A valid Spanish neuropsychological battery for epilepsy and beyond Lorna Myers, Ph.D. Northeast Regional Epilepsy Group Director of Clinical Neuropsychology

Why are we talking about epilepsy? 1 out of 100 people in the world have epilepsy, 60 million worldwide. >CP, PD, MS combined. Almost 500,000 American Latinos have epilepsy. Latinos: Neurocysticercosis, TBI, inadequate maternal-fetal care, lack of insurance, barriers to health care, stigma , ignorance Older age of diagnosis and poor medical care leads to greater cognitive deficits in our Latino patients by the time we see them. Stigma: punishment, possession, secret, MR, unable to marry, have children.

How important is neuropsychological testing in Epilepsy? Establish cognitive baselines against which medication changes can be compared. Treatment recommendations SURGICAL DECISIONS Assessment of post-surgical outcome Research: unapproved medication cognitive profiles and specific syndrome cognitive profiles. High overlap between epi and psych: depression is much higher than general population. Latinos higher depression rates (immigration, distance from family, poverty)

Neuropsychological testing in epilepsy for English-speakers Uses a comprehensive battery, given by a Psychologist who speaks the patients’ language, in a standardized procedure with validated tests and representative norms. IQ Language Memory-verbal and visual Attention/executive Motor Visual perceptual Personality and mood

Neuropsychological testing of Spanish patients with epilepsy Many of the neuropsychologists do not speak Spanish. Use of interpreters who translate tests during the testing session In-house translations of tests Reliance on “visual” tests and little or no language tests Use of non-representative norms (Anglo norms) In sum: an incomplete battery, given by a Psychologist who does not speak the patients’ language, in a non-standardized procedure with non-validated tests and unrepresentative norms.

Presurgical testing Utility: Lateralization (dominant and non dominant hemisphere-right and left) Localization (to a specific lobe-frontal, parietal, temporal, occipital) Determination of how “aggressive” surgery can be given the patient’s presurgical cognitive status.

Neuropsychological Screening Battery for Hispanics (NeSBHIS) Ponton et al (1996) reported on development of a battery with representative norms. Assesses: Language Visual-constructional and perceptual skills Verbal and visual memory Attention and executive functions Grooved pegboard for fine motor function Provides norms based on age and educational background (<10, >11). (n=300).

Batería III (Woodcock-Muñoz) Muñoz Sandoval et (2004): provides a measure of broad global cognitive functioning based on 20 subtests. Brief Intelligence Assessment (BIA) based on 3 subtests. Verbal Comprehension: Vocabulary, synonyms, antonyms, verbal reasoning. Concept Formation: visually-based logical reasoning Visual Matching: Perceptual and visuo-motor speed Normed on 8818 individuals.

A neuropsychological battery for Spanish speakers with epilepsy Administered by Spanish-speaking neuropsychologists on outpatient bases. n= 39 South America: 17, Central America: 12, Caribbean: 10 15 males, 24 females Mean Age: 47.7, +14.1, mean education: 9.4 +3.6 Left seizure onset: 25, right seizure onset: 14 All 39 had confirmed dominant left hemisphere (language functions).

Results Patients with left hemisphere focus performed significantly worse on: BIA Verbal Comprehension, Ponton-Satz Boston Naming Test, dominant hand on Grooved Pegboard, BIA Visual Matching. The Ponton-Satz BNT had predictive value in determining laterality of dysfunction. Replication is needed with larger samples. Lancman G, Vazquez-Casals GA, Perrine K, Feoli E, Myers L. (2012) Predictive value of Spanish neuropsychological testing for laterality in patients with epilepsy. Epilepsy Behav. 2012 Feb;23(2):142-5. Epub 2011 Dec 22.

Conclusion This study provides a viable option for US epilepsy centers where Spanish-speaking patients are being treated. A neuropsychological battery that is sensitive enough to be predictive of lateralization has potential use with other referral questions. This represents a concrete step towards implementing tests to Spanish speakers in a standardized manner and with representative norms