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Examination And Investigations

Neuropsychological investigation showed subnormal intelligence (Wechsler full-scale intelligence quotient (IQ) was 56), with corresponding verbal and performance scores (verbal IQ was 62 and performance IQ was 54). Beery tests for psychomotor development showed a psychomotor delay of about 3 years, a delay in language development, and symptoms of ADHD (especially attentional deficits and hyperactive behavior) and conduct disorders. There was evidence that the ADHD was a secondary symptom. During several periods, the sudden drops in alertness were observed. After such episodes, the symptoms of ADHD increased.

Definitions and Variations Learning Disability

The standard internationally accepted way of defining ID (also known as intellectual disability or mental retardation) in the International Statistical Classification of Diseases and Related Health Problems (ICD-10)1 is based on two main components low cognitive ability defined as an Intelligence Quotient (IQ) score of 70 and diminished social competence. Onset has to be during the developmental period. Intelligence Quotient is further used to differentiate four categories of severity (mild, moderate, severe, and profound). If IQ alone were used as the criterion,

Syndromes associated with learning differences

Reading compared with healthy controls, again despite normal intelligence and normal brain MRI 37 . Finally, a study of children with idiopathic epilepsy and normal-range intelligence quotient (IQ) had significantly lower academic achievement, IQ, memory and behaviour scores than their sibling controls 38 .

Origins of psychometry

Visitors and residents in nineteenth century London could attend an 'Anthropometric Laboratory' in South Kensington, and pay to have exact measurements made of their height, weight, breathing power, strength of pull and squeeze, colour sense and much else. This was the brainchild of Sir Francis Galton (1822-1911), a gentleman-scholar, explorer, meteorologist and cousin of Charles Darwin. Galton was interested in explaining the differences between individuals. He held views about the distribution of human abilities, and became convinced that heredity was of prime importance in defining them. He was mentor to Karl Pearson (1857-1936), whose name is well known to scientists for his significant contribution to the study of statistics, and who occupied the post of Galton Professor of Eugenics at University College London after Galton's death. Both Galton's and Pearson's views about the normal distribution of human abilities were influential in the subsequent design of intelligence quotient...

Crosssectional studies

Also, dependent variables, usually intelligence measures, can be treated differentially as we demonstrate by the following studies that are based on independent samples. In the first study we considered differences between an estimated measure of former or premorbid intelligence and the current performance in an intelligence test as a function of duration of epilepsy. This seems to be the only way to infer individually a cognitive decline using psychometric instruments during a single neuropsychological investigation. In the second study we directly related the duration of epilepsy with the current IQ test results. However, this approach is only appropriate for sample studies. Neuropsychological investigations of a patient frequently include so-called intelligence trace tests to estimate the former intelligence in order to compare it with current test results. Several studies have shown that most patients with cerebral lesions or early dementia are unimpaired in intelligence trace...

Special Consideration for Presurgical Evaluation in People with LD

The investigative process in patients with ID may be even more complicated than in those with normal intelligence. Vital to accurate seizure localization is the correlation between clinical features, imaging, and electroencephalograms (EEG). Patients with ID may not be as able as those with a higher IQ to give a detailed account of their seizure symptomatology, magnetic resonance imaging (MRI) may be difficult without a general anesthetic, and neuropsychological testing needs to take the low IQ into account.

Step Three Mandatory Investigations

AB undergoes a neuropsychological assessment, which reveals normal general cognitive ability (full scale intelligence quotient IQ 104), with mild verbal memory impairment. He also has a Wada test which lateralizes language to the left hemisphere. On testing of left-hemispheric memory (right ICA injection), AB correctly recalls 11 out of 12 objects, and on right-hemispheric testing (left ICA injection), he correctly recalls 12 out of 12 objects. Memory is equally good bilaterally, suggesting AB could have memory impairment following unilateral ATL if hippocampectomy is included. The finding of intact memory function bilaterally also supports the notion of a neocortical focus. Neuropsychological testing reveals mildly impaired verbal (but not visual) memory, which would suggest mild dysfunction of the left temporal region.

Should a Low IQ Be a Contraindication to Epilepsy Surgery

The first major multicenter study to examine this issue analyzed data retrospectively from over 1,000 adults who had undergone temporal lobe resective surgery in eight centers in the United States6 and had full pre- and postoperative neuropsychological assessments. Only 24 patients (2.3 ) had an IQ less than 70, highlighting the tendency for such patients to not receive resective surgical treatment. This study did show a relationship between preoperative IQ and seizure outcome, but the effect was modest. Indeed the remission rate in those with an IQ less than 70 was 54.2 , and was 73.2 for those with a borderline IQ level. This emphasizes that although a lower IQ may predict a slightly worse outcome in some, there are a significant proportion of patients who can derive great benefit. The poorest outcome in this study was in those with a low IQ who had a structural lesion other than hippocampal sclerosis. Several other small studies have also addressed this issue of preoperative IQ...

Neuropsychological Deterioration

All cases exhibit further, and often severe, decrease in function during the stage of ESES. The disturbances include a marked impairment of intelligence quotient (IQ), deterioration of language, temporo-spatial disorientation, behavioral changes (reduced attention span, hyperkinesis, aggressiveness, and difficulty in contact), and, rarely, psychotic states (Tassinari et al., 1985, 1992b). IQ was thoroughly investigated in 59 patients assembled during the Venice Colloquium and analytic interpretation of test and single subtest results was carried out (Mira et al., 1995). The data showed that ESES is associated with a disruption of all cognitive functions, but the impairment is sometimes greater in the field of logical-structural intelligence and sometimes in the field of infrastructural intelligence, possibly in relation to a previously different intellectual organization.

Epilepsy Surgery

This age group has been longitudinal evidence of improved developmental outcome following surgery and the relationship to seizure outcome. There is a lack of standardized measures that enables longitudinal follow-up of such children, and in particular comparator groups in whom surgery has not been performed. Studies therefore rely on parental report, which often refers to such parameters as increased awareness rather than definitive developmental gains 113 . In the very least, series suggest maintenance of developmental or intelligence quotient, which suggest a maintained developmental trajectory post-operatively, whereas in those who continue with seizures a slowed trajectory may be presumed, leading to a widening of the gap between individuals and their peers and therefore an apparent drop in IQ 120 . Further longitudinal studies are required to clarify this.

Patient background

In view of the common features that patients with interictal and postictal psychosis share, such as a comparatively long latent period between epilepsy and psychosis onset (longer than 10 years Table 9.4) and a close association with temporal lobe epilepsy, the prevailing view has been that interictal and postictal psychoses are probably similar (Savard et al., 1991). However, we have found that postictal and interictal psychoses differ in several fundamental demographic data. First, age at epilepsy onset was significantly younger in patients with interictal psychosis than in those with postictal psychosis. Second, the latent period between psychosis and epilepsy onset was still longer in postictal than interictal psychosis. Third, the proportion of those patients with reduced intelligence quotient (IQ) was significantly

Physical Examination

Mental retardation needs to be evaluated and this can be assessed using the intelligence quotient (IQ) system. IQ system is not watertight and a global examination by the physician is a must in order to have a clear impression. This has relevance as epilepsy and epilepsy syndromes related to prenatal and perinatal brain trauma is common in developing countries. The physical examination should consist of detailed neurological examination and examination of other systems. In most studies, authors rarely report the results of physical examination. In the study in 9 African countries, of the 1374 patients with epilepsy, only 58 were in good general status, 29 had an abnormal neurological examination, and 23 had mental retardation.9

Neurocognitive Risks

Clear evidence for the neurocognitive effects of intrauterine exposure to AEDs is difficult to obtain, since multiple influences on intellectual outcome must be taken into consideration in such studies. The most important influence on cognitive outcome in a child is the maternal intelligence quotient (IQ), and, secondarily, the social environment. Furthermore, children must be followed and evaluated years after birth. Several carefully performed studies have been performed to assess this risk.

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