Neuropsychological Evaluation Of Psychiatric And Neurolo

National Institute Of Mental Health

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Abstract

During the past four years, the main thrust of this work has involved a comparison of the neuropsychological test profiles of patients with seizure disorders (generalized as well as focal) with those of their first-degree relatives. In an earlier study of 12 families with probands diagnosed with childhood absence epilepsy (CAE), the results indicated that the mothers, but not the fathers of the patients share in mild form some of the behavioral impairment seen in the probands (Levav, 1991). This was evident in tests of sustained attention (the Continuous Performance Test, CPT; Rosvold et al., 1956). This result is consistent with prior research on the inheritance of the disorder. In the present study we assessed probands and their healthy first- degree relatives in an additional 60 families, as well as healthy control pairs, in their performance on neuropsychological tests. We assessed proband-relative pairs with Juvenile Myoclonic Epilepsy (JME), Temporal Lobe Epilepsy (TLE) and Childhood Absence Epilepsy (CAE). Attention, memory and problem-solving behavior were studied in order to evaluate possible familial aggregation of cognitive traits. The analysis thus far indicates that there is a strong familial aggregation of traits associated with control of impulsivity and vigilance in the sustained attention tasks, seen especially in JME families. This was not seen in the TLE families, and only to a modest extent in the CAE families. This work has been accepted for publication in the Journal of Clinical & Experimental Neuropsychology. We are currently collaborating with geneticists who are interested in localizing the epilepsy gene associated with JME--most likely including location 21.3 on chromosome 6p--and whose work on identifying the phenotype of JME dovetails well with our own neuropsychological data. In another study conducted in collaboration with colleagues at Johns Hopkins, we have found highly significant correlations between assays of bone lead, as measured by the K X-ray technique, and scores on the Continuous Performance Test of sustained attention (CPT). These findings were based on studies of an inner-city population of young adults and were recently presented (August 2001) at a poster session at the American Psychological Association convention in San Francisco, California. In addition, in a doctoral dissertation at Johns Hopkins by Huey-Fang Sun (2000), it was found that teacher-rated classroom aggression correlated significantly with scores on the CPT. Those children who scored poorly on the CPT (and on other attention tests) were more aggressive than children who performed better on the CPT. This persisted over at least five grades (2-6).