Poster Session 09 Program Schedule
02/16/2024
03:30 pm - 04:45 pm
Room: Majestic Complex (Posters 61-120)
Poster Session 09: Epilepsy | Oncology | MS | Infectious Disease
Final Abstract #107
Epilepsy Pre-Surgical Neuropsychological Evaluations for Patients in Mongolia
Sloane Sheldon, Mount Sinai Hospital, New York, United States
Bayarmaa Dondov, Alpha Wave Private Clinic, Ulaanbatar, Mongolia
Abai Sayez, Third State Central Hospital, Ulaanbaatar, Mongolia
Saadi Ghatan, Mount Sinai Hospital, New York, United States
Category: Epilepsy/Seizures
Keyword 1: temporal lobes
Keyword 2: assessment
Keyword 3: epilepsy / seizure disorders - surgical treatment
Objective:
The clinical utility of neuropsychological evaluations as part of pre-surgical workups for individuals with medically refractory epilepsy has been well established. In the U.S., we depend on appropriate normative data and well researched outcomes within our population. When treating patients in other countries, we must strive to provide thorough pre-surgical evaluations while acknowledging the limits of our tools. The current case series discusses the use of neuropsychological testing as part of pre-surgical workups on two adult Mongolian patients with left temporal lobe epilepsy to increase our knowledge in effectively providing care in underserved populations.
Participants and Methods:
Through the use of an interpreter and a translation that focused on both accurate language and the cultural appropriateness of the testing materials, both patients were administered the Repeatable Battery for the Assessment of Neuropsychological Status Update (RBANS; Randolph, 2009). In addition to using normative data from the manual, analyses were based on the percentage of encoded information that was retained after a delay for each memory task, including List Recall, Story Recall and Figure Recall.
Results:
Case 1: The patient is a 51-year-old, monolingual (Mongolian), right-handed woman with a seizure onset at the age of 49. Her seizure frequency increased over the past two years and currently occur up to twice per day. Her inter-ictal EEG was read as normal. MRI revealed a left parahippocampal cavernous malformation. Verbal memory performances showed 22% list retention and 0% story retention. Visual memory revealed 35% figure retention. Although her memory was weak overall, greater verbal memory deficits, along with clinical information (i.e., right-handedness, seizure onset in adulthood) suggested that she had left hemisphere language dominance, negatively impacted by her two-year seizure history. Lesionectomy and resection of surrounding hemosiderin was recommended and performed for seizure control, given the limited duration of her epilepsy and to minimize the risk of further memory decline.
Case 2: The patient is a 22-year-old, monolingual (Mongolian), right-handed woman with neonatal meningitis and seizure onset at 3 years. She currently experiences focal impaired awareness seizures several times per week. Her inter-ictal EEG demonstrated general slowing with left frontotemporal prominence. Her MRI revealed left mesial temporal sclerosis (MTS). Verbal memory performances showed 100% list retention and 100% story retention. Visual memory revealed 50% retention. These findings of well-preserved verbal memory, contrasting weaker visual memory, suggested hemispheric reorganization. Given a surgical focus in the non-dominant hemisphere and strong contralateral memory along with evidence of MTS, the risk of post-surgical cognitive decline was thought to be minimal, and a left temporal lobectomy was recommended and performed.
Conclusions:
Neuropsychological testing using the RBANS has utility for pre-surgical evaluations for patients with medically refractory epilepsy in Mongolia, and will be used for post-operative assessments in the patients described above.
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