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A valid Spanish neuropsychological battery for epilepsy and beyond
Lorna Myers, Ph.D. Northeast Regional Epilepsy Group Director of Clinical Neuropsychology
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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.
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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)
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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
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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.
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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.
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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).
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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.
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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: Left seizure onset: 25, right seizure onset: 14 All 39 had confirmed dominant left hemisphere (language functions).
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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 Feb;23(2): Epub 2011 Dec 22.
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Conclusion This study provides a viable option for US epilepsy centers where Spanish-speaking patients are being treated. A neuropsychological battery that is sensitive enough to be predictive of lateralization has potential use with other referral questions. This represents a concrete step towards implementing tests to Spanish speakers in a standardized manner and with representative norms
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