Neuropsychology/Language/Behavior: Adult

1Carla C.Adda,2Luiz H.Castro, and1RosaKashiara(1Division of Psychology, Hospital das Clinicas FMUSP, Sao Paulo, Sao Paulo, Brazil; and2 Neurology, Faculdade de Medicina USP, Sao Paulo, Sao Paulo, Brazil ) Rationale: Traditional neuropsychological testing may fail to detect abnormalities in declarative memory tests in epileptic patients. One possible explanation is that such tests do not adequately measure memory in real life activities. Prospective memory (PM), i.e. cognitive abilities related to remembering a planned intention in the correct setting, may be a more ecological measurement of memory function in daily activities. We studied the performance of patients with left and right mesial temporal sclerosis and normal controls in a prospective memory battery and compared results with performance in the Rey Auditory Verbal Learning Test (RAVLT) and with a self assessment questionaire for memory impairment (QMI). Methods: The battery consisted of six time and event related tasks to be recalled in the adequate situation, such as remembering to tell the examiner that they needed a new prescrition after fifteen minutes and remembering to ask for an personal object taken by the examiner at the end of a 105 minute session.Patients were submitted a neuropsychological test battery during the session, including the RAVLT and were asked to fill the QMI (24 items). Spontaneous and cued recall of the 15 RAVLT words was tested after 7 days. Performance in the PM tests was compared to RAVLT scores and to QMI score. A patient was considered impaired in either MP or RAVLT if performance fell below 2SD of controls. Significant memory compaints were considered if QMI score was 1SD above controls. Sensitivities and specificities for impairment measured by PM and RAVLT were calculated in relation to QMI assessed impairment (gold standard). Results: We studied 28 patients with mesial temporal sclerosis (MTS) (17 left) and 18 normal controls, matched by age (38±10 vs 40±12 yrs) and education (11±2 vs 11±2)(age 40 ±2). Left MTS patients performed significantly worse than controls in PM and spontaneous recall and in QMI score (p < 0.05). Both left and right MTS performed significantly worse than controls in 7‐day cued recall (p < 0.05). Sensitivities in relation to QMI were 56.2% for PM, 50% for RAVLT, 37.5% RAVLT and PM and 68,8% for RAVLT or PM. Specificities were 100% for PM, 83.3% for RAVLT, 100% for RAVLT and PM and 91.6% for PM or RAVLT measured impairment. Conclusions: This prospective memory test was able to differentiate memory performance between left MTS patients and controls. It is has a better specificity than RAVLT in relation to a self assessment memory questionaire. Its sensitivity is increased when used in combination with RAVLT. Further studies should better delineate its use in combination with other tests in the assessment of memory dysfunction in epileptic patients and in patients with memory impairment of other etiologies. 1JudithButman,2Maria E.Fontela,2,3VeronicaDe Simone,3MarinaDrake,1CeciliaSerrano,2Maria B.Viaggio,2,3AlfredoThomson, and1,3Ricardo F.Allegri(1Memory Center, Department of Neurolgy, Hospital Zubizarreta, Buenos Aires, Argentina;2Epilepsy Section, Department of Neurology, Hospital Frances, Buenos Aires, Argentina; and3 Neuropsychology Section, Department of Neurology, Hospital Britanico, Buenos Aires, Argentina ) Rationale: It has been proposed that behavioral impairment in patients with amygdala dysfunction might be related to an inability to reverse their behavior despite receiving negative feedback. Epileptic patients who undergo anterior temporal lobectomy represent an “in vivo” model to study the role of amygdala in cognitive flexibility. The aim of this study is to evaluate cognitive flexibility in epileptic patients with amygdala resection when facing negative feedback. Methods: Ten epileptic patients who underwent anterior temporal lobectomy (6 left temporal lobectomy and 4 right temporal lobectomy) were matched for age and education with 10 healthy controls. Subjects underwent an extensive neuropsychological and neuropsychiatric evaluation. To asses cognitive flexibility we used a reversal –learning task. Results: Patients' mean and standard deviation score were: Beck depression Inventory 8 ± 1.5; PANSS (positive) 10 ± 1.3; PANSS (negative) 14 ± 2.2; PANSS total 28.3 ± 2; verbal IQ 104.2 ± 7, nonverbal IQ 97.2 ± 6, full scale IQ 101.4 ± 6.3. Categories achieved on Wisconsin Card Sorting Test 5.7 ± 0.16. Patients had less number of reversions (mean:9.3) compared to controls (mean: 4.23; p < 0.001), and needed more trials before the first reversion (patients: 23.42 vs controls: 5; p < 0.05). Conclusions: Patients with epilepsy who undergo anterior temporal lobectomy appear to have post operative difficulties to perform a learning‐reversal task. Their lack of cognitive flexibility cannot be explained by psychiatric comorbidity, low IQs or a dysexecutive syndrome. 1Gus A.Baker(1 Division of Neurosciences, University of Liverpool, Liverpool, Merseyside, United Kingdom ) Rationale: There is a wealth of evidence to suggest that people with epilepsy, when compared to normal controls, are much more likely to experience a range of neuropsychological impairments. There are a number of factor that have been linked to the causation of these effects including the underlying lesion, the effects of continuous seizures, the sedative effects of AED treatment and the impact of mood. Determining the relative contributions of these various factors has been difficult but previous studies have confirmed cognitive side effects of several antiepileptic drugs such as central slowing, motor slowing and impairment of attention and concentration. The SANAD trial, a randomised controlled clinical trial of standard versus novel antiepileptic drug treatment, represents a unique opportunity to study the natural history of cognitive impairment in patients with newly diagnosed epilepsy who havge yet to be exposed to AED treatment and who have expereinced few seizures. Methods: A standardised battery of neuropsychological tests including measures of psychomotor speed, attention, memory, mental flexibility, tracking tasks, higher executive functioning, mood and patient perceived cognitive effects were administered prior to AED treatment, 3 months and 12 months. Results: There were differences between the epilepsy group and published control data for a number of key domains including: immediate, delayed and recognition memory; new learning; tests of higher executive functioning; sustained attention; and motor speed. These differences were significant at p = 0.001 level. In addition patients also had significantly worse profiles on the profile of mood scale. Conclusions: These results highlight that newly diagnosed patients with epilepsy are already significantly compromised in terms of their neuropsychological and psychological functioning prior to starting AED treatment and exposure to a significant number of seizures. This study will provide and opportunity to study the development of these cognitive effects allowing for treatment and seizure history. It will also allow for the identification of individuals most at risk of developing signficant cognitive difficulties. (Supported by the following pharmaceutical companies: GlaxoSmithKline, Novatis, Jansen Cilag and Sanofi Synthelabo.) 1William B.Barr,2EssieLarson,1KennethAlper, and1OrrinDevinsky(1NYU Comprehensive Epilepsy Center, New York University School of Medicine, New York, NY; and2 Department of Psychology, Fordham University, Bronx, NY ) Rationale: The Minnesota Multiphasic Personality Inventory – 2 (MMPI‐2) is an objective, self‐report instrument that is used frequently to examine personality and psychopathology in patients with epilepsy. One advantage of this test is that it provides validity indicators useful for identifying biases in responding that could potentially invalidate its results. The goal of this study is to examine the rates of invalid MMPI‐2 profiles in a sample of patients undergoing VEEG monitoring for the diagnosis and treatment of epilepsy. Methods: MMPI‐2 profiles were obtained from 126 patients undergoing continuous inpatient VEEG monitoring. The mean age of the sample was 37.1 years (range, 17 to 74 years). The sex distribution was 74.6% female. Non‐epileptic seizures (NES group) were identified in 75 patients. Fifty‐one patients had VEEG findings indicating partial (n = 30) or generalized (n = 21) epilepsy (ES group). The groups were matched in terms of age, education, and IQ. The NES group had a higher proportion of females (87% vs. 57%, p < .01). All subjects completed the 567‐item version of the MMPI‐2. Analyses were conducted on standard validity indices, including the L, F, and K‐scales, as well as the consistency indices, VRIN and TRIN. We also examined two other validity measures, the Fp‐scale and the FBS‐scale. The former was developed for assessment of rarely endorsed symptoms in populations with high rates of psychopathology. The latter (FBS, Fake‐Bad‐Scale) is used for measuring reporting bias in injury claimants attempting to exaggerate symptoms while maintaining a socially desirable appearance. Rates of invalid responding, as defined by scores exceeding published cutoffs, were assessed through standard tests of proportions. Results: Invalid MMPI‐2 profiles were identified in 43.6% of the total sample. A significantly higher rate of invalid responding was observed in the NES group than in the ES group (53.3% vs. 29.4%, p < .001). Invalid profiles were obtained in only 18.6% of the NES group and 17.6% of the ES group when limited to analysis of conventional validity indices (e.g., L, F, K, VRIN, & TRIN; Chi‐Square, NS). None of the 126 subjects participating in this study exhibited an elevation of the Fp‐Scale. Elevations of the FBS‐Scale were observed in 44.0% of the NES group and in 21.6% of the ES group (p < .001). Conclusions: Over 40% of our sample produced invalid MMPI‐2 profiles, which raises concern about the prevalent use of the instrument in this population. Rates of invalid responding in the NES and ES groups were the same when identified through standard validity indices. Higher rates of invalid responding observed with the FBS‐Scale indicate that patients with NES are twice as likely to produce exaggerated test profiles than patients diagnosed with partial or generalized epilepsy. 1Brian D.Bell, and1Bruce P.Hermann(1 Neurology/Neuropsychology, University of Wisconsin Medical School, Madison, WI ) Rationale: Conventional memory assessment might fail to identify memory dysfunction that is characterized by intact recall for a relatively brief period, but rapid forgetting thereafter. A recent study of auditory and visual selective reminding test performance revealed that temporal lobe epilepsy (TLE) patients demonstrated poorer memory ability than controls, but there were no group differences in rate of information loss at the 30‐minute and 24‐hour delay trials (Bell et al., 2005). In addition, at the individual level of analysis accelerated forgetting over 24 hours was not more common in TLE patients compared to controls. Methods: In this study, we assessed Wechsler Memory Scale‐3rd ed. (WMS‐III) Logical Memory subtest ( LM ) performance, including immediate memory and recall after 30‐minute and 14‐day delays, in a control group (n = 25) and a group of individuals with TLE (n = 25). The mean age of epilepsy onset was 11 years (SD = 8). Individuals with a history of right, left, bilateral or indeterminate TLE laterality were included and five of the TLE patients had undergone a left anterior temporal lobectomy (ATL) at the time of this study. The results described below were unchanged when the ATL patients were excluded. Results:Group analysis : A 2 X 3 (Group X Trial) univariate ANOVA for LM free recall raw scores revealed main effects of group and trial, but no significant group X trial interaction effect. T tests revealed that the control group performed significantly better than the TLE group on the immediate, 30‐minute delay, and 14‐day delay trials. Individual analysis : Memory impairment was defined as a score ≥ 1 standard deviation below the control group mean. Examination of raw scores revealed that the TLE group had a significantly higher percentage of individuals with impairment at the immediate and 30‐minute delay trials, but not at the 14‐day delay. Moreover, none of the TLE patients versus three controls (12%) showed memory impairment solely at the 14‐day trial. When examining percent retention scores, only 4% of the individuals with TLE versus 20% of the controls were unimpaired after 30 minutes but impaired after 14 days. Conclusions: Accelerated forgetting over a 14‐day delay was not present on a widely used story memory test (WMS‐III LM) in a group of individuals with TLE. This evidence suggests that the conventional 30‐minute delay utilized in clinical neuropsychological evaluations typically is sufficient for measuring memory functioning in TLE patients. Future study of word list retention after a delay of weeks in subsets of TLE patients with clearly lateralized seizures would further test this hypothesis. (Supported by NIH grants NS 37738, NS 42251, and MO1 RR03186 (General Clinical Research Center).) 1 Patient characteristicsPatient 1 Patient 2Age of sz onset 17 14 Age at WADA 43 41 Handedness right right Yrs of education 13 12 Previous surgery right anterior temporal lobectomy left anterior temporal lobectomy Current sz localization right frontal left temporal1Donald B.Burton,1PradeepModur,1RebeccaWoods,1EdgarPererra, and1MikeGruenthal(1 Neurology, University of Louisville, Louisville, KY ) Rationale: WADA testing is a standard part of the work‐up for epilepsy surgery, and assesses the likelihood of new post‐surgical language/memory deficits. We present the WADA results of two patients who had undergone anterior temporal lobectomy, but who had not been evaluated using the WADA. To our knowledge the results of WADA testing in patients who have already undergone anterior temporal‐hippocampal resection has not been previously reported. These cases allow for a comparison of the following conditions in regards to memory function: dominant hippocampus, nondominant hippocampus, and no hippocampus. Methods: Our WADA procedure includes a mental status exam, memory acquisition, sequential language testing, and memory recognition. The demographic and surgical data of our cases is detailed in Table 1. Patient 1 had previously undergone a right anterior temporal lobectomy and patient 2 had a left anterior temporal lobectomy. Neither surgery resulted in seizure control, necessitating a new surgical work‐up. Results: Results reveal that both patients are left hemisphere dominant for language. The right hemisphere resection patient did not sustain a disruption in memory function as the result of right hemisphere injection, while injection of the dominant hemisphere disrupted memory. In contrast, the left hemisphere resection case displayed more functional memory deficit after nondominant hemisphere injection, while injection of both hemispheres suppressed memory compared to baseline. Figure 1 reveals that the no hippocampus condition resulted in total suppression of memory function for both cases. When the dominant hippocampus was functioning in isolation no disruption of memory function was noted compared to baseline. When the nondominant hippocampus was functioning in isolation memory function was significantly diminished, but not completely suppressed. Conclusions: Current results support the hypotheses that there can be a dominance for memory function that is not solely based on material specificity. Second, resection of the dominant hippocampus results in greater memory impairment compared to resection of the nondominant hippocampus. Third, current results suggest that the nondominant hippocampus can support memory function to an extent, although not at the level of the dominant hippocampus. Finally, our results highlight the need for a comprehensive presurgical work‐up. 1[Memory Assesment: collapsed across cases (% of targets recongnized correctly).] 1Robyn M.Busch,1Heather D.Stott,1Thomas W.Frazier,1Richard I.Naugle,2ImadNajm, and3WilliamBingaman(1Psychiatry & Psychology, Cleveland Clinic Foundation, Cleveland, OH;2Neurology, Epilepsy & Sleep Disorders, Cleveland Clinic Foundation, Cleveland, OH; and3 Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH ) Rationale: Patients with temporal lobe epilepsy (TLE) have higher rates of depression and anxiety than patients with other focal epilepsies or generalized seizures. Memory problems are common among patients with mood and anxiety disorders as well as among patients with TLE. Given the high prevalence of mood and anxiety disorders and memory problems in patients with TLE, the present study sought to determine if presurgical mood and anxiety scores are useful in predicting memory change following anterior temporal lobectomy (ATL) and to ascertain if these scores have incremental validity over presurgical memory and intelligence scores. Methods: This retrospective study examined data from 174 patients with medically intractable TLE (Left = 79; Right = 95) seen for neuropsychological evaluations that included: Depression, Anxiety, Anxiety Related Disorders (ARD), and Mania subscales of the Personality Assessment Inventory; Beck Depression Inventory‐II; General Memory Index (GENMEM) from the Wechsler Memory Scale‐3rd Edition; and Full Scale IQ (FSIQ) from the Wechsler Adult Intelligence Scale‐3rd Edition. All patients later underwent ATL for treatment of their epilepsy and completed postsurgical neuropsychological testing. Participants' mean age and education were 34.25 (SD = 11.51) and 12.84 (SD = 2.11), respectively. The mean age of seizure onset was 14.92 (SD = 12.25) and mean duration of seizures was 19.49 years (SD = 12.59). There were no significant differences between the left and right groups in terms of age, race, sex, education, age of seizure onset, or seizure duration. Results: Simple regression analyses were conducted with mood and anxiety as independent variables (IVs) and memory change score as the dependent variable (DV). A hierarchical regression analysis was then computed with presurgical GENMEM and FSIQ scores entered as IVs in step one, the five mood variables in step two, and GENMEM change as the DV. Regression analyses were conducted separately for left and right TLE patients. Results of the simple regression revealed that presurgical mood and anxiety scores were significant predictors of postsurgical change in GENMEM for left TLE but not right TLE patients. Of the mood variables, the ARD subscale made the largest contribution to the prediction. Similarly, hierarchical regression analyses demonstrated that mood and anxiety scores added significantly to the prediction of GENMEM change above and beyond the prediction made by presurgical GENMEM and FSIQ scores among left but not right TLE patients. Again, ARD made the largest contribution to this prediction. Conclusions: This study supports the clinical utility of presurgical mood and anxiety scores in predicting memory change following ATL in patients with left, but not right, TLE. Furthermore, this study demonstrates that mood and anxiety scores add significantly to the prediction of postsurgical memory change beyond the prediction made by presurgical memory scores. 1Juliana P.DaPaz,1Carla C.Adda,1Leila M.DaRoz,1Leandro L.Valiengo,1Carmen L.Jorge,1Rosa Maria F.Valerio,1RosaKashiara, and1Luiz Henrique M.Castro(1 Neurology, Faculdade de Medicina USP, Sao Paulo, Sao Paulo, Brazil ) Rationale: Material specific memory deficits are often seen in temporal lobe epilepsy. Patients show verbal learning and confrontation naming deficits. These data were obtained lateralizing patients exclusively by MRI or interictal EEG (iEEG) data. Unilateral mesial temporal sclerosis (uMTS) is often a bilateral disease, with contralateral EEG abnormalities, which may impact on cognitive functioning. We compared neuropsychological scores (NP) in pure unilateral and bilateral uMTS patients. Methods: MRI‐diagnosed uMTS, ages (17–55), education >8 yrs, without other MRI lesions or significant psychiatric/neurologic disease. Patients underwent video‐EEG monitoring (VEEG), iEEG, WADA test and a NP battery [digit span, vocabulary and object assembly subtests (WAIS III), Stroop I,II,III, Trail Making Test, Wisconsin Card Sorting Test, Rey Auditory Verbal Learning Test (RAVLT), Boston Naming Test (BNT), Verbal Fluency (FAS), Rey Figure (Immediate and Late Recall)]. Patients were divided in four groups: right and left, unilateral or bilateral (RU, LU, RB and LB) by a laterality index obtained from a summated score of iEEG, VEEG and WADA, compared to MRI findings. Normal controls were matched by age and education. Scores on individual neuriopsychological tests were compared among all groups and controls. Results: 54 patients (30 or 56% men), 29 (or 54%) left MTS, education (10.6 ± 2.1yrs.) and 18 controls (4 or 22% men) education (11.1 ± 1.1yrs). 13 were RU, 20 LU, 12 RB and 9 LB.When comparing neuropsychological scores using MRI or iEEG isolatedly, classified as left or right, left MTS patients performed significantly worse in RAVLT (VI, VII and total score) and in FAS than controls and worse than controls and right MTS in BNT (p < 0.05, all tests) for both MRI or iEEG. When the 4 groups were compared, RU and LU differences disappeared. BL patients performed significantly worse than controls in RAVLT (VI, VII, total score), worse than controls, LU and RB in Stroop II and than RU in BNT. (p < 0.05, all tests). When iEEG was analyzed among the four groups, BL patients performed significantly worse than controls in RAVLT (VI, VII and total score) and worse than BR in BNT. Conclusions: Although it is widely accepted that left MTS patients show deficits in verbal learning and recall as well as confrontation naming, our data suggests that only patients with left MTS on MRI, but with bilateral involvement by other eletrophysiologic criteria (VEEG and iEEG) and cognitive functioning measures (WADA) perform significantly worse in episodic verbal memory and confrontation naming tasks. In this sample, pure left MTS patients do not show cognitive impairment in relation to right MTS patients (unilateral and bilateral) or controls. Bilateral temporal involvement with anatomic and/or functional involvement may be crucial for memory dysfunction in left temporal lobe epilepsy. (Supported by FAPESP.) 1MarinaDrake,2,1VeronicaDe Simone,2SantiagoO'Neill,2Maria E.Fontela,2Maria B.Viaggio,2AlfredoThomson, and1Ricardo F.Allegri(1Neuropsychology Section, Department of Neurology, Hospital Britanico, Buenos Aires, Argentina; and2 Epilepsy Section, Department of Neurology, Hospital Frances, Buenos Aires, Argentina ) Rationale: Patients with temporal lobe epilepsy (TLE) show impairment in confrontation naming tasks. Furthermore naming difficulties have been related to left temporal dysfunction. The objective of this study is to characterize naming difficulties in a group of temporal epileptic patients and further compare naming abilities between patients with right and left temporal lobe epilepsy. Methods: Thirty three epileptic patients were matched for age and education with 31 healthy volunteers. Fourteen patients had left TLE epilepsy and nineteen right TLE. All patients were right handed with IQs within the normal range. All subjects were administered an extensive neuropsychological battery. Confrontation naming was explored using the Boston Naming Test adapted version for Argentina. Total number of correct responses and type of errors committed were analyzed. Errors were classified into 5 categories: semantic errors, phonemic errors, visual errors, circumlocutory errors or nonresponse. For analysis purposes only the first 40 naming errors were considered as previous local studies showed that naming deficits in the last 20 pictures is strongly influenced by education and cultural background. Results: The epilepsy group performed significantly worse than controls on a naming test (TLE = 46 ± 6 vs controls = 53 ± 2, p < 0.001). Type of errors were: 42% semantic, 32% nonresponses, 13% circumlocutory, 9% visual and only 1% phonemic errors. No naming differences were found between right and left TLE patients (p = 0.7). Conclusions: Temporal lobe epilepsy patients showed poor performance on a naming task compared to control subjects further supporting the language deficit observed in this population. The most common type of errors (anomia and semantic) reflect dysfunction of the semantic system. Surprisingly, no differences were found when right and left temporal epilepsy patients were compared. This finding might reflect functional reorganization of language‐related neuronal networks in temporal lobe epilepsy. 1JelenaDjordjevic,1VivianeSziklas,1DominiquePiper,1SidoniePenicaud, and1MarilynJones‐Gotman(1 Neurology and Neurosurgery, McGill University ) Rationale: Auditory naming tasks may be more appropriate than visual ones as a measure of potential word‐finding difficulties in patients who are candidates for resection from the dominant anterior temporal lobe (1). We wished to optimize clinical usefulness of the existing auditory naming task (ANT) by creating a French version that would yield results similar to those obtained in English, and by increasing the number of items so that auditory naming results could be compared more directly with those from visual naming. Methods: To facilitate a more direct comparison of auditory naming with the visual naming task used most commonly (Boston Naming Test; BNT), we increased the number of items on the existing auditory naming task from 50 to 69 by adding 19 new items, then testing 119 healthy volunteers (53 francophone, 66 anglophone) on this longer version, and finally keeping the 60 items that gave the clearest results (i.e., elicited greatest agreement, fewest synonyms). To maximize equivalence between English and French versions, we compared results from anglophone and francophone subjects for each item, rejecting those on which language‐group differences were greater than 25%. These normative data were then used to rearrange items in order of increasing difficulty separately in each language. We are now comparing performance on the revised ANT to BNT in patients (n = 20) with epileptic focus in a temporal lobe. Results: Comparison of mean correct responses on the 60‐item ANT with those from the BNT showed a small, in absolute terms, but significant (p < .01) difference between tasks for healthy subjects, with BNT yielding the higher scores. There was a main effect of language, showing higher English than French scores on both tasks (p < .01). Patients with a left temporal‐lobe focus earned lower scores on both naming tasks compared to those with a right temporal‐lobe focus (p = .03); again ANT scores were lower overall than BNT scores. Conclusions: As reported also for the 50‐item ANT (1), auditory naming remains more difficult than visual naming for healthy subjects. Thus, despite equating the ANT and BNT for number of items, scores cannot be compared directly, as the difference in difficulty should be taken into account. Our French version of the ANT yields scores that are highly similar to the English, although the French are slightly lower. The French ANT is already proving useful in language evaluation of francophone patients in Quebec. 1. Hamberger M, Seidel W. JINS (2003); 9:479–89. (Supported by Canadian Institutes of Health Research.) 1Robert C.Doss, and1,2John R.Gates(1Epilepsy, Minnesota Epilepsy Group, P.A., St. Paul, MN; and2 Neurology, University of Minnesota, Minneapolis, MN ) Rationale: The assessment and diagnosis of psychogenic non‐epileptic seizures (NES) in inpatient epilepsy programs is very common (20–50% of admissions). The underlying etiology of NES can reflect a variety of conditions as denoted by the DSM‐IV. The aim of this study was to determine the most common psychiatric diagnoses of NES in a comprehensively evaluated sample of patients. Methods: The sample consisted of 58 consecutive admissions to the adult inpatient epilepsy unit who were eventually diagnosed with NES via video‐EEG monitoring. The determination of a psychogenic etiology was made after ruling out physiological causes, history review, neuropsychological and personality assessment (i.e., PAI), as well as psychiatric and/or psychological consultation. DSM‐IV diagnoses were made by either a consulting psychiatrist or psychologist. Results: There were 58 NES patients (67% female) with an average age, education, and WAIS‐III Full Scale IQ of 36.5, 13.2, and 94.0, respectively. Personality testing using the PAI showed a clinical elevation on the Somatic Complaints scale (Mean T‐score = 70.0) with Conversion being the most elevated subscale in the profile (Mean T‐score = 71.0). The most common preexisting psychiatric diagnoses included Depression (50%), PTSD (13.8%), other Anxiety (17.2%), Somatoform (13.8%), and Substance Abuse/Dependence (12.1%). Sixty‐five percent (65%) of the sample reported a history of physical and/or sexual abuse. The final DSM‐IV diagnosis for the NES was overwhelmingly Conversion Disorder (74.1%) and Somatoform Disorder NOS (8.6%). The remaining diagnoses for the NES included various anxiety, dissociative, and factitious disorders (17.3%). Conclusions: In an inpatient epilepsy monitoring unit, the vast majority of NES cases confirmed by video‐EEG are diagnosed as Conversion Disorder according to DSM‐IV criteria. That is, the NES are thought to reflect psychological factors (unconscious or not) that are manifested by pseudoneurological symptoms or deficits. Other less common diagnoses include panic attacks and dissociation associated with PTSD and/or a primary dissociative disorder. An accurate psychiatric diagnosis of NES is important in that treatment will necessarily be dictated by the underlying psychological disorder. Furthermore, diagnostic accuracy relies on a multidisciplinary approach that considers both the patient's medical and psychosocial history and current functioning. 1,5Mario F.Dulay,1,2,5Harvey S.Levin,1,2,5Michele K.York,2,5DanielYoshor,3Robert G.Grossman,4,5AmitVerma,4,5Ian L.Goldsmith, and4,5,6Eli M.Mizrahi(1Department of Psychiatry, Baylor College of Medicine (BCM);2Department of Neurosurgery, BCM;3Department of Neurosurgery, Methodist Hospital;4Peter Kellaway Section of Neurophysiology, Department of Neurology, BCM;5Baylor Comprehensive Epilepsy Center, BCM; and6 Section of Pediatric Neurology, Department of Pediatrics, BCM ) Rationale: Depression and anxiety are the most common psychiatric disorders found in patients with temporal lobe epilepsy (TLE) before and after anterior temporal lobectomy (ATL). Severity of depression is associated with neuropsychological impairment in TLE patients. No previous study has characterized the relationship between the presence of depression/anxiety and changes in memory function after ATL. Methods: We studied 56 patients (ages 17–56 years) who underwent ATL for refractory epilepsy. Patient data were divided into four groups: left‐ATL with (n = 10) and without (n = 13) psychiatric disturbance and right‐ATL with (n = 17) and without (n = 16) psychiatric disturbance. There were no significant differences between groups in age, education, age at seizure onset, duration of illness, pre‐ATL seizure frequency and post‐ATL seizure outcome. Retrospective chart review was used to determine the presence of psychiatric disturbance (mood and anxiety disorders), which was based on recommendations for psychiatric treatment after ATL made by the attending neuropsychologist. Patients were included if they had an IQ >84 to ensure that memory deficit was not attributable to generalized cognitive impairment. Memory abilities were assessed an average of 5 months before surgery and an average of 11 months after surgery using the Verbal and Nonverbal Selective Reminding Tests. Results: Twenty‐seven patients (48% of the sample) received recommendations for psychiatric treatment after surgery: 13 for mood disorders, 2 for anxiety disorders, and 12 for comorbid mood and anxiety disorders. Repeated measures ANOVA indicated that left‐ATL patients with psychiatric disturbance had the largest verbal memory reductions from before to after surgery compared to all other groups (Tukey post‐hoc p values <.01). There was also a drop in the number of words recalled by left‐ATL patients without psychiatric disturbance, but the reduction was significantly greater for left‐ATL patients with psychiatric disturbance. On the other hand, there was slight improvement in verbal recall ability for right‐ATL patients after surgery regardless of psychiatric status. There were no significant interactions or main effects for nonverbal memory. Conclusions: Our results suggest that besides side of excision, the presence of depression and anxiety should be taken into account when evaluating verbal memory deficits after ATL. Questions remain regarding whether or not verbal memory deficits will improve after ATL if psychiatric symptoms are remediated with psychotherapeutic or psychopharmaceutic interventions. 1DarrenFuerst,1AdeleHaber,1MichelleKieski,1JayShah,1AashitShah, and1CraigWatson(1 Neurology, Wayne State University School of Medicine, Detroit, MI ) Rationale: List learning has generally been less useful for the localization of temporal lobe seizures than has story recall. It has been hypothesized that executive functions may play a role in the learning, recall, and recognition of word lists. The purpose of this study was to determine the extent to which list learning and executive functioning measures are correlated. Methods: A total of 161 subjects took part in the study. Of these, 74 subjects were left temporal lobe epileptics, 55 were right temporal lobe epileptics, and 32 subjects had bi‐temporal onset or could not be lateralized by EEG. The word list learning measure used in this study was the CVLT. The variables used from the CVLT were the z‐scores of the number of words recalled on Trials 1, 5, and 1–5 total, short delay free and cued recall, long delayed free and cued recall, number of hits and false positives on recognition testing, number of perseverations, semantic clustering, and serial clustering. Executive functioning measures consisted of the Trail Making Testing B, lexical fluency (CFL), and measures from the Wisconsin Card Sort Test, including total responses, total correct, total errors, perseverative responses, perseverative errors, and the number of categories completed. Results: Overall, in the entire sample only Trails B reached statistical and practical significance its relationship with Trials 1, 5, and total 1–5, short delay free recall, short delay cued recall, and long delay free recall. None of the other measures correlated significantly and substantially. When subjects were divided into long delay free recall greater or less than ‐2, the only correlation of significance was between Trails B and total 1–5, for each group. When left temporal onset patients were examined, only Trails B correlated with trials 1, 5, and 1–5 total, and long delay free recall. For right temporal patients, Trails B correlated with Trials 1–5, short delay free and cued, and long delay free and cued recall. Also, for these subjects a number of WCST measures correlated with these variables. Conclusions: In general, word list learning is not related to executive functioning in temporal lobe epilepsy. This conclusion may be tempered somewhat in right temporal lobe patients, in which the relationship deserves further study. 1Anna R.Giovagnoli,2Rute F.Meneses, and1Antonio MartinsDa Silva(1Neuropathology and Neurology, “Carlo Besta” National Neurological Institute, Milano, Italy;2FCHS‐Fernando Pessoa University and IBCM‐University of Porto, Porto, Portugal; and3 ICBAS/IBCM‐University of Porto and Hospital Geral Santo Antonio, Porto, Portugal ) Rationale: Although the quality of life (QOL) of patients with chronic brain damage may reflect common stressing conditions, different facets and determinants may characterize the QOL of patients with different diagnosis. This study evaluated patients with partial epilepsy aiming to compare personal dimensions of their QOL with respect to patients with other chronic brain diseases. Methods: Sixty‐four adult patients with partial epilepsy (n = 36) and other chronic neurological diseases associated with brain lesion (vascular, tumour, or inflammatory) (n = 28) were evaluated after informed consent. They reported self‐evaluation of QOL, mood and cognitive efficiency using the WHO QOL‐100 and Spiritual, Religious and Personal Beliefs scales, Beck Depression Inventory, State‐Trait Anxiety Inventory, and Multiple Ability Self‐Report Questionnaire. Neuropsychological tests assessed reasoning, attention, language, visual perception, memory and executive abilities. Results: T statistics comparing the two patient groups did not show any difference in the total WHO QOL‐100 score. On the contrary, significant differences emerged in spirituality dimensions, with minor feelings of peace (p = 0.01) and life meaning (p = 0.02) in the epilepsy patients, and in neuropsychological performances (p = 0.01), with higher scores at attention and praxis tests in the epilepsy patients. Although not significantly so, the epilepsy patients were more anxious and depressed but perceived better cognitive abilities than the other patients. In the epilepsy group, the WHO QOL‐100 total score significantly correlated with the feelings of peace (r = 0.56, p = 0.006), state‐anxiety (r =−0.52, p = 0.01), trait‐anxiety (r =−0.58, p = 0.005), and depression (r =−0.62, p = 0.002), as revealed by separate Pearson's tests. In the other patient group, the WHO QOL‐100 total score significantly correlated with feelings of life meaning (r = 0.47, p = 0.01), hope (r = 0.536, p = 0.003), openness (r = 0.61, p = 0.001), forgiveness (r = 0.49, p = 0.008), self‐esteem (r = 0.62, p < 0.001), state‐anxiety (r =−0.78, p < 0.001), trait‐anxiety (r =−0.93, p < 0.001), depression (r =−0.79, p < 0.001), and the subjective perception of cognitive efficiency (r =−0.65, p = 0.006). Conclusions: These preliminary results suggest that QOL, as expressed by a single index, may appear similar in epilepsy patients and patients with other chronic brain diseases. However, they differ in spiritual facets, mood, and cognitive abilities. Even if in both groups mood has a central place in the perception of QOL, the subjective appraisal of health may reflect the interaction of different inner factors. Future studies are needed to determine the spectrum of psychological and spiritual facets relating to epilepsy, promoting specific health interventions. 1David S.Glosser,1Dayna A.Leis,1Joseph I.Tracy, and1Michael R.Sperling(1 Neurology, Jefferson Epilepsy Center, Jefferson Medical College, Philadelphia, PA ) Rationale: Mood disorders are frequent co‐morbidities in epilepsy and may be accompanied by polysomatic complaints. Studies of temporal lobectomy patients have reported post‐surgical mood changes with right vs left laterality differences. Among non‐epilepsy patients, right hemisphere lesions have been associated with diminished awareness of physical impairments. A sample of right (R) vs left (L) temporal lobectomy S's with pre and 1‐yr. post surgical measures was compared to evaluate the effect of surgery and laterality on Anxiety (anx.), Depression (dep.), and Somatization (somat.). Methods: We prospectively studied 20 (L) and 12 (R) side sequentially admitted temporal lobectomy patients, 16 male, and compared Personality Assessment Inventory (PAI) Anxiety, Depression, Somatization subtest scores pre and 1‐yr. post surgery. Pre‐surgical duration of epilepsy, age at surgery, gender, and IQ were assessed. The PAI is a reliable & valid standardized, multi‐dimensional, self‐report presonality trait test administered pre and post surgery. Results: L side patients had mean pre‐surgical sz duration of 25 yr, vs 18.3 yr. for R side patients. Mean age at L surgery = 43.3 yr, and R side = 36.5 yr. Age difference L vs R equalled the difference in pre‐surg. sz duration (7 yr.). Mean IQ's were L = 93; R = 98. L vs R sample equivalency was challenged by a significantly lower number of R side cases returning for 1 yr. post testing. Females and males, L & R side, had equal pre‐surgical scores on all variables (dep., anx., somat.). While R side S's post‐scores improved on all variables (p ≤ .014), L side patients post‐scores did not improve on anx. or dep. but did improve on somat. (p ≤ .008). Post‐surgically, L were more depressed than R side S's (p ≤ .04). Seizure improvement outcome grades at 1 yr. were equivalent, L and R. Conclusions: Principal findings are of equal pre‐surgical L vs R anx., dep., and somat.. However, anx., dep, & somat. scores improved 1 year post‐surgery for R side S's; while L S's improved only on somat. scores and had no improvement in anxiety or depression. This is consistent with reports that L hemisphere lesions more likely produce mood deterioration; while R damage is associated with decreased appreciation of physical impairment and, occasionally, denial of illness/injury. Alternatively, the combination of L focus and post‐surg sz reduction may deprive patients of anti‐depressant effects of seizures. Hence, while L side patients' depression and anxiety did not improve, the reduction in seizures produced reduced somat. scores. Though higher post‐surgical somatic complaints might have been expected in dominant hemisphere surgery, due to increased threat to language, this did not occur. The greater pre‐surgical sz duration of the L patients may reflect reluctance to operate on the dominant hemisphere. Although higher depression, anxiety, and somatization has often been reported among females, this was not seen. 1Arthur C.Grant,1SayehBeheshti,1PanyTehrani,2Roxan F.Saidi,1OliviaAguilar,1VeronicaMartin, and1StephanieMoore(1Neurology, University of California Irvine, Irvine, CA; and2 Medicine, St. Joseph's Hospital, Orange, CA ) Rationale: Limited English language skills complicate neuropsychometric assessment and Wada testing in patients with refractory TLE undergoing pre‐surgical evaluation. The patient population at our institution is culturally and ethnically diverse. For many patients English is a second or third language, and is understood and spoken with varying expertise. Although administering the neuropsychological component of the Wada test in a patient's native language is desirable, direct translation of English‐language Wada protocols into other languages does not account for cultural or language‐specific content. Methods: Our Wada test is a modification of one used at several epilepsy centers. It includes repetition and recall of spoken words and phrases, with additional foil words and phrases used when testing memory performance. Several of the phrases have cultural (e.g. “My country ‘tis of Thee”) and/or language‐specific (e.g. “Mary had a little lamb”) significance that would be lost with direct translation to other languages. We used a combination of culturally congruent substitutions and direct translations to adapt our Wada protocol for use with both Mexican‐born Spanish and Iranian‐born Farsi speaking patients. In addition, we attempted to preserve phrase length and general semantic content as much as possible. For instance, instead of “Mary had a little lamb,” the Farsi version uses a strikingly similar line from a well‐known Persian nursery rhyme, “gaveh Hassan chejooreh?” (How is Hassan's cow?), and the Spanish version uses a line from a familiar lullaby, “Los pollitos dicen pio pio” (The chicks say pio pio). Instead of “My country ‘tis of Thee” we substituted “Mexico lindo” in the Spanish version and “zardee‐ye man az tow” (My yellowness is from you) in the Farsi version. The latter phrase is part of a traditional exclamation made during a ritual associated with the Persian new year celebration. Medically‐trained native speakers administered the protocol to one Farsi speaking and two Spanish speaking patients, under the direct supervision of a neuropsychologist. Results: The procedure was administered without difficulty to all three patients, and was scored using criteria developed for the original English version. In all three patients, Wada memory and language results were consistent with other clinical data, and were incorporated into the surgical decision‐making process. Conclusions: Although the number of patients is small, these data suggest that culturally‐sensitive adaptations of English‐language Wada protocols provide reliable results, and can be used without independent validation in a large number of patients. (Supported in part by NIH K23 NS46347 to ACG.) 1Jennifer K.Bambara,2H. RandallGriffith,2Roy C.Martin, and2EdwardFaught(1Psychology, University of Alabama at Birmingham, Birmingham, AL; and2 Neurology, University of Alabama at Birmingham, Birmingham, AL ) Rationale: It has become important to understand the potential cognitive problems that older adults with epilepsy might encounter. We previously demonstrated cognitive impairments in epilepsy seniors. To further investigate potential cognitive declines in epilepsy seniors, we conducted a prospective study of cognitive performance across a three‐year time span. Methods: Fifteen epilepsy seniors averaging 68 years of age (range 62–77) at follow‐up were studied. Participants had partial‐onset seizures for 34 years on average. All participants completed measures of overall cognition, attention, language, memory, construction, abstraction, executive function, and mood at baseline and at an average follow‐up interval of 3.1 years. Results: Epilepsy seniors showed worsening executive control over the follow‐up period as measured by the Executive Interview Test (EXIT), t(13) =−3.06, p = .009. A trend towards significance was observed for poorer performance on WMS‐III Logical Memory I (p = .06). There were no other changes observed in neuropsychological test performance or mood across the follow‐up interval (all p values >.10). Conclusions: Across three years, epilepsy seniors had diminished executive control with some evidence of decreased verbal recall. Otherwise, stability in cognitive functioning was observed. Older adults with epilepsy appear prone to selective worsening of executive control. Numerous factors could contribute to executive dyscontrol, including brain atrophy related to continued seizures and/or cognitive effects of medications due to age‐related changes in pharmacokinetics. Further study is necessary to determine what factors contribute to worsening executive dyscontrol in epilepsy seniors. (Supported by Epilepsy Foundation of America and Centers for Disease Control.) Observed Neuropsychological Performance of Epilepsy Seniors at Baseline and Three‐year Follow‐upNeuropsychological 
Measure 
Baseline 
Follow‐up 
P ValueDRS Total Score 129.07 (8.66)  128.20 (7.49)  .69  DRS Attention 34.80 (1.70) 34.47 (1.30) .44  DRS Initiation 32.67 (3.48) 32.07 (4.37) .54  DRS Construction  5.20 (1.26) 5.80 (.56) .14  DRS Conceptualization 34.40 (3.58) 32.33 (7.81) .38  DRS Memory 22.00 (2.33) 21.33 (2.47) .47  WMS III Logical Memory Immediate 26.07 (7.98) 22.87 (9.05) .06  WMS III Logical Memory Delay 13.53 (7.30) 11.80 (6.70) .20  WMS III Recognition* 22.33 (2.77) 21.64 (4.27) .52  CFL Word Fluency* 25.79 (10.51) 22.80 (11.76) .33  Boston Naming Test 44.53 (13.55) 43.07 (13.15) .43  WRAT III Reading** 39.77 (4.94)  40.79 (4.76) .87  EXIT Total Score* 11.71 (3.81) 14.20 (4.23) .009 Geriatric Depression Scale Total Score* 8.79 (4.66)  8.60 (6.20) .96 *n = 14 participants **n = 12 participants1GuadalupeRojas,2MariaGudin,2AmaliaHernández,2IbanezRamon, and2VaamondeJulia(1Psychiatry, Ntra Sra de Alarcos Hospital, Ciudad Real, Castilla la Mancha, Spain; and2 Neurology, Ntra Sra de Alarcos Hospital, Ciudad Real, Castilla la Mancha, Spain ) Rationale: Pseudo seizures are paroxysmal alterations in behavior that resemble seizures but are without any organic cause. The objective of this work is to analyze the underlying psychiatric pathology of patients with pseudoseizures in a general outpatient clinic. Methods: A retrospective study of patients that underwent EEG due to a suspicion of pseudo seizures was realized. The clinical history, psychiatry diagnosis and EEG NONITORING were reviewed in sixteen patients (M/F: 10/6), middle age 40,6 years. All of them were studied by EEG monitoring, pseudoseizures seizures were recorded in 10 of these 16 patients, the other six had a high clinical suspicion. In 8 patients coexisted the pseudoseizures with epilepsy, 1 had migraine, 1 was diagnosed o syncopes, the rest of them did not have a clear epilepsy diagnosis. Results: Four patients did not have a clear psychiatric pathology. Five patients were malingering with clear secondary gain. One of the subjects admitted self‐induced illness and spontaneously improved after video EEG monitoring. The others ameliorated after retirement from their work. One patient had Alcohol Dependence. Four patients had an Anxiety Disorder NOS, 1 was a Depressive Disorder, 1 patient had an Impulse‐Control Disorder NOS, 7 patients were diagnosed of different Personality Disorder, all of those patients were women. The women improved when the socio familial circumstances changed. Men experienced some change when social aspects were modified. Conclusions: The women with pseudoseizures had been diagnosed basically of Personality Disorders. Men had secondary gain, or no clear psychiatric diagnosis. In this study we verify the importance of a psychiatric management to obtain adequate pseudoseizures control. 1Hajo M.Hamer,1AnjaHaag,1JohannesDorst,1FelixRosenow, and1SusanneKnake(1 Neurology, Philipps‐University, Marburg, Germany ) Rationale: Identification of eloquent cortex is a crucial issue in the preoperative assessment of patients with medically intractable epilepsy to reduce the risk of postoperative cognitive decline. Functional transcranial Doppler sonography (fTCD) is already a well established tool for language lateralisation. In this study we evaluated a fTCD‐paradigm that reliably lateralises to the non‐dominant hemisphere. Methods: 30 right handed healthy controls (17 male; 13 female age = 27,1 ± 7,5) participated in the study. While measuring cerebral blood flow velocity (CBFV) simultaneously and continuously in both middle cerebral arteries (MCA), all patients performed a mental rotation paradigm (cube filled with three ropes had to be rotated mentally to imagine views from different sides). The paradigm consisted of 20 activation and resting periods. In addition, the already established lexical fluency paradigm for language lateralisation was performed. Data were analysed offline with the software Average®, which performs a heart‐cycle integration and a baseline‐correction and calculated a laterality index (LI) with its standard error of the mean increase in blood flow separately for both MCA during activation. Results: One out of the 30 participants showed atypical right hemispheric language dominance and was excluded from further analysis. 21 participants (72%) of the 29 with left hemispheric language dominance showed right hemispheric dominance in the mental rotation paradigm. 7 (24%) patients generated greater left than right hemispheric activation and one participant did not show any lateralisation. There was no significant correlation between the LI in the mental rotation paradigm and test performance and no significant negative correlation between the LI of the mental rotation and the language paradigm. Conclusions: In more than two thirds of the participants the mental rotation paradigm showed a right hemispheric lateralisation. So far, mental rotation appears to be one of the best paradigm to activate predominantly the non‐dominant hemisphere in fTCD. Participants will be interviewed to elucidate whether different especially verbal strategies could be responsible for left hemispheric lateralisation in some participants. Evaluation of this paradigm in epileptic patients is warranted. 1Cynthia L.Harden,2Janice M.Buelow,3JoyceCramer,4Carl B.Dodrill,1BlagovestNikolov, and1KennethPerrine(1Comprehensive Epilepsy Center, Weill Medical College of Cornell University, New York, NY;2Nursing, Indiana University, Indianapolis, IN;3Psychiatry, Yale University School of Medicine, West Haven, CT; and4 Neurology, University of Washington School of Medicine, Seattle, WA ) Rationale: Mood disorders are prevalent in persons with epilepsy. As part of the Epilepsy Foundation of America's initiative on mood disorders, a professional education subcommittee developed a survey to assess knowledge of and attitudes and practices towards mood disorders in epilepsy. Methods: The survey entitled “Mood in Epilepsy Neurology Practice Questionnaire” consisted of 14 questions including three demographic items. A 5‐degree Likert scale was developed for most answer choices. The survey was piloted by some attendees of the American Epilepsy Society (AES) meeting in December 2004. Unselected attendees who passed by the EFA booth were asked to complete the anonymous, 1‐page survey. Results: Ninety‐nine responses were obtained and the total number of answers to selected questions are listed below.1 How often do you ask epilepsy patients about their mood? Never 2/Rarely 4/Sometimes 21/Often 47/Always 25 2 How much do you think that symptoms of a mood disorder are important factors in determining an epilepsy patient's quality of life? Very little 2/To a mild degree 1/Somewhat 2/Quite a bit 46/A lot 48 3 When you diagnose a mood disorder in an epilepsy patient, how often do you initiate a medication to treat it (medication for depression, anxiety, etc)? Never 4/Rarely 15/Sometimes 37/Often 39/Always 4 4 When you diagnose a mood disorder in an epilepsy patient with a mood disorder, how often do you refer the patient to a psychiatrist for initiation of treatment? Never 2/Rarely 14/Sometimes 34/Often 38/Always 11 5 How frequently do you limit your prescribing of antidepressants because of concern about exacerbating seizures? Always 1/Often 7/Sometimes 31/Rarely 41/Never 18 6 Your age in years 25–35 = 14/35–45 = 38/45–55 = 21/55–65 = 18/65 and older = 1 7 Type of Practice Adult Neuro –Academic 32/Adult Neuro – Private 5/Adult Epi–Academic 15/Adult Epi–Private 1/Ped Neuro–Academic13/Ped Neuro – Private3/Ped Epi –Academic12/Ped Epi– Private 2 8 Number of Years in Practice 1–9 = 41/10–20 = 18/> than 20 = 27Conclusions: These results reflect the youthful and highly academic membership of the AES who are well‐informed about the importance of mood disorders in epilepsy, and are very likely to either initiate antidepressant medication or refer for that purpose. Further, concern about exacerbating seizures is not a reason for withholding antidepressant medication among these practitioners. These findings suggest that educational efforts regarding mood disorders and epilepy have favorably impacted the practices of AES members, but whether this holds true in a larger group of general neurology practictioners assessed in a less biased manner remains to be determined. 1Chin‐WeiHuang,1Yi‐JungHsieh,1Ming‐ChyiPai, and1Jing‐JaneTsai(1 Epileptology and Neurology, National Cheng Kung University Medical Center, Tainan, Taiwan; Pediatrics, Chi‐Mei Foundation Medical Center, Tainan, Taiwan; Behavioral Neurology and Neurology, National Cheng Kung University Medical Center, Tainan, Taiwan; and Epileptology and Neurology, National Cheng Kung University Medical Center, Tainan, Taiwan ) Rationale: Cognitive impairment in epilepsy has gained much attention in clinical practice. most of them are focused on the seizure type, age at seizure onset, seizure duration, antiepileptic drugs and epilepsy surgery. Few studies specifically focused on cryptogenic epilepsy. In addition, how the cognitive performance in cryptogenic epilepsy responds to treatment remains elusive. Methods: We investigated the cognitive performance in cryptogenic epilepsy patients with the aid of cognitive ability screening instrument (CASI), based on cross‐sectional and longitudinal aspects. One hundred patients met the diagnostic criteria of cryptogenic epilepsy were recruited from a national university hospital. The patients with normal total CASI scores were compared with those with abnormal ones. We also compared the follow‐up CASI score after 3 years with the previous one in all cryptogenic epilepsy patients. Demographic and clinical variables of cryptogenic epilepsy patients with normal and abnormal total CASI scores as well as univariate analysis

Characteristics Normal 
CASI
(n = 64) Abnormal 
CASI
(n = 36) 

Odds Ratio 
Confidence
IntervalAge(years)  <25 17 10 1 ‐  25–34 22  7 0.36 0.13–1.19  35–44 11  6 0.80 0.24–3.11  >45 14 13 1.37 0.58–3.85 Sex  male 36 16 1 ‐  female 28 20 1.53 0.62–4.60 Education  <6 years  4  7 3.71 0.14–4.32  6‐8 years 12 13 5.85 1.01–8.30  >8 years 48 16 1 ‐ Disease duration  <5 years  7  4 1 ‐  5–10 years 17  7 0.64 0.14–1.69  >10 years 40 25 2.41 0.65–5.42 Number of seizure types    1 31 13  1 ‐    >2 33 23 2.83 0.66–4.26 Number of AEDs  none  8  2 1 ‐  1 23 10 2.1 0.22–5.66  >2 33 24 5.2 0.81–10.731The performance in Cognitive Ability Screening Instrument among patiets with crytogenic epilepsy. Black bar, initial score, gray bar, the following score, A: The group with initial normal total CASI score, B: The group with initial abnormal total CASI score group. Figure 1A.Results: 36% of cryptogenic epilepsy patients showed cognitive impairment. The variables correlated with higher risks of cognitive impairment were lower educational status, number of seizure types, duration of seizure and polytherapy, especially the lower educational status. The correlation between CASI and the MMSE was excellent. As to the follow‐up study, the abnormal group showed significant improvement in total CASI score. The normal group showed no significant change. Conclusions: We suggest that in cryptogenic epilepsy, lower educational status remains the most important factor in determining cognitive performance. Adequate treatment with anti‐epileptic drugs can improve cognitive performance in previously cognitively impaired patients. (Supported by National Cheng Kung University Hospital.) 1DavidIsaradisaikul,2Kelly A.McNally,1Jason M.Meckler,1Michael D.Privitera,2Bruce K.Schefft, and1Jerzy P.Szaflarski(1Neurology, University of Cincinnati, Cincinnati, OH; and2 Psychology, University of Cincinnati, Cincinnati, OH ) Rationale: Psychogenic non‐epileptic seizures (PNES) often manifest differently in different patients. Selwa et al. ( Epilepsia 2000; 41(10): 1330–1334) developed a system of PNES classification to describe different types of spells. Previous research has demonstrated that patients with PNES are commonly associated with elevations on the hypochondriasis and hysteria scales of the MMPI. In the present study, we sought to investigate the relationship between PNES spell type and MMPI profiles. Methods: We reviewed video‐EEG reports and MMPIs in 86 patients diagnosed with definite PNES after inpatient video‐EEG monitoring at the University of Cincinnati between January 2000 and March 2003. Definite PNES was defined as habitual spells recorded on video‐EEG without an ictal EEG discharge and normal background alpha rhythm during the event. The diagnosis of PNES was based on the results of the prolonged video‐EEG monitoring (PVEM), clinical characteristics of the events recorded, and other supporting evidence (e.g., neuropsychological testing/MMPI). Patients with mixed PNES and epileptic seizures were excluded. Based on review of spells, each patient was classified as predominantly or exclusively belonging to the catatonic, thrashing, automatisms, tremor, intermittent, or subjective categories of nonepileptic seizure type based on Selwa's classification. MMPI data were collected on each patient as part of the standard neuropsychological battery obtained prior to discussion of the diagnosis with the patient. Results: We found that the largest groups consisted of patients with intermittent (n = 22), subjective (n = 21), and thrashing (n = 19) types of PNES. Analysis of variance results indicated that there was a significant effect of PNES spell type on MMPI standardized T‐scores on a combination of the hypochondriasis scale (1) and the hysteria scale (3) (F = 3.87, p = 0.003). Post‐hoc pairwise comparisons with a Bonferroni correction for multiple comparisons revealed that patients with catatonic‐type PNES had significantly lower scores on scales 1 and 3 than all other PNES types. No other MMPI scales were found to be significantly related to PNES spell type. Conclusions: We found that patients classified with catatonic‐type PNES had significantly lower scores on the hypochondriasis and hysteria scales of the MMPI, as compared to all other types of PNES. According to previous research, patients in the catatonic subgroup tended to have a better outcome than other PNES types. This improved outcome in the catatonic group may be related to their decreased pathology on MMPI scales 1 and 3. 1Donya L.James,1Mike R.Schoenberg,1Kyra A.Dawson,1PamelaLang, and1Mary AnnWerz(1 Neurology, University Hospitals of Cleveland, Cleveland, OH ) Rationale: There is conflicting data in the literature regarding material‐specific memory deficits in patients with epilepsy (Kim et al., 2003). Some research suggests that patients with left hemisphere seizure lateralization have decreased capacity for verbal memory while patients with right hemisphere seizure lateralization have decreased capacity for visual memory. Subsequent research has not been able to fully confirm these findings.Methods: The participants were 23 patients diagnoses with epilepsy whose seizure lateralization evaluation including the Wechsler Memory Scale‐ 3rd Edition. Results: Primary Index scores [e.g. Auditory Immediate Memory (IM), Visual Immediate Memory (VI), General Memory Immediate (IM), Verbal Memory Delayed (AD), Visual Memory Delayed (VD), Auditory Recognition Memory Delayed (ARD), and General Delayed Memory (GM)] were compared using ANOVA. Significant differences were found between AI index scores and ARD index scores. Patients with right hemisphere seizure lateralization scored significantly better on both indexes. There were no significant differences between the groups on other WMS‐III indexes. Conclusions: The study provides further support for differences in patients performance on material‐specific memory tests. However, the degree of lateralization is less pronounced in patients with epilepsy having left hemisphere epileptic focus. This research provides further evidence of material specific memory deficits on the WMS‐III, although not for delayed memory. Patients with right lateralization of seizure activity perform better on tasks of immediate recall of auditory information as well as tasks involving the recognition of verbal information after a delay. 1S.Kennepohl,1V.Sziklas, and1M.Jones‐Gotman(1 Neurology and Neurosurgery, McGill University, Montreal, QC, Canada ) Rationale: We have previously raised a question whether the well‐known hemispheric difference in memory function might be process‐specific as well as material‐specific 1,2 ; i.e., related to both novelty vs. familiarity and verbal vs. nonverbal material. To test this question using neuroimaging, recognition memory must be used; our prior results with patients used recall. We have developed a single recognition memory protocol to be used in both clinical and neuroimaging research. Methods: We use 4 types of stimulus dichotomized along verbal/nonverbal and novel/familiarity dimensions (abstract words, nonsense words, drawings of objects and abstract designs). For each stimulus type, the task consists of two learning/recognition trials and a delayed recognition trial. The fMRI task differs from that used in clinical research primarily in that it uses a block design for item presentation (alternating blocks of stimuli and baseline items), includes a simple perceptual decision task (is item primarily “straight” or “curvy”) to ensure fixation during encoding, and does not use an interference task between learning and delayed recognition. Comparability of the two versions was assessed with groups of matched neurologically healthy participants (fMRI vs. clinical version; n = 35 and n = 18, respectively). A small sample of individuals with either primarily left‐ or right‐sided temporal lobe (TL) epilepsy was tested using the clinical version. Results: Our results show that healthy individuals demonstrate significant learning over the two first trials, with little‐to‐no forgetting following a delay. ANOVAs revealed: 1) no effect of version; 2) main effect of novelty (familiar > novel); 3) main effect of material (“nonverbal” > verbal); 4) main effect of trial. Significant interactions showed poor initial learning of novel material (with bigger improvements on Trial 2), and better overall recognition of drawings of objects. Preliminary results with a small sample of patients suggests that those with a left TL focus improve much more on learning novel than familiar material, whereas those with a right TL focus show little change over trials. Conclusions: We have developed a simple yes‐no recognition memory protocol allowing study of material‐ and process‐specific learning/retention using an almost identical paradigm in fMRI or clinical testing. The clinical and fMRI versions of the task appear directly comparable with respect to memory performance. To our knowledge, this represents the first learning/memory protocol using an identical paradigm, potentially yielding complementary information about brain regions active during memory compared with the result of focal lesions. The novelty/familiarity dimension yielded a large effect, confirming the importance of this factor in learning, and may be particularly salient in elucidating laterality effects in temporal‐lobe epilepsy. REFERENCES 1.  Majdan et al JCEN ( 1996 ); 18 : 416 – 30 . 2.  Jones‐Gotman et al Neuropsychologia ( 1997 ); 35 : 963 – 73 (Supported by Canadian Institutes of Health Research.)1Robyn M.Busch,1Thomas W.Frazier,1Kathryn A.Haggerty, and1Cynthia S.Kubu(1 Psychiatry & Psychology, Cleveland Clinic Foundation, Cleveland, OH ) Rationale: Confrontation naming tasks, such as the Boston Naming Test (BNT), have long been presumed to be sensitive to left temporal dysfunction and, consequently, are frequently used in the evaluation of surgical epilepsy patients. Several recent studies have demonstrated the diagnostic utility of the BNT in predicting seizure lateralization (i.e., ultimate side of surgery) in patients with temporal lobe epilepsy (TLE) 1, 2 . However, despite wide and frequent use of this instrument, few studies have examined factors that may moderate this relationship, and no known studies have examined the incremental validity of confrontation naming tasks in individuals with epilepsy. Methods: The current study examined the pre‐surgical BNT performance of 242 right‐handed adult patients with intractable epilepsy (Left = 120; Right = 122) to examine potential factors that may moderate the relationship between BNT performance and seizure lateralization and to determine the incremental validity of this measure in predicting seizure lateralization. Results: The results support the clinical utility of the BNT in determining ultimate side of surgery and indicate that age of seizure onset strongly moderates this relationship. BNT performance was helpful in identifying ultimate side of surgery in patients with later age of seizure onset (i.e., >6 years). This relationship was not apparent in patients with younger age of seizure onset. In addition, site of seizure focus (i.e., temporal vs. nontemporal) approached significance as a moderating variable with more robust relationships apparent in patients with temporal lobe epilepsy. FSIQ and duration of epilepsy were not significant moderating variables. Hierarchical logistic regression analyses supported the role of the BNT in predicting ultimate side of surgery and further demonstrated that this instrument has incremental validity over and beyond memory and IQ laterality scores. Conclusions: This study supports the clinical utility of the BNT in the pre‐operative evaluation of candidates for epilepsy surgery, particularly for patients with later seizure onset. REFERENCES 1.  Kubu CS , Carswell L , Harnadek M , Galvan N . The diagnostic utility of the Boston and Benton Naming Tests in epilepsy [abstract] . J Int Neuropsychol Soc . 2001 ; 7 ( 2 ): 210 . 2.  Schefft BK , Testa SM , Dulay MF et al Preoperative assessment of confrontation naming ability and interictal paraphasia production in unilateral temporal lobe epilepsy . Epilepsy Behav . 2003 ; 4 : 161 – 168 .1Jennifer J.Loyden,1Bruce K.Schefft,1Steven R.Howe,2DeanBeebe, and3Michael D.Privitera(1Psychology, Unniversity of Cincinnati, Cincinnati, OH;2Psychology, Children's Hospital Medical Center, Cincinnati, OH; and3 Neurology, University Hospital, Cincinnati, OH ) Rationale: Approximately 2% of the population is diagnosed with epilepsy and about one third of those diagnosed will develop intractable epilepsy (Snyder, 1998). Thus, surgical intervention, particularly anterior temporal lobectomy (ATL), has become a widely used form of treatment for those with medically uncontrolled seizures (Engel, 1996) and has a success rate of about 80% (Janszky et al., 2005; Olivier, 1988). Previous studies have found unilateral hippocampal atrophy, side of surgery, and duration of seizures to be significantly predictive of seizure control after ATL (Jeong et al., 1999; Olivier, 1988). Additionally, studies have shown that patients with higher preoperative IQ and language scores and lower preoperative verbal memory scores have good seizure control post ATL (Chelune et al., 1991; Chelune et al., 1998; Hennessey et al., 2001). The primary goal of this study was to determine changes in cognitive functioning after ATL and to identify predictors of favorable seizure and cognitive outcome post‐surgically. For seizure outcome, the predictors included hippocampal integrity, seizure laterality and duration, and pre‐surgical cognitive functioning. For cognitive outcome, the predictors examined were hippocampal integrity, seizure laterality and duration, and seizure outcome. Methods: Data from a convenience sample of 36 patients who underwent ATL for relief from medically intractable seizures were included in this study. Surgery was performed at University Hospital in Cincinnati, Ohio. All participants underwent prolonged video/EEG monitoring and pre‐ and post‐surgical neuropsychological evaluations. Seizure outcome was determined according to Engel's classification system. Results: Approximately 60% of patients' overall IQ and verbal memory scores improved or remained the same following ATL. The majority of these patients were seizure free post surgery, and those who improved on verbal memory tasks had undergone right ATL. Additionally, patients who were seizure free following ATL significantly improved on an executive functioning task. Interestingly, more than half of the patients declined on nonverbal memory and confrontation naming post right ATL. Multiple regression analyses demonstrated that only pre‐surgical cognitive scores were significantly predictive of seizure outcome F (8,15) = 2.713, p < .05), accounting for 59% of the variance. Futher, regression analyses yielded statistically significant main effects for nonverbal memory and confrontation naming ( t (29) = ‐2.43, p < .05 and t (29) = 2.27, p < .05, respectively). Conclusions: The results demonstrate that patients improved on most measures of cognitive functioning. Further, cognitive improvement appeared to be greatest in patients who were seizure free following ATL. Higher pre‐surgical cognitive scores were predictive of seizure relief post surgery. 1Carrie R.McDonald,1Dean C.Delis,1Marc A.Norman,2Evelyn S.Tecoma, and2Vicente J.Iragui(1Psychiatry, University of California, San Diego, San Diego, CA; and2 Neurosciences, University of California, San Diego, San Diego, CA ) Rationale: Executive dysfunction is common in patients with frontal lobe epilepsy (FLE) and is thought to be secondary to underlying frontal lobe dysfunction. However, executive dysfunction has also been reported in a subset of patients with temporal lobe epilepsy (TLE). Thus, the specificity of executive dysfunction to FLE versus TLE is unclear. In addition, the degree of executive dysfunction in these populations may be related to disease‐specific variables, including the side of the seizure focus, presence of a structural lesion, and/or the age of seizure onset. The goal of this investigation was to determine (1) the nature and extent of executive dysfunction in patients with FLE and TLE and (2) the relationships between disease‐specific variables and executive dysfunction. Methods: Participants in this investigation were 23 patients with FLE (10 left, 11 right, one bilateral), 20 patients with TLE (11 left, 8 right, one bilateral), and 23 age‐ and education‐matched controls. Fifteen patients with FLE had MRI‐confirmed frontal lobe lesions. All patients with TLE had mesial temporal sclerosis. All participants completed the Delis‐Kaplan Executive Functions System. Test performances were adjusted for age, gender, and education and transformed to a common metric (z scores). Composite z‐scores were created for each of the following domains: switching, inhibition, fluency, abstraction, and planning. Results: Results revealed that patients with FLE were impaired relative to controls in switching, inhibition, fluency, and abstraction, but not planning. Conversely, patients with TLE were found to be significantly impaired only in fluency relative to controls, although their performances across domains were decreased and did not differ from those with FLE. In the FLE group, correlation analyses did not reveal a relationship between age of seizure onset and any domain of executive functioning. Instead, a left‐sided seizure focus and structural lesions were associated with poorer performances. In patients with TLE, an early age of seizure onset was related to greater impairment in one domain (i.e., abstraction) regardless of the side of the seizure focus. Conclusions: Executive dysfunction in patients with FLE is pervasive and appears to depend on the side of the seizure focus and presence of structural pathology. In patients with TLE, executive dysfunction is relatively subtle but may be more pronounced in those with an early seizure onset. These findings are consistent with past research indicating that executive dysfunction is present in patients with FLE and TLE. However, our research extends the literature by demonstrating that the nature, extent, and disease‐specific correlates of executive dysfunction differ between the patient groups. (Supported by an Epilepsy Foundation Research Fellowship Award and a NIMH Training Grant T32‐MH18399.) 1Kelly A.McNally,1StevenHowe,1Bruce K.Schefft, and2Michael D.Privitera(1Psychology, University of Cincinnati, Cincinnati, OH; and2 Neurology, University of Cincinnati, Cincinnati, OH ) Rationale: Neuropsychological test results are often used in the differential diagnosis of epileptic seizures (ES) and psychogenic non‐epileptic seizures (PNES). However, since deficits have been reported in both groups, simply investigating overall performance may not be sufficient. It may be important for neuropsychologists to shift their attention to the qualitative differences in test responses between patients with PNES and ES. Signal Detection Theory (SDT) can be used to investigate differential response patterns on recognition memory tasks. SDT posits that performance is dependent on two independent factors: 1) ability to discriminate between targets and distractors (sensitivity, or actual memory ability) and 2) propensity to respond in a particular manner (response bias). Methods: One hundred patients diagnosed with PNES and 108 patients with temporal lobe ES, 62 left temporal (LTLE) and 46 right temporal (RTLE), were studied. Each participant was administered the Wechsler Memory Scale (WMS‐III). Scores on the recognition subtest of the List Learning task were analyzed with the traditional method of scoring and also subjected to SDT analytic decomposition into indices of sensitivity (d') and bias (c). Logistic regression analysis was conducted to investigate the diagnostic utility of raw scores and SDT measures. Results: Raw scores on the recognition memory task were found to significantly discriminate between ES and PNES (χ 2 = 6.01 p = .014, Area under ROC curve, or AUC = .57) however, analysis of SDT measures slightly improved the diagnostic utility (χ 2 = 16.95, p < .001, AUC = .62). Both sensitivity (Wald χ 2 = 8.43, p = .004) and bias (Wald χ 2 = 7.92, p = .005) significantly contributed to the discrimination of ES and PNES. Increased sensitivity and a more negative response bias increased the odds of PNES (odds ratio, OR, sensitivity = 1.84, bias = 0.09). Decomposition into SDT measures did not significantly improve the discrimination between LTLE and RTLE (raw scores χ 2 = 6.63, p = .01., AUC = .66; SDT measures χ 2 = 14.42, p < .001, AUC = .68). Sensitivity (Wald χ 2 = 8.17, p = .004) but not response bias (Wald χ 2 = 2.9, p = .09) was found to be a significant predictor of left versus right TLE, with decreased sensitivity increasing the odds of LTLE (OR = 0.45). Conclusions: This study provides evidence that SDT measures of sensitivity and response bias may be useful tools to aid in the differential diagnosis of ES and PNES. Patients with PNES were found to have a negative response bias as compared to patients with ES. The negative response bias in the PNES group may be related to depression, inadequate effort or low motivation on the diagnostic testing. These results suggest that, not only is overall performance on neuropsychological testing important, but differences in response patterns should also be considered. 1Cristiane S.Messas,2Luiz Henrique M.Castro,2Carmen L.Jorge, and1Leticia L.Mansur(1Physical, Speech and Occupational Therapy, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil; and2 Neurology, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil ) Rationale: Patients with left temporal lobe epilepsy show cognitive imparment in episodic memory. Semantic memory aspects have received less attention in temporal lobe epielpsy. We evaluated aspects of semantic memory in epileptic patients with temporal lobe epilepsy secondary a mesial temporal sclerosis. Methods: We studied patients with medically refractory mesial TLE undergoing presurgical evaluation for epilepsy surgery with MRI documented unilateral mesial temporal sclerosis. Patients were classified as right or left mesial temporal sclerosis (MTS), according to MRI findings. Inclusion criteria included right handed patients with ages between 18–55, education above 8 yrs and absence of other MRI lesions or other significant neurological or psychiatric disease. Patients underwent a detailed battery evaluating episodic memory (word list learning, with spontaneous, cued and recognition recall and imediate and late history recall) and semantic memory tests: picture‐word matching, definition of objects, common nouns, verbs and adjectives, word list generation [FAS, and category: animals and means of transportation), auditory responsive and visual confrontation naming (common and proper nouns, verbs and adjectives). Performance of left and right MTS patients was compared with a control group of normal individuals, matched by age, gender and education. Results: We evaluated 18 MTS patients (10 left, 8 right) and 22 controls. Groups did not differ in age, gender and education. All patients were high dose mono or polytherapy of antiepileptic drugs. Left MTS patients performed significantly worse than controls in immediate and late history recall (p < 0.05). Left MTS patients also performed worse than right MTS and controls in word list learning, but the difference did not reach statistical significance(p < 0.05). In semantic memory testing, both left and right MTS patients performed significantly worse than controls in confrontation naming for common and proper nouns, as well as in word list generation (FAS, animals and means of transportation). In word‐picture matching, right MTS patients performed significantly worse than controls (p < 0.05). Left MTS patients performed worse than controls, but this difference did not reach statistical significance (due to sample size). Left and right MTS patients performed worse than controls in responsive naming and in visual confrontation for verbs and adjectives, but this difference did not reach statistical significance. Groups did not differ in the definition task for objects, nouns, adjectives and verbs. Conclusions: In this group of patients, while episodic verbal memory impairment was noted in left MTS patients, imparment in some aspects of semantic memory was seen in both left and right MTS patients. 1YafaMinazad, and1LauraKalayjian(1 Neurology, University of Southern California, Keck School of Medicine, Los Angeles, CA ) Rationale: Epilepsy is a chronic illness that negatively impacts quality of life. Cultural factors may have an influence. At Los Angeles County Medical Center, the majority of patients are Spanish‐speaking, uninsured, and with low income and level of education. It is important to identify the factors associated with quality of life in this population to provide better care. Methods: Two hundred adult Hispanic patients, seen at our epilepsy clinic underwent a structured interview followed by a self‐administered questionnaire (English or Spanish). Demographic and other information regarding their epilepsy was collected. The questionnaire consisted of the Quality of Life in Epilepsy‐10 (QOLIE‐ 10) plus 11 additional questions designed to identify more cultural/social concerns. A statistical regression model was used to correlate these factors with mean QOLIE 10 scores. Results: Of the 200 patients interviewed, 61% were female. Mean age was 36 and mean duration of epilepsy was 20 years. 82% spoke Spanish as their primary language. 51% arrived by public transportation. Average number of antiepileptic medication prescribed was 2, and 74% of patients reported compliance. Mean seizure frequency was 1 per month. Mean percent optimal life scores (QOL) derived from the QOLIE 10 was 69.4%. Seizure frequency was significantly related with QOL, (p < 0.001). QOL decreased by 10% with every increase in category of seizure frequency; one every other month or less, more than every other month up to 2 per month, and 2 or more per month. Epilepsy duration was significantly and inversely associated with QOL (p < 0.04). Patients' gender, age of onset, seizure type, and etiology, did not correlate with QOL. Language was significantly associated with QOL (p < 0.01). English speaking Hispanics had lower QOL scores compared to Spanish speaking ones. Average length of education was 8 years. Of the 34% of patients who had stopped education due to epilepsy, 46% were below age 30. Patients with higher level of education (high school and above) had significantly lower QOL (p < 0.03). There was a significant association between sense of embarrassment (stigma) and QOL (p < 0.001). Twenty six percent reported being diagnosed with depression or anxiety. Of those diagnosed, 56% were receiving treatment. The question left unanswered the most by patients was regarding driving. Of the 14% of our patients who drove, only 51% owned a driver's license. Conclusions: Cultural factors and epilepsy burden play a role in quality of life in Hispanic epilepsy patients at a major US urban medical center. Stigma, language, and education had significant relationships with QOL. QOL was also significantly associated with increased seizure frequency and duration of disease. These results are similar to other studies showing refractory epilepsy patients have poor QOL. This information will enlighten health care providers to the needs of this cultural group. 1HilaryMounfield,2GusBaker,3MichaelFeichtinger, and4PhilippeRyvlin(1Chief Executive, Epilepsy Scotland, Glasgow, United Kingdom;2Clinical Neuropsychology, Walton Center for Neurology and Neurosurgery, Liverpool, United Kingdom;3Department of Neurology, Karl‐Franzens University, Graz, Austria; and4 Department of Functional Neurology and Epileptology, Neurology Hospital, Lyon, France ) Rationale: To provide a patients' perspective on the cognitive side effects of anti‐epileptic drug (AED) treatment and the consequences for quality of life. Methods: A nine‐item questionnaire comprising a combination of forced‐choice and open‐ended questions was distributed to 4,500 members of nine chapters of the International Bureau for Epilepsy (Austria, Belgium, Denmark, France, Ireland, Israel, Norway and Scotland). Results: Data analysis was performed on 837 completed questionnaires. The average age of respondents was 40 years, 54% were female and 95% were taking medication for their seizures (60% polytherapy vs 39% monotherapy). Average length of time on treatment was 18.07 years (± 18.07). Indicators of cognitive impairment considered to be affected ‘very much’ or ‘moderately’ included sleepiness/tiredness (57%), slowness of thought (42%) and difficulties learning something new (41%). Two thirds stated that cognitive impairment was related to their condition or AED therapy, with 41% attributing impairment to their AED therapy alone. More than half (59%) stated that cognitive impairment had prevented them from achieving a goal and approximately 50% reported that their quality of life had been affected including: work (48%), education (46%), relationships (48%) and leisure pursuits (44%). When asked what side effects they would most like to avoid, respondents reported indicators of cognitive impairment most frequently, including sleepiness/tiredness (35%), memory problems (19%), lethargy/sluggishness (9%) and difficulty paying attention (8%). Conclusions: Insights gained from this survey highlight the debilitating effect of cognitive impairment on individuals with epilepsy and the importance ascribed to minimising cognitive side effects of AEDs. (Supported by an unrestricted educational grant from UCB.) 1AdaPiazzini,1RosannaChifari,1KatherineTurner,1AlbertoMorabito,1RaffaeleCanger, and1Maria PaolaCanevini(1 Epilepsy Center, S. Paolo Hospital, University of Milan, Italy ) Rationale: The main aim of this investigation is to assess the possible cognitive changes in patients with epilepsy compared to controls over 5 years, and to investigate the clinical variables mainly implied in the mental alteration. Methods: 50 patients with focal epilepsy and 50 healthy controls were administered the same battery of comprehensive neuropsychological tests at baseline and 5 years later. Raw scores of all psychometric measures were converted to adjusted (age, gender, years of education) z scores. Results: Patients with focal epilepsy exhibited a significant impairment in substained attention compared to controls within 5 years, while the other cognitive domains did not show any important change. The worsening of attention was mainly related to the duration of epilepsy, the age of onset, a history of tonic‐clonic seizures, and the level of education. There was no relation to the AEDs regimen. Conclusions: Our results could have important implications considering the influence attention can have on other cognitive functioning, on the quality of life and on the work status, in order to prevent further cognitive deterioration, especially in those patients more at risk to develop that decline. 1SandraPouliot, and1MarilynJones‐Gotman(1 Montreal Neurological Institute, McGill University, Montreal, QC, Canada ) Rationale: We have found that healthy young adults remember odors leading to large emotional reactions (measured with self ratings and galvanic skin response (GSR)) better than odors provoking smaller emotional reactions. Because the amygdala seems to be critically implicated in memory for emotional information and because it is part of the primary olfactory area, we hypothesized that patients with a unilateral amygdala resection (included in a selective amygdalohippocampectomy (SAH) or a corticoamygdalohippocampectomy (CAH)) would not show the normal better memory for emotional than for nonemotional odors, but that instead their memory would be the same without respect to the emotion‐arousing properties of the odors to be remembered. Methods: We tested 20 patients who had undergone a SAH or CAH (10 left (6 men), 10 right (3 men)) for treatment of intractable epilepsy, and 32 healthy control subjects matched to the patients for age, education and gender. First, participants smelled passively 21 odors (time interval between odors: 45 seconds) while their breathing, heart rate and GSR were measured. Second, they smelled the same 21 odors again and rated each odor's intensity, pleasantness, familiarity and emotion‐arousing properties. Third, a few days later (mean = 5.3, standard deviation = 3.4), we gave participants an unexpected recognition odor memory test. Results: Patients did not show better memory for emotional odors than for nonemotional ones, whereas the healthy control subjects did. There was no difference between patients with a left or right resection in odor memory accuracy or response bias. However, patients with a right resection tended to rate all odors as less emotionally arousing than did patients with a left resection and healthy control subjects. Control subjects showed greater GSR changes to arousing than to nonarousing odors, but the breathing and heart rate measures did not differ as a function of these properties of the odors. Conclusions: Patients who undergo a SAH or CAH, whether in the left or right hemisphere, lose the memory advantage that odors causing strong emotional reactions normally have. This absence of an effect of arousal is not related to differences in perceiving the odors, because only individuals with right resections rated odors differently whereas both left‐ and right‐resection groups failed to remember the emotional odors better than nonemotional ones. This finding is likely owing to resection of the amygdala, which was included in both types of surgery. (Supported by Savoy Foundation and Canadian Institutes of Health Research.) 1Gail L.Risse,1RobertDoss,1WenboZhang, and1,2John R.Gates(1Epilepsy, Minnesota Epilepsy Group, P.A. of United and Children's Hospitals and Clinics ‐ St. Paul, St. Paul, MN; and2 Department of Neurology, University of Minnesota, Minneapolis, MN ) Rationale: Recent studies have reported a high rate of concordance between magnetoencephalography/magnetic source imaging (MSI) and the Intracarotid Amobarbital Procedure (IAP) in identifying patients with left hemisphere language dominance, despite the frequent co‐occurrence of some right hemisphere activation on MSI. This study examines the anatomical activation patterns in the right hemisphere in response to an auditory word recognition task in patients who were classified with bilateral language based on the IAP. Methods: Data from four patients diagnosed with chronic epilepsy and/or brain tumor who had been classified with bilateral language representation on IAP and who also underwent language mapping with MSI were retrospectively reviewed. MSI data were obtained with a 148‐channel Magnes 2500 WH system (4‐D Neuroimaging, SanDiego, CA) and analyzed using the single equivalent dipole model. For each patient, the number and anatomic location of right hemisphere dipoles were examined in relation to modality‐specific IAP language responses scored for the right hemisphere. Results: Evidence of correct responses on automatic speech tasks and/or at least one correct naming response was present in all four patients during maximum drug effect following the left injection on IAP. Two of 4 patients demonstrated some auditory comprehension in the right hemisphere as well. Right hemisphere MSI language activation sites included the superior temporal gyrus and/or angular gyrus in 3 of 4 patients. The fourth patient showed activation in the right inferior frontal region and a portion of the insula. This patient had the highest right hemisphere language score on IAP of the 4 cases reviewed. For all patients, activation of classical temporal lobe language areas in the left hemisphere significantly exceeded that seen on the right. Conclusions: These data appear to confirm independent activation of specific right hemisphere language areas in patients with unambiguous language function in both hemispheres. Results will be considered in relation to MSI activation in exclusively left language dominant cases and other neuropsychological variables. 1,5HeikeSchmolck,1,2,3AmitVerma,1,2,3IanGoldsmith,4DanielYoshor,4HarveyLevin,4Michele K.York,1,2,5Perry J.Foreman,1,2,3,6Eli M.Mizrahi, and1,5Paul E.Schulz(1Neurology, Baylor College of Medicine, Houston, TX;2Peter Kellaway Section of Neurophysiology, BCM, Houston, TX;3Baylor Comprehensive Epilepsy Center, BCM, Houston, TX;4Neurosurgery, BCM, Houston, TX;5Neurology, Michael DeBakey VAMC, Houston, TX; and6 Pediatric Neurology, Department of Pediatrics, BCM, Houston, TX ) Rationale: Semantic Memory (SM) is impaired in neurodegenerative diseases (e.g., AD, FTD) or structural lesions affecting the lateral temporal cortex bilaterally (e.g., Herpes Encephalitis). The effect of unilateral lesions is less understood. Prior studies reported deficits in pre‐ as well as postsurgical temporal lobe epilepsy (TLE) patients. These deficits have been suggested to be highly specific to the clinical difficulties experienced by TLE patients. Our goal is to study SM in patients before and after anterior temporal lobectomy (ATL) to determine the effect of seizure laterality and the impact of surgery. Our specific aims are to investigate whether deficits in SM after ATL are related to the surgery or the TLE, to assess the magnitude of possible effects, and to determine whether dominant ATL represents a higher risk. Methods: We use 4 tests of semantic knowledge for 48 items. They test the ability to name an item when provided with either a picture or a description (confrontation naming, auditory naming), to provide a definition of the item, and to generate exemplars from a category (category fluency). We have cross‐sectionally examined 14 pre‐ATL and 18 post‐ATL patients, and 8 controls. A prospective study arm is comparing performance before and after ATL in individual patients. Results: Both dominant and non‐dominant TLE patients were impaired compared to controls, but the deficit in dominant TLE patients was more severe (ANCOVA IQ covariate, p < 0.05). Interestingly, surgical patients did significantly or marginally worse than presurgical patients on both naming tasks, but they performed better on the definitions task (p < 0.05). Surgical patients supplied more information about the items defined, whereas error rates were similar. Category fluency was also better in the ATL group. Overall performance remains impaired for TLE patients regardless of surgical status in reference to controls. Conclusions: This cross‐sectional study found that SM was impaired before and after ATL, suggesting that ATL does not substantially alter SM. However, our prospective study will provide firmer conclusions regarding the impact of ATL on SM. SM was more impaired in dominant TLE. Postsurgical patients performed worse on confrontation naming but better on the definitions task; the latter is likely to be due to a nonspecific effect of improved fluency (less AEDs and less seizures) since error rates did not differ. (Supported by the Epilepsy Foundation through the generous support of the Roger F. and Edna F. Evans Fund.) 1,2Carol J.Schramke,1April A.Valeri,1,2James P.Valeriano, and1,2Kevin M.Kelly(1Neurology, Allegheny General Hospital, Pittsburgh, PA; and2 Neurology, Drexel University College of Medicine, Philadelphia, PA ) Rationale: This study compares patients with verified epileptic seizures (ES) and non epileptic seizure like events (NESLE), based on information obtained in clinical interviews, to determine which historical variables most reliably distinguish between these groups. Methods: All patients who were admitted for video EEG monitoring at Allegheny General Hospital between December 1998 and December 2004 and had a report, from at least 24 hours of video EEG monitoring, that suggested either an epileptic seizure or a non epileptic event were included. All patients admitted for monitoring were seen for a clinical interview by the first author. Data were coded based on that clinical interview including whether or not patients reported (1) pending litigation, (2) pending application for disability, (3) marital discord, (4) an unstable work history, (5) history of working in healthcare, (6) significant abuse or psychosocial stress during childhood, (7) history of sexual abuse, (8) current family conflict, (9) history of antisocial behavior, (10) history of delinquincy in childhood, (11) family history of seizures, (12) family history of mental health problems, CFS, or fibromyalgia, (13) family history of alcohol abuse, (14) incontinence during events, (15) history of self injury during an event, (16) events during sleep, (17) psychotropic medication at time of evaluation, (18) that events are related to stress, (19) history of psychiatric hospitalization, (20) history of panic disorder, (21) history of other anxiety disorder, (22) history of depression, and (23) history of other psychiatric diagnosis. Data were subjected to chi square analysis to determine whether there were significant between group differences. Results: Of the 153 reports of monitoring available for review, 65 recorded seizures and 56 recorded NESLE. In the other cases patients did not have events or events were not clearly classified. There were significant between group differences in patient report of (1) marital discord, (2) significant abuse or psychosocial stress during childhood, (3) history of sexual abuse, (4) family history of mental health problems, CFS, or fibromyalgia, (5) family history of alcohol abuse, (6) psychotropic medication at time of evaluation, (7) history of psychiatric hospitalization, (8) history of panic disorder, (9) history of other anxiety disorder, (10) history of depression, and (11) history of other psychiatric diagnosis. Conclusions: Many variables previously suggested to distinguish between patients with ES and NEE were not found to be significantly different in our two patient groups. The variables that did differ in the two groups suggest patients with NESLE are more likely to report histories of significant stress and abuse during childhood, current isues with relationships, and psychiatric diagnoses and treatment. 1AlonSinai,1Piotr J.Franaszczuk, and1Nathan E.Crone(1 Neurology, The Johns Hopkins University, School of Medicine, Baltimore, MD ) Rationale: Lexical semantic judgments are expected to depend on modality‐specific, as well as amodal, lexical semantic processing. To verify the existence of these different components of lexical semantic processing, we used electrocorticographic (ECoG) recordings during a semantic relatedness task to measure event‐related cortical activation with high spatial and temporal resolution. Methods: Having undergone surgical implantation of subdural electrode grids for the treatment of intractable epilepsy, six native English speakers (15–43 years old, mean 30 y.o.; 3 female, all left hemisphere dominant for language) judged whether sequentially presented pairs of words were semantically related or not, responding with a forced choice button press. Time‐frequency analyses utilized matching pursuits to measure event‐related ECoG spectral responses with respect to a 1‐sec baseline preceding stimulus presentation. Word pairs were presented in either visual or auditory modalities during separate blocks. Event‐related changes in frequency‐specific signal energy were compared within subjects between conditions (visual/auditory; semantically related/non‐related). Results: Event‐related increases and decreases in ECoG signal energy were observed in a variety of frequency ranges, including increases in high gamma (>70 Hz) activity. Modality‐specific event‐related energy changes were observed in at least one recording site in all subjects. Modality‐independent energy changes were observed in 5 of the 6 subjects. In 4 subjects event‐related energy changes at some sites were significantly different for semantically related vs. unrelated word pairs. These findings were most prominent in left superior temporal gyrus, supramarginal gyrus, inferior frontal gyrus, and basal temporal cortex, as well as some of their right hemisphere counterparts. Conclusions: Lexical semantic processing occurs in both modality‐specific, as well as amodal, cortical networks, distributed across cortical language regions in the dominant hemisphere, as well as in homologous regions of the nondominant hemisphere. (Supported by NINDS RO1‐NS41598.) 1Erik K.St. Louis,1SeanMc Evoy,1Qian ChiShi, and1MatthewRizzo(1 Iowa Comprehensive Epilepsy Program, Department of Neurology, University of Iowa Carver College of Medicine and University of Iowa Hospitals and Clinics, Iowa City, IA; Division of Neuroergonomics, Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA; Division of Neuroergonomics, Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA; and Division of Neuroergonomics, Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA ) Rationale: Patients with epilepsy are at risk for automobile crashes. Cognitive effects of epilepsy and antiepileptic drugs (AEDs) may impair driving performance. Useful Field of View (UFOV) is a sensitive and specific predictor of automobile collisions. We analyzed UFOV in subjects with partial epilepsy. Methods: 20 partial epilepsy subjects (aged 21–61 years, mean = 41.5) and 50 neurologically normal controls (aged 24–56 years, mean = 39.3) participated. Epilepsy syndromes were temporal (n = 18; 12 had prior anterior temporal lobectomy) and extratemporal (n = 2). UFOV was assessed using the Visual Attention Analyzer, Model 3000 (Visual Resources, Inc.). UFOV Task 1 measures processing speed at central fixation. Task 2 analyzes divided attention between central and peripheral targets. Task 3 involves selective attention between a peripheral target and distracters. Task 4 is a more difficult discrimination task. The dependent measure is a threshold score (ms) for 75% correct target identification. Higher scores indicate poorer performance. UFOV Task scores were added to calculate a UFOV Total score for each subject. Results: UFOV scores were significantly higher on all UFOV tasks in subjects with partial epilepsy (Wilcoxon Rank Sum Test; see Table), indicative of impairments of processing speed, divided attention, and selective attention. Conclusions: UFOV scores are increased in subjects with partial epilepsy compared to neurologically normal individuals, suggesting a greater crash risk in individuals with partial epilepsy. Causes of impaired UFOV scores include reduced processing speed, divided and selective attention impairments, and mild superior quadrantic visual field deficits due to surgical lesions. Our future studies in drivers with epilepsy aim to further differentiate effects of seizures, AEDs, and lesions upon cognitive abilities critical to safe automobile driving. Useful field of view scores in partial epilepsy and neurologically normal subjectsEpilepsy Subjects Control SubjectsSample Size 20 (11F, 9M) 50 (25F, 25M)Useful Field of View (msec) Mean (SD) Mean (SD) p‐value UFOV Task 1 24.8 (36.6) 16.0 (0.00)  0.0214 UFOV Task 2 55.1 (75.4) 24.9 (31.7)  0.0008 UFOV Task 3 147.1 (101.5) 81.3 (48.5)  0.0001 UFOV Task 4 269.9 (96.2)  206.9 (76.8)   0.0075 UFOV Total Tasks 1–3 226.9 (193.8) 122.2 (76.5)  <0.0001 UFOV Total Tasks 1–4 496.8 (273.6) 329.1 (141.3)  0.0019SD: Standard Deviation.1Maria B.Viaggio,1Maria E.Fontela,1VeronicaDe Simone, and1Alfredo E.Thomson(1 Neurology Department, Hospital Frances, Buenos Aires, Argentina ) Rationale: Epileptic patients have an increased risk of psychiatric comorbidity causing considerable burden and impact on quality of life. Prevalence of psychotic disorders in epilepsy is between 2–9%. Psychosis is more often classified according to the chronologic relation between the psychotic episode and the preceding seizure, i.e., ictal, postictal or interictal psychosis. The aim of this study is to characterize the clinical features and to evaluate the prevalence of psychotic disorders in our epileptic population. Methods: Clinical records of 370 epileptic patients evaluated in our section between 2002 and 2004 were review. Patients who presented psychotic disorders were included for analysis. Patients MRI, EEG recordings, demographic and clinical data were analyzed. Patients with: psychosis antedating epilepsy, history of substance abuse, other neurological disorder or symptoms related to AEDs, were excluded. Results: Twenty‐six patients (7%) experienced psychosis. The mean age was 36 years old (SD:11.02) ‐ Ictal Psychosis: Three patients (11.53%). All had localization related epilepsy with complex partial seizures (CPS). Psychosis and EEG discharges stopped with AEDs.The mean time of epilepsy diagnosis was 2.3 years (SD: 00.57) ‐ Postictal psychosis: Seven patients (26.92%), 6 patients post status epilepticus and one post cluster of seizures. The mean interval between epilepsy and psychosis onset was 22.28 years (SD: 11.98). Five patients suffered CPS secondary to remote symptomatic epilepsy. Two patients had generalized seizures and idiophatic epilepsy. In all cases symptoms ceased within 7 days. ‐ Interictal psychosis: Twenty patients (76.92%). The mean interval between onset of epilepsy and psychosis was 21 years (SD: 11.02). Most patients had remote symptomatic CPS. Seventeen patients showed focal interictally epileptiform discharges on EEG. Conclusions: Prevalence of psychotic disorders in our study are in accordance with previous studies. Our data also support that psychosis might be associated with CPS and remote symptomatic epilepsy. Interictal and postictal psychosis appears to be related to longstanding epilepsy. Adequate treatment of psychotic disorders is as important as seizure control for epilepsy management. Detecting and treating psychiatric comorbidities is required to help patients to achieve their maximal functional state and improve their quality of life. REFERENCESKanner AM. Stagno S. Kotagel P. Postictal psychiatric events during prolonged video‐electroencephalographic monitoring studies . Arch Neurol 1996 ; 53 : 258 – 263 .Kanemoto K. Kawasaki J. Kawai I. Postictal psychosis: a comparison with acute interictal and chronic psychosis . Epilepsia 1996 ; 37 : 551 – 556 .Onuma T. Adachi N. Ishida S. , et al Prevalence and annual incidence of psychosis in patients with epilepsy . Epilepsia 1995 ; 36 ( suppl 3 ): S 218 .Kanner AM. Barry J. Depression and psychotic disorders associated with epilepsy. Are they unique Epilepsy Behav 2001 ; 2 : 170 – 186 .1Laura K.Vogtle,1RoyMartin, and1R. E.Faught(1 Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, AL; Department of Neurology, University of Alabama at Birmingham, Birmingham, AL; and Department of Neurology, University of Alabama at Birmingham, Birmingham, AL ) Rationale: A significant proportion of adults with epilepsy are over the age of 60 (Hauser, 1992). Due to health issues related to advancing age, epilepsy and side effects of AEDs, aspects of quality of life are a concern for this population. A comparison of quality of life issues between a sample of elderly with and without epilepsy is described. Methods: Thirty elderly adults 60 years of age and older without epilepsy (EA) (12 males, 17 females) were compared to a sample of 27 elderly adults with epilepsy (EAE) (14 males, 11 females). All subjects were living independently in the community. EA were older (M = 71.97 SD = 5.48) than EAE (M = 64.41 SD = 3.81). Inclusion criteria for EAE were a seizure occurrence within the last 12 months and seizure disorder not resulting from stroke or TBI. Quality of life was assessed using the Older Americans Resource Survey (Fillenbaum, 1988), a self‐report instrument containing 5 subscales (social resources, economic resources, mental health, physical health, ADL) and a cumulative score. Results: Three subscales of the OARS showed significantly lower scores for EAE; mental health, physical health, and ADL scores (see Table 1). Additionally, EAE were significantly more likely to be dependent on others for transportation (U = .001) and EA were more likely to have hearing impairments (U = .02). Conclusions: Assessment outcomes reveal poorer quality of life in EAE in the areas of mental and physical health and activities of daily living, in spite of the fact that the EAE sample was considerably younger than the EA comparison group. These findings underscore the need for further study regarding quality of life issues in EAE, particularly aspects of physical and mental health and their impact on a person's ability to manage personal care (ADL). Such findings may also reflect a need to provide careful follow‐up and education in aspects of care such as medication compliance with EAE. (Supported by Center for Disease Control and Prevention.) Older Americans Resources Survey ComparisonSubscale Mean Score SignificanceSocial Resources  EA  1.55 .097  EAE  1.93Economic Resources  EA  2.34 .39   EAE  2.11Mental Health  EA  1.90  .03*   EAE  2.37Physical Health  EA  2.72  .05*   EAE  3.19ADL  EA  1.55  .02*   EAE  2.07Cumulative rating scale  EA 10.14  .08   EAE 11.67*p < .05.1Robert T.Wechsler,2John J.Barry,2Kim D.Bullock,3Patrick D.MacLeamy, and1Robert S.Fisher(1Neurology, Stanford University Hospital and Clinics, Stanford, CA;2Psychiatry, Stanford University Hospital and Clinics, Stanford, CA; and3 PGSP‐Stanford Psy.D Consortium, Stanford University Hospital and Clinics, Stanford, CA ) Rationale: Psychogenic nonepileptic seizures (PNES) are commonly encountered during evaluations for refractory epilepsy. Treatment for this debilitating condition centers on various forms of psychotherapy. Group therapy may be an effective therapeutic strategy, particularly in combination with individual therapy. Outcome in therapeutic trials have focused mainly on measures of event frequency or quality of life, which can be influenced by comorbid physical, psychological, and social factors. Changes in the subjective quality of PNES in response to therapy have received relatively little attention. Methods: The authors devised a preliminary, retrospective study to assess the impact of group therapy in combination with individual therapy on subjective measures of PNES including frequency, intensity, duration, and semiology. Questionnaires focusing on subjective measures were completed by 7 of 10 participants in Psychodynamic Group Therapy (PDT) and 4 of 6 in Cognitive Behavioral Group Therapy (CBT). Participants had long‐standing history of refractory PNES. Results: Mean duration of participation was 16.7 months in PDT group and 6.4 months in CBT group. Two of 7 PGT respondents stopped having PNES. Of the 9 respondents who continued having PNES, 7 felt their events were less disabling, 6 reported improvement in frequency, 6 reported less intense events, 5 reported shorter events, 5 characterized events as less severe, 2 reported change in semiology, and 2 noted less cognitive impairment during events. Eight of 9 with persistent PNES had multiple event types. Five of these 8 reported a change in relative proportion of event types with decrease of more disabling events. Conclusions: This preliminary study reveals improvement in the subjective experience of PNES within the context of group therapy. Participants who continued to have PNES experienced fewer, less intense, and subjectively less disabling events. This preliminary retrospective study raises the possibility that measures of the subjective experience of PNES may be useful for assessing progress in psychotherapeutic interventions. Further similar analyses using validated tools and prospective designs may be of value. 1MichaelWesterveld,1Kimberly R.Stoddard,2John T.Langfitt,3WilliamBarr,1Dennis D.Spencer, and4Susan S.Spencer(1Neurosurgery, Yale University School of Medicine, New Haven, CT;2Neurology, University of Rochester, Rochester, NY;3Neurology, New York University (NYU), New York, NY; and4 Neurology, Yale University School of Medicine, New Haven, CT ) Rationale: Although there have been numerous previous studies reporting memory outcome following temporal lobectomy, these studies typically do not follow patients for periods greater than one‐two years after surgery. Consequently, little is known about long‐term (i.e., more than 2 years post‐surgery) cognitive outcome following temporal lobectomy. Variables that relate to outcome, particularly long‐term seizure control, have also not been studied. The current study reports on the verbal memory outcome for patients enrolled in a multi‐center, prospective epilepsy surgery outcome study. Methods: A total of 80 patients who had reached the 5 year post‐surgical date and for whom follow‐up memory data were available are included in this report. Patients were enrolled in the multicenter study of epilepsy surgery (MSES), and underwent neuropsychological testing as part of their pre‐surgical evaluation, follow‐up testing at two years post‐surgery, and again at 5 years following surgery. Neuropsychological evaluation included general cognitive ability (Wechsler Adult Intelligence Scale), and verbal memory testing (California Verbal Learning Test). Results: Neuropsychological testing at baseline revealed no significant pre‐operative differences in Verbal, Performance or Full Scale IQ scores between the right and left TL surgery groups. Interestingly, there was no significant difference in the baseline verbal memory testing between the right and left TL groups. Repeated measures ANOVA reveals a trend toward better verbal memory outcome among patients with at least one 3 year remission period (p = .07), regardless of side of surgery. There is no significant main effect for side of surgery, but there was a significant interaction between time, side of surgery, and seizure outcome. While patients who underwent successful right temporal lobectomy (defined as at least 3 year seizure free period during follow‐up) had the best verbal memory outcome, patients undergoing right temporal lobectomy that did not have a 3 year remission had the worst memory outcome, and were comparable to the left TL group without a 3 year remission. Post‐hoc analysis also revealed that 3 of the 4 groups declined between the 2 year and 5 year outcome points. Conclusions: These results reveal that patients undergoing temporal lobectomy continue to evidence evolving changes in cognitive function 5 years after surgery. Although seizure outcome is a key factor, other variables also play a role, including side of surgery and baseline level of function. These findings indicate that patients may remain vulnerable to verbal memory declines as long as 5 years following temporal lobectomy. (Supported by NIH Grant Number 2 R01 NS32375‐06.) 1,3David J.Williamson,2Daniel L.Drane,2Elizabeth S.Stroup,1,2AlanWilensky,2Mark D.Holmes, and2John W.Miller(1Scientific Affairs, Janssen Medical Affairs, LLC, Titusville, NJ;2School of Medicine, University of Washington, Seattle, WA; and3 Neurology, University of South Alabama, Mobile, AL ) Rationale: Recent investigations have demonstrated that the majority of patients with psychogenic nonepileptic seizures (PNES) perform in the invalid range on tests designed to detect valid effort on neurocognitive testing (Williamson et al., 2003, 2004). However, a small percentage of patients with video‐telemetry confirmed epilepsy also fail symptom validity testing (SVT), including some without evidence of somatoform disorder or apparent motivation to perform in a suboptimal manner. There are inconsistent findings about the extent to which recent epileptiform activity influences neurocognitive performance (Aldenkamp & Arends, 2004). Clinically, we noted that patients with epilepsy who experienced seizures within the past 24 hours seemed more likely to fail symptom validity testing. We investigated this matter in a more systematic fashion to determine the extent to which recent seizure activity may compromise the validity of neurocognitive findings. Methods: Sixty‐three patients referred for continuous video‐EEG monitoring for evaluation of uncontrolled seizures at the University of Washington were administered the Word Memory Test as part of a comprehensive epilepsy neuropsychological evaluation. Only patients classified on the basis of their ictal EEG recordings and behavioral presentation as experiencing epileptic seizures were included in the study. In order to screen out patients with known cognitive deficits severe enough to decrease the likelihood of normal performance on SVT, patients unable to live independently were excluded. Results: Of the patients who failed SVT, 75% had suffered a seizure within the preceding 24‐hour period. ROC analysis suggests that simply knowing that a patient had suffered a seizure within the preceding 24 hours significantly improves one's ability to predict whether they will fail SVT (p = .03). These findings appear to be particularly true for patients diagnosed with complex partial seizures: 3/8 patients with complex‐partial seizures with a right‐sided focus who had suffered a recent seizure failed (vs. 0/8 who had not seized), whereas 5/8 patients with a recent left‐sided focal seizure failed (vs. 0/8 who had not seized). Conclusions: Based upon these preliminary data, it appears that suffering a seizure within 24 hours of neurocognitive testing may place a sizeable proportion of patients with epilepsy at risk for failing SVT, particularly if a patient suffers from complex partial seizures. Given the demonstrated relationship between failed SVT and improbably poor scores on neurocognitive testing in epilepsy and other populations, this may have important implications for clinical decision‐making based upon such test results. 1Pezhman M.Zadeh,1Adriana E.Palade, and1John F.Brick(1 Neurology, West Virginia University, Morgantown, WV ) Rationale: Posterior Communicating Artery Wada for memory evaluation is rarely done. The presurgical internal carotid artery Wada for memory evaluation provides sufficient information in many patients with medically intractable epilepsy. We report five cases in which performance of posterior communicating artery Wada helped us evaluate the hippocampus involvement in memory function, after the Internal Carotid Artery WADA injection demonstrated that patients may be at risk for memory loss if mesiotemporal structures would be removed. Methods: In the five patients bilateral internal carotid artery injection of amobarbital was performed with concurrent EEG recording. Subsequently patients had language and memory evaluation done by Neuropsycology team. The evaluation of memory function suggested bihemispheric memory representation, with the concern that the patients may experience memory decline after ipsilateral resection of mesiotemporal structures.Additional testing with amobarbital injected in the ipsilateral posterior communicating artery supplying the hippocampus was done, with additional small amounts of amobarbital being needed until patient developed a visual field cut. Results: Clinically, patients were evaluated for development of homonymous hemianopsia which suggests adequate posterior communicating artery injection. In all of the cases the concurrent EEG recording showed minimal background slowing of the hemisphere being injected. Additional memory testing was performed and demonstrated good memory support in the remaining hemisphere not supplied by PCA and in the contralateral hemisphere therefore allowing safe resection of the tested hippocampus. Post‐surgical follow up with Neuropsychological testing did not demonstrate any memory impairment. Conclusions: Inconclusive bilateral carotid Wada testing does not disqualify the patients with intractable epilepsy from being a good candidate for surgical resection of mesiotemporal structures. Posterior communicating artery Wada is very useful in assessing involvement of hippocampus in memory function.