William B. Barr, Ph.D.

Measuring brain electrical activity to track recovery from sport-related concussion
Barr, William B; Prichep, Leslie S; Chabot, Robert; Powell, Matthew R; McCrea, Michael
2012 ;26(1):58-66, Brain injury
PRIMARY OBJECTIVE: To follow recovery from concussion in a sample of athletes using an electroencephalographic (EEG) index of quantitative brain activity developed previously on an independent Emergency Department (ED) sample of head-injured subjects with traumatic brain injury. METHODS AND PROCEDURES: EEG recordings from five frontal electrode sites were obtained on 59 injured athletes and 31 controls at the time of injury and at 8 and 45 days afterward. All subjects also completed standardized clinical assessment of post-concussion symptoms, postural stability and cognitive functioning at injury and 8 and 45 days post-injury. RESULTS: Abnormalities in clinical assessment measures were observed in injured subjects only at time of injury. Statistical analysis of brain electrical activity measures with the ED-based algorithm revealed significant differences between injured athletes vs controls at the time of injury and at day 8. Measures from the two groups did not differ on day 45. CONCLUSIONS: This study demonstrated that an algorithm of brain electrical activity developed on an independent sample of ED subjects with head injury is sensitive to the effects of sport-related concussion. Using this algorithm, abnormal features of brain electrical activity were detected in athletes with concussion at the time of injury and persisted beyond the point of recovery on clinical measures
— id: 149954, year: 2012, vol: 26, page: 58, stat: Journal Article,

Volume of the human septal forebrain region is a predictor of source memory accuracy
Butler, Tracy; Blackmon, Karen; Zaborszky, Laszlo; Wang, Xiuyuan; Dubois, Jonathan; Carlson, Chad; Barr, William B; French, Jacqueline; Devinsky, Orrin; Kuzniecky, Ruben; Halgren, Eric; Thesen, Thomas
2012 Jan;18(1):157-161, Journal of the International Neuropsychological Society
Septal nuclei, components of basal forebrain, are strongly and reciprocally connected with hippocampus, and have been shown in animals to play a critical role in memory. In humans, the septal forebrain has received little attention. To examine the role of human septal forebrain in memory, we acquired high-resolution magnetic resonance imaging scans from 25 healthy subjects and calculated septal forebrain volume using recently developed probabilistic cytoarchitectonic maps. We indexed memory with the California Verbal Learning Test-II. Linear regression showed that bilateral septal forebrain volume was a significant positive predictor of recognition memory accuracy. More specifically, larger septal forebrain volume was associated with the ability to recall item source/context accuracy. Results indicate specific involvement of septal forebrain in human source memory, and recall the need for additional research into the role of septal nuclei in memory and other impairments associated with human diseases. (JINS, 2012, 18, 157-161)
— id: 147692, year: 2012, vol: 18, page: 157, stat: Journal Article,

Diagnosis and assessment of concussion
Barr, William B; McCrea, Michael
The handbook of sport neuropsychology New York, NY, US: Springer Publishing Co; US, 2011,
(from the chapter) It is now universally established that athletes experiencing the effects of concussion should refrain from competition until they are completely asymptomatic. In order to follow this rule, however, the clinician must be armed with sensitive and accurate measures for diagnosing and assessing concussion symptoms. Many specializing in the care arid treatment of athletes still consider the diagnosis and management of concussion as among the most difficult and challenging tasks they face on a regular basis. For many years medical personnel involved in the care of athletes were forced to make important decisions regarding the presence of concussion and whether an athlete was fit to return to play based solely on their experience and subjective observations. The past 15 years have been marked by a substantial increase in the evidence base on the signs and symptoms of concussion, as well as the true natural history of recovery after concussion. This body of work has driven us in the direction of a more evidence-based approach to diagnosis, assessment, and management of concussion. Included among these have been a number of guidelines for defining the presence of concussion and a number of methods for assessing its symptoms. While some of the information offered to clinicians has been established from results of empirical research, too much of it has been based on clinical folklore or 'expert' opinion. The goal of this chapter is to provide a brief survey of recent trends in diagnosis and assessment of sport concussion and a summary of the evidence-based literature.
— id: 5634, year: 2011, vol: , page: 91, stat: Chapter,

Structural evidence for involvement of a left amygdala-orbitofrontal network in subclinical anxiety
Blackmon K; Barr WB; Carlson C; Devinsky O; Dubois J; Pogash D; Quinn BT; Kuzniecky R; Halgren E; Thesen T
2011 Dec 30;194(3):296-303, Psychiatry research
Functional neuroimaging implicates hyperactivity of amygdala-orbitofrontal circuitry as a common neurobiological mechanism underlying the development of anxiety. Less is known about anxiety-related structural differences in this network. In this study, a sample of healthy adults with no history of anxiety disorders completed a 3T MRI scan and self-report mood inventories. Post-processing quantitative MRI image analysis included segmentation and volume estimation of subcortical structures, which were regressed on anxiety inventory scores, with depression scores used to establish discriminant validity. We then used a quantitative vertex-based post-processing method to correlate (1) anxiety scores and (2) left amygdala volumes with cortical thickness across the whole cortical mantle. Left amygdala volumes predicted anxiety, with decreased amygdala volume associated with higher anxiety on both state and trait anxiety measures. A negative correlation between left amygdala volume and cortical thickness overlapped with a positive correlation between anxiety and cortical thickness in left lateral orbitofrontal cortex. These results suggest a structural anxiety network that corresponds with a large body of evidence from functional neuroimaging. Such findings raise the possibility that structural abnormalities may result in a greater vulnerability to anxiety or conversely that elevated anxiety symptoms may result in focal structural changes
— id: 139495, year: 2011, vol: 194, page: 296, stat: Journal Article,

Structural evidence for involvement of a left amygdala-orbitofrontal network in subclinical anxiety
Blackmon, Karen; Barr, William B.; Carlson, Chad; Devinsky, Orrin; DuBois, Jonathan; Pogash, Daniel; Quinn, Brian T.; Kuzniecky, Ruben; Halgren, Eric; Thesen, Thomas (thomas.thesen@med.nyu.edu)
2011 DEC 30 ;194(3):296-303, Psychiatry Research Neuroimaging
Functional neuroimaging implicates hyperactivity of amygdala-orbitofrontal circuitry as a common neurobiological mechanism underlying the development of anxiety. Less is known about anxiety-related structural differences in this network. In this study, a sample of healthy adults with no history of anxiety disorders completed a 3T MRI scan and self-report mood inventories. Post-processing quantitative MRI image analysis included segmentation and volume estimation of subcortical structures, which were regressed on anxiety inventory scores, with depression scores used to establish discriminant validity. We then used a quantitative vertex-based post-processing method to correlate (1) anxiety scores and (2) left amygdala volumes with cortical thickness across the whole cortical mantle. Left amygdala volumes predicted anxiety, with decreased amygdala volume associated with higher anxiety on both state and trait anxiety measures. A negative correlation between left amygdala volume and cortical thickness overlapped with a positive correlation between anxiety and cortical thickness in left lateral orbitofrontal cortex. These results suggest a structural anxiety network that corresponds with a large body of evidence from functional neuroimaging. Such findings raise the possibility that structural abnormalities may result in a greater vulnerability to anxiety or conversely that elevated anxiety symptoms may result in focal structural changes. (C) 2011 Elsevier Ireland Ltd. All rights reserved. C1 Thesen, Thomas; NYU, Dept Neurol, Comprehens Epilepsy Ctr, 223 E 34th St, New York, NY 10016 USA
— id: 150857, year: 2011, vol: 194, page: 296, stat: Journal Article,

Individual differences in verbal abilities associated with regional blurring of the left gray and white matter boundary
Blackmon, Karen; Halgren, Eric; Barr, William B; Carlson, Chad; Devinsky, Orrin; Dubois, Jonathan; Quinn, Brian T; French, Jacqueline; Kuzniecky, Ruben; Thesen, Thomas
2011 Oct 26;31(43):15257-15263, Journal of neuroscience
Blurring of the cortical gray and white matter border on MRI is associated with normal aging, pathological aging, and the presence of focal cortical dysplasia. However, it remains unclear whether normal variations in signal intensity contrast at the gray and white matter junction reflect the functional integrity of subjacent tissue. This study explores the relationship between verbal abilities and gray and white matter contrast (GWC) in healthy human adults. Participants were scanned at 3 T MRI and administered standardized measures of verbal expression and verbal working memory. GWC was estimated by calculating the non-normalized T1 image intensity contrast above and below the cortical gray/white matter interface. Spherical averaging and whole-brain correlational analyses were performed. Sulcal regions exhibited higher contrast compared to gyral regions. We found a strongly lateralized and regionally specific profile with reduced verbal expression abilities associated with blurring in left hemisphere inferior frontal cortex and temporal pole. Reduced verbal working memory was associated with blurring in widespread left frontal and temporal cortices. Such lateralized and focal results provide support for GWC as a measure of regional functional integrity and highlight its potential role in probing the neuroanatomical substrates of cognition in healthy and diseased populations
— id: 139752, year: 2011, vol: 31, page: 15257, stat: Journal Article,

Cortical thickness abnormalities associated with depressive symptoms in temporal lobe epilepsy
Butler T; Blackmon K; McDonald CR; Carlson C; Barr WB; Devinsky O; Kuzniecky R; Dubois J; French J; Halgren E; Thesen T
2011 Jan;23(1):64-67, Epilepsy & behavior
Depression in patients with temporal lobe epilepsy (TLE) is highly prevalent and carries significant morbidity and mortality. Its neural basis is poorly understood. We used quantitative, surface-based MRI analysis to correlate brain morphometry with severity of depressive symptoms in 38 patients with TLE and 45 controls. Increasing severity of depressive symptoms was associated with orbitofrontal cortex (OFC) thinning in controls, but with OFC thickening in TLE patients. These results demonstrate distinct neuroanatomical substrates for depression with and without TLE, and suggest a unique role for OFC, a limbic region for emotional processing strongly interconnected with medial temporal structures, in TLE-related depressive symptoms
— id: 141935, year: 2011, vol: 23, page: 64, stat: Journal Article,

Long-term association between seizure outcome and depression after resective epilepsy surgery
Hamid, H; Liu, H; Cong, X; Devinsky, O; Berg, A T; Vickrey, B G; Sperling, M R; Shinnar, S; Langfitt, J T; Walczak, T S; Barr, W B; Dziura, J; Bazil, C W; Spencer, S S
2011 Nov 29;77(22):1972-1976, Neurology
OBJECTIVE: This study explored the association between long-term epilepsy surgery outcome and changes in depressive symptoms. METHODS: Adults were enrolled between 1996 and 2001 in a multicenter prospective study to evaluate outcomes of resective epilepsy surgery. The extent of depressive symptoms and depression case status (none, mild, or moderate/severe) were assessed using the Beck Depression Inventory (BDI) preoperatively and 3, 12, 24, 48, and 60 months postoperatively. A mixed-model repeated-measures analysis was performed, adjusting for covariates of seizure location, gender, age, race, education, and seizure control. RESULTS: Of the total 373 subjects, 256 were evaluated at baseline and 5 years after surgery. At baseline, 164 (64.1%) were not depressed, 34 (13.3%) were mildly depressed, and 58 (22.7%) had moderate to severe depression. After 5 years, 198 (77.3%) were not depressed, 20 (7.8%) were mildly depressed, and 38 (14.8%) were moderately to severely depressed. Five years after surgery, the reduction in mean change from baseline in BDI score was greater in subjects with excellent seizure control than in the fair and poor seizure control groups (p = 0.0006 and p = 0.02 respectively). Those with good seizure control had a greater reduction in BDI score than the poor seizure control group (p = 0.02) and borderline significant reduction compared with the fair seizure control group (p = 0.055). CONCLUSION: Although study participants had initial improvement in depressive symptoms, on average, after resective surgery, only patients with good or excellent seizure control had sustained long-term improvement in mood
— id: 149924, year: 2011, vol: 77, page: 1972, stat: Journal Article,

Medically refractory epilepsy in autism
Sansa, Gemma; Carlson, Chad; Doyle, Werner; Weiner, Howard L; Bluvstein, Judith; Barr, William; Devinsky, Orrin
2011 Jun;52(6):1071-1075, Epilepsia
Purpose: Epilepsy and electroencephalographic abnormalities are frequent in idiopathic autism, but there is little information regarding treatment-resistant epilepsy (TRE) in this group. We sought to define the clinical and electrophysiologic characteristics and treatment outcomes in these patients. Methods: We retrospectively reviewed clinical and laboratory data of patients with idiopathic autism evaluated at NYU Epilepsy Center during a 20-year period. Key Findings: One hundred twenty-seven patients had idiopathic autism and at least one epileptic seizure; 33.9% had TRE and 27.5% were seizure free. The remaining 38.6% of patients had infrequent seizures or insufficient data to categorize. Patients with TRE had a significantly earlier onset of seizures than seizure-free patients, and a trend for more developmental regression and motor and language delays. Three patients had surgical resection (two had limited improvement and one had no improvement) and one had an anterior callosotomy (no improvement). Vagus nerve stimulator (VNS) implantation provided limited improvement (2 patients) and no improvement (7). Significance: This study found that TRE is common in idiopathic autism and more common with early age of seizure onset. Relatively few patients underwent surgical resection due to multifocal partial epilepsy, comorbid generalized epilepsy, or limited impact of ongoing partial seizures given other problems related to autism. Our small sample suggests that surgical and VNS outcomes in this group are less favorable than in other TRE populations
— id: 134461, year: 2011, vol: 52, page: 1071, stat: Journal Article,

Not forgetting about memory
Barr, William B
2010 ;16(2):394-395, Journal of the International Neuropsychological Society
Reviews the book, Marking the Mind: A History of Memory, by Kurt Danziger (see record 2008-14739-000). This book provides a very interesting, readable, and concise account of how our conceptions of memory have developed over the ages. In this book, the author places memory within a sociohistorical context, demonstrating how the metaphors used to describe this process have, over the ages, paralleled developments in communication technology. While reading this book, one readily discovers how the development of psychology as an empirical science has resulted in separating the study of memory from any relationship to context or meaning. The book is composed of nine well-organized chapters. Each of these is preceded by a useful chapter outline placed within a clearly readable table. Overall, the book does a nice job of reintroducing us to views of memory taken from the past while simultaneously challenging the dogma of many of our current approaches to this phenomenon.
— id: 109025, year: 2010, vol: 16, page: 394, stat: Journal Article,

An interdisciplinary approach to neuropsychological test construction: Perspectives from translation studies
Bender, H Allison; Martin Garcia, Adolfo; Barr, William B
2010 Mar;16(2):227-232, Journal of the International Neuropsychological Society
Few neuropsychological tests have been developed specifically for non-English speakers. Rather, assessment measures are often derived from English source texts (STs) and translated into foreign language target texts (TTs). An abundant literature describes the potential for translation error occurring in test construction. While the neuropsychology community has striven to correct these inadequacies, interdisciplinary approaches to test translation have been largely ignored. Translation studies, which has roots in linguistics, semiotics, computer science, anthropology, and philosophy, may provide a much-needed framework for test development. We aim to apply specific aspects of Descriptive Translation Studies to present unique and heretofore unapplied frameworks to the socio-cultural conceptualizations of translated tests. In doing so, a more theoretical basis for test construction will be explored. To this end, translation theory can provide valuable insights toward the development of linguistically and culturally relevant neuropsychological test measures suitable for an increasingly diverse patient base. (JINS, 2010, 16, 227-232.)
— id: 107376, year: 2010, vol: 16, page: 227, stat: Journal Article,

Phonetically irregular word pronunciation and cortical thickness in the adult brain
Blackmon, Karen; Barr, William B; Kuzniecky, Ruben; Dubois, Jonathan; Carlson, Chad; Quinn, Brian T; Blumberg, Mark; Halgren, Eric; Hagler, Donald J; Mikhly, Mark; Devinsky, Orrin; McDonald, Carrie R; Dale, Anders M; Thesen, Thomas
2010 Jul 15;51(4):1453-1458, Neuroimage
Accurate pronunciation of phonetically irregular words (exception words) requires prior exposure to unique relationships between orthographic and phonemic features. Whether such word knowledge is accompanied by structural variation in areas associated with orthographic-to-phonemic transformations has not been investigated. We used high-resolution MRI to determine whether performance on a visual word-reading test composed of phonetically irregular words, the Wechsler Test of Adult Reading (WTAR), is associated with regional variations in cortical structure. A sample of 60 right-handed, neurologically intact individuals were administered the WTAR and underwent 3T volumetric MRI. Using quantitative, surface-based image analysis, cortical thickness was estimated at each vertex on the cortical mantle and correlated with WTAR scores while controlling for age. Higher scores on the WTAR were associated with thicker cortex in bilateral anterior superior temporal gyrus, bilateral angular gyrus/posterior superior temporal gyrus, and left hemisphere intraparietal sulcus. Higher scores were also associated with thinner cortex in left hemisphere posterior fusiform gyrus and central sulcus, bilateral inferior frontal gyrus, and right hemisphere lingual gyrus and supramarginal gyrus. These results suggest that the ability to correctly pronounce phonetically irregular words is associated with structural variations in cortical areas that are commonly activated in functional neuroimaging studies of word reading, including areas associated with grapheme-to-phonemic conversion
— id: 109791, year: 2010, vol: 51, page: 1453, stat: Journal Article,

Seizure prediction and recall
DuBois, J M; Boylan, L S; Shiyko, M; Barr, W B; Devinsky, O
2010 May;18(1-2):106-109, Epilepsy & behavior
Using separate generalized mixed-effects models, we assessed seizure recall and prediction, as well as contributing diagnostic variables, in 83 adult patients with epilepsy undergoing video/EEG monitoring. The model revealed that when participants predicted a seizure, probability equaled 0.320 (95% CI: 0.149-0.558), a significant (P<0.05) increase over negative predictions (0.151, 95% CI: 0.71-0.228]). With no seizure, the rate of remembering was approximately 0.130 (95% CI: 0.73-0.219), increasing significantly to 0.628 (95% CI: 0.439 to 0.784) when a seizure occurred (P<0.001). Of the variables analyzed, only inpatient seizure rate influenced predictability (P<0.001) or recollection (P<0.001). These models reveal that patients were highly aware of their seizures, and in many cases, were able to make accurate predictions, for which seizure rate may be an important factor
— id: 111369, year: 2010, vol: 18, page: 106, stat: Journal Article,

THE POLITICS OF TECHNICIANS
Festa, JR; Barr, WB; Pliskin, N
2010 JUN ;24(3):506-517, Clinical neuropsychologist
An unintended consequence of the New York psychology Scope of Practice legislation led to a restriction in the use of testing technicians that has yet to be reversed after 4 years. The misperception of neuropsychology by state legislators and psychology colleagues was a key obstacle to achieving a timely solution. We discuss how the political agenda and practice philosophies of New York neuropsychologists were at odds with those of our psychology colleagues, and how that brought about a protracted struggle affecting both patient care and the practice of clinical neuropsychology. Neuropsychologists must maintain an active role in professional and political organizations with equal attention at the local, state, and national levels to avoid similar restrictions to their clinical practice
— id: 109689, year: 2010, vol: 24, page: 506, stat: Journal Article,

Acute effects and recovery after sport-related concussion: a neurocognitive and quantitative brain electrical activity study
McCrea, Michael; Prichep, Leslie; Powell, Matthew R; Chabot, Robert; Barr, William B
2010 Jul-Aug;25(4):283-292, Journal of head trauma rehabilitation
OBJECTIVE: To investigate the clinical utility and sensitivity of a portable, automatic, frontal quantitative electroencephalographic (QEEG) acquisition device currently in development in detecting abnormal brain electrical activity after sport-related concussion. DESIGN: This was a prospective, non-randomized study of 396 high school and college football players, including cohorts of 28 athletes with concussion and 28 matched controls. All subjects underwent preseason baseline testing on measures of postconcussive symptoms, postural stability, and cognitive functioning, as well as QEEG. Clinical testing and QEEG were repeated on day of injury and days 8 and 45 postinjury for the concussion and control groups. MAIN OUTCOMES AND RESULTS: The injured group reported more significant postconcussive symptoms during the first 3 days postinjury, which resolved by days 5 and 8. Injured subjects also performed poorer than controls on neurocognitive testing on the day of injury, but no differences were evident on day 8 or day 45. QEEG studies revealed significant abnormalities in electrical brain activity in the injured group on day of injury and day 8 postinjury, but not on day 45. CONCLUSIONS: Results from the current study on clinical recovery after sport-related concussion are consistent with early reports indicating a typical course of full recovery in symptoms and cognitive dysfunction within the first week of injury. QEEG results, however, suggest that the duration of physiological recovery after concussion may extend longer than observed clinical recovery. Further study is required to replicate and extend these findings in a larger clinical sample, and further demonstrate the utility of QEEG as a marker of recovery after sport-related concussion
— id: 139132, year: 2010, vol: 25, page: 283, stat: Journal Article,

Reliable change indices and regression-based measures for the Rey-Osterreith Complex Figure test in partial epilepsy patients
Nakhutina, L; Pramataris, P; Morrison, C; Devinsky, O; Barr, W B
2010 Jan;24(1):38-44, Clinical neuropsychologist
The Rey-Osterreith Complex Figure (ROCF) is commonly used in evaluations of patients undergoing epilepsy surgery. We assessed test-retest performance on ROCF in 30 partial epilepsy patients (mean interval = 33.7 months) to derive reliable change indices (RCIs) and regression-based measures for change. ROCF reproductions were rescored by three raters (IRR Copy: 0.963; Delayed Recall: 0.986). The derived adjusted RC (90% CI) cutoff values for the ROCF Copy were (<or=-6.5, >or=8.4) and were (<or=-6.8, >or=10.0) for the Delayed Recall. Results from regression-based analyses were negative, using age, education, seizure duration, and age of onset, whereas a baseline score was a significant predictor of a follow-up score. The results provide a means to evaluate long-term outcome in epilepsy patients using the ROCF
— id: 105958, year: 2010, vol: 24, page: 38, stat: Journal Article,

Ictal mnemestic aura and verbal memory function
Vederman, Aaron C; Holtzer, Roee; Zimmerman, Molly E; Devinsky, Orrin; Barr, William B
2010 Apr;17(4):474-477, Epilepsy & behavior
Deja vu aura is a well-known phenomenon experienced by some patients with epilepsy. This study sought to explore the relationship between verbal memory and the experience of deja vu or other types of mnemestic auras in 42 individuals with intractable seizures and 42 age- and education-matched patient controls. Verbal memory was assessed with indices of learning, long delay recall, and recognition from the California Verbal Learning Test. Results indicated that auras of any type were not associated with memory performance on the California Verbal Learning Test. As expected, age and education were related to verbal memory performance. Mnemestic auras were associated with clinical indices of illness, suggesting that the presence of these auras may be regarded as a risk factor for greater chronicity and severity in epilepsy
— id: 134083, year: 2010, vol: 17, page: 474, stat: Journal Article,

Diagnostic validity of a neuropsychological test battery for Hispanic patients with epilepsy
Barr, William B; Bender, Heidi A; Morrison, Chris; Cruz-Laureano, Daniel; Vazquez, Blanca; Kuzniecky, Ruben
2009 Nov;16(3):479-483, Epilepsy & behavior
The Neuropsychological Screening Battery for Hispanics (NeSBHIS) was developed to address the growing need for linguistically appropriate Spanish-language assessment measures. Despite the potential benefits to clinical practice, no prior study has assessed its diagnostic validity in populations with epilepsy. One hundred and fifteen patients with confirmed epilepsy were evaluated via the NeSBHIS; these data were standardized according to age- and education-based norms. Performance decrements were observed in more than 40% of participants on measures of processing speed and naming. Deficits in verbal and visual recall were also exhibited by 29 and 26% of the sample, respectively. No significant differences in test performance emerged between patients with VEEG evidence of left (N=48) versus right (N=24) temporal lobe epilepsy. Although the NeSBHIS is sensitive to the cognitive impairments commonly observed in populations with epilepsy, there are limitations to its ability to identify lateralized neuropsychological impairment in patients with temporal lobe epilepsy
— id: 105248, year: 2009, vol: 16, page: 479, stat: Journal Article,

Construct validity of the Neuropsychological Screening Battery for Hispanics (NeSBHIS) in a neurological sample
Bender, H Allison; Cole, Jeffrey R; Aponte-Samalot, Myrelis; Cruz-Laureano, Daniel; Myers, Lorna; Vazquez, Blanca R; Barr, William B
2009 Mar;15(2):217-224, Journal of the International Neuropsychological Society
Epidemiological studies suggest that the Hispanic population is at increased risk for neurological disorders. Yet, few assessment measures have been developed for, adapted to, or normalized with Spanish-speakers. The Neuropsychological Screening Battery for Hispanics (NeSBHIS) was developed to address the lack of resources available to this underserved community. Although the NeSBHIS possesses robust construct validity and clinical utility in a community-based sample, these properties remain largely untested in neurological populations. One hundred and twenty-seven Spanish-speaking Hispanic patients with confirmed epilepsy (mean age = 37.8, SD = 13.3) were evaluated using the NeSBHIS. All participants self-identified as 'Hispanic' and immigrated from Spanish-speaking countries. Data were analyzed using confirmatory factor analysis with the a priori assumption that variables would load according to theoretical expectations reported by Ponton and colleagues (2000). The overall model fit indices were in the desired range: Comparative Fit Index = 0.936, Tucker Lewis Index = 0.915, RMSEA = 0.090, and SRMR = 0.069. All NeSBHIS subtests loaded significantly (p < .001) on their respective factors; the standardized loadings were high, ranging from 0.562 to 0.995, with the exception of Block Design (-0.308). Overall, findings suggest that the NeSBHIS has robust construct validity in a neurological sample
— id: 95082, year: 2009, vol: 15, page: 217, stat: Journal Article,

The Clinical Utility of the RBANS Spanish Research Edition in a Neurological Sample
Bender, HA; Rodriguez, RM; Karantzoulis, S; Murphy, K; MacAllister, WS; Senior, E; Vazquez, BR; Barr, WB
2009 ;23(4):07-07, Clinical neuropsychologist
— id: 125470, year: 2009, vol: 23, page: 07, stat: Journal Article,

Emotional recognition in depressed epilepsy patients
Brand, Jesse G; Burton, Leslie A; Schaffer, Sarah G; Alper, Kenneth R; Devinsky, Orrin; Barr, William B
2009 Jul;15(3):333-338, Epilepsy & behavior
The current study examined the relationship between emotional recognition and depression using the Minnesota Multiphasic Personality Inventory, Second Edition (MMPI-2), in a population with epilepsy. Participants were a mixture of surgical candidates in addition to those receiving neuropsychological testing as part of a comprehensive evaluation. Results suggested that patients with epilepsy reporting increased levels of depression (Scale D) performed better than those patients reporting low levels of depression on an index of simple facial recognition, and depression was associated with poor prosody discrimination. Further, it is notable that more than half of the present sample had significantly elevated Scale D scores. The potential effects of a mood-congruent bias and implications for social functioning in depressed patients with epilepsy are discussed
— id: 101883, year: 2009, vol: 15, page: 333, stat: Journal Article,

The politics of Technicians
Festa, Joanne R; Barr, William B; Pliskin, Neil
2009 Jan 29;:1-12, Clinical neuropsychologist
An unintended consequence of the New York psychology Scope of Practice legislation led to a restriction in the use of testing technicians that has yet to be reversed after 4 years. The misperception of neuropsychology by state legislators and psychology colleagues was a key obstacle to achieving a timely solution. We discuss how the political agenda and practice philosophies of New York neuropsychologists were at odds with those of our psychology colleagues, and how that brought about a protracted struggle affecting both patient care and the practice of clinical neuropsychology. Neuropsychologists must maintain an active role in professional and political organizations with equal attention at the local, state, and national levels to avoid similar restrictions to their clinical practice
— id: 95083, year: 2009, vol: , page: 1, stat: Journal Article,

Epilepsy in Treated Brain Tumor Patients
Goldlust, SA; Amodeo, PP; Barr, WB; Pacia, SV
2009 ;72(11 Suppl 3):A29-A29, Neurology
— id: 104481, year: 2009, vol: 72, page: A29, stat: Journal Article,

Neuropsychological consequences of boxing and recommendations to improve safety: a National Academy of Neuropsychology education paper
Heilbronner, Robert L; Bush, Shane S; Ravdin, Lisa D; Barth, Jeffrey T; Iverson, Grant L; Ruff, Ronald M; Lovell, Mark R; Barr, William B; Echemendia, Ruben J; Broshek, Donna K
2009 Feb;24(1):11-19, Archives of clinical neuropsychology
Boxing has held appeal for many athletes and audiences for centuries, and injuries have been part of boxing since its inception. Although permanent and irreversible neurologic dysfunction does not occur in the majority of participants, an association has been reported between the number of bouts fought and the development of neurologic, psychiatric, or histopathological signs and symptoms of encephalopathy in boxers. The purpose of this paper is to (i) provide clinical neuropsychologists, other health-care professionals, and the general public with information about the potential neuropsychological consequences of boxing, and (ii) provide recommendations to improve safety standards for those who participate in the sport
— id: 101884, year: 2009, vol: 24, page: 11, stat: Journal Article,

Effects of a symptom-free waiting period on clinical outcome and risk of reinjury after sport-related concussion
McCrea, Michael; Guskiewicz, Kevin; Randolph, Christopher; Barr, William B; Hammeke, Thomas A; Marshall, Stephen W; Kelly, James P
2009 Nov;65(5):876-882, Neurosurgery
OBJECTIVE: This study is the first to investigate the influence of a symptom-free waiting period (SFWP) on clinical outcome and risk of repeat injury after sport-related concussion. METHODS: This was a prospective, nonrandomized study of 16 624 player seasons from 1999 to 2004, including a cohort of 635 concussed high school and college athletes grouped on the basis of an SFWP or no SFWP observed after their concussion. Clinical outcome in symptoms, cognitive functioning, and postural stability 45 and 90 days postinjury was compared with preinjury baseline. Data on SFWP and same-season repeat concussion were recorded. RESULTS: An SFWP was observed in 60.3% of cases. There were no significant differences between the SFWP and no SFWP groups in acute injury characteristics or clinical outcome with respect to symptom recovery or postinjury performance on formal neuropsychological and balance testing. Most repeat concussions (79.2%) occurred within 10 days of the initial injury. The rate of repeat concussion was actually higher in the SFWP group (6.49%) than the no SFWP group (0.90%) (P < 0.005), but the repeat concussion subgroup's SFWP was 2.82 days shorter (95% confidence interval, 0.61-5.03; P < 0.01) and these athletes resumed participation 3.55 days sooner (95% confidence interval, 0.06-7.04; P < 0.05) than those in the SFWP group in which there was no repeat concussion. CONCLUSION: Our findings suggest that an SFWP did not intrinsically influence clinical recovery or reduce risk of a repeat concussion. The overall risk of same-season repeat concussion seems to be relatively low, but there may be a period of vulnerability that increases risk of repeat concussion during the first 7 to 10 days postinjury. Further study is required to investigate this preliminary finding and help determine whether this risk can be reduced further with specific injury-management strategies
— id: 105277, year: 2009, vol: 65, page: 876, stat: Journal Article,

An integrated review of recovery after mild traumatic brain injury (MTBI): implications for clinical management
McCrea, Michael; Iverson, Grant L; McAllister, Thomas W; Hammeke, Thomas A; Powell, Matthew R; Barr, William B; Kelly, James P
2009 Nov;23(8):1368-1390, Clinical neuropsychologist
The diagnosis and treatment of mild traumatic brain injury (MTBI)have historically been hampered by an incomplete base of scientific evidence to guide clinicians. One question has been most elusive to clinicians and researchers alike: What is the true natural history of MTBI? Fortunately, the science of MTBI has advanced more in the last decade than in the previous 50 years, and now reaches a maturity point at which the science can drive an evidence-based approach to clinical management. In particular, technological advances in functional neuroimaging have created a powerful bridge between the clinical and basic science of MTBI in humans. Collectively, findings from clinical, basic science, and functional neuroimaging studies now establish a foundation on which to build integrative theories and testable hypotheses around a comprehensive model of MTBI recovery. We review the current scientific literature on postconcussion symptom recovery, neuropsychological outcome, and neurophysiological healing after MTBI. Special emphasis is placed on how the new evidence base can help guide clinicians in the evaluation and management of military-related MTBI
— id: 105276, year: 2009, vol: 23, page: 1368, stat: Journal Article,

Distributed source modeling of language with magnetoencephalography: Application to patients with intractable epilepsy
McDonald, Carrie R; Thesen, Thomas; Hagler, Donald J Jr; Carlson, Chad; Devinksy, Orrin; Kuzniecky, Rubin; Barr, William; Gharapetian, Lusineh; Trongnetrpunya, Amy; Dale, Anders M; Halgren, Eric
2009 Oct;50(10):2256-2266, Epilepsia
Purpose: To examine distributed patterns of language processing in healthy controls and patients with epilepsy using magnetoencephalography (MEG), and to evaluate the concordance between laterality of distributed MEG sources and language laterality as determined by the intracarotid amobarbital procedure (IAP). Methods: MEG was performed in 10 healthy controls using an anatomically constrained, noise-normalized distributed source solution (dynamic statistical parametric map, dSPM). Distributed source modeling of language was then applied to eight patients with intractable epilepsy. Average source strengths within temporoparietal and frontal lobe regions of interest (ROIs) were calculated, and the laterality of activity within ROIs during discrete time windows was compared to results from the IAP. Results: In healthy controls, dSPM revealed activity in visual cortex bilaterally from approximately 80 to 120 ms in response to novel words and sensory control stimuli (i.e., false fonts). Activity then spread to fusiform cortex approximately 160-200 ms, and was dominated by left hemisphere activity in response to novel words. From approximately 240 to 450 ms, novel words produced activity that was left-lateralized in frontal and temporal lobe regions, including anterior and inferior temporal, temporal pole, and pars opercularis, as well as bilaterally in posterior superior temporal cortex. Analysis of patient data with dSPM demonstrated that from 350 to 450 ms, laterality of temporoparietal sources agreed with the IAP 75% of the time, whereas laterality of frontal MEG sources agreed with the IAP in all eight patients. Discussion: Our results reveal that dSPM can unveil the timing and spatial extent of language processes in patients with epilepsy and may enhance knowledge of language lateralization and localization for use in preoperative planning
— id: 101387, year: 2009, vol: 50, page: 2256, stat: Journal Article,

Self-reported Versus Clinician Rated Depression and Anxiety in Psychogenic Nonepileptic Seizures
Murphy, KE; Barr, WB; Brand, JG; Karantzoulis, S; Bender, HA; Alper, K
2009 ;23(4):61-61, Clinical neuropsychologist
— id: 125471, year: 2009, vol: 23, page: 61, stat: Journal Article,

Concussion Symptom Inventory: An empirically derived scale for monitoring resolution of symptoms following sport-related concussion
Randolph, Christopher; Millis, Scott; Barr, William B; McCrea, Michael; Guskiewicz, Kevin M; Hammeke, Thomas A; Kelly, James P
2009 ;24(3):219-229, Archives of clinical neuropsychology
Self-report post-concussion symptom scales have been a key method for monitoring recovery from sport-related concussion, to assist in medical management, and return-to-play decision-making. To date, however, item selection and scaling metrics for these instruments have been based solely upon clinical judgment, and no one scale has been identified as the 'gold standard'. We analyzed a large set of data from existing scales obtained from three separate case-control studies in order to derive a sensitive and efficient scale for this application by eliminating items that were found to be insensitive to concussion. Baseline data from symptom checklists including a total of 27 symptom variables were collected from a total of 16,350 high school and college athletes. Follow-up data were obtained from 641 athletes who subsequently incurred a concussion. Symptom checklists were administered at baseline (preseason), immediately post-concussion, post-game, and at 1, 3, and 5 days post-injury. Effect-size analyses resulted in the retention of only 12 of the 27 variables. Receiver-operating characteristic analyses were used to confirm that the reduction in items did not reduce sensitivity or specificity. The newly derived Concussion Symptom Inventory is presented and recommended as a research and clinical tool for monitoring recovery from sport-related concussion.
— id: 114877, year: 2009, vol: 24, page: 219, stat: Journal Article,

Postictal psychosis in partial epilepsy: a case-control study
Alper, Kenneth; Kuzniecky, Ruben; Carlson, Chad; Barr, William B; Vorkas, Charles K; Patel, Jignasa G; Carrelli, Angela L; Starner, Karen; Flom, Peter L; Devinsky, Orrin
2008 May;63(5):602-610, Annals of neurology
OBJECTIVE: Divergent findings among prior studies on correlates of risk for postictal psychosis (PIP) suggest the value of a controlled study involving a relatively large number of patients. METHODS: The study population consisted of a consecutive series of 59 patients with partial epilepsy and a history of PIP, and 94 control patients with partial epilepsy and no history of PIP evaluated as inpatients with video-electroencephalography. The groups did not differ significantly regarding demographic features. Exact tests yielded a subset of variables and a tentative interpretation that were evaluated further utilizing principal components analysis and logistic regression. RESULTS: PIP was associated with extratemporal versus temporal (p = 0.036) or undetermined (p = 0.001) localization of seizure onset, bilateral interictal epileptiform activity (p = 0.017), secondary generalization (p = 0.049), and history of encephalitis (p = 0.018). Interictal slow activity was more frequently absent in control patients (p = 0.045). PIP was associated with family histories of psychiatric disorders (p = 0.007) and epilepsy (p = 0.042), which themselves were significantly intercorrelated (r = 0.225; p = 0.006). Age of onset or duration of epilepsy and lateralized electroencephalographic or magnetic resonance imaging asymmetries did not differ significantly between control and PIP groups. The analysis indicated four underlying domains of risk for PIP: ambiguous/extratemporal localization, family neuropsychiatric history, abnormal interictal electroencephalographic activity, and encephalitis. Each unit increase on a simple additive scale composed of 9 dichotomous independent variables multiplied the odds ratio for PIP by 1.71 (95% confidence interval, 1.36-2.15; p < 0.0001). INTERPRETATION: PIP in partial epilepsy is associated with relatively broadly and bilaterally distributed epileptogenic networks, genetic determinants of psychiatric disorders and seizures, and encephalitis
— id: 79550, year: 2008, vol: 63, page: 602, stat: Journal Article,

Historical development of the neuropsychological test battery
Barr, William B
Textbook of clinical neuropsychology New York, NY, US: Psychology Press, 2008,
(from the chapter) The goal of this chapter is to focus on the development of various approaches to neuropsychological assessment as they developed from the larger discipline of psychology in the middle part of the 20th century. Again, there have been a number of excellent summaries of the origins of specific tests and accounts of neuropsychology's pioneers (Boake, 2002; Jones & Butters, 1983; Meier, 1992; Reitan, 1994; Stringer, Cooley, & Christensen, 2002). This chapter will differ from those contributions by emphasizing how early systematic movements in psychology influenced the development of neuropsychological testing as it is practiced today. (PsycINFO Database Record (c) 2008 APA, all rights reserved)
— id: 4811, year: 2008, vol: , page: 3, stat: Chapter,

Neuropsychological approaches to criminality and violence
Barr, William B
Clinical neuropsychology in the criminal forensic setting New York, NY, US: Guilford Press, 2008,
(from the chapter) This chapter reviews scientific literature supporting the view that a number of neurobiological factors have the potential to influence violent behavior Some of these factors are present in individuals at risk for committing violence, such as persons with certain forms of personality disorder, or those identified by having already committed a violent act, such as convicted felons. In each case, I espouse the view that neurobiology is rarely the sole cause of the violence. Each case must be viewed in a context based on not only the characteristics of the defendant but also a thorough analysis of the crime. Although these individuals are often referred to in the scientific literature as exhibiting features of psychopathy, I focus on the term antisocial personality disorder (APD) from the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; American Psychiatric Association, 2000). First, I review some of the neurobiological influences known to affect aggression and violence in animals and humans, and a method to differentiate these from the effects of developmental or acquired disease. (PsycINFO Database Record (c) 2008 APA, all rights reserved)
— id: 4800, year: 2008, vol: , page: 238, stat: Chapter,

Neuropsychology of sports-related injuries
Barr, William B; McCrea, Michael; Randolph, Christopher
Textbook of clinical neuropsychology New York, NY, US: Psychology Press, 2008,
(from the chapter) This chapter will provide an overview of the use of neuropsychological methods in sports, emphasizing an evidence-based approach to assessing and managing symptoms of concussion. We will begin with a neurological introduction to sports concussion and continue with a review of the methods and results obtained in neuropsychological studies. The chapter will conclude with case examples and a discussion of the implications of sports findings to the topic of mild traumatic brain injury (MTBI) in general. (PsycINFO Database Record (c) 2008 APA, all rights reserved)
— id: 4810, year: 2008, vol: , page: 660, stat: Chapter,

Emotional recognition ability in patients with epileptic vs. non-epileptic seizures
Brand, JG; Barr, WB; Schaffer, SG; Burton, LA; Alper, KR; Devinsky, O
2008 SEP ;22(4):747-747, Clinical neuropsychologist
— id: 104236, year: 2008, vol: 22, page: 747, stat: Journal Article,

Robust and conventional neuropsychological norms: diagnosis and prediction of age-related cognitive decline
De Santi, Susan; Pirraglia, Elizabeth; Barr, William; Babb, James; Williams, Schantel; Rogers, Kimberley; Glodzik, Lidia; Brys, Miroslaw; Mosconi, Lisa; Reisberg, Barry; Ferris, Steven; de Leon, Mony J
2008 Jul;22(4):469-484, Neuropsychology
The aim of the study was to compare the performance of Robust and Conventional neuropsychological norms in predicting clinical decline among healthy adults and in mild cognitive impairment (MCI). The authors developed Robust baseline cross sectional and longitudinal change norms from 113 healthy participants retaining a normal diagnosis for at least 4 years. Baseline Conventional norms were separately created for 256 similar healthy participants without follow-up. Conventional and Robust norms were tested in an independent cohort of longitudinally studied healthy (n=223), MCI (n=136), and Alzheimer's disease (AD, n=162) participants; 84 healthy participants declined to MCI or AD (NL-->DEC), and 44 MCI declined to AD (MCI-->AD). Compared to Conventional norms, baseline Robust norms correctly identified a higher proportion of NL-->DEC with impairment in delayed memory and attention-language domains. Both norms predicted decline from MCI-->AD. Change norms for delayed memory and attention-language significantly incremented baseline classification accuracies. These findings indicate that Robust norms improve identification of healthy individuals who will decline and may be useful for selecting at-risk participants for research studies and early interventions
— id: 86549, year: 2008, vol: 22, page: 469, stat: Journal Article,

Chapter 21 Visual agnosia
Devinsky, Orrin; Farah, Martha J; Barr, William B
2008 ;88:417-427, Handbook of clinical neurology
— id: 95084, year: 2008, vol: 88, page: 417, stat: Journal Article,

Personality disorders
Devinsky, Orrin; Vorkas, Charles; Barr, William B; Hermann, Bruce P
Epilepsy : a comprehensive textbook Philadelphia PA : Wolters Kluwer/Lippincott Williams & Wilkins, 2008,
— id: 5444, year: 2008, vol: ?, page: ?, stat: Chapter,

Temporal lobe epilepsy does not impair visual perception
Grant, Arthur C; Donnelly, Kiely M; Chubb, Charlie; Barr, William B; Kuzniecky, Ruben; Devinsky, Orrin
2008 Apr;49(4):710-713, Epilepsia
Temporal lobe epilepsy (TLE) can impair interictal cognitive function. In the perceptual domain, previous psychophysical studies demonstrated specific deficits in auditory and tactile perception in patients with TLE. This study compared performance of 25 TLE subjects and 27 controls on two low-level, visual tasks: luminance discrimination and frequency discrimination. Both tasks were performed under a relatively easy and a relatively difficult condition, by adjusting the stimulus duration. TLE subjects performed as well as controls on both tasks at both stimulus durations. These results imply that interictal occipital lobe function, as reflected in performance on low-level visual tasks, is not impaired in TLE, consistent with functional imaging data. Furthermore, since TLE subjects performed normally while taking therapeutic doses of multiple AEDs, the data suggest that these AEDs do not impair visual perception
— id: 95086, year: 2008, vol: 49, page: 710, stat: Journal Article,

Bilateral capacity for speech sound processing in auditory comprehension: Evidence from Wada procedures
Hickok, G; Okada, K; Barr, W; Pa, J; Rogalsky, C; Donnelly, K; Barde, L; Grant, A
2008 DEC ;107(3):179-184, Brain & language
Data from lesion studies suggest that the ability to perceive speech sounds, as measured by auditory comprehension tasks, is supported by temporal lobe systems in both the left and right hemisphere. For example, patients with left temporal lobe damage and auditory comprehension deficits (i.e., Wernicke's aphasics), nonetheless comprehend isolated words better than one would expect if their speech perception system had been largely destroyed (70-80% accuracy). Further, when comprehension fails in such patients their errors are more often semantically-based, than-phonemically based. The question addressed by the present study is whether this ability of the right hemisphere to process speech sounds is a result of plastic reorganization following chronic left hemisphere damage, or whether the ability exists in undamaged language systems. We sought to test these possibilities by studying auditory comprehension in acute left versus right hemisphere deactivation during Wada procedures. A series of 20 patients undergoing clinically indicated Wada procedures were asked to listen to an auditorily presented stimulus word, and then point to its matching picture on a card that contained the target picture, a semantic foil, a phonemic foil, and an unrelated foil. This task was performed under three conditions, baseline, during left carotid injection of sodium amytal, and during right carotid injection of sodium amytal. Overall, left hemisphere injection led to a significantly higher error rate than right hemisphere injection. However, consistent with lesion work, the majority (75%) of these errors were semantic in nature. These findings suggest that auditory comprehension deficits are predominantly semantic in nature, even following acute left hemisphere disruption. This, in turn, supports the hypothesis that the right hemisphere is capable of speech sound processing in the intact brain. (C) 2008 Elsevier Inc. All rights reserved
— id: 98116, year: 2008, vol: 107, page: 179, stat: Journal Article,

Use of the WAIS-III/WMS-III six factor structure in left and right temporal lobe epilepsy
Karantzoulis, S; Morrison, CE; Barr, WB; Devinsky, O
2008 MAR 11 ;22(3):409-410, Clinical neuropsychologist
— id: 104240, year: 2008, vol: 22, page: 409, stat: Journal Article,

Differential neuropsychological test sensitivity to left temporal lobe epilepsy
Loring, David W; Strauss, Esther; Hermann, Bruce P; Barr, William B; Perrine, Kenneth; Trenerry, Max R; Chelune, Gordon; Westerveld, Michael; Lee, Gregory P; Meador, Kimford J; Bowden, Stephen C
2008 May;14(3):394-400, Journal of the International Neuropsychological Society
We examined the sensitivity of the Rey Auditory Verbal Learning Test (AVLT), California Verbal Learning Test (CVLT), Boston Naming Test (BNT), and Multilingual Aphasia Examination Visual Naming subtest (MAE VN) to lateralized temporal lobe epilepsy (TLE) in patients who subsequently underwent anterior temporal lobectomy. For the AVLT (n = 189), left TLE patients performed more poorly than their right TLE counterparts [left TLE = 42.9 (10.6), right TLE = 47.7 (9.9); p < .002 (Cohen's d = .47)]. Although statistically significant, the CVLT group difference (n = 212) was of a smaller magnitude [left LTE = 40.7 (11.1), right TLE = 43.8 (9.9); (p < .03, Cohen's d = .29)] than the AVLT. Group differences were also present for both measures of confrontation naming ability [BNT: left LTE = 43.1 (8.9), right TLE = 48.1 (8.9); p < .001 (Cohen's d = .56); MAE VN: left TLE = 42.2, right TLE = 45.6, p = .02 (Cohen's d = .36)]. When these data were modeled in independent logistic regression analyses, the AVLT and BNT both significantly predicted side of seizure focus, although the positive likelihood ratios were modest. In the subset of 108 patients receiving both BNT and AVLT, the AVLT was the only significant predictor of seizure laterality, suggesting individual patient variability regarding whether naming or memory testing may be more sensitive to lateralized TLE
— id: 95085, year: 2008, vol: 14, page: 394, stat: Journal Article,

Neuropsychological evaluation -- adults
Loring, David; Barr, William B; Hamberger, Marla
Epilepsy : a comprehensive textbook Philadelphia PA : Wolters Kluwer/Lippincott Williams & Wilkins, 2008,
— id: 5448, year: 2008, vol: ?, page: ?, stat: Chapter,

Distributed Source Modeling of Language with Magnetoencephalography: Application to Patients with Left Temporal Lobe Epilepsy
McDonald, CR; Thesen, T; Hagler, DJ; Carlson, C; Devinksy, O; Kuzniecky, R; Barr, W; Patel, RH; Gharapetian, L; Dale, AM; Halgren, E
2008 DEC ;64(6):S150-S150, Annals of neurology
— id: 98111, year: 2008, vol: 64, page: S150, stat: Journal Article,

Gender and major depression in a sample of epilepsy patients
Wolkin, JR; Barr, WB; Alper, KR; Zemon, V; Devinsky, O
2008 SEP ;22(4):747-747, Clinical neuropsychologist
— id: 104237, year: 2008, vol: 22, page: 747, stat: Journal Article,

Epilepsy and neuropsychology: past, present, and future
Barr, William B
2007 Dec;17(4):381-383, Neuropsychology review
— id: 76081, year: 2007, vol: 17, page: 381, stat: Journal Article,

Recovering from mild traumatic brain injury: What psychology has learned from sports concussion research
Barr, William B
2007 ;19(5):24-29 Dec, Notebook (New York State Psychological Association)
Research on sports concussion has contributed significantly to our knowledge on the characteristics and course of recovery from mild traumatic brain injury (MTBI). Findings from research studies on injured athletes indicate that most symptoms of concussion resolve within 7-10 days of the injury. Results from studies examining the development of more persistent symptoms have found relationships with a number of psychological factors, including expectation and maladaptive coping styles. Systematic reviews of intervention strategies have indicated that psychological approaches to treatment of MTBI, such as early education and support, are more effective than any form of drug treatment. Psychologists should be aware of these findings and the potential for playing a significant role in treating individuals with MTBI. (journal abstract)
— id: 75682, year: 2007, vol: 19, page: 24, stat: Journal Article,

Temporal lobe epilepsy does not impair visual perception
Donnelly, K; Barr, W; Kuzniecky, R; Devinsky, O; Grant, AC
2007 OCT ;48(4):237-237, Epilepsia
— id: 104241, year: 2007, vol: 48, page: 237, stat: Journal Article,

The influence of hippocampal sclerosis on the cortical distribution of naming sites
Hamberger, M; Seidel, W; Williams, A; Goodman, R; Perrine, K; Devinsky, O; Barr, W; McKhann, G
2007 OCT ;48(1):221-221, Epilepsia
— id: 87153, year: 2007, vol: 48, page: 221, stat: Journal Article,

Worsening of quality of life after epilepsy surgery - Effect of seizures and memory decline
Langfitt, JT; Westerveld, M; Hamberger, MJ; Walczak, TS; Cicchetti, DV; Berg, AT; Vickrey, BG; Barr, WB; Sperling, MR; Masur, D; Spencer, SS
2007 JUN 5 ;68(23):1988-1994, Neurology
Background: Surgery for intractable temporal lobe epilepsy usually controls seizures and improves health-related quality of life (HRQOL), but some patients experience continued seizures, memory decline, or both. The relative impact of these unfavorable outcomes on HRQOL has not been described. Methods: We studied seizure control, memory change, and HRQOL among 138 patients in the Multicenter Study of Epilepsy Surgery (MSES), an ongoing, prospective study of epilepsy surgery outcomes. Seizure remission at 2 years and 5 years was prospectively determined based upon regularly scheduled follow-up calls to study patients throughout the follow-up period. HRQOL was assessed annually using the Quality of Life in Epilepsy Inventory (QOLIE-89). Memory decline was determined by change in verbal delayed recall from baseline to the 2- or 5-year follow-up. Results: HRQOL improved in patients who were in remission at the 2-year or 5-year follow-up, regardless of memory outcome. Among those not in remission at both 2 and 5 years (25/138, 18%), HRQOL remained stable when memory did not decline (14/138, 10%), but HRQOL declined when memory did decline (11/138, 8%). These 11 patients had baseline characteristics predictive of poor seizure or memory outcome. Declines were most apparent on HRQOL subscales assessing memory, role limitations, and limitations in work, driving, and social activities. Conclusions: After temporal resection, health-related quality of life (HRQOL) improves or remains stable in seizure-free patients despite memory decline, but HRQOL declines when persistent seizures are accompanied by memory decline. These results may be useful in presurgical counseling and identifying patients at risk for poor psychosocial outcome following surgery
— id: 98045, year: 2007, vol: 68, page: 1988, stat: Journal Article,

Effects of patient occupation and education variables on the choice of neuropsychological assessment instruments
Rabin, Laura A; Barr, William B; Burton, Leslie A
2007 ;14(4):247-254, Applied neuropsychology
The current study surveyed test-usage practices of clinical neuropsychologists to determine whether respondents varied their assessment batteries based on specific patient demographic characteristics. Respondents were 747 doctorate-level psychologists (40% usable response rate) affiliated with Division 40 of the American Psychological Association, National Academy of Neuropsychology, or the International Neuropsychological Society. Respondents read a vignette about a traumatic brain injury patient and subsequently reported the instruments they would utilize to assess this patient's memory, attention, executive functioning, and ability to return to work. There were three versions of the case study, which varied according to the patient's occupation and level of education. Results revealed that the reported proportion of only 9 of 516 instruments (1.7%) varied across classifications, indicating that some neuropsychologists slightly modified their test batteries based on patients' demographic characteristics. The implications of these findings are discussed in relation to enhancing predictions of real-world outcomes based on neuropsychological test data
— id: 95087, year: 2007, vol: 14, page: 247, stat: Journal Article,

[image omitted]Utilization Rates of Ecologically Oriented Instruments Among Clinical Neuropsychologists
Rabin, Laura A; Burton, Leslie A; Barr, William B
2007 Sep;21(5):727-743, Clinical neuropsychologist
The ecological validity of neuropsychological instruments has become an important topic in recent decades, as neuropsychologists are asked to address real-world outcomes with increasing frequency. Although novel instruments that tap skills required for everyday functioning have been developed, it is unclear whether these instruments are migrating from research laboratories into the applied settings of clinical neuropsychologists. The current study surveyed assessment practices of neuropsychologists with regard to their utilization of instruments designed with ecological concerns in mind. Respondents included 747 North American, doctorate-level psychologists (40% usable response rate) affiliated with Division 40 of the American Psychological Association, National Academy of Neuropsychology, or the International Neuropsychological Society. Results indicated that approximately one-third of respondents reported use of ecologically oriented instruments (EOIs), and these instruments were generally utilized with much less frequency than traditional measures. Additionally, certain practice demographics affected usage rates of EOIs. Study findings are interpreted in the context of a growing body of literature that calls attention to the importance of developing and utilizing instruments that are able to handle the complex, real-world issues increasingly addressed during the neuropsychological assessment process
— id: 73911, year: 2007, vol: 21, page: 727, stat: Journal Article,

Non-invasive mapping of language and memory cortex with fMRI and MEG
Thesen T; McDonald CR; Carlson CE; Kuzniecky RI; Huang MX; Ahmadi; Hagler DJ; Stout JD; Nearing KI; Dale AM; Barr WB; Devinsky O; Halgren E
2007 ;:256-256 #G144, Annual meeting abstract program (Cognitive Neuroscience Society)
— id: 74457, year: 2007, vol: , page: 256, stat: Journal Article,

Comparing fMRI and MEG in the study of language processing
Thesen, T; Carlson, CE; McDonald, CM; Kuzniecky, RI; Hagler, DJ; Stout, JD; Nearing, KI; Dale, AM; Barr, WB; Devinsky, O; Halgren, E
2007 OCT ;48(3):221-222, Epilepsia
— id: 98145, year: 2007, vol: 48, page: 221, stat: Journal Article,

A Contemporary Approach to Geriatric Neuropsychology
Barr, William B
2006 ;12(5):761-762 Sep, Journal of the International Neuropsychological Society
Reviews the book, Geriatric Neuropsychology: Assessment and Intervention by Deborah K. Attix and Kathleen Welsh-Bohmer (Eds.) (see record 2005-16543-000). The editors are to be commended for providing a coherent, organized structure to the book that makes it comprehensive, yet very readable. The book has two parts, with Part I focusing on assessment and Part II on intervention. Many of the chapters, particularly in the first section, follow a predictable sequence, which will make this book valuable as a 'quick and easy' reference source for both clinicians and researchers. The book is comprehensive and well organized, which makes it an ideal selection as a resource to place on one's bookshelf. It is up-to-date and differs from similar books by providing a uniquely neuropsychological point-of-view about neurodegenerative disorders and related syndromes rather than simply rehashing methods for conducting a differential diagnosis. Whether a veteran or a recent entrant into the field, neuropsychologists from all backgrounds and specialties will benefit from this book's well-presented introduction to contemporary practice in geriatric neuropsychology.
— id: 69054, year: 2006, vol: 12, page: 761, stat: Journal Article,

Assessing Mild Traumatic Brain Injury on the Sideline
Barr, William B
Sports neuropsychology: Assessment and management of traumatic brain injury New York, NY, US: Guilford Press, 2006,
(from the chapter) The consensus opinion is that the sideline evaluation provides critical information for making the initial diagnosis of mild traumatic brain injury (MTBI) in athletes and for making decisions regarding readiness for an immediate return to play. It appears that the sideline evaluation is performed most appropriately by team physicians and certified athletic trainers who possess the knowledge and requisite training to evaluate the effects of other types of injuries that might accompany an MTBI. There is no consensus on the relative importance of loss of consciousness (LOC), posttraumatic amnesia (PTA), and other symptoms in assessing the severity of the injury. The existence of multiple grading scales and guidelines for returning to play will likely continue until more definitive empirical data are obtained. Most agree that a sideline evaluation of mental status should include information regarding orientation, concentration, and memory. However, there continues to be much disagreement whether these evaluations should be performed informally or with the use of standardized and empirically validated instruments. There is agreement that all athletes who are considered to have sustained an MTBI should receive a medical evaluation to determine the need for any more detailed neurological consultation or follow-up with neuroimaging (e.g., computed tomography scan, magnetic resonance imaging), electrophysiological testing (e.g., electroencephalogram), and neuropsychological testing. No athlete should return to play until all symptoms have resolved completely.
— id: 4071, year: 2006, vol: , page: 87, stat: Chapter,

Prediction of false-positive recognition errors during Wada testing
Barr, William B; Raghavan, Manoj; Kim Nelson, Peter; Devinsky, Orrin
2006 Oct;28(7):1065-1072, Journal of clinical & experimental neuropsychology
False-positive (FP) errors during recognition memory testing often interfere with interpretation of Wada test results. This study examined which clinical and neuropsychological variables provide the best prediction of these errors. Fifty-six patients completed the Wada test and the California Verbal Learning Test (CVLT). Subjects with three or more FP errors on the recognition trials of the CVLT were nearly twice as likely to exhibit FP responding during the Wada test. Further analysis indicates that FP errors during the Wada test appear to be the primary result of a stable and liberal response-bias rather than a result of any other neurological or procedure-related factor
— id: 68659, year: 2006, vol: 28, page: 1065, stat: Journal Article,

Interictal perceptual disturbances in temporal lobe epilepsy
Grant, AC; Donnelly, KM; Barr, WB; Kuzniecky, R; Devinsky, O
2006 MAR ;47(1):97-97, Epilepsia
— id: 104250, year: 2006, vol: 47, page: 97, stat: Journal Article,

Degree of handedness and cerebral dominance
Isaacs, Keren L; Barr, William B; Nelson, Peter Kim; Devinsky, Orrin
2006 Jun 27;66(12):1855-1858, Neurology
OBJECTIVE: To examine the relationship between the degree of handedness and hemispheric language dominance in patients with epilepsy. METHODS: The authors examined the relationship between degree of handedness and hemispheric language dominance in 174 epilepsy surgery candidates using the intracarotid amobarbital procedure and results from a modified version of the Edinburgh Handedness Inventory. RESULTS: The incidence of atypical language dominance increased linearly with the degree of left-handedness, from 9% in strong right-handers (laterality quotient [LQ] = +100) to 46% in ambidextrous individuals and 69% in strong left-handers (LQ = -100). CONCLUSIONS: The incidence of atypical language dominance depends not only on the direction but also on the degree of handedness. In addition, direction of language dominance varies with hemisphere of seizure focus and degree of handedness. A familial history of sinistrality may have an additional effect on the likelihood of atypical dominance
— id: 69637, year: 2006, vol: 66, page: 1855, stat: Journal Article,

Postictal psychosis: A case control study
Kuzniecky, R; Vorkas, CK; Alper, K; Carlson, C; Barr, W; Devinsky, O
2006 SEP ;47(3):279-279, Epilepsia
— id: 69541, year: 2006, vol: 47, page: 279, stat: Journal Article,

Acute language changes following epilepsy surgery
Morrison, CE; Barr, WB; Doyle, W; Carlson, C; Zaroff, CM; Devinsky, O
2006 MAR ;47(1):101-102, Epilepsia
— id: 104251, year: 2006, vol: 47, page: 101, stat: Journal Article,

Influence of demographically corrected norms on lateralizing seizures in African Americans
Morrison, CE; Barr, WB; Zaroff, CM; Gupta, S; Devinsky, O
2006 SEP ;20(3):598-598, Clinical neuropsychologist
— id: 104253, year: 2006, vol: 20, page: 598, stat: Journal Article,

The use, education, training and supervision of neuropsychological test technicians (psychometrists) in clinical practice. Official statement of the National Academy of Neuropsychology
Puente, Antonio E; Adams, Russell; Barr, William B; Bush, Shane S; Ruff, Ronald M; Barth, Jeffrey T; Broshek, Donna; Koffler, Sandra P; Reynolds, Cecil; Silver, Cheryl H; Troster, Alexander I
2006 Dec;21(8):837-839, Archives of clinical neuropsychology
— id: 69636, year: 2006, vol: 21, page: 837, stat: Journal Article,

Psychometric and measurement properties of concussion assessment tools in youth sports
Valovich McLeod, Tamara C; Barr, William B; McCrea, Michael; Guskiewicz, Kevin M
2006 Oct-Dec;41(4):399-408, Journal of athletic training
CONTEXT: Establishing psychometric and measurement properties of concussion assessments is important before these assessments are used by clinicians. To date, data have been limited regarding these issues with respect to neurocognitive and postural stability testing, especially in a younger athletic population. OBJECTIVE: To determine the test-retest reliability and reliable change indices of concussion assessments in athletes participating in youth sports. A secondary objective was to determine the relationship between the Standardized Assessment of Concussion (SAC) and neuropsychological assessments in young athletes. DESIGN: We used a repeated-measures design to evaluate the test-retest reliability of the concussion assessments in young athletes. Correlations were calculated to determine the relationship between the measures. All subjects underwent 2 test sessions 60 days apart. SETTING: Sports medicine laboratory and school or home environment. Patients or Other Participants: Fifty healthy young athletes between the ages of 9 and 14 years. MAIN OUTCOME MEASURE(S): Scores from the SAC, Balance Error Scoring System, Buschke Selective Reminding Test, Trail Making Test B, and Coding and Symbol Search subsets of the Wechsler Intelligence Scale for Children were used in the analysis. RESULTS: Our test-retest indices for each of the 6 scores were poor to good, ranging from r = .46 to .83. Good reliability was found for the Coding and Symbol Search tests. The reliable change scores provided a way of determining a meaningful change in score for each assessment. We found a weak relationship ( r < .36) between the SAC and each of the neuropsychological assessments; however, stronger relationships ( r > .70) were found between certain neuropsychological measures. CONCLUSIONS: We found moderate test-retest reliability on the cognitive tests that assessed attention, concentration, and visual processing and the Balance Error Scoring System. Our results demonstrated only a weak relationship between performance on the SAC and the selected neuropsychological tests, so it is likely that these tests assess somewhat different areas of cognitive function. Our correlational findings provide more evidence for using the SAC along with a more complex neuropsychological assessment battery in the evaluation of concussion in young athletes
— id: 95088, year: 2006, vol: 41, page: 399, stat: Journal Article,

Mental retardation: Relationship to seizures and tuber burden in tuberous sclerosis
Zaroff, C; Barr, W; Devinsky, O; Miles, D; Nass, R
2006 MAR ;60(3):S127-S128, Annals of neurology
— id: 104247, year: 2006, vol: 60, page: S127, stat: Journal Article,

Mental retardation and relation to seizure and tuber burden in tuberous sclerosis complex
Zaroff, Charles M; Barr, William B; Carlson, Chad; LaJoie, Josiane; Madhavan, Deepak; Miles, Daniel K; Nass, Ruth; Devinsky, Orrin
2006 Oct;15(7):558-562, Seizure
In patients with tuberous sclerosis complex (TSC), the high rates of mental retardation are associated with cortical tubers, seizure activity, and genetic factors. The goal of the study was to investigate the relationship between bilateral cortical tubers and seizure variables and mental retardation in individuals with TSC. The records of 27 patients with TSC (age 6 months to 33 years) undergoing neuropsychological assessment and the following clinical variables were examined: bilateral versus non-bilateral cortical tubers, the age of seizure onset, and presence of infantile spasms. Results were statistically analyzed. Bilateral cortical tubers (p=0.02) and early age of seizure onset (p=0.04) were significantly related to impaired cognitive functioning. Only one of the seven patients with normal cognitive functioning had bilateral tubers, whereas 13/21 patients with intellectual impairment had bilateral tubers. Patients with normal cognitive functioning experienced a mean age of seizure onset after 6 years. A trend was observed between infantile spasms and cognitive functioning (p=0.06); the lack of statistical significance likely reflects the small sample size. Neither age nor gender was related to cognitive status. Further investigation incorporating additional neuroimaging factors, antiepileptic treatment effects, and genetic variables, is needed
— id: 69073, year: 2006, vol: 15, page: 558, stat: Journal Article,

Rates of invalid MMPI-2 responding in patients with epileptic and nonepileptic seizures
Barr, WB; Larson, E; Alper, K; Devinsky, O
2005 SEP ;46(11):60-60, Epilepsia
— id: 59584, year: 2005, vol: 46, page: 60, stat: Journal Article,

A group treatment approach to treating memory disorder in epilepsy
Barr, WB; Morrison, C; Isaacs, K; Devinsky, O
2005 JUN ;19(2):144-145, Clinical neuropsychologist
— id: 104261, year: 2005, vol: 19, page: 144, stat: Journal Article,

Boyfriend Busted in Fatal Stabbing
Barr, William B
Forensic Neuropsychology Casebook New York, NY, US: Guilford Press, 2005,
(from the chapter) The author received a telephone call from an Assistant District Attorney inquiring about availability to serve as an expert witness for the prosecution of murder charges against a defendant. He stated that the defendant had completed a psychological evaluation by an expert retained by his counsel. The test results had apparently shown that the defendant was unable to appreciate the nature of his actions at the time of the murder as a result of psychosis. To supplement testing of intelligence, the author administered the Validity Indicator Profile (VIP). Maldonado's scores were invalid, with a performance curve indicating that he had approached the test in an inconsistent and careless manner, indicating that the defendant's performance was not an accurate indication of his true ability. The author recalled that similar findings were apparent in his performance as evidenced by a review of the records provided by the expert retained by the defendant's counsel. Now there was evidence in both examinations that the defendant's low scores on IQ tests were the result of poor effort, rather than any purported limitation in his level of intelligence. Based upon the current author's interview, behavioral observations and neuropsychological test results she believed that that the defendant's behavior was not consistent with someone who was not able to appreciate the nature and consequences of his actions at the time of the murder. Efforts to obtain collateral interviews to gain more insight into the defendant were relatively unsuccessful. Much of the hardest work in this case resulted from having to reconstruct the lives of both the defendant and the victim through available records. The task would have been much easier if the author had been able to obtain more information from individuals who had known both of them, saw them interacting, and had some sense of what kind of relationship they had. The individuals I contacted provided only limited information. Others who had potentially more useful information refused to speak to me. For example, conversations with the defendant's treating psychiatrist would have provided insight into his drug history. Remaining questions make it clear that forensic work involves an integration of much more information than is provided in a series of test responses, particularly if the subject fails to exert reasonable effort during examination.
— id: 3777, year: 2005, vol: , page: 239, stat: Chapter,

Changes in depression and anxiety after resective surgery for epilepsy
Devinsky, O; Barr, W B; Vickrey, B G; Berg, A T; Bazil, C W; Pacia, S V; Langfitt, J T; Walczak, T S; Sperling, M R; Shinnar, S; Spencer, S S
2005 Dec 13;65(11):1744-1749, Neurology
OBJECTIVE: To determine changes in depression and anxiety after resective surgery. METHODS: Data from subjects enrolled in a prospective multicenter study of resective epilepsy surgery were reviewed with the Beck Psychiatric Symptoms Scales (Beck Depression Inventory [BDI] and Beck Anxiety Inventory [BAI]) and Composite International Diagnostic Interview (CIDI) up to a 24-month period. chi2 analyses were used to correlate proportions. RESULTS: A total of 358 presurgical BDI and 360 BAI results were reviewed. Moderate and severe levels of depression were reported in 22.1% of patients, and similar levels of anxiety were reported by 24.7%. Postoperative rates of depression and anxiety declined at the 3-, 12-, and 24-month follow-up periods. At the 24-month follow-up, moderate to severe levels of depression symptoms were reported in 17.6 and 14.7% of the patients who continued to have postoperative seizures. Moderate to severe depression and anxiety were found in 8.2% of those who were seizure-free. There was no relationship, prior to surgery, between the presence or absence of depression and anxiety and the laterality or location of the seizure onset. There were no significant relationships between depression or anxiety at 24-month follow-up and the laterality or location of the surgery. CONCLUSIONS: Depression and anxiety in patients with refractory epilepsy significantly improve after epilepsy surgery, especially in those who are seizure-free. Neither the lateralization nor the localization of the seizure focus or surgery was associated with the risk of affective symptoms at baseline or after surgery
— id: 99309, year: 2005, vol: 65, page: 1744, stat: Journal Article,

Standard regression-based methods for measuring recovery after sport-related concussion
McCrea, Michael; Barr, William B; Guskiewicz, Kevin; Randolph, Christopher; Marshall, Stephen W; Cantu, Robert; Onate, James A; Kelly, James P
2005 Jan;11(1):58-69, Journal of the International Neuropsychological Society
Clinical decision making about an athlete's return to competition after concussion is hampered by a lack of systematic methods to measure recovery. We applied standard regression-based methods to statistically measure individual rates of impairment at several time points after concussion in college football players. Postconcussive symptoms, cognitive functioning, and balance were assessed in 94 players with concussion (based on American Academy of Neurology Criteria) and 56 noninjured controls during preseason baseline testing, and immediately, 3 hr, and 1, 2, 3, 5, and 7 days postinjury. Ninety-five percent of injured players exhibited acute concussion symptoms and impairment on cognitive or balance testing immediately after injury, which diminished to 4% who reported elevated symptoms on postinjury day 7. In addition, a small but clinically significant percentage of players who reported being symptom free by day 2 continued to be classified as impaired on the basis of objective balance and cognitive testing. These data suggest that neuropsychological testing may be of incremental utility to subjective symptom checklists in identifying the residual effects of sport-related concussion. The implementation of neuropsychological testing to detect subtle cognitive impairment is most useful once postconcussive symptoms have resolved. This management model is also supported by practical and other methodological considerations
— id: 69639, year: 2005, vol: 11, page: 58, stat: Journal Article,

Assessment practices of clinical neuropsychologists in the United States and Canada: a survey of INS, NAN, and APA Division 40 members
Rabin, Laura A; Barr, William B; Burton, Leslie A
2005 Jan;20(1):33-65, Archives of clinical neuropsychology
The present study surveyed assessment practices and test usage patterns among clinical neuropsychologists. Respondents were 747 North American, doctorate-level psychologists (40% usable response rate) affiliated with Division 40 of the American Psychological Association (APA), the National Academy of Neuropsychology (NAN), or the International Neuropsychological Society (INS). Respondents first provided basic demographic and practice-related information and reported their most frequently utilized instruments. Overall, the Wechsler Adult Intelligence Scales and Wechsler Memory Scales were most frequently used, followed by the Trail Making Test, California Verbal Learning Test, and Wechsler Intelligence Scale for Children. Respondents also reviewed a vignette about a traumatic brain injury patient, and then reported the instruments they would use to assess this patient's specific cognitive symptomatology, general cognitive ability, and capacity to return to work. Particular attention was paid to the areas of memory, attention, and executive functioning. The current study represents the largest and most comprehensive test usage survey conducted to date within the field of clinical neuropsychology. Survey results update and greatly expand knowledge about neuropsychologists' assessment practices. Following a review of findings, results are compared to those obtained in prior surveys and implications for the field of neuropsychology are discussed
— id: 69640, year: 2005, vol: 20, page: 33, stat: Journal Article,

Is neuropsychological testing useful in the management of sport-related concussion?
Randolph, Christopher; McCrea, Michael; Barr, William B
2005 Jul-Sep;40(3):139-152, Journal of athletic training
Objective: Neuropsychological (NP) testing has been used for several years as a way of detecting the effects of sport-related concussion in order to aid in return-to-play determinations. In addition to standard pencil-and-paper tests, computerized NP tests are being commercially marketed for this purpose to professional, collegiate, high school, and elementary school programs. However, a number of important questions regarding the clinical validity and utility of these tests remain unanswered, and these questions present serious challenges to the applicability of NP testing for the management of sport-related concussion. Our purpose is to outline the criteria that should be met in order to establish the utility of NP instruments as a tool in the management of sport-related concussion and to review the degree to which existing tests have met these criteria.Data Sources: A comprehensive literature review of MEDLINE and PsychLit from 1990 to 2004, including all prospective, controlled studies of NP testing in sport-related concussion.Data Synthesis: The effects of concussion on NP test performance are so subtle even during the acute phase of injury (1-3 days postinjury) that they often fail to reach statistical significance in group studies. Thus, this method may lack utility in individual decision making because of a lack of sensitivity. In addition, most of these tests fail to meet other psychometric criteria (eg, adequate reliability) necessary for this purpose. Finally, it is unclear that NP testing can detect impairment in players once concussion-related symptoms (eg, headache) have resolved. Because no current guideline for the management of sport-related concussion allows a symptomatic player to return to sport, the incremental utility of NP testing remains questionable.Conclusions/Recommendations: Despite the theoretic rationale for the use of NP testing in the management of sport-related concussion, no NP tests have met the necessary criteria to support a clinical application at this time. Additional research is necessary to establish the utility of these tests before they can be considered part of a routine standard of care, and concussion recovery should be monitored via the standard clinical examination and subjective symptom checklists until NP testing or other methods are proven effective for this purpose
— id: 69638, year: 2005, vol: 40, page: 139, stat: Journal Article,

Mental retardation and relation to seizure and tuber burden in tuberous sclerosis complex
Zaroff, CM; Barr, W; Devinsky, O; Miles, D; Nass, R
2005 SEP ;46(11):166-166, Epilepsia
— id: 59587, year: 2005, vol: 46, page: 166, stat: Journal Article,

The neuropsychological performance of children with epilepsy on the NEPSY
Bender, HA; Zaroff, CM; Marks, BC; Brown, E; Devinsky, O; Barr, WB
2004 NOV ;19(7):939-940, Archives of clinical neuropsychology
— id: 104264, year: 2004, vol: 19, page: 939, stat: Journal Article,

Side of surgery and hippocampal sclerosis are sole predictors of verbal memory decline after anterior temporal lobectomy
Langfitt, J; Tracy, J; Westerveld, M; Barr, W; Hamberger, M; Facchini, R; Masur, D; Beniak, T; Berg, A; Spencer, S
2004 FEB ;45(1):345-345, Epilepsia
— id: 98183, year: 2004, vol: 45, page: 345, stat: Journal Article,

The neuropsychology of insight in psychiatric and neurological disorders
Laroi, Frank; Barr, William B; Keefe, Richard S. E
Insight and psychosis: Awareness of illness in schizophrenia and related disorders (2nd ed) New York, NY, US: Oxford University Press, 2004,
(from the chapter) This chapter comprises three parts. The first involves a description of impairments of awareness in neurobehavioural disorders. Then, a parallel between these impairments of awareness with those found in schizophrenia will be presented. The second part of the chapter involves the presentation of a form of awareness disorder that has recently been studied in schizophrenia, namely, an impairment in autonoetic awareness. Finally, the third part will briefly present major theoretical approaches to disorders of awareness, in particular, neurobehavioural and neuropsychological theories
— id: 4723, year: 2004, vol: , page: 119, stat: Chapter,

Facial closure: interrelationship with facial discrimination, other closure tests, and subjective contour illusions
Wasserstein, Jeanette; Barr, William B; Zappulla, Russ; Rock, Donald
2004 ;42(2):158-163, Neuropsychologia
Findings from previous research have argued for the dissociation of two visual-perceptual tasks traditionally thought to be mediated by the nondominant hemisphere (i.e. perceptual closure and facial discrimination). This, primarily methodological, study examined the extent to which the facial closure measure (Mooney closure faces test) involves 'closure' and/or facial discrimination. A factor analysis of six visual perceptual measures, carried out separately for left brain damaged (LBDs, n=33) and right brain damaged (RBDs, n=30) patients, resulted in two relatively independent factors (i.e. a closure factor and a facial discrimination factor), with the Mooney closure faces test loading on both. The mixed factorial structure did not aid the facial closure measure's sensitivity to right-sided brain disease. Moreover, age and education intercorrelated differently with the two factors. Results argue for the use of more discrete visual-perceptual measures when examining perceptual functioning and/or right hemisphere integrity, and imply the existence of at least two discrete cortical level visual-perceptual neural systems
— id: 69643, year: 2004, vol: 42, page: 158, stat: Journal Article,

Delineating the functions of the nondominant hemisphere
Barr, William B
2003 Dec;4(6):797-798, Epilepsy & behavior
— id: 69642, year: 2003, vol: 4, page: 797, stat: Journal Article,

Neuropsychological testing of high school athletes. Preliminary norms and test-retest indices
Barr, William B
2003 Jan;18(1):91-101, Archives of clinical neuropsychology
This study provides preliminary norms and test-retest indices on a brief battery of neuropsychological tests administered to a sample of 60 male and 40 female high school athletes. Forty-eight subjects completed retesting 8 weeks later. Analyses of baseline scores indicate that girls outperform boys on selected measures of processing speed and executive functions [Wechsler Adult Intelligence Scale-III (WAIS-III) Digit Symbol, Trails B, and Controlled Oral Word Association Test (COWAT)]. Test-retest reliability was low and varied widely among the tests. There were no gender differences in test-retest reliability. Reliable Change Indices (RCIs) were computed on the test-retest data for use in clinical interpretation. These preliminary results indicate that caution should be used in interpreting neuropsychological test data from high school athletes. The current findings indicate that separate norms for boys and girls are warranted. Caution should be used in interpreting discrepancies from baseline scores as a result of what may turn out to be poor test-retest reliability in this population
— id: 39009, year: 2003, vol: 18, page: 91, stat: Journal Article,

Pitfalls in the method of double dissociation: delineating the cognitive functions of the hippocampus
Barr, William B; Goldberg, Elkhonon
2003 Feb;39(1):153-157, Cortex
— id: 39276, year: 2003, vol: 39, page: 153, stat: Journal Article,

Acute effects and recovery time following concussion in collegiate football players: the NCAA Concussion Study
McCrea, Michael; Guskiewicz, Kevin M; Marshall, Stephen W; Barr, William; Randolph, Christopher; Cantu, Robert C; Onate, James A; Yang, Jingzhen; Kelly, James P
2003 Nov 19;290(19):2556-2563, JAMA
CONTEXT: Lack of empirical data on recovery time following sport-related concussion hampers clinical decision making about return to play after injury. OBJECTIVE: To prospectively measure immediate effects and natural recovery course relating to symptoms, cognitive functioning, and postural stability following sport-related concussion. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study of 1631 football players from 15 US colleges. All players underwent preseason baseline testing on concussion assessment measures in 1999, 2000, and 2001. Ninety-four players with concussion (based on American Academy of Neurology criteria) and 56 noninjured controls underwent assessment of symptoms, cognitive functioning, and postural stability immediately, 3 hours, and 1, 2, 3, 5, 7, and 90 days after injury. MAIN OUTCOME MEASURES: Scores on the Graded Symptom Checklist (GSC), Standardized Assessment of Concussion (SAC), Balance Error Scoring System (BESS), and a neuropsychological test battery. RESULTS: No player with concussion was excluded from participation; 79 players with concussion (84%) completed the protocol through day 90. Players with concussion exhibited more severe symptoms (mean GSC score 20.93 [95% confidence interval [CI], 15.65-26.21] points higher than that of controls), cognitive impairment (mean SAC score 2.94 [95% CI, 1.50-4.38] points lower than that of controls), and balance problems (mean BESS score 5.81 [95% CI, -0.67 to 12.30] points higher than that of controls) immediately after concussion. On average, symptoms gradually resolved by day 7 (GSC mean difference, 0.33; 95% CI, -1.41 to 2.06), cognitive functioning improved to baseline levels within 5 to 7 days (day 7 SAC mean difference, -0.03; 95% CI, -1.33 to 1.26), and balance deficits dissipated within 3 to 5 days after injury (day 5 BESS mean difference, -0.31; 95% CI, -3.02 to 2.40). Mild impairments in cognitive processing and verbal memory evident on neuropsychological testing 2 days after concussion resolved by day 7. There were no significant differences in symptoms or functional impairments in the concussion and control groups 90 days after concussion. CONCLUSIONS: Collegiate football players may require several days for recovery of symptoms, cognitive dysfunction, and postural instability after concussion. Further research is required to determine factors that predict variability in recovery time after concussion. Standardized measurement of postconcussive symptoms, cognitive functioning, and postural stability may enhance clinical management of athletes recovering from concussion
— id: 69644, year: 2003, vol: 290, page: 2556, stat: Journal Article,

An effective neuropsychological screening battery for Hispanic epilepsy patients
Myers, L; Barr, WB; Vazquez, B; Devinsky, O
2003 FEB ;17(1):92-92, Clinical neuropsychologist
— id: 104268, year: 2003, vol: 17, page: 92, stat: Journal Article,

A recent classic on violence in epilepsy
Barr WB
2002 Dec;3(6):548-549, Epilepsy & behavior
— id: 39290, year: 2002, vol: 3, page: 548, stat: Journal Article,

Neuropsychological testing for assessment of treatment effects: methodologic issues
Barr, William B
2002 Apr;7(4):300-2, 304, CNS spectrums
Neuropsychological (NP) testing is now recognized as an important method for evaluating treatment effects. However, there are limitations to how these tests are currently used in most drug treatment protocols. Changes in cognition are typically defined in statistical terms, with little knowledge as to whether the observed differences are meaningful in any other sense. Methods for assessing changes in test scores need to account for test-retest reliability, practice effects, regression to the mean, and the impact of initial performance. All of these factors may vary according to the individual characteristics of the subject. This article reviews two methods from the NP literature that have attempted to account for these sources of test-retest bias. The reliable change index provides a confidence interval for predicted change by taking into account the test-retest reliability of the measure. Standardized regression-based measures use a more sophisticated statistical approach that enables them to better account for other potential sources of confound. Use of this methodology has been limited to studies of epilepsy surgery and sports-related concussion. These methods have the potential for enhancing the interpretation of NP test data in drug treatment protocols by providing an empirically based definition of clinically meaningful change
— id: 69641, year: 2002, vol: 7, page: 300, stat: Journal Article,

Treatment of memory disorders in epilepsy
Shulman MB; Barr W
2002 Oct;3(5S):30-34, Epilepsy & behavior
Impaired memory is a common and often debilitating complaint in patients with epilepsy. Overlapping variables such as seizure control, attentional dysfunction, and mood disorders further complicate diagnosis and management. Direct therapy for memory deficits associated with epilepsy is rarely attempted. The varied pharmacological (AED selection, cholinesterase inhibitors, stimulants, antidepressants, and herbal supplements) and nonpharmacological approaches to cognitive remediation in epilepsy patients are reviewed
— id: 95532, year: 2002, vol: 3, page: 30, stat: Journal Article,

Schizophrenia and attention deficit disorder. Two complex disorders of attention
Barr WB
2001 Jun;931(4):239-250, Annals of the New York Academy of Sciences
Attentional dysfunction can be found in nearly every form of psychopathology, not just in attention deficit disorder (ADD). Being able to distinguish ADD from other psychiatric conditions is crucial for clinicians working with adolescents and young adults, particularly in the case of psychoses where making the correct diagnosis and beginning treatment promptly is extremely important. In this paper we review the literature on the attentional dysfunction found in schizophrenia and compare it to that found in ADD in an effort to increase our knowledge of etiology and underlying mechanisms. Investigators studying ADD may learn from the study of schizophrenia by realizing that ADD is also a complex disorder of attention that occurs across the developmental spectrum and is characterized by various predispositional, environmental, and maturational factors.
— id: 21040, year: 2001, vol: 931, page: 239, stat: Journal Article,

Sensitivity and specificity of standardized neurocognitive testing immediately following sports concussion
Barr WB; McCrea M
2001 Sep;7(6):693-702, Journal of the International Neuropsychological Society
Neuropsychology, with its emphasis on standardized and empirically based methods, has made a number of scientific contributions to address growing concerns about concussions resulting from sports injuries. This study employs a test-retest paradigm to determine the immediate effects of concussion in high-school and college athletes. The Standardized Assessment of Concussion (SAC) was administered to 1,313 male athletes prior to the beginning of the competitive season. Reliable change indices and multiple regression models were computed on retest scores obtained from 68 noninjured athletes who were readministered the SAC at either 60 or 120 days following baseline testing. Receiver operating characteristic (ROC) curve analyses were used to test these models with data obtained on 50 athletes tested immediately following concussion. The results indicate that a decline of I point on the SAC at retesting classified injured and noninjured participants with a level of 94% sensitivity and 76% specificity. The RCI and multiple regression models provided comparable levels of group classification, but provided cut-offs that are conservative for use with this population. The results support and extend previous research findings indicating that the SAC is a valid instrument for detecting the immediate effects of mild traumatic brain injury
— id: 26653, year: 2001, vol: 7, page: 693, stat: Journal Article,

Methodologic issues in neuropsychological testing
Barr, WB
2001 JUL-SEP ;36(3):297-302, Journal of athletic training
Objective: To familiarize athletic trainers with methodologic issues regarding the development and implementation of neuropsychological tests used in programs for monitoring sport-related cerebral concussion. Data Sources: Knowledge base and MEDLINE and PsychLit searches from 1980-2000 using the terms sports, athletes, concussion, and brain. Data Synthesis: Neuropsychological testing is a proven method for evaluating symptoms of concussion that results from a variety of different causes. These tests have been shown to be effective in evaluating symptoms of subtle cognitive dysfunction in a number of patient groups, Applying these tests in an athletic population has required some procedural modifications, including the use of brief test batteries, collection of preseason baseline data, and evaluation of subtle postconcussive changes in test scores over time. New methods are now being used for improved evaluation of the reliability and validity of neuropsychological tests in athletes. Proper scientific analysis of the psychometric properties of neuropsychological tests and the ultimate value of their use in the sport setting will require years of detailed study on large numbers of athletes with and without symptoms of concussion. Conclusions/Recommendations: Athletic trainers and related personnel need to be aware of the training and methodologic issues associated with neuropsychological testing. Knowledge of the scientific properties of these tests, their advantages, and current limitations will ultimately enhance the athletic trainer's ability to use information from neuropsychological testing in an effective manner
— id: 55308, year: 2001, vol: 36, page: 297, stat: Journal Article,

Adult-onset idiopathic generalized epilepsy: clinical and behavioral features
Cutting S; Lauchheimer A; Barr W; Devinsky O
2001 Nov;42(11):1395-1398, Epilepsia
PURPOSE: To identify and define clinical and behavioral features of patients with adult-onset idiopathic generalized epilepsy (IGE). METHODS: We reviewed the charts of 313 IGE patients at the NYU Comprehensive Epilepsy Center over the past 5 years to identify patients with adult onset (18 years old or older). We excluded patients with childhood or adolescent symptoms that suggested absence, myoclonic, or tonic-clonic seizures, as well as those with a history of significant head injury or other known causes of localization-related epilepsy. RESULTS: Forty-two (13.4%) patients had a clear onset of IGE in adulthood; average age of onset was early 20s (mean, 23.8 years; range, 18-55 years). Twenty-one patients had adult myoclonic epilepsy (AME, 50%), and three had generalized tonic-clonic seizures on awakening (GTCS-A, 7%). More than two thirds (n=30) are well controlled with current antiepileptic drugs (AEDs), and almost 90% are currently employed (n=37). One third were diagnosed and treated for mental disorders, including depression (n=12), anxiety (n=7), obsessive-compulsive personality disorder (n=2), and postictal psychosis (n=1). CONCLUSIONS: Adult-onset IGE is associated with a good prognosis. An association may exist between psychological disorders, psychotropic medication, and level of seizure control in adults with IGE
— id: 34412, year: 2001, vol: 42, page: 1395, stat: Journal Article,

Temporal lobectomy in children: cognitive outcome
Westerveld M; Sass KJ; Chelune GJ; Hermann BP; Barr WB; Loring DW; Strauss E; Trenerry MR; Perrine K; Spencer DD
2000 Jan;92(1):24-30, Journal of neurosurgery
OBJECT: The authors sought to determine the impact of early temporal lobectomy (in patients younger than age 17 years) on intellectual functioning. The efficacy of temporal lobectomy for treating seizures is well established and the procedure is becoming more acceptable as a treatment for children whose seizures are intractable. However, cognitive outcomes of temporal lobectomy in children and adolescents are largely unreported. The present study takes advantage of a unique multicenter collaboration to examine retrospectively intellectual functioning in a large sample of children who underwent temporal lobectomy. METHODS: Intellectual functioning was assessed before and after temporal lobectomy for treatment of medication-resistant seizures in 82 patients at eight centers of epilepsy surgery. All children underwent standard presurgical examinations, including electroencephalography-video monitoring, magnetic resonance (MR) imaging, and neuropsychological testing, at their respective centers. Forty-three children underwent left temporal lobectomy and 39 underwent right temporal lobectomy. For the entire sample, there were no significant declines in intelligence quotient (IQ) following surgery. Children who underwent left temporal lobectomy demonstrated no significant loss in verbal intellectual functioning and improved significantly in nonverbal intellectual functioning. Children who underwent right temporal lobectomy did not demonstrate significant changes in intellectual functioning. Although group scores showed no change in overall IQ values, an analysis of individual changes revealed that approximately 10% of the sample experienced a significant decline and 9% experienced significant improvement in verbal functioning. Significant improvement in nonverbal cognitive function was observed in 16% of the sample and only 2% of the sample showed significant declines. Risk factors for significant decline included older patient age at the time of surgery and the presence of a structural lesion other than mesial temporal sclerosis on MR imaging. CONCLUSIONS: The present study provides preliminary data for establishing the risk of cognitive morbidity posed by temporal lobectomy performed during childhood. With respect to global intellectual functioning, a slight improvement was significantly more likely to occur than a decline. However, there were several patients in whom significant declines did occur. It will be necessary to study further the factors associated with such declines. In addition, further study of more specific cognitive functions, particularly memory, is needed.
— id: 21041, year: 2000, vol: 92, page: 24, stat: Journal Article,

Relations among indexes of memory disturbance and depression in patients with Lyme borreliosis
Barr WB; Rastogi R; Ravdin L; Hilton E
1999 ;6(1):12-18, Applied neuropsychology
This study examined the relation between complaints of memory disturbance and measures of mood and memory functioning in 55 patients with serological evidence of late-stage Lyme Borreliosis (LB). Patients completed the Self-Ratings of Memory Questionnaire (SRMQ) and the Beck Depression Inventory. Memory functioning was assessed with the California Verbal Learning Test. Depressed patients exhibited more frequent complaints of memory disturbance on the SRMQ, although their pattern of responses did not differ from nondepressed patients. There was a significant correlation between subjective memory ratings and self-reported depression (Spearman rho = -.57, p < .001). No relation was observed between subjective memory ratings and objective memory performance. The results indicate subjective complaints of more severe memory disturbance in patients with LB and depression. Particular attention should be paid to the assessment of depression and subjective symptoms of memory disturbance when administering neuropsychological tests of memory functioning in patients with LB.
— id: 21043, year: 1999, vol: 6, page: 12, stat: Journal Article,

Effects of anomalous language representation on neuropsychological performance in temporal lobe epilepsy
Loring DW; Strauss E; Hermann BP; Perrine K; Trenerry MR; Barr WB; Westerveld M; Chelune GJ; Lee GP; Meador KJ
1999 Jul 22;53(2):260-264, Neurology
OBJECTIVE: To examine the effects of anomalous language representation (i.e., mixed- and right-cerebral dominant) on neuropsychological performance. BACKGROUND: Right cerebral language dominance resulting from early cerebral injury is associated with relatively preserved language function with decreased visuospatial ability. However, previous reports of this phenomenon have examined patients with relatively large cerebral injuries (e.g., infantile hemiplegia) or limited sample sizes. METHODS: A total of 561 patients with complex partial seizures of left temporal lobe origin were studied. Patients were classified into left (n = 455), bilateral (n = 58), and right (n = 48) language dominant groups based on Wada testing. RESULTS: Right language dominant patients performed more poorly on multiple tests of visuospatial function, including Performance IQ (PIQ), than did left language patients. No significant group differences were detected for measures of language or general verbal function. The effects of bilateral language on PIQ differed according to handedness. Lowered PIQ was present in the bilateral nondextral group but not for bilateral dextral patients, and this pattern was observed with other visuospatial measures. CONCLUSIONS: In patients with relatively small lesions restricted to the left mesial temporal lobe, a shift in language dominance to the right hemisphere is associated with decreased visuospatial functions but preserved verbal abilities. Nondextral patients with bilateral language representation also displayed decreased visuospatial performance, although dextral patients with bilateral language did not.
— id: 21044, year: 1999, vol: 53, page: 260, stat: Journal Article,

The neuropsychological examination of naming in Lyme borreliosis
Svetina C; Barr WB; Rastogi R; Hilton E
1999 ;6(1):33-38, Applied neuropsychology
Although subjective complaints of word finding and naming deficits are commonly reported by patients with Lyme Borreliosis (LB), the existence of these disturbances has not been thoroughly investigated. Forty-four patients with LB and 43 healthy controls were administered a symptom questionnaire, the Boston Naming Test (BNT), the Controlled Oral Word Association Test (COWAT), and a series of category naming tasks. LB patients had a higher rate of complaints of word-finding disturbance (55% vs. 14%). Lower mean scores were observed on the BNT, but not on the COWAT, nor on category naming tasks. Thirty-six percent of the LB sample exhibited BNT scores in the impaired range. BNT scores in this group were correlated with a measure of memory retrieval, but not with verbal fluency indexes. There was no relation between naming scores and depression. LB patients exhibit impairments in word finding that appear to be secondary to a generalized retrieval deficit.
— id: 21042, year: 1999, vol: 6, page: 33, stat: Journal Article,

Does presurgical IQ predict seizure outcome after temporal lobectomy? Evidence from the Bozeman Epilepsy Consortium
Chelune GJ; Naugle RI; Hermann BP; Barr WB; Trenerry MR; Loring DW; Perrine K; Strauss E; Westerveld M
1998 Mar;39(3):314-318, Epilepsia
PURPOSE: Considerable debate exists concerning whether the presence of low preoperative IQ should be a contraindication for focal resective epilepsy surgery. METHODS: We examined the relationship between baseline IQ scores and seizure outcome in 1,034 temporal lobectomy cases from eight epilepsy surgery centers participating in the Bozeman Epilepsy Consortium. RESULTS: Those patients who continued to have seizures following surgery had statistically lower preoperative IQ scores than those who were seizure-free (p < 0.009), but only by 2.3 points. This small but statistically significant relationship was fairly robust; it was observed across seven of the eight centers, and indicates that the findings can be generalized. Among patients with IQ scores of < or = 75, 32.8% continued to have seizures following surgery, whereas 23.8% and 16.9% were not seizure-free when IQ scores were between 76 and 109 and > or = 110, respectively. Relative risk analyses revealed no significant increase in risk among patients with low IQ scores who had no structural lesions other than mesial temporal sclerosis. However, patients with IQ scores of < or = 75 had nearly a fourfold (390%) increase in risk for continued seizures as compared with those with higher IQ scores if structural lesions were present. CONCLUSIONS: While our results suggest that preoperative IQ scores alone are not good predictors of seizure outcome and should not be used to exclude patients as potential surgical candidates. IQ scores can be useful for counseling patients and their families concerning the relative risks of surgery.
— id: 21046, year: 1998, vol: 39, page: 314, stat: Journal Article,

New-onset psychogenic seizures after surgery for epilepsy
Ney GC; Barr WB; Napolitano C; Decker R; Schaul N
1998 May;55(5):726-730, Archives of neurology
BACKGROUND: The emergence of psychogenic seizures after surgery for epilepsy is not well recognized. OBJECTIVES: To identify the frequency of psychogenic seizures in an 11-year surgical experience and to characterize the patients with this complication. METHODS: Ninety-six patients underwent surgery for epilepsy between 1985 and 1996. The surgical database was reviewed and all patients who experienced postoperative psychogenic seizures were identified. Patients were characterized by sex, age, psychopathologic conditions, full-scale IQ, duration of epilepsy, surgical procedure, and operative complications. Patients were compared with the surgical group as a whole for these variables. SETTING: A comprehensive epilepsy center. RESULTS: Five patients were identified: 3 men and 2 women. Mean full-scale IQ was 73 (range, 66-82). Mean age was 29.8 years (range, 22-36 years). Three patients were diagnosed as having psychosis, 1 with borderline personality disorder and 1 with generalized anxiety. Operations included 4 anterior temporal lobectomies and 1 occipital lobectomy. Two patients experienced operative complications. Compared with the surgical cohort, patients had a higher frequency of preoperative psychopathologic conditions, lower mean full-scale IQ, and a greater occurrence of operative complications. CONCLUSIONS: (1) Patients can develop new-onset psychogenic seizures after surgery for epilepsy. (2) Low full-scale IQ, serious preoperative psychopathologic conditions, and major surgical complications may be risk factors. (3) Atypical postoperative seizures should be evaluated with video electroencephalographic monitoring before concluding that they are epileptic.
— id: 21045, year: 1998, vol: 55, page: 726, stat: Journal Article,

Examining the right temporal lobe's role in nonverbal memory
Barr WB
1997 Oct;35(1):26-41, Brain & cognition
Tests of facial recognition and spatial learning were administered to presurgical patients with unilateral temporal lobe EEG foci. Right temporal lobe patients obtained lower facial recognition scores than left temporal lobe patients. The groups performed equally on the spatial learning test. A factor analysis revealed two independent factors: a general visuospatial factor and a more specific facial identification factor. The findings provide support for the existence of two dissociable visual processing systems. Memory impairments associated with right temporal lobe dysfunction may be characterized as an impairment in a ventral visual processing system responsible for facial memory and pattern recognition.
— id: 21048, year: 1997, vol: 35, page: 26, stat: Journal Article,

Brain morphometric comparison of first-episode schizophrenia and temporal lobe epilepsy
Barr WB; Ashtari M; Bilder RM; Degreef G; Lieberman JA
1997 Jun;170(1):515-519, British journal of psychiatry
BACKGROUND: Converging evidence has suggested that the abnormalities in brain morphology observed in schizophrenia are similar to those seen in temporal lobe epilepsy (TLE). The purpose of this study was to compare the features of these groups directly with measures of the brain using magnetic resonance (MR) morphometry. METHOD: Morphometric measures of ventricular and hippocampal volumes obtained from FLASH MR images were studied in 32 patients with first-episode schizophrenia (FES), 39 patients with TLE (21 left, 18 right), and 42 healthy controls. RESULTS: Ventricular volumes in the FES and TLE groups were both significantly larger that those seen in controls and did not differ from each other. The FES group showed significantly larger temporal horns, while the TLE group had relatively larger frontal horns. Analyses of hippocampal volumes revealed a significant group by hemisphere effect. The FES group showed relative reductions in left hippocampal volume that were comparable only to TLE patients with seizures originating from the left hemisphere. CONCLUSION: The results indicate that FES and TLE groups both show evidence of ventricular enlargement. Lateralised morphological abnormalities of the hippocampal formation in FES and left TLE are comparable, and may be specific to temporolimbic regions.
— id: 21049, year: 1997, vol: 170, page: 515, stat: Journal Article,

Bilateral reductions in hippocampal volume in adults with epilepsy and a history of febrile seizures
Barr WB; Ashtari M; Schaul N
1997 Oct;63(4):461-467, Journal of neurology neurosurgery & psychiatry
OBJECTIVES: To examine the degree and frequency of reductions in hippocampal volume in patients with temporal lobe epilepsy with and without a history of febrile seizures. METHODS: In vivo measures of hippocampal volume were computed from three dimensional gradient echo (FLASH) images in 44 patients undergoing comprehensive evaluations for epilepsy surgery. Twenty one patients (48%) reported a history of febrile seizures. The volumes from these patients were compared with those from 23 patients without a history of febrile seizures and 34 healthy controls. RESULTS: The febrile seizure group had significant reductions in volume, both ipsilateral (30% decrease) and contralateral (15% decrease), to the EEG seizure focus. Twelve of 18 patients with febrile seizures exhibited clinically significant ipsilateral volume reductions, defined as volumes falling 2 SD below the mean obtained from the control sample. Only four of 19 patients without febrile seizures exhibited this degree of reduction. No significant correlations were found between seizure variables (for example, duration of epilepsy, seizure frequency) and ipsilateral reductions in volume. However, a significant inverse correlation (r=-0.45, P<0.05) between seizure frequency and the volume of the hippocampus contralateral to the seizure focus was found in the febrile seizure group. CONCLUSION: These results suggest that a history of febrile seizures is associated with the finding of a smaller hippocampus on the side ipsilateral to the subsequent temporal lobe focus whereas chronic factors seem to be be related to pathology contralateral to the seizure focus.
— id: 21047, year: 1997, vol: 63, page: 461, stat: Journal Article,

The use of figural reproduction tests as measures of nonverbal memory in epilepsy surgery candidates
Barr WB; Chelune GJ; Hermann BP; Loring DW; Perrine K; Strauss E; Trenerry MR; Westerveld M
1997 Sep;3(5):435-443, Journal of the International Neuropsychological Society
The construct of nonverbal memory, as assessed by figural reproduction tests, has recently been questioned by a number of investigators. The purpose of this study was to reexamine this construct and its relationship to right temporal lobe dysfunction. Figural reproduction test scores were examined in 757 epilepsy surgery candidates obtained from 8 epilepsy centers participating in the Bozeman Epilepsy Consortium. All participants exhibited unequivocal evidence of left (LTL) or right (RTL) temporal lobe epilepsy observed in ictal and interictal EEG recordings. All subjects also had IQ scores exceeding 70, right-hand preference, and left hemisphere language dominance confirmed by intracarotid sodium amytal testing. Comparisons of LTL and RTL groups showed no significant differences in scores on the Visual Reproduction subtests from the Wechsler Memory Scale (WMS) or Wechsler Memory Scale-Revised (WMS-R) or on the copy and delayed recall conditions of the Rey-Osterrieth Complex Figure Test (ROCFT). Significant differences were observed among centers on WMS and ROCFT scores, which are likely to be a result of variations in administration and/or scoring procedures. The lack of significant differences between LTL and RTL groups in this large sample raise questions about the nature of nonverbal memory and its relationship to right temporal lobe dysfunction.
— id: 21050, year: 1997, vol: 3, page: 435, stat: Journal Article,

Differential rates of age of seizure onset between sexes and between hemispheres?
Strauss E; Hunter M; Hermann BP; Loring DW; Trenerry MR; Barr WB; Chelune GJ; Perrine K; Westerveld M; Wada J
1997 Sep;3(5):428-434, Journal of the International Neuropsychological Society
In a descriptive analysis of 158 patients with temporal lobe epilepsy, Taylor (1969) reported that the age of first seizure varied systematically as a function of laterality and sex. We conducted inferential analyses of Taylor's original data which (1) provided support for his proposal of disproportionate left hemisphere vulnerability to seizure onset in early life, but (2) failed to provide evidence of sex differences in age of onset of unilateral seizures. Examination of these effects in a larger sample of 844 patients drawn from the Bozeman Epilepsy Consortium provided some additional support for findings from the inferential analysis. Specifically, the left hemisphere appeared more vulnerable to seizure onset in childhood, this increased vulnerability extending to about age 5 years. Age of onset of seizures was not different when males and females were compared. Thus, reanalysis of Taylor's original data as well as examination of data from a larger, more contemporary sample suggest that seizure onset varies as a function of laterality, but not sex.
— id: 21051, year: 1997, vol: 3, page: 428, stat: Journal Article,

Memory functioning in Lyme borreliosis
Ravdin LD; Hilton E; Primeau M; Clements C; Barr WB
1996 Jul;57(7):282-286, Journal of clinical psychiatry
BACKGROUND: To objectively measure memory functioning in patients with Lyme borreliosis and examine the relationship between subjective reports of memory dysfunction and actual impairment. METHOD: A prospective pretreatment study of patients with Lyme borreliosis (N = 21), a patient control group (osteomyelitis, N = 21), and healthy controls (N = 21) was conducted by using tests of verbal memory functioning (California Verbal Learning Test) and self-reported depression (Beck Depression Inventory-Cognitive Index), fatigue (Fatigue Severity Scale), and subjective ratings of memory abilities (Self-Rating Scale of Memory Functions). RESULTS: Patients with Lyme borreliosis performed worse than healthy controls on verbal memory testing, but did not perform significantly differently from patient controls. Lyme borreliosis patients reported increased fatigue, which was correlated with poorer memory performance. Although the Lyme borreliosis patients rated their memory as more impaired, subjective complaints were not correlated with objective memory scores. CONCLUSION: These findings suggest impaired memory performance is not specific to Lyme borreliosis and may be a result of evaluating cognitive functioning in patients with physical illness and somatic complaints. Fatigue is a prominent presenting complaint in patients with Lyme borreliosis and needs to be controlled for since it is known to influence neuropsychological performance. Subjective complaints are not correlated with objective memory assessment, so self-report of memory impairment should not be the criterion for inclusion in studies investigating cognitive manifestations of Lyme borreliosis.
— id: 21052, year: 1996, vol: 57, page: 282, stat: Journal Article,

Bismuth subsalicylate toxicity as a cause of prolonged encephalopathy with myoclonus
Gordon MF; Abrams RI; Rubin DB; Barr WB; Correa DD
1995 Mar;10(2):220-222, Movement disorders
Bismuth subsalicylate preparations are over-the-counter products for gastrointestinal complaints. Bismuth toxicity causes delirium, psychosis, ataxia, myoclonus, and seizures and is reversible over several weeks or months, when bismuth intake is stopped. We report a 54-year-old man with a 6-week history of progressive confusion and memory difficulty and a 2-3-week history of involuntary movements and gait impairment. His encephalopathy was further characterized by marked multifocal myoclonic jerks, coarse postural tremors, postural instability, and gait ataxia. He gradually improved. Extensive toxic, metabolic, and infectious workup demonstrated bismuth toxicity. Spinal tap and brain magnetic resonance scan were normal. Electroencephalography showed bihemispheric slowing. As his encephalopathy cleared, he reported using bismuth subsalicylate long term (daily intake of 8 oz). Bismuth levels 5 weeks after cessation of bismuth were elevated and normalized after 12 weeks. He followed a typical course for bismuth toxicity with subacute progressive encephalopathy and gradual recovery. Creutzfeldt-Jakob was strongly considered due to his rapidly progressive encephalopathy, multifocal myoclonus, and ataxia. Due to its rarity, bismuth toxicity is often overlooked. We hope this presentation will increase recognition of bismuth toxicity. We believe more detailed labeling of bismuth products is needed to avoid similar toxicity from this readily available product.
— id: 21055, year: 1995, vol: 10, page: 220, stat: Journal Article,

Cerebral metabolic topography in unilateral temporal lobe epilepsy
Rubin E; Dhawan V; Moeller JR; Takikawa S; Labar DR; Schaul N; Barr WB; Eidelberg D
1995 Dec;45(12):2212-2223, Neurology
OBJECTIVE: Fluorodeoxyglucose positron emission tomography (FDG-PET) studies of temporal lobe epilepsy (TLE) generally report interictal hypometabolism in the vicinity of the seizure focus. Yet, other evidence suggests that interictal metabolic abnormalities might extend to remote brain areas. We used FDG-PET to evaluate metabolism in selected regions distant from the focus in TLE. SUBJECTS: Twenty adult patients with medically intractable TLE were selected by criteria favoring a unilateral mesiobasal temporal focus. Structural imaging in this sample were normal except for medial temporal sclerosis in 13 patients. Twenty normal volunteers were controls. DESIGN: PET imaging was performed interictally. Regional glucose metabolism normalized by global metabolism was analyzed using t tests and correlation analysis. RESULTS: Ipsilateral to the seizure focus, metabolism was depressed compared with normal in the temporal pole (p = 0.001), but relatively elevated in the mesiobasal region (p = 0.005). Contralateral to the focus, metabolism was elevated in lateral temporal cortex (p = 0.0003) and mesiobasal regions (p = 0.0001). Metabolic correlation between ipsilateral and contralateral mesiobasal regions was similar in normal subjects (r = 0.74) and patients (r = 0.68). In contrast, correlations were abnormal between temporal poles and other temporal lobe subregions, both ipsilateral and contralateral to the seizure focus. CONCLUSIONS: Relative to normal values, both elevations and depressions of metabolism exist interictally in TLE. Such abnormalities, and accompanying changes in interregional correlations, may have wide spatial distribution. These findings are atypical among PET studies but are consistent with other physiologic, anatomic, and neuropsychological investigations of TLE.
— id: 21053, year: 1995, vol: 45, page: 2212, stat: Journal Article,

The roles of semantic networks and search efficiency in verbal fluency performance in intractable temporal lobe epilepsy
Troster AI; Warmflash V; Osorio I; Paolo AM; Alexander LJ; Barr WB
1995 May;21(1):19-26, Epilepsy research
Two competing hypotheses (i.e., disruption of semantic networks vs. search inefficiency) concerning the mechanisms underlying impaired semantic verbal fluency in temporal lobe epilepsy (TLE) were tested within a single paradigm. Reports that semantic verbal fluency is more impaired in left than right TLE groups were confirmed by the findings that the left TLE group produced fewer words on a supermarket fluency task than did the normal control (NC) group, and that the performance of the right TLE group was intermediate to that of the left TLE and NC groups. Because both TLE groups generated fewer words per category of supermarket items sampled, and produced a higher ratio of category labels relative to category exemplars than did the NC group, it can be surmised that TLE disrupts semantic memory networks. The findings did not support the competing hypothesis that reduced semantic verbal fluency in TLE is a manifestation of inefficient search/retrieval strategies, possibly associated with distal frontal lobe pathophysiology. Specifically, the TLE and NC groups did not differ significantly in their mean number of perseverations, intrusions, or search efficiency (operationalized as the ratio of the number of shifts between categories to the number of categories sampled).
— id: 21054, year: 1995, vol: 21, page: 19, stat: Journal Article,

Postictal and chronic psychoses in patients with temporal lobe epilepsy
Umbricht D; Degreef G; Barr WB; Lieberman JA; Pollack S; Schaul N
1995 Feb;152(2):224-231, American journal of psychiatry
OBJECTIVE: This study sought to elucidate the relation of clinical, neuropsychological, and seizure variables to chronic and postictal psychoses in patients with temporal lobe epilepsy. METHOD: Forty-four patients with treatment-refractory temporal lobe epilepsy were given formal psychiatric evaluations; 29 patients had no psychiatric disorder or a nonpsychotic disorder, eight patients had postictal psychoses, and seven patients had chronic psychoses. Comparisons of clinical, neuropsychological, magnetic resonance imaging, and seizure variables were made between the nonpsychotic and the psychotic patients and, secondarily, between the patients with transient postictal psychoses and those with chronic psychoses. RESULTS: Bitemporal seizure foci, clustering of seizures, and absence of febrile convulsions were associated with both postictal psychoses and chronic psychoses. Younger age at onset of epilepsy and lower verbal and full-scale IQs differentiated the patients with chronic psychoses from those with postictal psychoses. CONCLUSIONS: Patients with temporal lobe epilepsy with chronic and postictal psychoses show similar profiles of clinical and seizure variables, suggesting shared etiologic factors. These factors may increase the propensity to develop psychotic symptoms, while other factors, such as time of onset of epilepsy and underlying neuropathology, may determine whether transient or chronic psychotic symptoms develop. Even among patients with treatment-refractory temporal lobe epilepsy, a specific subgroup of patients, characterized by bitemporal seizure foci, an absence of febrile convulsions, and a history of clustering of seizures, appears to be particularly prone to develop psychotic disorders. A process similar to secondary epileptogenesis may be involved in the development of the psychoses.
— id: 21056, year: 1995, vol: 152, page: 224, stat: Journal Article,

Bismuth toxicity
Gordon MF; Abrams RI; Rubin DB; Barr WB; Correa DD
1994 Dec;44(12):2418-2418, Neurology
— id: 21057, year: 1994, vol: 44, page: 2418, stat: Journal Article,

Cerebellar atrophy in patients with long-term phenytoin exposure and epilepsy
Ney GC; Lantos G; Barr WB; Schaul N
1994 Aug;51(8):767-771, Archives of neurology
OBJECTIVE: Cerebellar atrophy has been noted in patients with phenytoin exposure. This finding has been attributed by some investigators to seizures, but by others to phenytoin. Previous studies included patients with mental retardation and convulsive seizures. We undertook a study in a group of nonretarded patients with partial epilepsy to better elucidate the cause of the cerebellar atrophy. DESIGN: Case control study. SETTING: Referral population from an epilepsy center. PATIENTS: Thirty-six patients with partial epilepsy and long-term phenytoin exposure were selected from a consecutive sample of admissions to an epilepsy center. Patients with histories of ethanol abuse, perinatal distress, anoxia, status epilepticus, or neurodegenerative disorders were excluded. Age- and sex-matched controls were selected from a pool of healthy volunteers and patients who had undergone magnetic resonance imaging for complaints of headache and dizziness. INTERVENTIONS: All patients and controls underwent magnetic resonance imaging. MAIN OUTCOME MEASURE: Degree of cerebellar atrophy. RESULTS: The magnetic resonance imaging scans were reviewed in a blind fashion. A rating was assigned to each scan based on the degree of cerebellar atrophy. Cerebellar atrophy was significantly more pronounced in patients than in controls. No correlation was found between cerebellar atrophy and variables reflective of seizure severity or degree of phenytoin exposure. CONCLUSIONS: Cerebellar atrophy may be seen in phenytoin-exposed patients with epilepsy in the absence of generalized tonic-clonic seizures or preexistent brain damage. Whether it is the phenytoin or the seizures that play the primary etiologic role remains unanswered. These factors may be synergistic.
— id: 21058, year: 1994, vol: 51, page: 767, stat: Journal Article,

VERBAL AND NONVERBAL SUPRASPAN LEARNING IN LATERALIZED COMPLEX PARTIAL SEIZURES
HAYWOOD, CS; PERRINE, K; BARR, W; LUCIANO, DJ; SCHAUL, N; DEVINSKY, O
1993 JAN ;15(1):101-101, Journal of clinical & experimental neuropsychology
— id: 104312, year: 1993, vol: 15, page: 101, stat: Journal Article,

Game-playing epilepsy
Siegel M; Kurzrok N; Barr WB; Rowan AJ
1992 Jan-Feb;33(1):93-97, Epilepsia
A 25-year-old woman with documented generalized seizures evoked by playing checkers was given a battery of psychological tests as well as a series of cognitive and non-game-related tasks during a session of intensive EEG-video monitoring. Generalized epileptiform discharges during each task, as well as during intervals of checkers playing, were quantified to determine possible triggering factors. Previous reports have discussed the roles of attention, concentration, stress, thinking, and spatial processing in similar cases. Our analysis showed significant activation of the EEG only with tasks involving strategic thinking, i.e., considering a sequence of moves based on evaluating the consequences of previous moves.
— id: 21059, year: 1992, vol: 33, page: 93, stat: Journal Article,

Three-dimensional fast low-angle shot imaging and computerized volume measurement of the hippocampus in patients with chronic epilepsy of the temporal lobe
Ashtari M; Barr WB; Schaul N; Bogerts B
1991 Sep-Oct;12(5):941-947, AJNR. American journal of neuroradiology
This study investigated the use of three-dimensional fast low-angle shot (FLASH) imaging and computer-assisted morphometry for identifying hippocampal changes associated with unilateral temporal lobe seizures. Contiguous 3.1-mm coronal FLASH images were obtained in 28 patients with electroencephalographically verified left (n = 17) or right (n = 11) temporal lobe seizures and 28 age- and sex-matched control subjects. Hippocampal volumes were calculated with the use of a computerized mensuration system developed for detailed morphometric assessment. The results of a multivariate analysis of variance revealed a significant group difference by hemisphere interaction (F = 26.3, p less than .001). Significant reductions in left hippocampal volume (32%, p less than .001) were exhibited in patients with left temporal lobe seizures, and significant reductions in right hippocampal volume (35%, p less than .001) were seen in patients with right temporal lobe seizures. A discriminant analysis with the use of left and right hippocampal volumes classified patients with left temporal lobe seizures with 94% sensitivity and 73% specificity and patients with right temporal lobe seizures with 89% sensitivity and 94% specificity. The results of this study demonstrate that unilateral temporal lobe seizures are accompanied by significant reductions in hippocampal volume ipsilateral to the seizure focus. The use of FLASH imaging and computer-assisted morphometry of the hippocampus appears to provide valuable structural information for confirming the laterality of the electroencephalographic seizure focus.
— id: 21060, year: 1991, vol: 12, page: 941, stat: Journal Article,

Pathophysiologic mechanisms underlying spatial disorientation in patients with Alzheimer's disease
Barr WB; Bilder RM; Kaplan E
1990 Jun;47(6):618-619, Archives of neurology
— id: 21061, year: 1990, vol: 47, page: 618, stat: Journal Article,

Retrograde amnesia following unilateral temporal lobectomy
Barr WB; Goldberg E; Wasserstein J; Novelly RA
1990 ;28(3):243-255, Neuropsychologia
Remote memory performance was assessed in a carefully matched sample of temporal lobectomy subjects and normal controls. Left temporal lobectomy subjects exhibited a consistent pattern of remote memory disturbance. Right temporal lobectomy subjects performed at the same level as normal controls. The pattern of impairment observed in left temporal lobectomy subjects was characterized by deficits in recall of chronological information from the past decade and extended to deficits in recall in some aspects of factual knowledge. The disorder could not be attributed solely to language deficits and was at least as severe as accompanying deficits in recent memory. These findings suggest that the left medial temporal region may play a significant role in recall of remote information in addition to its role in recent memory functions.
— id: 21062, year: 1990, vol: 28, page: 243, stat: Journal Article,

The neuropsychology of schizophrenic speech
Barr WB; Bilder RM; Goldberg E; Kaplan E; Mukherjee S
1989 Oct;22(5):327-349, Journal of communication disorders
Recent interest in the biological basis of schizophrenia has led to a reexamination of many symptomatic aspects of the disorder in terms of brain-behavioral models. Schizophrenic speech disturbances have traditionally been described in terms of a model of acquired aphasia. We review some of the limitations of this model and provide an alternative model for the study of some characteristics of schizophrenic speech based on neuropsychological theories of frontal lobe dysfunction in schizophrenia. The emphasis is placed on the study of productive errors noted in schizophrenic speech, most notably verbal perseverations. In a study of errors observed during a sample of 15 schizophrenics performance on a confrontation naming test, we were able to reliably identify and classify hierarchic categories of verbal perseverations occurring at both semantic and phonemic levels. These perseverations constituted 20% of the total errors. We argue that these perseverations represent a special case of executive dysfunction resulting from a disturbance of language monitoring mechanisms. We examine the implications of these findings for a hypothesis of schizophrenic speech disturbances in terms of frontal lobe dysfunction and the developmental neuropathological processes involved in the illness.
— id: 21063, year: 1989, vol: 22, page: 327, stat: Journal Article,

Regional distribution of cerebral arteriovenous malformations. Interactions with sex and handedness
Barr WB; Jaffe J; Wasserstein J; Michelson WJ; Stein BM
1989 Apr;46(4):410-412, Archives of neurology
On the basis of clinical observation and a developmental theory of cerebral laterality, Geschwind and Galaburda suggested that cerebral arteriovenous malformations (AVMs) are more common in the left hemispheres of male patients. We tested this hypothesis by examining interactions among sex, handedness, and location of lateralized, supratentorial AVMs. Data from 112 cases were analyzed by log-linear procedures. We found that (1) females had a greater proportion of left-hemisphere AVMs, whereas males showed an opposite trend; (2) there were no interactions between sex and handedness; and (3) nondextrals showed a higher proportion of AVMs located in frontal regions, regardless of the hemispheric side of the lesion. Although these findings appear to be inconsistent with the Geschwind-Galaburda hypothesis, the inconsistency may be attributable to the embryonic stage at which this developmental abnormality occurs. In addition, the unexpected findings may also reflect our use of multivariate statistical procedures, which control for interaction effects.
— id: 21064, year: 1989, vol: 46, page: 410, stat: Journal Article,

Anomalous dominance and persistent tardive dyskinesia
Barr WB; Mukherjee S; Degreef G; Caracci G
1989 Apr 1;25(7):826-834, Biological psychiatry
We examined handedness and cerebral hemispheric asymmetries on computed tomography (CT) scan in a sample of schizophrenic patients who were rated also for the presence or absence of persistent tardive dyskinesia (TD). Patients with TD showed a more standard dominance pattern, with dextral hand preference and normal occipital asymmetry. Anomalous dominance was associated with a marked underrepresentation of TD. Stepwise discriminant analyses indicated that the statistical prediction of TD was enhanced by the inclusion of dominance measures. Schizophrenic patients with strong standard dominance patterns may be more susceptible to developing TD, or conversely, anomalous dominance may confer protection against TD.
— id: 21065, year: 1989, vol: 25, page: 826, stat: Journal Article,

Neuropsychological function in physically asymptomatic, HIV-seropositive men
Perry S; Belsky-Barr D; Barr WB; Jacobsberg L
1989 Summer;1(3):296-302, Journal of neuropsychiatry & clinical neurosciences
Twenty asymptomatic, HIV-seropositive homosexual men and a control group of 20 seronegative homosexual men were evaluated for evidence of neuropsychological impairment. Two-tailed paired t-tests of group differences revealed that the seropositive patients had significantly lower scores on two of 20 neuropsychological measures. Ten seropositive patients had scores two standard deviations below the sample, compared with three seronegative patients, a significantly different distribution (p = .04). The HIV-infected group exhibited lower mean scores on 17 of 20 variables (binomial probability, p less than .005). The 10 seropositive patients with scores that fell below the cut-off had significantly lower mean T4/T8 ratios than the 10 seropositive patients with scores above the cut-off (p = .02). The data suggest that a subpopulation of HIV-infected adults may exhibit subtle neuropsychological impairment before they develop clinical signs of cognitive deficit or immunosuppression.
— id: 21066, year: 1989, vol: 1, page: 296, stat: Journal Article,

Epileptic aphasia
Rosenbaum DH; Siegel M; Barr WB; Rowan AJ
1986 Jun;36(6):822-825, Neurology
We document a case of isolated epileptic aphasia with clear correlation between episodic clinical and electrographic events. This disorder is rarely recognized, perhaps because it is obscured by ictal motor activity or speech arrest, or by the lack of clinical manifestations if the seizure occurs when the patient is not attempting to speak.
— id: 21067, year: 1986, vol: 36, page: 822, stat: Journal Article,