Publication: Evaluación de la hipótesis de conectoma mediante pruebas neuropsicológicas
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2016-02-19
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Universidad Complutense de Madrid
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Abstract
Objetivos: Evaluar la sensibilidad de las pruebas neuropsicológicas para diferenciar patrones entre pacientes con epilepsia del lóbulo frontal (ELF) y pacientes con epilepsia del lóbulo temporal con esclerosis mesial (ELTM). Metodología: 60 pacientes epilépticos lesionales (30 con ELF y 30 con ELTM) fueron valorados mediante una completa batería neuropsicológica incluyendo pruebas habitualmente relacionadas con la memoria (subtest de la Escala de Memoria Wechsler- Revisada, Test de denominación de Boston) y las funciones ejecutivas (Trail Making Test, Fluidez verbal, Test de colores y palabras Stroop, Test de Clasificación de cartas de Wisconsin, Test de la Torre de Hanoi, subtest Mapa del Zoo del Test de Evaluación Conductual del Síndrome Disejecutivo). En análisis posteriores fueron comparados respecto a un grupo control formado por 20 participantes sanos, incluyendo además la lateralización de la lesión. Resultados: De todas las pruebas administradas, son algunas relacionadas con las funciones ejecutivas, las que mejor discriminan entre los grupos ELF y ELTM. Éstas son las que hacen referencia a la velocidad de procesamiento de la información, a la capacidad de inhibición de respuestas automáticas y a los tiempos invertidos en la consecución de tareas de planificación así como a su eficacia final. En todas ellas, los pacientes con ELF muestran rendimientos inferiores al grupo con ELTM. Al incluir en los análisis al grupo control, sólo dos pruebas muestran su capacidad para discriminar entre los grupos clínicos; de nuevo los pacientes con ELF muestran más dificultades para el control de impulsos a la vez que invierten más tiempo en tareas de planificación. Las demás diferencias encontradas se dan entre los grupos de ELF y ELTM en comparación con el grupo control. Así, los pacientes frontales muestran velocidades de procesamiento de la información enlentecidas, mayores dificultades para alternar la atención y un mayor número de respuestas perseverativas. Los pacientes con ELTM izquierda presentan mayores dificultades para la recuperación de información episódica verbal y de denominación, utilizando además en mayor medida claves fonéticas para acceder a las palabras. Por otra parte ambos grupos ejecutan por 7 igual tareas de codificación de memoria episódica verbal así como tareas de fluidez verbal. Otras variables como un bajo nivel educativo y el encontrarse en tratamiento farmacológico en politerapia se asocian con rendimientos inferiores. Conclusiones: Existen pruebas neuropsicológicas relacionadas con el funcionamiento ejecutivo que facilitan la diferenciación entre ambos grupos clínicos, mostrando rendimientos inferiores para el grupo de pacientes con ELF. Variables sociodemográficas y relativas a la enfermedad permiten predecir la ejecución en este tipo de pacientes. El resto de las diferencias observadas se manifiesta en relación al grupo control, pero no entre los grupos clínicos. Si bien algunos resultados muestran tendencias no significativas estadísticamente en procesos concretos como en relación a la capacidad de codificación de memoria episódica verbal y la capacidad de fluidez semántica, es muy probable que incluso aumentando el tamaño de la muestra, ambos grupos compartan alteraciones, aunque no exactamente en el mismo grado ni por el mismo motivo. Esto se explica por la naturaleza multifactorial de las pruebas neuropsicológicas, algunas características intrínsecas de la enfermedad (propagación de las crisis) y al hecho de que ambas localizaciones formen parte de redes neurales comunes. Todo ello obliga a dejar de pensar en términos de relación unívoca entre procesos cognitivos y localizaciones cerebrales específicas, haciendo hincapié en la existencia de redes funcionales.
Objective: To assess the sensitivity of neuropsychological tests to differentiate patterns between patients with frontal lobe epilepsy (ELF) and patients with temporal lobe epilepsy with mesial sclerosis (ELTM). Methods: 60 lesional epilepsy patients (30 with ELF and 30 with ELTM) were evaluated using a comprehensive neuropsychological battery including tests usually related to memory (subtest of the Wechsler Memory Scale Revised, Boston Naming Test) and executive functions (Trail Making Test, verbal fluency , Test Stroop color-word, Wisconsin Card Sorting Test, Test Tower of Hanoi, subtest Zoo map from the Behavioral Assessment of the Dysexecutive Syndrome Test). Further analyzes were compared with respect to a control group of 20 healthy participants, also including the lateralization of the lesion. Results: Some tests related to executive functions were the ones that best discriminate between ELF and ELTM groups. These are referring to the speed of information processing, the ability to inhibit automatic responses and the time spent on achieving planning tasks as well as to their ultimate effectiveness. In all of them, patients with ELF show performance below ELTM group. When a control group was included in the analysis, only two tests show their ability to discriminate between clinical groups; again ELF patients show more difficulty controlling impulses while spending more time planning tasks. Other differences found are between the ELF and ELTM groups compared with the control group. Thus, the FLE patients show speed slowed in processing information, more difficult to switch attention and a higher number of perseverative responses. Patients with left ELTM show more difficulties to recover verbal episodic information and naming, also using more phonetic cues to access to words. On the other hand both groups performed equally at encoding verbal episodic memory tasks and verbal fluency tasks. Other variables such as low educational level and pharmacological treatment in politherapy are associated with lower performance. 9 Conclusions: There are neuropsychological tests related to executive functioning that facilitate differentiation between the two clinical groups, showing lower performance for patients with ELF. Demographic and disease related variables allow predictions in the performance in these patients. The other observed differences are evident in relation to the control group, but not between the clinical groups. Although some results show trends not statistically significant in specific processes as in relation to the decoding ability of verbal episodic memory and semantic fluency capacity, it is likely that even increasing the sample size, both groups share alterations, although not exactly in the same extent and for the same reasons. This is explained by the multifactorial nature of the neuropsychological tests, some intrinsic features of the disease (spread of seizures) and the fact that both locations are part of common neural networks. This requires changes to stop thinking in terms of one relationship between cognitive processes and specific brain locations, emphasizing the existence of functional networks
Objective: To assess the sensitivity of neuropsychological tests to differentiate patterns between patients with frontal lobe epilepsy (ELF) and patients with temporal lobe epilepsy with mesial sclerosis (ELTM). Methods: 60 lesional epilepsy patients (30 with ELF and 30 with ELTM) were evaluated using a comprehensive neuropsychological battery including tests usually related to memory (subtest of the Wechsler Memory Scale Revised, Boston Naming Test) and executive functions (Trail Making Test, verbal fluency , Test Stroop color-word, Wisconsin Card Sorting Test, Test Tower of Hanoi, subtest Zoo map from the Behavioral Assessment of the Dysexecutive Syndrome Test). Further analyzes were compared with respect to a control group of 20 healthy participants, also including the lateralization of the lesion. Results: Some tests related to executive functions were the ones that best discriminate between ELF and ELTM groups. These are referring to the speed of information processing, the ability to inhibit automatic responses and the time spent on achieving planning tasks as well as to their ultimate effectiveness. In all of them, patients with ELF show performance below ELTM group. When a control group was included in the analysis, only two tests show their ability to discriminate between clinical groups; again ELF patients show more difficulty controlling impulses while spending more time planning tasks. Other differences found are between the ELF and ELTM groups compared with the control group. Thus, the FLE patients show speed slowed in processing information, more difficult to switch attention and a higher number of perseverative responses. Patients with left ELTM show more difficulties to recover verbal episodic information and naming, also using more phonetic cues to access to words. On the other hand both groups performed equally at encoding verbal episodic memory tasks and verbal fluency tasks. Other variables such as low educational level and pharmacological treatment in politherapy are associated with lower performance. 9 Conclusions: There are neuropsychological tests related to executive functioning that facilitate differentiation between the two clinical groups, showing lower performance for patients with ELF. Demographic and disease related variables allow predictions in the performance in these patients. The other observed differences are evident in relation to the control group, but not between the clinical groups. Although some results show trends not statistically significant in specific processes as in relation to the decoding ability of verbal episodic memory and semantic fluency capacity, it is likely that even increasing the sample size, both groups share alterations, although not exactly in the same extent and for the same reasons. This is explained by the multifactorial nature of the neuropsychological tests, some intrinsic features of the disease (spread of seizures) and the fact that both locations are part of common neural networks. This requires changes to stop thinking in terms of one relationship between cognitive processes and specific brain locations, emphasizing the existence of functional networks
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Psicología, Departamento de Psicología Básica II (Procesos Cognitivos), leída el 11-01-2016