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41 Characterizing the Cognitive Profile of Pediatric Insular Epilepsy
- Szimonetta Mulati, Jeffrey Bolton, Trey Moore, Brigitte Wilson, Song Dam, Alena Hornak, Katrina Boyer, Clemente Vega, Melissa Tsuboyama, Moshe Maiman, Phillip L Pearl
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 39-40
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Objective:
Little research exists characterizing the neuropsychological profile of pediatric insular epilepsy. Accurate diagnosis of insular epilepsy is challenging due to difficulties localizing deep brain structures with current non-invasive neurodiagnostic tools, as well as seizure semiology that may mimic temporal, frontal, and parietal seizures for this patient population [1]. Therefore, we investigated trends across neuropsychological data to help characterize the cognitive profile of pediatric insular epilepsy. This is important because studies that could accurately characterize insular epilepsy into cognitive phenotypes could potentially provide supporting evidence for insular localization during epilepsy surgery work-up. The insula is situated underneath the temporal, parietal, and frontal opercula, and has a number of diffuse projections to key brain structures involved in language, executive functioning, motor coordination, and sensory function [2]. Therefore, we hypothesized that children with insular epilepsy will demonstrate particular weaknesses in language and executive functioning skills.
Participants and Methods:Retrospective medical records review identified 19 children with insular epilepsy who completed neuropsychological assessment (Age: M=8.2 years, SD=3.4) at Boston Children’s Hospital. Insular epilepsy was defined by ictal insular localization on long-term monitoring EEG. The current sample includes 59% males and 41% females. The majority of participants (69%) had left sided lateralization and more than one seizure type (63%). MRI findings were widely distributed across frontal, temporal, and multiple lobes as well as insular and perisylvian brain regions. A lesion was identified on MRI findings for most participants (63%).
Results:Descriptive analyses showed that overall IQ (FSIQ: M=84, SD=12, range=68-102) fell in the Low Average range. Verbal and visual reasoning skills were equally developed in the Low Average range (VIQ: M=88, SD=12, range=70-104; PIQ: M=88, SD=16, range=53-117). Participants exhibited lower performance on speeded expressive language measures, including measures of phonemic fluency (M=5.5, SD=1.5, range=2-8) and semantic fluency (M=6.7, SD=2.5, range=3-11). With regard to executive functioning, reduced cognitive flexibility was observed on D-KEFS Trail Making Test (Trial 4, Number-Letter Switching: M=5.9, SD=4.9, range=1-12). Additionally, working memory skills fell in the Below Average range (WMIQ: M=77, SD=8.5, range=67-88).
Conclusions:Our results indicate that pediatric patients with insular epilepsy present with reduced scores across aspects of speeded expressive language and executive functioning, including working memory and cognitive flexibility. Additional research is needed to replicate these preliminary findings with a larger sample size and determine whether these trends in cognitive profile would help with seizure localization. Future research should investigate whether insular epilepsy has a clearly identifiable and distinct cognitive phenotype that could be helpful in differential diagnostic workup.
38 Fine Motor Skills in Pediatric Frontal Lobe Epilepsy are Associated with Executive Dysfunction and ADHD Symptomatology
- Moshe Maiman, Madison Berl, Jennifer I Koop, Donald J Bearden, Katrina Boyer, Crystal M Cooper, Amanda M Decrow, Priscilla H. Duong, Patricia Espe-Pfeifer, Marsha Gabriel, Elise Hodges, Kelly A McNally, Andrew Molnar, Emily Olsen, Kim E Ono, Kristina E Patrick, Brianna Paul, Jonathan Romain, Leigh N Sepeta, Rebecca LH Stilp, Greta N Wilkening, Mike Zaccariello, Frank Zelko, Clemente Vega, Trey Moore, Szimonetta Mulati, Phillip Pearl, Jeffrey Bolton, Alyssa Ailion
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 37-38
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Objective:
Pediatric patients with frontal lobe epilepsy (FLE) have higher rates of attention deficit hyperactivity disorder (ADHD), as well as executive functioning (EF) and fine motor (FM) challenges. Relations between these constructs have been established in youth with ADHD and are supported by FM and EF skill involvement in frontal-subcortical systems. Still, they are not well understood in pediatric FLE. We hypothesized that poorer FM performance would be related to greater executive dysfunction and ADHD symptomatology in this group.
Participants and Methods:47 children and adolescents with FLE (AgeM=12.47, SD=5.18; IQM=84.07; SD=17.56; Age of Seizure OnsetM=6.85, SD=4.64; right-handed: n=34; left-handed: n=10; Unclear: n=3) were enrolled in the Pediatric Epilepsy Research Consortium dataset as part of their phase I epilepsy surgical evaluation. Participants were selected if they had unifocal FLE and completed the Lafayette Grooved Pegboard (GP). Seizure lateralization (left-sided: n=19; right-sided: n=26; bilateral: n=2) and localization were established via data (e.g., EEG, MRI) presented at a multidisciplinary team case conference. Patients completed neuropsychological measures of FM, attention, and EF. Parents also completed questionnaires inquiring about their child’s everyday EF and ADHD symptomatology. Correlational analyses were conducted to examine FM, EF, and ADHD relations.
Results:Dominant hand (DH) manual dexterity (GP) was related to parent-reported EF (Behavior Rating Inventory of Executive Function, Second Edition [BRIEF-2]-Global Executive Composite [GEC]: r(15) =-.70, p<.01, d=1.96). While not statistically significant, medium to large effect sizes were found for GP DH and parent-reported inattention (Behavior Assessment System for Children, Third Edition [BASC-3]-Attention Problems: r(12)=-.39, p=.17, d=.85) and hyperactivity/impulsivity (BASC-3-Hyperactivity: r(11)= -.44, p=.13, d=.98), as well as performance-based attention (Conners Continuous Performance Test, Third Edition -Omission Errors: r(12)=-.35, p=.22, d=.41), working memory (Wechsler Intelligence Scale for Children - Fifth Edition [WISC-V]-Digit Span [DS]: r(19)=.38, p=.09, d=.82) and cognitive flexibility (Delis-Kaplan Executive Function System (D-KEFS) Verbal Fluency Category Switching: r(13)=.46, p=.08, d=1.04); this suggests that these relations may exist but that our study was underpowered to detect them. Non-dominant hand (NDH) manual dexterity was related to performance-based working memory (WISC-V-DS: r(19)=.50, p<.01, d=1.12) and cognitive flexibility (D-KEFS-Trails Making Test Number-Letter Switching: r(17)=.64, p<.01, d=1.67). Again, while underpowered, medium to large effect sizes were found for GP NDH and parent-reported EF (BRIEF-2 GEC: r(15) =-.45, p=.07, d=1.01) and performance-based phonemic fluency (D-KEFS-Letter Fluency: r(13)=.31, p=.20, d=.65).
Conclusions:Our findings suggest that FM, EF, and ADHD are related in youth with FLE; however, these relations appear to vary by skill and hand. We posit that our findings are due in part to the frontal-cerebellar networks given their anatomic proximity between frontal motor areas and the dorsolateral prefrontal cortex - as well as their shared functional involvement in these networks. Future studies should evaluate the predictive validity of initial FM skills for later executive dysfunction and ADHD symptomatology in FLE. If such relations emerge, contributions of early FM interventions on EF development should be examined. Further replication of these findings with a larger sample is warranted.
Skeletal effect of casein and whey protein intake during catch-up growth in young male Sprague–Dawley rats
- Majdi Masarwi, Yankel Gabet, Oleg Dolkart, Tamar Brosh, Raanan Shamir, Moshe Phillip, Galia Gat-Yablonski
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- Journal:
- British Journal of Nutrition / Volume 116 / Issue 1 / 14 July 2016
- Published online by Cambridge University Press:
- 18 May 2016, pp. 59-69
- Print publication:
- 14 July 2016
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The aim of the present study was to determine whether the type of protein ingested influences the efficiency of catch-up (CU) growth and bone quality in fast-growing male rats. Young male Sprague–Dawley rats were either fed ad libitum (controls) or subjected to 36 d of 40 % food restriction followed by 24 or 40 d of re-feeding with either standard rat chow or iso-energetic, iso-protein diets containing milk proteins – casein or whey. In terms of body weight, CU growth was incomplete in all study groups. Despite their similar food consumption, casein-re-fed rats had a significantly higher body weight and longer humerus than whey-re-fed rats in the long term. The height of the epiphyseal growth plate (EGP) in both casein and whey groups was greater than that of rats re-fed normal chow. Microcomputed tomography yielded significant differences in bone microstructure between the casein and whey groups, with the casein-re-fed animals having greater cortical thickness in both the short and long term in addition to a higher trabecular bone fraction in the short term, although this difference disappeared in the long term. Mechanical testing confirmed the greater bone strength in rats re-fed casein. Bone quality during CU growth significantly depends on the type of protein ingested. The higher EGP in the casein- and whey-re-fed rats suggests a better growth potential with milk-based diets. These results suggest that whey may lead to slower bone growth with reduced weight gain and, as such, may serve to circumvent long-term complications of CU growth.
Contributors
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- By Phillip L. Ackerman, Neil Anderson, Jens B. Asendorpf, R. Michael Bagby, Michael Harris Bond, Gregory J. Boyle, Andrea L. Briggs, Giles St J. Burch, Turhan Canli, David Canter, Gianvittorio Caprara, Charles S. Carver, Douglas F. Cellar, Gordon Claridge, Susan Cloninger, Elisabeth D. Conradt, Philip J. Corr, Sharon Dawe, Ian J. Deary, Boele De Raad, Edward L. Deci, Colin G. DeYoung, M. Brent Donnellan, Juris G. Draguns, Marko Elovainio, Aurelio José Figueredo, David C. Funder, Paul Gladden, Rapson Gomez, Samuel D. Gosling, Jeremy R. Gray, Robert D. Hare, B. Austin Harley, Edward Helmes, Robert Hogan, Lauri A. Jensen-Campbell, Daniel Nelson Jones, Mika Kivimäki, Jennifer M. Knack, James T. Lamiell, Natalie J. Loxton, Geoff MacDonald, Gerald Matthews, Robert R. McCrae, Mario Mikulincer, Stephanie N. Mullins-Sweatt, Marcus R. Munafò, Vickie Nam, Craig S. Newmann, Rainer Reisenzein, Madeline Rex-Lear, Richard W. Robins, Michael D. Robinson, Mary K. Rothbart, Richard M. Ryan, Gerard Saucier, Michael F. Scheier, Constantine Sedikides, Phillip R. Shaver, Brad E. Sheese, Yuichi Shoda, Ronald E. Smith, Alice F. Stuhlmacher, Rhonda Swickert, Avril Thorne, David D. Vachon, Geneva Vásquez, Michele Vecchione, Seth A. Wagerman, Fiona Warren, Hannelore Weber, Thomas A. Widiger, Pedro Sofio Abril Wolf, Donna Youngs, Moshe Zeidner
- Edited by Philip J. Corr, University of East Anglia, Gerald Matthews, University of Cincinnati
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- Book:
- The Cambridge Handbook of Personality Psychology
- Published online:
- 05 June 2012
- Print publication:
- 16 July 2009, pp xv-xvii
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