Transcript A New Family with Autosomal Dominant Partial Epilepsy with

Table 1: Sample Characteristics
Participation in an Outpatient Memory Treatment Program
Lebeau, K., Trobliger, R., Mahaila, C., Copans, T. and Lancman, M.
Northeast Regional Epilepsy Group, Hackensack, NJ, USA.
Introduction
Seizure activity is commonly associated with the onset, and then often
worsening, of cognitive deficits which can affect day-to-day functioning.
Cognitive difficulties are typically ranked highest among patient concerns
(Fisher et al., 2000). Most cognitive complaints in adult patients involve
mental slowness, memory difficulties, and attention deficits (Bennet, 1992;
Moore & Baker, 2002; van Rijckevorsel, 2006). In fact, approximately half
of all referrals present with complaints regarding memory functioning
(Thompson & Corcoran, 1992). Patients often have difficulty adjusting to
and compensating for such. Cognitive rehabilitation is used to address
these difficulties through a number of means. Many approaches involve
computer-based training exercises which focus on practicing attention and
memory skills and are used to demonstrate and rehearse basic principles
behind cognitive processes. Research on the generalization of improvement
from the exercises to daily functioning has been inconsistent but has shown
some promise for the future (Finlayson, Alfano & Sullivan, 1987; Giaquinto
& Fiori, 1992; Niemann, Ruff, & Baser, 1990; Tate, 1997). Other programs
focus on teaching and discussing the use of compensatory strategies. This
study examines the effectiveness of a group program focusing on training in
compensatory strategies – helping patients in identifying new ways to
compensate for their cognitive difficulties.
Methods
A total of 18 cases were included in the study. All subjects had a
documented history of epileptogenic activity on EEG studies. The
mean age was 52.11 years, with a range of 26 to 71 years. The
mean education level was 13.44 years, with a range of 8 to 20
years. Subjects participated in six sessions, with foci on attention,
external strategies, internal strategies, and organization strategies.
Memory and its relationship to epilepsy were discussed in the
introductory session. Each session involved a review of the
previous week’s content and homework, a brief presentation,
discussion, and provision of homework assignments for the next
week. At the time of the first session, participants were given
multiple self-report questionnaires to complete including: the
Memory Complaints Inventory (MCI-E), Quality of Life in Epilepsy
Questionnaire (QOLIE), Beck Depression Inventory – Second
Edition (BDI-II), Beck Anxiety Inventory (BAI), Neurological
.
Disorders Depression Inventory for Epilepsy (NDDI-E), and the
Cognitive Failures Questionnaire (CFQ). Questionnaires were again
given before the last session. Differences in mean scores pre- and
post- group participation were calculated for the group using paired
samples t-tests.
Table 1: Sample Characteristics
Mean
Standard
Deviation
Range
Conclusions
Results
Significant differences were found for subjects on pre- and post- measures
involving the MCI Total score (p < .01), the CFQ total score (p <.01), and
the BAI total score (p < .05).
Table 2: Paired Samples t-test Results for Pre and Post Measures
Mean
Difference
(Standard
Deviation)
T (Level of
Significance)
Mean
Difference
(Standard
Deviation)
T (Level of
Significance
)
QOLIE –
11.0 (34.4)
Seizure Worry
1.319 (.206)
MCI –
General
Memory
.91 (5.6)
.534 (.605)
QOLIE –
-2.4 (28.8)
Quality of Life
-.331 (.746)
MCI –
Numeric
Memory
-1.8 (21.0)
-.288 (.779)
QOLIE –
Emotional
-1.0 (6.6)
-.522 (.612)
-.950 (.365)
QOLIE –
Energy
-0.8 (16.3)
-.177 (.863)
QOLIE –
Cognitive
-12.1 (30.9)
-1.361 (.201)
MCI –
-3.5 (12.4)
Visual
Memory
MCI –
-1.8 (12.3)
Verbal
Memory
MCI –
0.4 (2.9)
Seizure
Interference
QOLIE –
Medication
-1.4 (31.6)
-.156 (.879)
MCI – Work 7.2 (25.4)
Interference
.936 (.371)
-.227 (.825)
-.492 (.633)
.369 (.723)
Age
52.11
14.471
26-71
Age of
Diagnosis
34.00
24.403
1-68
QOLIE- Social -3.4 (16.4)
Functioning
-.722 (.486)
MCI –
Remote
Memory
Level of
Education
13.44
2.955
8-20
QOLIE – Total -4.72 (11.9)
-1.374 (.197)
MCI –
2.7 (5.5)
Comprehens
ion
MCI – Word .4 (1.8)
Finding
1.6 (.133)
MCI – Total 9.3 (5.5)
5.558 (.000)
Gender
Ethnic
Background
9 male,
9 female
16 White, NonHispanic
2 Hispanic
CFQ
12.3 (16.1)
2.653 (.022)
NDDI
.8 (2.1)
1.177 (.269)
BDI – II
2.3 (5.3)
1.521 (.156)
BAI
5.4 (6.2)
2.448 (.044)
-0.6 (9.3)
.574 (.584)
Analyses demonstrated significant differences in mean
scores on a few scales; however, these scales were
important. Two were indicators of total experienced
difficulties with cognitive functioning, including attention
and memory, which were main foci of the group. The
third was a measure of experienced anxiety. As
heightened levels of mood and anxiety symptomology are
associated with increased cognitive difficulties, a decrease
in perceived level of anxiety following participation in the
group is an important apparent by-product of such and
perhaps the result of increased self-confidence and selfefficacy on the part of the subjects following
participation. Further research is needed to follow up on
this notion. The sample size of this study was small;
however, the results are encouraging and indicate that at
the very least these patients perceived a benefit from
participation in the group. The results also suggest that
patients benefit from instruction in compensatory
strategies which can be applied relatively easily and
practically in daily life. Further research regarding the
long-term effects of participation in such instruction on
levels of mood, anxiety, and cognitive complaints levels is
needed. Additionally, research on whether strategies
learned in session are then practiced on a continual,
long-term basis, after participation in sessions is over, is
needed.
References
Bennet, T.L. (1992). The neuropsychology of epilepsy.
New York: Plenum Press.
Finlayson, M., Alfano, D., & Sullivan, J. (1987). A
neuropsychological approach to cognitive remediation:
Microcomputer applications. Canadian Psychology,
28(2), 180-190.
Fisher, R., Vickrey, B., Gibson, P., Hermann, B., Penovich,
P., Scherer, A., et al., (2002). The impact of epilepsy
from the patient’s perspective I. Descriptions and
subjective perceptions. Epilepsy Research, 41, 39-51.
Giaquinto, S. & Fiori, M. (1992). THINKable, a
computerized cognitive remediation. First results. Acta
Neurologica (Napoli), 14 (4-6), 547-560.
Moore, P.M. & Baker, G.A. (2002). The
neuropsychological and emotional consequences of living
with intractable temporal lobe epilepsy: Implications for
clinical management. Seizure, 11, 224 - 230.
Niemann, H., Ruff, R., & Baser, C. (1990). Computerassisted attention retraining in head-injured individuals:
A controlled efficacy study of an outpatient program.
Journal of Consulting and Clinical Psychology, 58(6),
811-817.
Tate, R. (1997). Beyond one bun, two shoe: recent
advances in the psychological rehabilitation of memory
disorders after acquired brain injury. Brain Injury,
11(12), 907-918.
Thompson, P. & Corcoran, R. (1992). Everyday memory
failures in people with epilepsy. Epilepsia, 1992, 33
(suppl 6), S18-20.
Van Rijckevorsel, K. (2006). Cognitive problems related
to epilepsy syndromes, especially malignant epilepsies.
Seizure, 15(4), 227-234.