A valid Spanish neuropsychological battery for epilepsy and
A valid Spanish neuropsychological battery for epilepsy and beyond Lorna Myers, Ph. D. Northeast Regional Epilepsy Group Director of Clinical Neuropsychology
Why are we talking about epilepsy? • 1 out of 100 people in the world have epilepsy, 60 million worldwide. >CP, PD, MS combined. • Almost 500, 000 American Latinos have epilepsy. • Latinos: Neurocysticercosis, TBI, inadequate maternal-fetal care, lack of insurance, barriers to health care, stigma , ignorance • Older age of diagnosis and poor medical care leads to greater cognitive deficits in our Latino patients by the time we see them. • Stigma: punishment, possession, secret, MR, unable to marry, have children.
How important is neuropsychological testing in Epilepsy? • Establish cognitive baselines against which medication changes can be compared. • Treatment recommendations • SURGICAL DECISIONS • Assessment of post-surgical outcome • Research: unapproved medication cognitive profiles and specific syndrome cognitive profiles. • High overlap between epi and psych: depression is much higher than general population. Latinos higher depression rates (immigration, distance from family, poverty)
Neuropsychological testing in epilepsy for English-speakers • Uses a comprehensive battery, given by a Psychologist who speaks the patients’ language, in a standardized procedure with validated tests and representative norms. • • IQ Language Memory-verbal and visual Attention/executive Motor Visual perceptual Personality and mood
Neuropsychological testing of Spanish patients with epilepsy • Many of the neuropsychologists do not speak Spanish. • Use of interpreters who translate tests during the testing session • In-house translations of tests • Reliance on “visual” tests and little or no language tests • Use of non-representative norms (Anglo norms) • In sum: an incomplete battery, given by a Psychologist who does not speak the patients’ language, in a non-standardized procedure with non-validated tests and unrepresentative norms.
Presurgical testing • Utility: • Lateralization (dominant and non dominant hemisphere-right and left) • Localization (to a specific lobe-frontal, parietal, temporal, occipital) • Determination of how “aggressive” surgery can be given the patient’s presurgical cognitive status.
Neuropsychological Screening Battery for Hispanics (Ne. SBHIS) • Ponton et al (1996) reported on development of a battery with representative norms. • Assesses: • • Language Visual-constructional and perceptual skills Verbal and visual memory Attention and executive functions • Grooved pegboard for fine motor function • Provides norms based on age and educational background (<10, >11). (n=300).
Batería III (Woodcock-Muñoz) • Muñoz Sandoval et (2004): provides a measure of broad global cognitive functioning based on 20 subtests. • Brief Intelligence Assessment (BIA) based on 3 subtests. • Verbal Comprehension: Vocabulary, synonyms, antonyms, verbal reasoning. • Concept Formation: visually-based logical reasoning • Visual Matching: Perceptual and visuo-motor speed • Normed on 8818 individuals.
A neuropsychological battery for Spanish speakers with epilepsy • Administered by Spanish-speaking neuropsychologists on outpatient bases. • n= 39 • South America: 17, Central America: 12, Caribbean: 10 • 15 males, 24 females • Mean Age: 47. 7, +14. 1, mean education: 9. 4 +3. 6 • Left seizure onset: 25, right seizure onset: 14 • All 39 had confirmed dominant left hemisphere (language functions).
Results • Patients with left hemisphere focus performed significantly worse on: BIA Verbal Comprehension, Ponton-Satz Boston Naming Test, dominant hand on Grooved Pegboard, BIA Visual Matching. • The Ponton-Satz BNT had predictive value in determining laterality of dysfunction. • Replication is needed with larger samples. • Lancman G, Vazquez-Casals GA, Perrine K, Feoli E, Myers L. (2012) Predictive value of Spanish neuropsychological testing for laterality in patients with epilepsy. Epilepsy Behav. 2012 Feb; 23(2): 142 -5. Epub 2011 Dec 22.
Conclusion • This study provides a viable option for US epilepsy centers where Spanish-speaking patients are being treated. • A neuropsychological battery that is sensitive enough to be predictive of lateralization has potential use with other referral questions. • This represents a concrete step towards implementing tests to Spanish speakers in a standardized manner and with representative norms
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