01.004
Abstract: Drug-resistant pediatric epilepsy involves unpredictable seizures and long-term medical management. Both factors can alter a child's psychosocial development and the dynamics of the family, to the detriment of patient and family wellbeing. While drug-resistant pediatric epilepsy can be successfully treated by neurosurgery in some cases, the outlook for psychosocial and family functioning after surgery remains unclear. A total of 163 participants across four groups took part in the current study: these were (i) in iduals who had undergone surgical treatment of drug-resistant focal seizures approximately five years prior as children, and were now largely adolescents or young adults ('Patients' n = 23), (ii) their caregivers ('Patient Caregivers' n = 27), (iii) healthy in iduals of similar age and gender to the Patients ('Controls' n = 53), and (iv) their caregivers ('Control Caregivers' n = 60). Based on similar software validated in adults, we built an interactive computer program, 'Living with Epilepsy', to evaluate the achievement of age-specific developmental tasks in Patients relative to their peers. The Family Adaptability and Cohesion Scale measured family dynamics. The findings showed that in the context of seizure freedom, after pediatric epilepsy surgery, Patients are similar to their healthy peers in terms of attaining developmental tasks, with no differences between the Patient and Control groups (P > .05). Family dynamics, however, seemed resistant to postsurgical adaptation, with Patients reporting lower levels of balanced family dynamics (cohesion, flexibility) and higher rates of unbalanced family dynamics (disengagement, chaos, rigidity, enmeshment) relative to Patient Caregivers (P < .001-0.041), and the Controls (P = .011-0.034). Patients also reported reduced family satisfaction compared with that of Patient Caregivers (P = .002), which was associated with polytherapy prior to surgery that is, more drug-resistant seizures. These findings suggested that childhood-onset epilepsy has a lasting effect on family functioning, even when the child has an optimal medical and psychosocial outcome. These initial findings have significant implications for the provision of pre- to postoperative family support in pediatric epilepsy cases.
Publisher: Wiley
Date: 08-02-2021
DOI: 10.1002/EPI4.12455
Abstract: The Psychology Task Force of the Medical Therapies Commission of the International League Against Epilepsy (ILAE) has been charged with taking steps to improve global mental health care for people with epilepsy. This study aimed to inform the direction and priorities of the Task Force by examining epilepsy healthcare providers’ current practical experiences, barriers, and unmet needs around addressing depression and anxiety in their patients. A voluntary 27‐item online survey was distributed via ILAE chapters and networks. It assessed practices in the areas of screening, referral, management, and psychological care for depression and anxiety. A total of 445 participants, from 67 countries (68% high income), commenced the survey, with 87% completing all components. Most respondents (80%) were either neurologists or epileptologists. Less than half of respondents felt adequately resourced to manage depression and anxiety. There was a lack of consensus about which health professionals were responsible for screening and management of these comorbidities. About a third only assessed for depression and anxiety following spontaneous report and lack of time was a common barrier ( %). Routine referrals to psychiatrists ( %) and psychologists ( %) were common, but approximately one third relied on watchful waiting. A lack of both trained mental health specialists ( %) and standardized procedures ( %) was common barriers to referral practices. The majority ( %) of respondents’ patients identified with depression or anxiety had previously accessed psychotropic medications or psychological treatments. However, multiple barriers to psychological treatments were endorsed, including accessibility difficulties (52%). The findings suggest that while the importance of managing depression and anxiety in patients with epilepsy is being recognized, there are ongoing barriers to effective mental health care. Key future directions include the need for updated protocols in this area and the integration of mental health professionals within epilepsy settings.
Publisher: Springer Science and Business Media LLC
Date: 19-06-2017
DOI: 10.1007/S11910-017-0765-7
Abstract: A paradigm shift in contemporary epileptology has been the reframing of both epilepsy and its comorbid memory disorders as the product of diseased brain networks. The current review discusses some of the clinical and theoretical implications that stem from this shift. Some implications of a network conceptualisation of epilepsy include a need for more widespread cognitive phenotyping in epilepsy recognition that memory disorders in epilepsy can be multi-determined, including by non-structural factors deeper consideration given to the neurodevelopmental context in which memory problems emerge the utility of new methods to characterise memory impairments in epilepsy and a call for greater recognition of the close interrelationships between memory comorbidities and psychiatric symptoms in epilepsy. Memory disorder significantly worsens the quality of life of people with epilepsy, underscoring the importance to patient wellbeing of giving due consideration to the up-to-date neuropsychological practises outlined in this review.
Publisher: Elsevier BV
Date: 11-2010
DOI: 10.1016/J.YEBEH.2010.07.019
Abstract: People with epilepsy frequently present with bitter memory complaints. Previous research variously attributes this to symptoms of mood disturbance or objective memory deficits. To investigate the influence of the epileptogenic region on this variability, we examined interrelationships between mood, objective memory, and memory complaints in a s le of patients with refractory focal epilepsy and controls (N = 96). Patients had either mesial temporal (MT, n = 39) or non mesial-temporal (NMT, n = 21) foci. In contrast to controls (n = 36), both patient groups were highly concerned about their memory (P<0.001) and were more likely to have a history of depression (P = 0.005). Multiple regression showed that objective memory dysfunction and current depressive symptoms predicted the memory complaints of patients with MT epilepsy (P = 0.005), whereas a history of depression predicted the complaints of patients with NMT epilepsy (P = 0.008). These findings suggest that patients have concerns about their memory underpinned by distinct psychological and neurobiological factors depending on the location of their epileptogenic focus.
Publisher: Wiley
Date: 13-01-2015
DOI: 10.1111/EPI.12902
Abstract: Autobiographic memory encompasses the encoding and retrieval of episodes, people, and places encountered in everyday life. It can be impaired in both epilepsy and frontal lobe damage. Here, we performed an initial investigation of how autobiographic memory is impacted by chronic frontal lobe epilepsy (FLE) together with its underlying pathology. We prospectively studied a series of nine consecutive patients with medically refractory FLE, relative to 24 matched healthy controls. Seven of the nine patients had frontal lobe structural abnormalities. Episodic and semantic autobiographic memory functioning was profiled, and factors associated with impaired autobiographic memory were identified among epileptologic, neuroimaging, neuropsychiatric, and cognitive variables including auditory-verbal and visual memory, and the executive function of cognitive control. Results showed that the FLE group experienced significantly higher rates of autobiographic memory and mood disturbance (p < 0.001), with detailed assessment of in idual patients revealing two profiles of impairment, primarily characterized by cognitive or mood disturbance. Five of the patients (56%) exhibited significant episodic autobiographic memory deficits, whereas in three of these, knowledge of semantic autobiographic facts was preserved. Four of them also had reduced cognitive control. Mood disorder was largely unrelated to poor autobiographic memory. In contrast, the four cases with preserved autobiographic memory were notable for their past or current depressive symptoms. These findings provide preliminary data that frontal lobe seizure activity with its underlying pathology may selectively disrupt large-scale cognitive or affective networks, giving rise to different neurobehavioral profiles that may be used to inform clinical management.
Publisher: Wiley
Date: 05-02-2021
DOI: 10.1111/EPI.16827
Publisher: Wiley
Date: 02-05-2023
DOI: 10.1111/EPI.17619
Abstract: Living with epilepsy can shape the dynamics of the whole family unit. The first objective of this study was to establish the reliability and validity of our purpose‐built online family mapping tool: “Living with Epilepsy.” Our second objective was to identify distinct patterns of emotional closeness between family members (family typologies), and to explore (1) whether family typologies are shaped by epilepsy‐related factors, and (2) which typologies confer optimal psychological outcomes to people with epilepsy. Ninety‐one adults with chronic epilepsy and their caregivers ( n = 56) participated and 70 similarly aged healthy controls and 36 caregiver controls ( N = 253). Purpose‐built software assessed a range of epilepsy‐specific psychosocial issues, including family mapping. Questionnaires validated for epilepsy evaluated mood and quality of life (QOL). The reliability and validity of the family mapping tool was established. Family maps revealed three typologies varying in emotional closeness, each with distinct patterns of healthy vs maladaptive family behavior: Extremely Close (32%), Close (54%), and Fractured (14%). There was no difference in the frequency of typology between epilepsy and control families ( p .05). Within the epilepsy cohort, however, patients with seizure onset in childhood largely belonged to the extreme typologies: Extremely Close (47%) or Fractured (42%). In comparison, those with adolescent or adult onset commonly belonged to the moderate typology: Close (53%). People with epilepsy from Extremely Close families reported significantly higher QOL ( p = .013) and lower mood symptoms ( p = .008) relative to other typologies no such association was found for controls or caregivers ( p .05). These findings suggest that adults whose epilepsy commenced in childhood are likely to have extreme family dynamics characterized by either being brought closer together or driven apart. Extremely close families appear highly adaptive for people with epilepsy, bringing benefits for mood and QOL not seen in their caregivers or controls. The results provide strong empirical support for the value of an emotionally supportive family when living with epilepsy and suggest that fostering healthy connections within epilepsy families can optimize long‐term patient well‐being.
Location: Australia
Location: Australia
No related grants have been discovered for Genevieve Rayner.