Publications by authors named "Elisabeth M S Sherman"

46 Publications

Multidimensional Malingering Criteria for Neuropsychological Assessment: A 20-Year Update of the Malingered Neuropsychological Dysfunction Criteria.

Arch Clin Neuropsychol 2020 Aug;35(6):735-764

Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.

Objectives: Empirically informed neuropsychological opinion is critical for determining whether cognitive deficits and symptoms are legitimate, particularly in settings where there are significant external incentives for successful malingering. The Slick, Sherman, and Iversion (1999) criteria for malingered neurocognitive dysfunction (MND) are considered a major milestone in the field's operationalization of neurocognitive malingering and have strongly influenced the development of malingering detection methods, including serving as the criterion of malingering in the validation of several performance validity tests (PVTs) and symptom validity tests (SVTs) (Slick, D.J., Sherman, E.M.S., & Iverson, G. L. (1999). Diagnostic criteria for malingered neurocognitive dysfunction: Proposed standards for clinical practice and research. The Clinical Neuropsychologist, 13(4), 545-561). However, the MND criteria are long overdue for revision to address advances in malingering research and to address limitations identified by experts in the field.

Method: The MND criteria were critically reviewed, updated with reference to research on malingering, and expanded to address other forms of malingering pertinent to neuropsychological evaluation such as exaggeration of self-reported somatic and psychiatric symptoms.

Results: The new proposed criteria simplify diagnostic categories, expand and clarify external incentives, more clearly define the role of compelling inconsistencies, address issues concerning PVTs and SVTs (i.e., number administered, false positives, and redundancy), better define the role of SVTs and of marked discrepancies indicative of malingering, and most importantly, clearly define exclusionary criteria based on the last two decades of research on malingering in neuropsychology. Lastly, the new criteria provide specifiers to better describe clinical presentations for use in neuropsychological assessment.

Conclusions: The proposed multidimensional malingering criteria that define cognitive, somatic, and psychiatric malingering for use in neuropsychological assessment are presented.
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http://dx.doi.org/10.1093/arclin/acaa019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7452950PMC
August 2020

Factor structure of the CNS Vital Signs computerized cognitive battery in youth with neurological diagnoses.

Child Neuropsychol 2019 10 24;25(7):980-991. Epub 2019 Jan 24.

f Department of Brain Health Program , Copeman Healthcare Centre , Calgary , Canada.

Computerized cognitive batteries, such as CNS Vital Signs (CNSVS), can provide valuable information in clinical and research settings. However, psychometric properties, especially in children and adolescents, remain relatively understudied. The aim of this study was to investigate the factor structure of CNSVS in children and adolescents with neurological diagnoses. Participants with neurological diagnoses ( = 280) age 7-19 years were assessed as part of their clinical care at a tertiary hospital. All participants received the full CNSVS computerized cognitive battery, which contains seven subtests designed to measure attention, executive functioning, psychomotor speed, and memory. Principal components analyses were used to examine factor structure. Scores from CNSVS subtests loaded onto a three-component solution and accounted for 46% of the variance. The three components were deemed to best represent (1) speed, (2) memory, and (3) inhibition, with subtest scores loading differently than the original 11 primary and secondary domain scores would have suggested. Although the CNSVS program generates numerous primary and secondary domain scores, a three-component solution represents a more parsimonious approach to interpreting performance on the CNSVS in youth with neurological diagnoses. Confirmation of this factor solution in other samples is warranted.
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http://dx.doi.org/10.1080/09297049.2019.1569609DOI Listing
October 2019

The WISC-V in children and adolescents with epilepsy.

Child Neuropsychol 2019 10 24;25(7):992-1002. Epub 2019 Jan 24.

g Copeman Healthcare Centre.

Despite its popularity in the neuropsychological evaluation of children, the utility of the Wechsler Intelligence Scale for Children - Fifth Edition (WISC-V) has not yet been investigated in children with epilepsy. Eighty clinically referred children and adolescents with epilepsy were administered the WISC-V as part of a comprehensive assessment and scores were compared to matched controls from the WISC-V standardization sample. tests compared WISC-V indices and subtests between patients and controls and Chi-square analyses compared the rates of low scores. Correlational analyses assessed the relationships between epilepsy severity variables (e.g., age of onset, duration of epilepsy, number of antiepileptic drugs, seizure frequency). All WISC-V composites and subtests were significantly lower in patients versus controls and the rate of low scores was higher in patients than controls for all composites and subtests with the exception of Figure Weights. The Working Memory Index and Processing Speed Index were most sensitive to impairment, while the Verbal Comprehension Index and Fluid Reasoning Index were least sensitive. Of the epilepsy severity variables, age of seizure onset and number of antiepileptic drugs were strong predictors of deficits, whereas seizure frequency was the weakest predictor. Importantly, no significant differences were seen in children with right hemisphere epilepsy versus left on the five WISC-V composites, though a trend was seen towards a lower Visual-Spatial Index in those with right-sided focal seizures.
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http://dx.doi.org/10.1080/09297049.2019.1571181DOI Listing
October 2019

Derivation of New Embedded Performance Validity Indicators for the Child and Adolescent Memory Profile (ChAMP) Objects Subtest in Youth with Mild Traumatic Brain Injury.

Arch Clin Neuropsychol 2019 Jun;34(4):531-538

Copeman Healthcare Centre, Calgary, Alberta, Canada.

Background: Development of an embedded performance validity test (PVT) is desired for visual memory tests. The goal of this study was to derive an embedded PVT for the Child and Adolescent Memory Profile (ChAMP) Objects visual memory subtest in youth with mild traumatic brain injury (MTBI).

Methods: Children and adolescents (N = 91; mean age = 14.9 years, SD = 2.2, range = 8-18) on average 25.2 weeks (SD = 15.4) post-MTBI were administered ChAMP Objects. Two stand-alone PVTs (Test of Memory Malingering and Medical Symptom Validity Test) were administered, which allowed for grouping into valid (zero failed stand-alone PVTs) and invalid (both stand-alone PVTs failed). Cutoff scores for invalid performance on ChAMP Objects and Objects Delayed were established using failure on two PVTs as the criterion.

Results: One in five youth (n = 19) failed both PVTs. Invalid performance was not associated with demographics or time since injury, but was significantly correlated with both ChAMP Objects (r = .53, p<.001) and Objects Delayed (r = -.63, p<.001). Area under the curve suggested adequate discrimination by Objects (.87) and excellent discrimination by Objects Delayed (.91). A cutoff scaled score of 5 or less on ChAMP Objects provided sensitivity of 58% for detecting invalid performance with 96% sensitivity. A cutoff scaled score of 5 or less on ChAMP Objects Delayed achieved sensitivity of 63% and specificity of 96%. Interpreting the two embedded PVTs simultaneously improved sensitivity to 79% with 93% specificity.

Conclusion: This study yields promising new embedded PVTs for the ChAMP Objects subtest with strong sensitivity and specificity for detecting invalid performance in youth with MTBI.
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http://dx.doi.org/10.1093/arclin/acy068DOI Listing
June 2019

Using the Memory Validity Profile (MVP) to detect invalid performance in youth with mild traumatic brain injury.

Appl Neuropsychol Child 2019 Oct-Dec;8(4):319-325. Epub 2018 Jul 2.

Copeman Healthcare Centre , Calgary , Alberta , Canada.

Performance validity tests (PVT) should be used when assessing youth with mild traumatic brain injury (MTBI). The goal of this study was to derive a new cutscore for determining invalid performance on the Memory Validity Profile (MVP) in youth with MTBI. Children and adolescents ( = 92; mean age =14.8 years,  = 2.3, range =8-18) on average six months ( = 3.6) post-MTBI were administered the MVP as part of their assessment. Two validated PVTs [Test of Memory Malingering (TOMM) and Medical Symptom Validity Test (MSVT)] were administered and used to group the sample into valid ( = 73, neither TOMM/MSVT failed) and invalid ( = 19, both TOMM/MSVT failed). New cutscores for the MVP to determine invalid performance in this sample were established using failure on both TOMM/MSVT as the criterion. MVP performance correlated significantly with failure on TOMM/MSVT. Youth with invalid performance had significantly lower MVP total scores and area under the curve was .80, suggesting good separation of groups. A cutscore of 31 or less on the MVP provided sensitivity of 63% for detecting invalid performance with 93% specificity. This study yields a promising new cutscore for the MVP that has good sensitivity and strong specificity for detecting invalid performance in youth with MTBI.
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http://dx.doi.org/10.1080/21622965.2018.1476865DOI Listing
February 2020

A new kid on the block: The Memory Validity Profile (MVP) in children with neurological conditions.

Child Neuropsychol 2019 05 6;25(4):561-572. Epub 2018 Jun 6.

e Brain Health Program , Copeman Healthcare Centre , Calgary , Canada.

Determining the validity of obtained data is an inherent part of a neuropsychological assessment. The purpose of this study was investigate the failure rate of the Memory Validity Profile (MVP) in a large clinical sample of children and adolescents with neurological diagnoses. Data were obtained from 261 consecutive patients (mean age = 12.0, SD = 3.9, range = 5-19) who were referred for a neuropsychological assessment in a tertiary care pediatric hospital and were administered the MVP. In this sample, 4.6% of youth failed the MVP. Mean administration time for the MVP was 7.4 min, although time to complete was not associated with failure rates. Failure rates were held relatively consistent at approximately 5% across age ranges, diagnoses, and psychomotor processing speed abilities. Having very low, below normal, or above normal intellectual abilities did not alter failure rate on the MVP. However, those with intellectual disability (i.e., IQ<70) had a higher fail rate at 12% on MVP Total Score, but only 6% on the MVP Visual portion. Failure rates on the MVP were associated with lower scores on memory tests. This study provides support for using the MVP in children as young as 5 years with neurological diagnoses.
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http://dx.doi.org/10.1080/09297049.2018.1477929DOI Listing
May 2019

Validity of a Computerized Cognitive Battery in Children and Adolescents with Neurological Diagnoses.

Arch Clin Neuropsychol 2018 Mar;33(2):247-253

Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.

Objective: Little is known about the validity of computerized cognitive batteries, such as CNS Vital Signs (CNSVS), in pediatric patients. The purpose of this study was to examine convergent and divergent validity of the CNSVS in a clinical pediatric sample with neurological diagnoses.

Method: Participants included 123 pediatric patients assessed in a tertiary care setting as part of clinical care. CNSVS (Memory, Psychomotor Speed, Reaction Time, Complex Attention, and Cognitive Flexibility domains, and a Neurocognition Index) and paper-and-pencil neuropsychological measures assessing learning, memory, processing speed, reaction time, attention, and executive functioning were administered.

Results: Most correlations between CNSVS domain scores and neuropsychological measures assessing similar constructs were medium in strength. With the exception of stronger correlations between psychomotor speed tests, correlations between tests of similar constructs were not significantly higher than those between dissimilar constructs.

Conclusions: These results provide support for validity of the CNSVS battery, but also caution that many abilities are inter-correlated.
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http://dx.doi.org/10.1093/arclin/acx067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6093387PMC
March 2018

Performance on the Test of Memory Malingering in children with neurological conditions.

Child Neuropsychol 2016 11;22(2):133-42. Epub 2014 Dec 11.

a Neurosciences Department (Brain Injury and Rehabilitation Programs), Alberta Children's Hospital , Calgary , AB , Canada.

Despite increasing interest in the use of performance validity tests with youth, relatively little is known about how children and adolescents with neurological diagnoses perform on these measures. The purpose of this study was to examine performance on the Test of Memory Malingering (TOMM) in a general pediatric neurologic sample. Data were obtained from 266 consecutive patients (mean age = 13.0, SD = 3.7, range = 5-18) referred for a neuropsychological assessment in a tertiary care pediatric hospital. As part of a broader neuropsychological battery, patients were administered the TOMM. In this sample, 94% of children passed the TOMM. Pass rate was 87% for 5-7 year-olds but was ≥ 90% for all other ages. Children with a history of stroke had the lowest pass rate (86%), with other diagnostic groups scoring ≥ 90%, including epilepsy, traumatic brain injury, and hydrocephalus. Lower TOMM performance was related to slower processing speed and weaker memory performance. The results support using the TOMM with children and adolescents who have neurological diagnoses. Caution may still be warranted when interpreting scores in those who are younger and/or who have more significant cognitive difficulty.
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http://dx.doi.org/10.1080/09297049.2014.986446DOI Listing
March 2016

Embedded validity indicators on CNS vital signs in youth with neurological diagnoses.

Arch Clin Neuropsychol 2014 Aug;29(5):422-31

Department of Physical Medicine and Rehabilitation, Harvard Medical School, Calgary, AB, Canada Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, MA, USA Copeman Healthcare Centre, Vancouver, BC, Canada.

Computerized screening measures can provide valuable information on cognition. However, determining the validity of obtained data is critical for interpretation. The purpose of this study was to examine the embedded validity indicators on the CNS Vital Signs battery in a sample of youth with neurological diagnoses. The sample included 275 children and adolescents (mean = 13.9, SD = 3.0) with neurological disorders. Six out of seven subtests and six of the nine domain scores on CNS Vital Signs had fewer than 5% of the sample flagged as invalid on the embedded indicators. However, the Shifting Attention Test and its derived domain scores had higher rates of being flagged. Patients with one or more flagged scores (18% of sample) were younger and had lower intellectual abilities, psychomotor speed, verbal memory, and performance on other validity tests. Compared to stand-alone validity tests, CNS Vital Signs embedded validity indicators had low sensitivity. More research is needed with the embedded indicators in youth.
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http://dx.doi.org/10.1093/arclin/acu029DOI Listing
August 2014

Reliability and variability of diffusion tensor imaging (DTI) tractography in pediatric epilepsy.

Epilepsy Behav 2014 Aug 10;37:116-22. Epub 2014 Jul 10.

Alberta Children's Hospital, 2888 Shaganappi Tr NW, Calgary, AB T3B 6A8, Canada; Alberta Children's Hospital Research Institute (ACHRI), Room 293, Heritage Medical Research Building, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada; Copeman Healthcare Centre, 400-628 12 Avenue SW, Calgary, AB T2R 0H6, Canada.

Background: Diffusion tensor imaging (DTI) tractography is useful for isolating white matter (WM) trajectories and exploring microstructural integrity. Tractography can be performed on atypical brain anatomy when landmarks are malformed or displaced but has been criticized for its subjectivity even when investigators have advanced anatomical knowledge. Also, little is known about the variability and reliability of tractography as a tool for assessing white matter damage in clinical populations such as children with pediatric epilepsy.

Methods: Children diagnosed with epilepsy [N=43, mean age=11.7 years, standard deviation=3.7 years, 53% male] underwent a DTI sequence (6 directions, 2×2×3 mm voxels). Tractography for six white matter tracts (anterior forceps, fornices, bilateral arcuate fasciculi, and bilateral anterior cingula) was conducted twice by two experienced tractographers. Percent coefficient of variation (CV; for measuring variability) and intraclass correlation coefficients (ICCs; for measuring reliability) were calculated for tract volume and diffusion variables (fractional anisotropy [FA], mean diffusivity [MD], axial diffusivity [AD] and radial diffusivity [RD]).

Results: Diffusion variables showed low variability (CV=2.7-8.8%) and very high reliability (ICC=.97-.99) except for limbic tracts [fornix (ICC=.75-.94); cingulum (ICC=.71-.98)]. Tract volume measurements showed high variability (CV=21.9-62.0%) and moderate reliability (ICC=.54-.99). Overall, tract volume measurements were much more variable and less reliable than diffusion characteristics. Limbic structures showed more variability compared with others.

Conclusions: This suggests that DTI tractography and resulting diffusivity variables can reliably inform on the integrity of WM structures in a clinical sample with pediatric epilepsy and highlights the importance of reporting reliability information in studies that aim to answer clinical questions about WM integrity.
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http://dx.doi.org/10.1016/j.yebeh.2014.06.020DOI Listing
August 2014

Memory and health-related quality of life in severe pediatric epilepsy.

Pediatrics 2013 Feb 14;131(2):e525-32. Epub 2013 Jan 14.

Alberta Children's Hospital, Neurosciences, 2888 Shaganappi Trail NW, Calgary, AB, Canada T3B 6A8.

Objectives: The purpose of this paper was to investigate the contributions of sociodemographic, neurologic, and neuropsychological variables to health-related quality of life (HRQoL) in children with epilepsy and high seizure burden. Focus was placed on the relationship between memory and HRQoL, which has not been previously investigated.

Methods: Ninety children with epilepsy receiving clinical care at a tertiary-level children's hospital were retrospectively identified. Primary assessment measures were verbal memory (California Verbal Learning Test-Children's Version) and HRQoL. Other neuropsychological variables included intellectual function, executive function, emotional and behavioral function, and adaptive function. Sociodemographic and neurologic variables were extracted from chart review.

Results: No significant correlations were found between HRQoL and sociodemographic or neurologic variables. Moderate correlations were found between neuropsychological variables and HRQoL. Emotional function (Child Behavior Checklist) and verbal memory (California Verbal Learning Test-Children's Version) emerged as significant predictor variables of HRQoL. Low verbal memory was associated with a twofold risk of low HRQoL, emotional and behavioral difficulty with a 10-fold risk, and the combination of emotional and behavioral difficulty and low verbal memory with a 17-fold risk.

Conclusions: Verbal memory and emotional and behavioral difficulty are associated with increased risk of low HRQoL, even when other important variables are considered in children with high seizure burden. The results reinforce the importance of neuropsychological assessment in clinical care in pediatric epilepsy and suggest important areas of focus for psychological intervention.
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http://dx.doi.org/10.1542/peds.2012-1428DOI Listing
February 2013

Wechsler Intelligence Scale for Children-fourth edition (WISC-IV) short-form validity: a comparison study in pediatric epilepsy.

Child Neuropsychol 2014 10;20(1):49-59. Epub 2012 Dec 10.

a Alberta Health Services and Alberta Children's Hospital Research Institute , Calgary , Alberta , Canada.

Purpose: The purpose of this article was to investigate the accuracy of the WISC-IV short forms in estimating Full Scale Intelligence Quotient (FSIQ) and General Ability Index (GAI) in pediatric epilepsy.

Methods: One hundred and four children with epilepsy completed the WISC-IV as part of a neuropsychological assessment at a tertiary-level children's hospital. The clinical accuracy of eight short forms was assessed in two ways: (a) accuracy within +/- 5 index points of FSIQ and (b) the clinical classification rate according to Wechsler conventions. The sample was further subdivided into low FSIQ (≤ 80) and high FSIQ (> 80).

Results: All short forms were significantly correlated with FSIQ. Seven-subtest (Crawford et al. [2010] FSIQ) and 5-subtest (BdSiCdVcLn) short forms yielded the highest clinical accuracy rates (77%-89%). Overall, a 2-subtest (VcMr) short form yielded the lowest clinical classification rates for FSIQ (35%-63%). The short form yielding the most accurate estimate of GAI was VcSiMrBd (73%-84%).

Conclusions: Short forms show promise as useful estimates. The 7-subtest (Crawford et al., 2010) and 5-subtest (BdSiVcLnCd) short forms yielded the most accurate estimates of FSIQ. VcSiMrBd yielded the most accurate estimate of GAI. Clinical recommendations are provided for use of short forms in pediatric epilepsy.
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http://dx.doi.org/10.1080/09297049.2012.741225DOI Listing
June 2014

Development of an online tool to determine appropriateness for an epilepsy surgery evaluation.

Neurology 2012 Sep 15;79(11):1084-93. Epub 2012 Aug 15.

Department of Clinical Neurosciences and Hotchkiss BrainInstitute, University of Calgary, Calgary, Alberta, Canada.

Objectives: Despite evidence that epilepsy surgery is more effective than medical therapy, significant delays between seizure intractability and surgery exist. We aimed to develop a new Web-based methodology to assist physicians in identifying patients who might benefit from an epilepsy surgery evaluation.

Methods: The RAND/UCLA appropriateness method was used. Clinical scenarios were developed based on eligibility criteria from previously published surgical series. Thirteen national experts rated the scenarios for their appropriateness for an epilepsy surgery evaluation based on published evidence. All scenarios were rerated after a face-to-face meeting following a modified Delphi process. Appropriate scenarios were rerated for necessity to determine referral priority.

Results: Of the final 2646 scenarios, 20.6% (n = 544) were appropriate, 17.2% (n = 456) uncertain, and 61.5% (n = 1626) inappropriate for a surgical evaluation. Of the appropriate cases, 55.9% (n = 306) were rated as very high priority. Not attempting AED treatment was always rated as inappropriate for a referral. Trial of 2 AEDs was usually rated as appropriate unless seizure-free or not fully investigated Based on these data, a Web-based decision tool (www.epilepsycases.com) was created.

Conclusions: Using the available evidence through 2008 and expert consensus, we developed a Web-based decision tool that provides a guide for determining candidacy for epilepsy surgery evaluations. The tool needs clinical validation, and will be updated and revised regularly. This rendition of the tool is most appropriate for those over age 12 years with focal epilepsy. The Rand/UCLA appropriate methodology might be considered in the development of guidelines in other areas of epilepsy care.
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http://dx.doi.org/10.1212/WNL.0b013e3182698c4cDOI Listing
September 2012

Detecting epilepsy-related cognitive problems in clinically referred children with epilepsy: is the WISC-IV a useful tool?

Epilepsia 2012 Jun 3;53(6):1060-6. Epub 2012 May 3.

Alberta Health Services and Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.

Purpose: The Wechsler Intelligence Scale for Children - Fourth Edition is the most widely used intelligence quotient (IQ) test in use today. However, despite numerous studies on IQ in childhood epilepsy, data exist almost exclusively from prior editions of the test, and no studies to date provide information on the sensitivity of specific WISC-IV scores (full-scale IQ [FSIQ], index, and subtest scores) to epilepsy-related cognitive impairments. The goal of this study was to determine the relative sensitivity of WISC-IV index and subscale scores in detecting cognitive problems in a group of clinically referred children with epilepsy compared to matched controls, and to define the relationship among WISC-IV scales, demographic factors, and epilepsy-related variables.

Methods: WISC-IV data for children with epilepsy and high seizure burden were obtained from the Alberta Children's Hospital (ACH) and the New York University Comprehensive Epilepsy Center (NYU), two tertiary care medical centers for pediatric epilepsy. All children were clinically referred and received a standard assessment including WISC-IV. Matched controls were obtained from the WISC-IV Canadian and American standardization samples.

Key Findings: WISC-IV scores from 212 children were included: 106 children with epilepsy (46 girls, 60 boys; mean age 11.0 years, standard deviation [SD] 3.1; parental education 14.5 years, SD 2.8), and 106 controls matched for age, gender, ethnicity, and parental education. Of the children with epilepsy, 44 had a clearly lateralized focus on electroencephalography (EEG) involving either the right or left hemisphere (26 left, 18 right). FSIQ for the epilepsy group was significantly lower than for controls, and 36.8% of children had IQs compatible with intellectual disability (FSIQ < 70), versus <1% of controls. In children with epilepsy, Working Memory and Processing Speed Index scores were lower than those for Verbal Comprehension and Perceptual Reasoning (p < 0.01). At the subtest level, scores for children with epilepsy were highest on visual and verbal subtests measuring reasoning skills such as Matrix Reasoning, and lowest on Coding (mean 5.93, SD 3.6). In terms of percentage of children on each subtest with low scores (i.e., scores below 2 SDs from the expected normative mean of 10), the Coding subtest identified the most children (28.3%) with low scores, and the Similarities subtest identified the fewest (16%). Later age at onset and shorter epilepsy duration were both correlated with higher WISC-IV FSIQ and index scores (r correlation coefficient values ranging from 0.36 to 0.44, p < 0.0001), and number of current and previous antiepileptic drug trials were both inversely correlated with FSIQ and index scores (r -0.27 to -0.47, all p-values < 0.01). Neither the FSIQ nor the index scores were significantly related to seizure frequency. A similar pattern was found for subtest scores. No differences in FSIQ, index scores, or subtest scores were found between children with left- and right-hemisphere seizure foci, or between those with positive or negative magnetic resonance imaging (MRI) findings.

Significance: The WISC-IV is sensitive to epilepsy-related cognitive problems in clinically referred children with high seizure burden, particularly problems relating to expressive verbal, working memory, and processing speed difficulties. Compared to healthy children, these children have a very high rate of cognitive difficulties as assessed by the WISC-IV. The usefulness of the WISC-IV in detecting cognitive deficits in children with milder forms of epilepsy remains to be determined.
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http://dx.doi.org/10.1111/j.1528-1167.2012.03493.xDOI Listing
June 2012

Systematic review and case series of neuropsychological functioning after epilepsy surgery in children with dysembryoplastic neuroepithelial tumors (DNET).

Epilepsy Behav 2012 Apr 2;23(4):481-6. Epub 2012 Mar 2.

Alberta Health Services, Canada.

Rationale: The purposes of this study were to 1) conduct a review of neuropsychological (NP) outcomes after epilepsy surgery for DNET and 2) present pre/post-surgical NP results from a series of children with DNET.

Methods: First, a systematic literature review was conducted with specific inclusion criteria. Second, a review of DNET surgical patients seen at two tertiary-care hospitals using reliable change methods of NP functioning was conducted.

Results: Of 300 citations retrieved, 7 studies met criteria. Studies reported low average to average pre-surgical IQ. Engel Class I outcome was approximately 85%.

Case Series: Thirteen children completed pre/post-surgical NP assessments. Pre-surgically, children demonstrated low average to average functioning. Post-surgically, few patients showed reliable change. One-third of children demonstrated psychological improvement.

Conclusions: NP outcome following DNET has not been well-described. Children with DNET demonstrate low average to average NP functioning pre-surgically, good seizure outcome, and stable NP functioning post-surgically.
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http://dx.doi.org/10.1016/j.yebeh.2011.12.011DOI Listing
April 2012

Computerized neuropsychological testing to rapidly evaluate cognition in pediatric patients with neurologic disorders.

J Child Neurol 2012 Aug 30;27(8):982-91. Epub 2012 Jan 30.

Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada.

Computerized neuropsychological tests represent a viable method for rapidly screening cognition. The purpose of this study was to explore performance on the CNS Vital Signs in a large pediatric neurology sample. Participants included 166 neurology patients (mean age, 13.0 years; standard deviation, 3.2) and 281 controls (mean age, 13.2 years; standard deviation, 3.2) between 7 and 19 years. The neurology sample performed significantly worse on all domain scores and nearly all subtest scores. Cohen d effect sizes were small to medium for verbal memory (d= 0.44), visual memory (d= 0.40), and reaction time (d= 0.48) and very large for psychomotor speed (d= 1.19), complex attention (d = 0.94), cognitive flexibility (d = 0.94), and the overall composite score (d = 1.08). Using the criterion for cognitive impairment of 2 or more scores ≤5th percentile, 36.6% of the neurology sample was identified as having an uncommon cognitive profile. This is the first study to demonstrate the performance of pediatric patients with neurologic disorders on CNS Vital Signs.
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http://dx.doi.org/10.1177/0883073811430863DOI Listing
August 2012

Utility of TOMM Trial 1 as an indicator of effort in children and adolescents.

Arch Clin Neuropsychol 2012 Jan 31;27(1):23-9. Epub 2011 Oct 31.

Alberta Children' s Hospital and University of Calgary, Calgary, Alberta, Canada.

Although measuring test compliance in a pediatric neuropsychological evaluation is important, increasing demands on clinicians' time and the need for efficiency during assessments may make it difficult to routinely include effort testing. This study investigated whether performance on Trial 1 of the Test of Memory Malingering (TOMM) is predictive of overall performance in children and adolescents with neurological disorders. Participants included 53 children and adolescents between six and 19 years (mean age = 12.4, SD = 4.1) who were followed through a neurology clinic at a tertiary care hospital. Several cutoff scores were examined, with the goal of maximizing positive predictive (accurate detection of failure on the TOMM) and negative predictive (accurate detection of passing the TOMM) values. Every participant who scored ≥36 on Trial 1 (n = 50) went on to pass the TOMM. This study is the first step in providing evidence that performance on Trial 1 might be used as a quick screening measure of overall performance on the TOMM in children and adolescents. Further research on this topic is warranted.
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http://dx.doi.org/10.1093/arclin/acr086DOI Listing
January 2012

Assessment of executive functioning in childhood epilepsy: the Tower of London and BRIEF.

Child Neuropsychol 2012 3;18(4):404-15. Epub 2011 Oct 3.

Department of Neurology, Comprehensive Epilepsy Center, New York University, New York, USA.

Children and adolescents with epilepsy are known to demonstrate executive function dysfunction, including working memory deficits and planning deficits. Accordingly, assessing specific executive function skills is important when evaluating these individuals. The present investigation examined the utility of two measures of executive functions-the Tower of London and the Behavioral Rating Inventory of Executive Functioning (BRIEF)-in a pediatric epilepsy sample. Ninety clinically referred children and adolescents with seizures were included. Both the Tower of London and BRIEF identified executive dysfunction in these individuals, but only the Tower of London variables showed significant relations with epilepsy severity variables such as age of epilepsy onset, seizure frequency, number of antiepileptic medications, etc. Further, the Tower of London and BRIEF variables were uncorrelated. Results indicate that objective measures of executive function deficits are more closely related to epilepsy severity but may not predict observable deficits, as reported by parents. Comprehensive evaluation of such deficits, therefore, should include both objective measures as well as subjective ratings from caregivers.
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http://dx.doi.org/10.1080/09297049.2011.613812DOI Listing
October 2012

Measuring patient satisfaction following epilepsy surgery.

Epilepsia 2011 Aug 18;52(8):1409-17. Epub 2011 Jul 18.

Department of Clinical Neurosciences, Alberta Health Services, Calgary, Alberta, Canada.

Purpose: To systematically review primary research examining patient satisfaction with epilepsy surgery in order to obtain evidence-based estimates of this surgical outcome; to assess methods used to measure epilepsy surgery satisfaction, overall epilepsy surgery satisfaction ratings, and predictors of epilepsy surgery satisfaction.

Methods: Systematic review of published studies in English up to June 2009, focusing on patient satisfaction with all types of epilepsy surgery in patients of all ages. We excluded studies that focused on satisfaction with epilepsy treatment in general, on quality of life without specific exploration of patient satisfaction with surgery, and on satisfaction with the process of health care delivery, rather than with surgery and its outcomes.

Key Findings: Eight studies met inclusion criteria. Satisfaction was assessed using one or more global questions. Four epilepsy surgery satisfaction question content patterns emerged: (1) satisfied or dissatisfied, (2) perceived success or failure, (3) overall positive or negative impact, and (4) willingness to repeat surgery or regretting surgery. Overall 71% were satisfied; 64% considered it a success; it had a positive effect for 78%; and 87% would repeat surgery. Seizure freedom was the most common predictor of epilepsy surgery satisfaction, whereas postoperative neurologic deficit predicted dissatisfaction.

Significance: Patient satisfaction with interventions is an important aspect of patient-centered care, but it has received little attention in epilepsy surgery. Future research is required to develop and validate epilepsy surgery satisfaction tools. We provide preliminary guiding principles for measuring satisfaction after epilepsy surgery.
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http://dx.doi.org/10.1111/j.1528-1167.2011.03160.xDOI Listing
August 2011

Social skills in children with epilepsy: how do they compare to healthy and chronic disease controls?

Epilepsy Behav 2011 Jul 13;21(3):238-41. Epub 2011 May 13.

Division of Child Neurology, Ohio State University College of Medicine, Columbus, OH 43205, USA.

Studies have shown poor long-term social outcomes in adults with childhood-onset epilepsy. Our goal was to compare social skills in children with epilepsy with those of healthy and chronic disease controls. Children (8-16 years) with epilepsy (n=59) were compared with age- and gender-matched children with chronic kidney disease (n=40) and healthy controls (n=41). Parents completed the Social Skills Rating System (SSRS) questionnaire. Children with epilepsy had significantly poorer SSRS total scores when compared with healthy controls (P=0.002); however, their scores did not differ from those of children with chronic kidney disease (P=0.52). Children with epilepsy were less cooperative (P=0.02), less assertive (P=0.004), and less responsible (P=0.05) and displayed poorer self-control (P=0.005) than healthy controls. Our results suggest that having a chronic disease plays a role in the social functioning of children with epilepsy. The impact of epilepsy itself on social functioning should be further elucidated through detailed prospective assessments over time.
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http://dx.doi.org/10.1016/j.yebeh.2011.03.033DOI Listing
July 2011

Neuropsychological outcomes after epilepsy surgery: systematic review and pooled estimates.

Epilepsia 2011 May 22;52(5):857-69. Epub 2011 Mar 22.

Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.

Purpose: Epilepsy surgery is a safe surgical procedure, but it may be associated with cognitive changes. Estimates of the risk of decline in specific neuropsychological domains after epilepsy surgery would assist surgical decision making in clinical practice. The goal of this study was to conduct a systematic review to derive pooled estimates of the rate of losses and gains in neuropsychological functions after epilepsy surgery, using empirically based methods for quantifying cognitive change.

Methods: An extensive literature search using PubMed, EmBase, and the Cochrane database was conducted, yielding 5,061 articles on epilepsy surgery, with 193 on neuropsychological outcomes (IQ, memory, language, executive functioning, attention, and subjective cognitive changes).

Key Findings: Of these, 23 met final eligibility criteria, with 22 studies involving temporal surgery only. Key aspects of inclusion criteria were N ≥ 20 and use of reliable change index or standardized regression-based change estimates. In addition to the proportion of patients experiencing losses and gains in each individual test, a single pooled estimate of gains and losses for each cognitive domain was derived using a random effects model. Weighted estimates indicated a risk to verbal memory with left-sided temporal surgery of 44%, twice as high as the rate for right-sided surgery (20%). Naming was reduced in 34% of left-sided temporal patients, with almost no patients with gains (4%). Pooled data on IQ, executive functioning, and attention indicated few patients show declines post surgery, but a substantial rate of improvement in verbal fluency with left-sided temporal surgery (27%) was found. Self-reported cognitive declines after epilepsy surgery were uncommon, and gains were reported in some domains where losses were found on objective tests (i.e., verbal memory and language). Variations in surgical techniques did not appear to have a large effect on cognitive outcomes, except for naming outcomes, which appeared better with more conservative resections. Sensitivity to postoperative changes differed across visual memory tests, but not verbal memory tests. Few conclusions could be made regarding cognitive risks and benefits of extratemporal epilepsy surgery, or of epilepsy surgery in children.

Significance: In sum, epilepsy surgery is associated with specific cognitive changes, but may also improve cognition in some patients. The results provide base rate estimates of expected cognitive gains and losses associated with epilepsy surgery that may prove useful in clinical settings.
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http://dx.doi.org/10.1111/j.1528-1167.2011.03022.xDOI Listing
May 2011

Psychiatric outcomes of epilepsy surgery: a systematic review.

Epilepsia 2011 May 22;52(5):880-90. Epub 2011 Mar 22.

Department of Psychology, University of Calgary, Calgary, Alberta, Canada.

Purpose: The objective of this systematic review was to identify: (1) prevalence and severity of psychiatric conditions before and after resective epilepsy surgery, (2) incidence of postsurgical psychiatric conditions, and (3) predictors of psychiatric status after surgery.

Methods: A literature search was conducted using PubMed, EmBase, and the Cochrane database as part of a larger project on the development of an appropriateness and necessity rating tool to identify patients of all ages with potentially resectable focal epilepsy. The search yielded 5,061 articles related to epilepsy surgery and of the 763 articles meeting the inclusion criteria and reviewed in full text, 68 reported psychiatric outcomes. Thirteen articles met the final eligibility criteria.

Key Findings: The studies demonstrated either improvements in psychiatric outcome postsurgery or no changes in psychiatric outcome. Only one study demonstrated deterioration in psychiatric status after surgery, with higher anxiety in the context of continued seizures post-surgery. One study reported a significantly increased rate of psychosis after surgery. The two main predictors of psychiatric outcome were seizure freedom and presurgical psychiatric history. De novo psychiatric conditions occurred postsurgery at a rate of 1.1-18.2%, with milder psychiatric issues (e.g., adjustment disorder) being more common than more severe psychiatric issues (e.g., psychosis).

Significance: Overall, studies demonstrated either improvement in psychiatric outcomes postsurgery or no change. However, there is a need for more prospective, well-controlled studies to better delineate the prevalence and severity of psychiatric conditions occurring in the context of epilepsy surgery, and to identify specific predictors of psychiatric outcomes after epilepsy surgery.
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http://dx.doi.org/10.1111/j.1528-1167.2011.03014.xDOI Listing
May 2011

Parents report more ADHD symptoms than do teachers in children with epilepsy.

Epilepsy Behav 2010 Nov;19(3):428-35

Alberta Children's Hospital, Calgary, Alberta, Canada.

Children with epilepsy have a high rate of attention deficit/hyperactivity disorder (ADHD), yet parent-teacher agreement on ADHD symptoms in epilepsy is unknown despite the need to assess symptoms across settings such as home and school. Parent-teacher agreement on ADHD ratings was investigated in 208 children with epilepsy (mean age = 11.2, SD = 3.6) using the ADHD Rating Scale IV, along with associations with demographic variables, epilepsy severity, adaptive level, and quality of life. Children were four times more likely to be identified as having clinically elevated ADHD symptoms when parent ratings were the benchmark versus teachers. Agreement was highest for children with more severe ADHD symptoms, for the Hyperactivity-Impulsivity dimension of behavior, and for children with broadly normal adaptive behavior. Higher parent and teacher ADHD ratings were related to reduced quality of life, but unrelated to epilepsy severity. Exclusive reliance on parent or teacher ratings may yield variable rates of ADHD symptoms in children with epilepsy.
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http://dx.doi.org/10.1016/j.yebeh.2010.08.015DOI Listing
November 2010

Healthy children get low scores too: prevalence of low scores on the NEPSY-II in preschoolers, children, and adolescents.

Arch Clin Neuropsychol 2010 May 22;25(3):182-90. Epub 2010 Feb 22.

Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada.

Knowing the prevalence of low test scores in healthy people is valuable for clinical interpretation of neuropsychological performance because it reduces the likelihood of over-diagnosing cognitive deficits. Base-rate information on adult batteries has flourished recently but is relatively unknown for pediatric tests. The purpose of this paper is to present the base rates of low scores for a pediatric neuropsychological battery, the NEPSY-II. Participants included 1,200 healthy preschoolers, children, and adolescents between 3 and 16 years of age from the NEPSY-II standardization sample. Measures included subtests from the attention and executive functioning, language, learning and memory, and visuospatial processing domains, organized to yield a 1- and 2-hr battery with optimal reliability. Analyses were conducted for three age groups (3-4, 5-6, and 7-16 years) and stratified by the level of parental education (
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http://dx.doi.org/10.1093/arclin/acq005DOI Listing
May 2010

Identifying cognitive problems in children and adolescents with depression using computerized neuropsychological testing.

Appl Neuropsychol 2010 Jan;17(1):37-43

Neurosciences, Alberta Children's Hospital, Calgary, Alberta, Canada T3B 6A8.

Depression in children and adolescents can negatively impact cognitive functioning, social development, and academic performance. The purpose of this study was to determine whether a computerized battery of neuropsychological tests could detect neurocognitive difficulties in children and adolescents with depression. Participants included 30 children and adolescents between the ages of 9 and 17 years (M = 14.6, SD = 2.1) with a clinical diagnosis of depression. Healthy control participants were individually matched on age, education, sex, race, primary language, handedness, and self-reported computer familiarity. All participants completed the Central Nervous System Vital Signs computerized battery. This battery of seven tests yields 23 test scores and 5 domain scores (Memory, Psychomotor Speed, Reaction Time, Complex Attention, and Cognitive Flexibility). Children and adolescents with depression performed worse on the Memory (Cohen's d = .43) and Complex Attention domains (d = .58) than matched controls. On the individual test scores, children and adolescents with depression performed worse on delayed verbal memory (d = .63), delayed visual memory (d = .34), measures of reaction time (d = .34-.53), and accuracy/inhibition on complex attention tasks (d = .49-.65). When considering the five domain scores simultaneously, children and adolescents with depression were more likely to have two or more scores at or below the 5th percentile (p = .05). Children and adolescents with depression have problems with reduced processing speed, memory for verbal information, and executive functioning on this computerized battery of tests, which represents a feasible method for neuropsychological screening.
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http://dx.doi.org/10.1080/09084280903526083DOI Listing
January 2010

Maximizing quality of life in people living with epilepsy.

Can J Neurol Sci 2009 Aug;36 Suppl 2:S17-24

Alberta Children's Hospital and University of Calgary, Calgary, AB, Canada.

Improving quality of life is now seen as a major challenge facing people with epilepsy. Can research on human happiness shed light on why it is that the wellbeing and quality of life of people with epilepsy is worse than the condition's clinical and medical prognosis would predict? Empirical research on subjective wellbeing and happiness in healthy people indicates that there are a small number of key factors that are related to wellbeing, including employment, social interactions, family relationships, and experiential activities. This paper reviews these crucial components of wellbeing, discusses how each factor applies to people living with epilepsy, and identifies epilepsy-specific factors such as stigma and comorbidity that contribute to low quality of life. Lastly, this review provides a list of program-based approaches to improving quality of life, as well as practical recommendations for use by practitioners and people living with epilepsy.
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August 2009

Are children with epilepsy at greater risk for bullying than their peers?

Epilepsy Behav 2009 Aug 23;15(4):500-5. Epub 2009 Jul 23.

Division of Child Neurology, Ohio State University, College of Medicine, 700 Children's Drive, Columbus, OH 43205, USA.

The primary goal of this study was to determine the prevalence of bullying in children with epilepsy compared with their healthy peers and peers with chronic disease. Children with epilepsy were compared with healthy children and a cohort of children with chronic kidney disease (CKD). The following self-report questionnaires were completed: Revised Olweus Bully/Victim, Piers-Harris Self-Concept Scale, Revised Child Manifest Anxiety Scale, Child Depression Index, and Social Skills Rating System. Children with epilepsy were more frequently victims of bullying (42%) than were healthy controls (21%) or children with CKD (18%) (P = 0.01). Epilepsy factors such as early age at seizure onset, seizure type, and refractory epilepsy were not found to be predictors of victim status. Surprisingly, poor social skills, increased problem behaviors, poor self-concept, depression, and anxiety did not correlate with bully victim status. The relatively high prevalence of bullying behaviors in these children is concerning and, from a clinical standpoint, requires greater research specifically addressing peer relationships and consideration of the implementation of anti-bullying measures and coping strategies for children with epilepsy.
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http://dx.doi.org/10.1016/j.yebeh.2009.06.015DOI Listing
August 2009

Healthy children and adolescents obtain some low scores across a battery of memory tests.

J Int Neuropsychol Soc 2009 Jul;15(4):613-7

Neurosciences Program, Alberta Children's Hospital, 2888 Shaganappi Trail NW, Calgary, Alberta T3B 6A8, Canada.

Obtaining some low memory scores across a battery of tests is common. The purpose of this study was to examine the prevalence of low scores on the Children's Memory Scale (CMS). Participants were 1000 children and adolescents between 5 and 16 years of age from the CMS standardization sample. Consistent with research on other batteries, having some low memory scores is common in healthy children and adolescents. The prevalence of low memory scores also increases with lower intelligence. Clinicians should be cautious when interpreting isolated low memory scores as sole evidence of memory impairment. Knowing the prevalence of low scores as a supplement to clinical judgment should reduce the likelihood of misdiagnosing memory problems.
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http://dx.doi.org/10.1017/S1355617709090651DOI Listing
July 2009

Maternal depression: the cost of caring for a child with intractable epilepsy.

Pediatr Neurol 2008 Dec;39(6):418-22

Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada.

The aims of this study were to: (1) determine the prevalence of depression and sleep disruption in mothers of children with intractable epilepsy, and (2) assess which family factors and neurologic/behavioral characteristics of a child with epilepsy correlate with maternal depression. Mothers of children aged 2-18 years with intractable epilepsy completed a Beck Depression Inventory and Pittsburgh Sleep Questionnaire for themselves, and a Child Behavior Checklist, Attention Deficit Hyperactivity Disorder Rating Scale, and Scale of Independent Behavior-Revised for their child. Charts were reviewed for age at seizure onset, seizure frequency and type, number of failed treatments, and presence of autism. Mothers were queried regarding family type, educational level, income, and number of children in the home. Fifty-two of 80 (65%) eligible mothers returned completed questionnaires. Forty-five percent demonstrated elevated scores on the depression questionnaire, with 25% in the moderate/severely depressed range. Sleep disruption was reported in 67%. Maternal depression correlated with high attention deficit and problem behaviors in children, but not with most epilepsy-related variables, autism, adaptive delay, or family income.
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http://dx.doi.org/10.1016/j.pediatrneurol.2008.08.007DOI Listing
December 2008

Anxiety and depressive symptoms in children presenting with a first seizure.

Pediatr Neurol 2008 Oct;39(4):236-40

Division of Pediatric Neurology, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada.

We investigated whether children presenting with a first seizure experienced anxiety and depressive signs. Children (aged 7-17 years) with a first unprovoked afebrile seizure participated. These patients (mean age, 12 +/- 2.7 years S.D.; 14 female/8 male) completed the Revised Child Manifest Anxiety Scale (n = 22) and Children's Depression Inventory (n = 20). Scores were compared with: (1) published norms, and (2) control patients with new medical signs. Compared with the published norms, children reported greater total anxiety (P < 0.02), worry/oversensitivity (P < 0.008), and social concerns/concentration (P < 0.005). However, compared with the control patients, no difference was seen between groups. Total Children's Depression Inventory scores were higher than for published norms (P = 0.05) and control patients (P = 0.04). Children with a first seizure reported greater interpersonal problems (P < 0.01), ineffectiveness (P < 0.03), and negative self-esteem (P < 0.05) than published norms, and increased negative mood (P = 0.04), ineffectiveness (P = 0.04), anhedonia (P = 0.05), and negative self-esteem (P = 0.05) than control patients. Our results suggest that anxiety may be related to an illness or to the hospital experience itself, whereas depressive signs may be a comorbidity present at time of presentation of the first seizure. If a larger cohort substantiates these results, early screening for these signs would be of clinical importance.
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http://dx.doi.org/10.1016/j.pediatrneurol.2008.07.005DOI Listing
October 2008