Four-Way Wada: SEEG-based mapping with electrical stimulation, high frequency activity, and phase amplitude coupling to complement traditional Wada and functional MRI prior to epilepsy surgery

Presurgical evaluation of refractory epilepsy involves functional investigations to minimize postoperative deficit. Assessing language and memory is conventionally undertaken using Wada and fMRI, and occasionally supplemented by data from invasive intracranial electroencephalography, such as electrical stimulation, corticortical evoked potentials, mapping of high frequency activity and phase amplitude coupling. We describe the comparative and complementary role of these methods to inform surgical decision-making and functional prognostication. We used Wada paradigm to standardize testing across all modalities. Postoperative neuropsychological testing confirmed deficit predicted based on these methods.

A-41 Verbal Fluency and Switching Accuracy Differences in Pediatric Epilepsy Pre- and Post- Surgery

Objective

In patients with epilepsy, research is variable with regard to language difficulties. Previous research generally focuses on phonemic and semantic verbal fluency in pediatric populations post-surgery; however, few studies examine category switching accuracy. This study compared phonemic fluency, categorical fluency, switching accuracy, and the number of switches among pre-surgical and post-surgical groups.

Methods

Participants included 31 epilepsy patients (age 5-20 years old; M = 12.23 years pre-surgery; M = 14.72 years post-surgery; 20 males, 11 females) who underwent neuropsychological evaluations prior to and following open brain resection surgery (i.e., temporal lobectomy, temporal resection, frontal lobectomy). Verbal Fluency was assessed by the Delis-Kaplan Executive Functioning System (D-KEFS), measuring phonemic fluency, categorical fluency, switching accuracy, and the number of switches.

Results

Statistically significant differences were found between groups on the D-KEFS Verbal Fluency subtest using a one-way ANOVA. Specifically, switching accuracy decreased following surgery, F(1,25) = 6.470, p = 0.02 (M = 104.44 pre-surgery, M = 89.44 post-surgery). Further, a downward trend was noted regarding the number of switches between the two groups, F (1, 26) = 3.172, p = 0.09; however, no differences were found in phonemic, F(1,34) = 0.854, p = 0.63, and categorical, F(1,35) = 0.828, p = 0.37, fluency tasks.

Conclusions

Results from this study revealed a decrease in the participants ability to accurately switch between verbal categories following brain resection surgery. Similarly, a downward trend was noted for number of switches completed pre- and post- surgery. Consistent with previous research, phonemic and semantic verbal fluency tasks remain unchanged post-surgery. Implications of this study highlight the need to assess executive functioning after surgery as it has an impact on treatment outcome and school planning.

A-68 Yoga Therapy in Pediatric Epilepsy

Objective

This pilot study examines the effects of yoga therapy on anxiety, depression symptoms, inattention, and seizure frequency in children diagnosed with Epilepsy.

Data Selection

The sample consisted of 5 participants (4 male, 1 female), ages 7-12 years old, with diagnoses of generalized epilepsy, absence epilepsy, and complex partial epilepsy. Participants all had average cognitive abilities (IQ SS = 100.7; VCI SS = 106.3; PRI SS = 108.3), a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD), and clinically significant levels of anxiety and depression. Participants participated in 30-45-minute-long yoga sessions over a 6-week period with 2-3 home sessions each week. Differences in hyperactivity, anxiety, depression, and inattention were measured via parent rating Likert scales (0-poor, 10-best) at 1 month, 3 months, and 6 months. Participants also completed weekly self-report measures to assess anxiety and depression (Revised Children’s Manifest Anxiety, Second Edition (RCMAS-2) and Children’s Depression Inventory, Second Edition (CDI-2)).

Data Synthesis

No significant reliable change differences were found between sessions; however, a downward trend was visible in reduction of anxiety (RCMAS-2; first session M = 16.4, last session M = 9.4) and depression symptoms (CDI-2; first session M = 52.8, last session M = 49.2). Further, parents reported a decrease in anxiety (first session M = 4.8, last session M = 6.4). No seizures were reported during the study.

Conclusions

There is no previous research using pediatric populations and yoga therapy effects on reducing seizure frequency, anxiety, depression, and attention problems. This pilot study showed promising results in reducing anxiety, and depression symptoms. Limitations of study include small sample size and attrition, which are both important to consider when conducting another study.

A-38 Examining Cognitive Differences of Pre- and Post- Surgery in Pediatric Epilepsy

Objective

Intractable epilepsy is often associated with cognitive difficulties in the language domain. Few studies examining verbal domains of cognitive functioning indicate a small increase of verbal skills post-surgery. The current study compared Verbal IQ and Performance IQ domains in pediatric populations before and after open resection surgery.

Method

Participants included 31 epilepsy patients (age 5-20 years old; M = 12.23 years pre-surgery; M = 14.72 years post-surgery; 20 males, 11 females) who underwent neuropsychological evaluations prior to and following an open brain resection surgery (i.e., temporal lobectomy, temporal resection, frontal lobectomy). Cognitive ability was assessed by Weschler Abbreviated Scale of Intelligence (WASI) in order to analyze differences between pre-surgical and post-surgical cognitive function, specifically verbal comprehension and perceptual reasoning ability.

Results

No statistically significant differences were found, using a One-way ANOVA, between the two groups; however, a downward trend was noted for the Verbal IQ (VIQ) domain, F(1, 25) = 2.624, p = 0.118, including the verbal subtests vocabulary, F(1, 23) = 2.203, p = 0.151, and similarities, F(1, 24) = 1.678, p = 0.207. No differences or trends were noted within the Performance IQ (PIQ) domain, block design, or matrix reasoning.

Conclusions

Findings indicated that participants verbal ability decreased after epilepsy surgery when compared to prior evaluations. This is not consistent with previous research, which stated an increase in verbal abilities following surgical resection. Variable time between surgery and re-evaluation might account for discrepancies. Further, no differences in nonverbal reasoning abilities were noted. Results indicated a need for further research in open brain resection surgeries and the outcome of verbal processing.

A-35 Assessing the Impact of Expressive Language on Performance on Conners’ Continuous Performance Test 3rd Edition (CPT3) in Inpatients with Aphasia

Objective

The current study examined the impact of expressive language difficulties, assessed by the Neuropsychological Assessment Battery (NAB) naming subtest, on the Conners’ Continuous Performance Test-Third edition (CPT3) in an inpatient acquired brain injury (ABI) population.

Method

A sample of 19 individuals (female n = 3, male n = 16) was evaluated through an inpatient ABI rehabilitation program. Two groups based on diagnosed aphasia (n = 7) versus no aphasia (n = 12) were used. Ages ranged from 15 to 67 (M = 38.37, SD = 16.55) and had an average level of education of 14.9 years.

Results

One-way ANOVAs were used to determine how expressive language impacts performance on the CPT3. As expected, statistically significant results revealed that having aphasia yields a lower score on NAB naming F(1,17) = 11.435, p = .004. Individuals who did not have aphasia had a higher number of Perseverations, F(1,17) = 5.295, p = .034. No differences were noted between Omissions F(1,17) = 2.060, p = .169, Commissions F(1,17) = 3.090, p = .097, and Hit Reaction Time F(1,17) = .434, p = .519.

Conclusions

In our sample, patients with and without aphasia had similar reaction times and similar performances for omissions and commissions. The aphasia group, with significantly worse expressive language abilities, did not score significantly worse on any of the CPT3-related indices. Our study supports previous literature that CPT3 is an appropriate attention measure for individuals with aphasia but adds to the literature in providing evidence for use of the measure with an acute inpatient population with aphasia. While the results are promising, our sample is small and future research would be stronger with a larger sample with more specific information provided regarding the types of aphasia.