Laura S Boylan, M.D.

Following the money in epilepsy therapeutics
Boylan, L S
2010 Dec;88(6):763-763, Clinical pharmacology & therapeutics
— id: 114588, year: 2010, vol: 88, page: 763, 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,

Motor worsening and tardive dyskinesia with aripiprazole in Lewy body dementia
Boylan, Laura S; Hirsch, Scott
2009 ;2009:?-?, BMJ case reports
Aripiprazole (APZ) is a novel antipsychotic agent which does not block dopamine (DA) receptors but is rather a partial DA agonist. Thus, it has been proposed that APZ may not induce tardive dyskinesia (TD), a disfiguring and sometimes disabling and irreversible side effect of neuroleptics. Our patient had Lewy body dementia (LBD) and developed severe worsening of parkinsonism over 1 month of APZ treatment. Within days of discontinuation of APZ dramatic orobuccal dyskinesias emerged. Treatment emergent worsening of parkinsonism improved but orobuccal dyskinesias persisted unchanged until his death 8 months later. Others have reported severe extrapyramidal reactions including neuroleptic malignant syndrome and TD with APZ. APZ has been suggested as a treatment for TD but treatment benefit may reflect 'masked' dyskinesia. We conclude that, despite an attractive in vitro profile and promising animal data, APZ can induce serious extrapyramidal side effects, including TD
— id: 134468, year: 2009, vol: 2009, page: ?, stat: Journal Article,

Behavioral indices in medical care outcome: the working alliance, adherence, and related factors
Fuertes, Jairo N; Boylan, Laura S; Fontanella, Jessie A
2009 Jan;24(1):80-85, Journal of general internal medicine
BACKGROUND: The working alliance has been shown to be a consistent predictor of patient outcome and satisfaction in psychotherapy. This study examines the role of the working alliance and related behavioral indices in predicting medical outcome. OBJECTIVE: Cognitive and emotional dimensions of the physician-patient relationship were examined in relation to patients' ratings of physician empathy, physician multicultural competence, perceived utility of treatment, and patients' adherence self-efficacy. These factors were then examined as part of a theoretical framework using path analyses to explain patient self-reported adherence to and satisfaction with treatment. DESIGN: The study was based on an ex-post facto field correlation design. PARTICIPANTS: One hundred fifty-two adult outpatients from a neurology clinic at Bellevue Hospital, a large municipal hospital in New York City, participated in the study. INTERVENTIONS: Surveys given to participants. MEASUREMENTS: We used the following measurements: Physician-Patient Working Alliance Scale, Perceived Utility Scale, Treatment Adherence Self-Efficacy Scale, Medical Outcome Study Adherence Scale, Physician Empathy Questionnaire, Physician Multicultural Competence Questionnaire, Medical Patient Satisfaction Questionnaire. MAIN RESULTS: The effect sizes for adherence are between 0.07 and 0.21 and for satisfaction between 0.10 to >0.50. Regression and path analyses showed that ratings of physician multicultural competence and patient adherence self-efficacy beliefs predicted patient adherence (SB = 0.34) and (SB = 0.30) and satisfaction (SB = 0.18) and (SB = 0.12), respectively. Working alliance ratings also predicted patient satisfaction (SB = 0.49). CONCLUSIONS: Psychological and interpersonal dimensions of medical care are related to patient adherence and satisfaction. Medical care providers may be able to use these dimensions to target and improve health care outcomes
— id: 95197, year: 2009, vol: 24, page: 80, stat: Journal Article,

Psychotropic effects of antiepileptic drugs
Boylan, Laura S
2007 Oct 16;69(16):1640-1640, Neurology
— id: 95198, year: 2007, vol: 69, page: 1640, stat: Journal Article,

The physician-patient working alliance
Fuertes, Jairo N; Mislowack, Alexa; Bennett, Jennifer; Paul, Laury; Gilbert, Tracey C; Fontan, Gerardo; Boylan, Laura S
2007 Apr;66(1):29-36, Patient education & counseling
OBJECTIVE: Cognitive and emotional dimensions of the physician-patient relationship (working alliance) were examined in relation to patients' beliefs about the usefulness of treatment (perceived utility), patients' beliefs about being able to adhere to treatment (adherence self-efficacy beliefs), patients' follow through on their treatment plan (adherence), and patients' satisfaction. METHODS: Participants were 51 men and 67 women who averaged 38.9 years of age (S.D.=12.28). Seventy-two were Euro-American, 23 African-American, 6 Asian-American, 11 Hispanic, and 6 'Other.' They reported an average of 7.3 years (S.D.=7.48) since being diagnosed with a chronic medical illness and an average of 7.1 (S.D.=4.88) visits to their doctor within the last year. Patients' conditions included HIV+/AIDS, hypertension, diabetes, asthma, and cancer. RESULTS: Results show moderate to strong relationships between working alliance and perceived utility (r=0.63, P<0.001), self-efficacy (r=0.47, P<0.001), adherence (r=0.53, P<0.001), and satisfaction (r=0.83, P<0.001). Regression analyses showed that ratings of the working alliance (SB=0.25, P<0.005) and self-efficacy beliefs (SB=0.48, P<0.001) predicted patient adherence and that working alliance ratings (SB=0.83, P<0.001) also predicted patient satisfaction. CONCLUSION: The working alliance can be measured in medical care and appears to be strongly associated with patients' adherence to and satisfaction with treatment. PRACTICE IMPLICATIONS: The working alliance is important in medical treatment, as it is associated with patient adherence and satisfaction. Patients' self-efficacy ought to be assessed and promoted as it is also associated with treatment adherence
— id: 95199, year: 2007, vol: 66, page: 29, stat: Journal Article,

Auras are frequent in idiopathic generalized epilepsy
Boylan, L S; Labovitz, D L; Jackson, S C; Starner, K; Devinsky, O
2006 Jul 25;67(2):343-345, Neurology
The occurrence of an aura is often considered evidence of a partial rather than an idiopathic generalized epilepsy syndrome. The authors examined this hypothesis by prospectively recording reports of auras by patients being admitted for video-EEG monitoring. Auras were equally common (70%) among patients with idiopathic generalized epilepsy as they were among those with localization-related epilepsy. Presence of an aura is not a reliable indicator of localization-related epilepsy
— id: 67391, year: 2006, vol: 67, page: 343, stat: Journal Article,

Sudden deafness from stroke
Boylan, Laura S; Staudinger, Robert; Brust, John C M
2006 Sep 12;67(5):919-919, Neurology
— id: 80342, year: 2006, vol: 67, page: 919, stat: Journal Article,

Depression but not seizure frequency predicts quality of life in treatment-resistant epilepsy
Boylan, L S; Flint, L A; Labovitz, D L; Jackson, S C; Starner, K; Devinsky, O
2004 Jan 27;62(2):258-261, Neurology
BACKGROUND: The two-thirds of patients with epilepsy who become seizure-free have a quality of life (QOL) similar to the general population. The major treatment challenge is patients with refractory epilepsy. Whereas neurologists typically focus on seizure reduction in the treatment of these patients, results of studies relating seizure frequency to QOL are conflicting. As depression is associated with reduced QOL in epilepsy and antiepileptic medications (AEDs) can cause depression, it is important to determine the relative roles of depression and seizure frequency in QOL in refractory epilepsy. METHODS: Prospective evaluation was conducted of patients with refractory epilepsy being admitted to an inpatient video-EEG monitoring unit. The impact of clinical variables (age, sex, marital status, seizure frequency, duration and type of seizure disorder, seizure localization, number of AEDs, depression) on QOL was analyzed. RESULTS: Depression was a powerful predictor of QOL (n = 122, beta = -35.8, p < 0.0001). No other variable predicted QOL. Depression was common (54%), severe (19% with suicidal thoughts), underdiagnosed (37%), and largely untreated (17% on antidepressants). CONCLUSIONS: Treatment of depression may be inadequately prioritized in the management of intractable epilepsy
— id: 47901, year: 2004, vol: 62, page: 258, stat: Journal Article,

Unbalanced statistical analysis of combined divalproex and antipsychotic therapy for schizophrenia
Boylan, Laura S; Labovitz, Daniel L
2004 Mar;29(3):636-636, Neuropsychopharmacology
— id: 69211, year: 2004, vol: 29, page: 636, stat: Journal Article,

Depression but not seizure frequency predicts quality of life in treatment-resistant epilepsy - Reply from the authors
Boylan, LS; Labovitz, DL; Flint, LA; Devinsky, O
2004 SEP 14 ;63(5):942-943, Neurology
— id: 69277, year: 2004, vol: 63, page: 942, stat: Journal Article,

Postictal laughter following absence status epilepticus
Boylan, Laura S; Kaley, Thomas J; Singh, Anuradha; Devinsky, Orrin
2003 Feb 15;4(6):773-775, Epilepsy & behavior
Acute pathologic neurologic laughter has been described as an ictal phenomenon in epilepsy, as a result of electrical brain stimulation to the cortex and to deep brain structures, in brain tumors, and in stroke. We report what is, to our knowledge, the first report of a case of postictal pathologic laughter. Previously diagnosed with medically refractory complex partial seizures, our patient was admitted to the hospital with phenytoin toxicity. During video-EEG monitoring she experienced multiple brief absence seizures as well as a prolonged episode of absence status epilepticus. Immediately following cessation of the seizure she began to laugh. Her laughter was mirthful and infectious. This lasted several minutes and was followed immediately by several minutes of crying and then a return to normal. We propose that diffuse cortical inhibition led to release of subcortical structures involved in emotional expression. Possible neural substrates of laughter are discussed
— id: 46275, year: 2003, vol: 4, page: 773, stat: Journal Article,

Premorbid psychiatric risk factors for postictal psychosis: In reply
Alper, Kenneth R; Devinsky, Orrin; Boylan, Laura
2002 ;14(4):465-466 Fal, Journal of neuropsychiatry & clinical neurosciences
Responds to G. C. Fong et al's comments (see record 2002-06521-015) on K. Alper et al's article (see record 2001-09677-006) which reported interest in the relationship between seizure cluster characteristics, presence of mood disorder among first- and second-decree relatives, and postictal psychosis. The current authors agree that the approach would be useful. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
— id: 80779, year: 2002, vol: 14, page: 465, stat: Journal Article,

Peri-Ictal Behavioral and Cognitive Changes
Boylan LS
2002 Feb;3(1):16-26, Epilepsy & behavior
Peri-ictal behavioral and cognitive changes contribute substantially to disability and distress among people with epilepsy. Psychosis, depression, and suicide may all occur as complications of seizures. Greater appreciation and understanding of the peri-ictal period is clinically important and might open novel therapeutic windows. At the same time this period provides a model for understanding basic mechanisms underlying mood and thought disorders and the substrates of cognition, volition, emotion, and consciousness. This review will discuss behavioral and cognitive antecedents of seizures, including the preictal milieu, reflex seizures, and self-induced seizures. Behavioral and cognitive treatment approaches that have been undertaken are reviewed. Both acute and delayed postictal emotional, behavioral, and cognitive changes will be discussed. Finally, possible mechanisms by which epileptic brain activity and behavior may modify each other are considered
— id: 95200, year: 2002, vol: 3, page: 16, stat: Journal Article,

Psychiatric uses of antiepileptic treatments
Boylan LS; Devinsky O; Barry JJ; Ketter TA
2002 Oct;3(5):S54-S59, Epilepsy & behavior
Antiepileptic drugs (AEDs) possess potent negative or positive psychotropic effects. Clear evidence of benefit exists for valproate, carbamazepine, and lamotrigine in bipolar disorder. Reports of benefit from various AEDs in mood, anxiety, impulse control, and personality disorder are reviewed. Further research is needed to clarify which patients are likely to benefit. Clinicians must closely attend to the ongoing risk/benefit analysis and consider possible iatrogenic worsening of neuropsychiatric symptoms
— id: 34392, year: 2002, vol: 3, page: S54, stat: Journal Article,

Religious/spiritual beliefs and behavior in epilepsy
Hayton, T; Boylan, LS; Jackson, SC; Devinsky, O
2002 SEP ;52(3):S20-S20, Annals of neurology
— id: 104270, year: 2002, vol: 52, page: S20, stat: Journal Article,

Enhancing analogic reasoning with rTMS over the left prefrontal cortex
Boylan LS
2001 Oct 9;57(7):1349-1349, Neurology
— id: 27287, year: 2001, vol: 57, page: 1349, stat: Journal Article,

Postictal psychosis related regional cerebral hyperfusion
Boylan LS
2001 Jan;70(1):137-138, Journal of neurology neurosurgery & psychiatry
— id: 21318, year: 2001, vol: 70, page: 137, stat: Journal Article,

Focal prefrontal seizures induced by bilateral ECT
Boylan LS; Devanand DP; Lisanby SH; Nobler MS; Prudic J; Sackeim HA
2001 Sep;17(3):175-179, Journal of ECT
INTRODUCTION: It has been proposed that the greater efficacy of bilateral (BL) over right unilateral (RUL) electroconvulsive therapy (ECT) at low stimulus intensity is due to differences in site of seizure initiation. We hypothesized that focal prefrontal seizures are more common with BL than RUL administration. METHOD: Records were reviewed of the 1,007 ECT treatments of 84 consecutive patients randomized to RUL or BL electrode placement. RESULTS: Eight events were identified in which there was an electroencephalographic seizure without motor manifestation. All of these events occurred at titration sessions and with BL stimuli (p = 0.002). These events were more likely to occur later in the course of treatment. DISCUSSION: We suggest that BL ECT may induce focal seizures in prefrontal areas and that these seizures are more likely to occur later in the treatment course
— id: 26675, year: 2001, vol: 17, page: 175, stat: Journal Article,

Developmental apraxia arising from neonatal brachial plexus palsy
Boylan LS; Fouladvand M
2001 Feb 27;56(4):576-577, Neurology
— id: 21316, year: 2001, vol: 56, page: 576, stat: Journal Article,

Repetitive transcranial magnetic stimulation to SMA worsens complex movements in Parkinson's disease
Boylan LS; Pullman SL; Lisanby SH; Spicknall KE; Sackeim HA
2001 Feb;112(2):259-264, Clinical neurophysiology
OBJECTIVES: To evaluate the therapeutic potential of repetitive transcranial magnetic stimulation (rTMS) for Parkinson's disease (PD) by delivering stimulation at higher intensity and frequency over longer time than in previous research. Promising beneficial effects on movement during or after rTMS have been reported. METHODS: Ten patients with idiopathic PD were enrolled in a randomized crossover study comparing active versus sham rTMS to the supplementary motor area (SMA). Assessments included reaction and movement times (RT/MT), quantitative spiral analysis, timed motor performance tests, United Parkinson's Disease Rating Scale (UPDRS), patient self-report and guess as to stimulation condition. RESULTS: Two of 10 patients could not tolerate the protocol. Thirty to 45 min following stimulation, active rTMS as compared with sham stimulation worsened spiral drawing (P=0.001) and prolonged RT in the most affected limb (P=0.030). No other significant differences were detected. CONCLUSIONS: We sought clinically promising improvement in PD but found subclinical worsening of complex and preparatory movement following rTMS to SMA. These results raise safety concerns regarding the persistence of dysfunction induced by rTMS while supporting the value of rTMS as a research tool. Studies aimed at understanding basic mechanisms and timing of rTMS effects are needed
— id: 21317, year: 2001, vol: 112, page: 259, stat: Journal Article,

Augmentation of sertraline antidepressant treatment with transcranial magnetic stimulation
Lisanby SH; Pascual-Leone A; Sampson SM; Boylan LS; Burt T; Sackeim HA
2001 Apr 15;49(8S):81S-81S, Biological psychiatry
— id: 27286, year: 2001, vol: 49, page: 81S, stat: Journal Article,

Limbic encephalitis and late-onset psychosis
Boylan LS
2000 Aug;157(8):1343-1344, American journal of psychiatry
— id: 21319, year: 2000, vol: 157, page: 1343, stat: Journal Article,

Determinants of seizure threshold in ECT: benzodiazepine use, anesthetic dosage, and other factors
Boylan LS; Haskett RF; Mulsant BH; Greenberg RM; Prudic J; Spicknall K; Lisanby SH; Sackeim HA
2000 Mar;16(1):3-18, Journal of ECT
The electrical dosage of the ECT stimulus impacts on efficacy and cognitive side effects, yet seizure threshold (ST) may vary as much as 50-fold across patients. It would be desirable to predict ST on the basis of patient and treatment characteristics. In particular, concerns have been raised that benzodiazepine use and higher dosage of barbiturate anesthetics elevate ST. In a three-site study, ST was quantified at the first ECT session using an identical empirical titration procedure in 294 patients who met RDC and DSM-IIIR criteria for a major depressive episode. ST varied over a 35-fold range across patients treated with right unilateral (RUL) (n = 267) and bilateral (BL) (n = 27) ECT. Higher ST was associated with BL electrode placement (p = 0.001). Among patients treated with RUL ECT, univariate analyses indicated that higher ST was associated with advanced age (p < 0.001), male gender (p < 0.001), greater burden of medical illness (p < 0.001), weight (p < 0.01), duration of mood disorder (p < 0.01), and history of previous ECT (p < 0.05). Average lorazepam dose in the 48 hours prior to ECT was not associated with ST, but was associated with decreased seizure duration (p < 0.01). Absolute, but not weight-adjusted, methohexital dose was associated with ST (p < 0.01). Multivariate analyses in patients treated with unilateral ECT showed that only 27.6% of the variance in ST (p < 0.0001) could be predicted. In the multivariate analyses, only age (p = 0.0001), gender (p = 0.01), and methohexital dose (p = 0.0001) were independently related to ST. Low dosage of lorazepam and methohexital dosage below 1 mg/kg are unlikely to impact on ST. Given the limited capacity to predict ST, empirical titration remains the only accurate method to determine electrical dosage in RUL ECT
— id: 21320, year: 2000, vol: 16, page: 3, stat: Journal Article,

Magnetoelectric brain stimulation in the assessment of brain physiology and pathophysiology
Boylan LS; Sackeim HA
2000 Mar;111(3):504-512, Clinical neurophysiology
OBJECTIVE: To review findings from transcranial magnetic stimulation (TMS)-induced motor evoked potentials in normal subjects, in various neurological diseases and with pharmacologic manipulation. METHODS: MEDLINE was searched to identify pertinent articles and articles referenced therein were also reviewed. RESULTS: TMS is a safe and non-invasive technique which has been used widely in the study of corticospinal and corticocortical connectivity as well as in the assessment of basal ganglia disorders, diffuse diseases, and neuropharmacology. CONCLUSIONS: TMS motor measures have utility in examination of brain structure and function within and beyond the corticospinal tract. These measures have both research and clinical applications
— id: 21321, year: 2000, vol: 111, page: 504, stat: Journal Article,

Mutual influences between paroxysmal hypertension and psychiatric disturbance
Boylan LS
1999 Sep 27;159(17):2091-2092, Archives of internal medicine
— id: 21322, year: 1999, vol: 159, page: 2091, stat: Journal Article,

The epidemiology of HIV infection in children and their mothers--vertical transmission
Boylan L; Stein ZA
1991 ;13:143-177, Epidemiologic reviews
— id: 30182, year: 1991, vol: 13, page: 143, stat: Journal Article,