Copy and recall drawings of the Rey Complex Figure obtained during the standard clinical testing of patients with well-localized epileptic foci before and after left frontal-, left temporal-, right temporal-lobe resection were re-scored blind as to lesion site using standard protocol (18 elements scored 0, 1/2, 1, or 2 based on whether they are drawn and placed correctly for a total out of 36). They were also scored for which, and how many, elements were missing, distorted, displaced, and/or repeated. Contrary to previous findings, no main effects of side or lobe or side-by-lobe interactions were found on copy and recall scores obtained either before or after surgery, and all patients' recall improved equally from pre-operative to follow-up testing. Furthermore, patients' lesion site could not be predicted on the basis of any single measure or across all measures of performance. While group differences had been found on the previously assigned scores, the between-group overlap was almost complete and the original scoring was not done blindly. These results suggest that, despite previous claims, the Rey Complex Figure, a widely-used measure of non-verbal memory, is not an effective tool for localizing neural disturbance in temporal- and frontal-lobe epilepsy patients.

Ph.D. / Epilepsy is a multidimensional disorder that extends beyond the medical implications to impact nearly every aspect of the person's life, as well as the lives of the people in the surrounding environment. Intractable epilepsy has a poor prognosis with possible worsening of seizures and cognitive decline over time. Anterior temporal lobe surgery for epilepsy provides an opportunity for the alleviation of seizures; however there are potential risks, to memory in particular. Research on surgery outcome thus far has evaluated outcome from a linear paradigm and has studied impact of surgery on isolated areas of function, the results derived from this have been largely inconsistent. So far, there has been very little research that focuses on the person as a whole, and as yet there has been no integrated approach to studying surgical outcome. The aim of the current study was therefore to investigate the impact of anterior temporal lobe surgery, specifically the symptomatic and functional surgical outcomes, in an integrated and holistic manner. This was done in accordance with the paradigm of complex systems theory as a critique of the previous literature in this field, and to gain a more holistic understanding of surgical outcome. A combination of methodologies was employed in order to achieve this. The sample consisted of male (n=10) and female (n=24) patients with intractable epilepsy undergoing left-sided (n=13) and right-sided (n=21) temporal lobe surgery at the Milpark Hospital Johannesburg between the ages of 14 and 58 (mean = 39 years), over a period of seven years. A pretest-posttest design was employed to obtain quantitative data (n=34). Post surgical assessments were conducted up to seven years post surgery (mean=3.6 years). Pre and post surgery assessment included neurocognitive functioning, particularly memory and language functions, by means of the Rey Complex Figure Test, Wechsler Memory Scale-Ill, and Controlled Oral Word Association Test; as well as emotional functioning, particularly depression and anxiety, by means of the Beck Depression lnventory-11 and Beck Anxiety lnventory-11. The quantitative data was subjected to statistical analysis of the sample as a whole, as well as gender and side of surgery comparisons, and included tests of normality of distribution of the data; the paired samples t-test; the independent samples t-test; the Wilcoxon Signed Ranks test; the Mann-Whitney U test; and the Wilks' Lambda test. A semi-structured interview was also conducted (n=30) in order to obtain qualitative data on the functional (psychosocial) aspects of outcome. The interview included an assessment of postoperative seizure outcome; changes in daily activity functions; the client's report on positive and negative outcomes of surgery; quality of life changes and satisfaction with surgery. The qualitative data was analysed using the methods of open coding and axial coding. The results for neuropsychological function reflected known lateralization effects with memory showing auditory-verbal memory deficits after left-sided surgery; and visual (figural) memory deficits after right-sided surgery. Gender differences reflected known neuropsychological differences with female superiority in verbal fluency and a male advantage on visual-spatial tasks. Importantly, there was no relationship between neuropsychological deficit and decrements in daily activity functions, emotional functioning or quality of life. This indicates little impact of neuropsychological deficit post surgery and may be an indication of the effectiveness of the preoperative screening procedures. The results for emotional functioning showed a statistically significant improvement in the 'moderate/severe' depression and anxiety groups from pre to post surgery. This indicates a substantial improvement in both depression and anxiety for this severity group. The qualitative results showed that surgery rendered 74% of the sample seizure free, 15% showing worthwhile improvement, and 11% no change or worse seizures. Seizure outcome however did not determine quality of life changes, even those with some improvement or no change still reported an improvement in quality of life post surgically. The functional outcomes showed little postoperative change in daily activity functions (driving, occupational functioning and marital status) but still a reported improvement in quality of life. There were far more reports on perceived positive than negative outcomes. The most positive benefit of surgery, as reported by participants, was that of increased feelings of control, decreased helplessness, and less anxiety and worry of having seizures. The overwhelming majority of participants reported improved quality of life (90%) and satisfaction with surgery (93%).

Indiana University-Purdue University Indianapolis (IUPUI) / Voltage-‐gated sodium channels (VGSCs) are critical for the initiation and propagation of electrical signals in neurons; consequently they are significant regulators of neuronal excitability. They are exquisitely tuned and aberrations in their activity can lead to pathophysiological conditions. This dissertation highlights the roles of two prominent brain isoforms of VGSCs, Nav1.1 and Nav1.6. These isoforms have distinct localization in the brain. Specifically, Nav1.1 is predominantly expressed in the soma and proximal axon initial segment (AIS) of GABAergic neurons, while Nav1.6 is found at the distal AIS and nodes of Ranvier of both GABAergic and excitatory neurons. Several mutations have been identified in Nav1.1 and recently mutations in Nav1.6 have been discovered in patients with distinct epileptic phenotypes that respond poorly to current anti-epileptics. There is a need to better understand mechanistically how mutations in these channel isoforms lead to epilepsy in order to identify more efficacious treatment strategies. Therefore, the aims of this dissertation were to 1) examine the differential biophysical properties of Nav1.1 and Nav1.6, 2) determine the biophysical consequences of epilepsy-­associated mutations in Nav1.1 and Nav1.6 and examine the effects of cannabinoids on wildtype and mutant channel activity and 3) test the effects of selective inhibition of Nav1.1 versus Nav1.6 on epileptiform activity. To address these aims, whole­‐cell electrophysiology and mutlielectrode array recordings were used. The results demonstrate that 1) Nav1.1 and Nav1.6 have important differences in their biophysical properties that may be important in the fine­‐tuning of neuronal excitability, 2) epilepsy-­‐associated mutations in Nav1.1 and Nav1.6 alter several biophysical properties of the channels but have differential effects on resurgent current generation suggesting a divergence in the mechanism by which they induce epileptogenesis and cannabidiol can inhibit aberrant channel activity and reduce neuronal excitability and 3) pharmacological inhibition of Nav1.6, but not Nav1.1, abolishes epileptiform activity. Overall, this dissertation provides insight into the distinct contributions of Nav1.1 and Nav1.6 to physiological and pathophysiological firing activity and their ability to be targeted for therapeutic purposes. This knowledge is critical for understanding the potential role of VGSCs in epilepsy syndromes and identifying possible drug targets for more efficacious treatment strategies.

No description available.

Doctorat en sciences psychologiques / info:eu-repo/semantics/nonPublished

Inclusive education is one of the major changes in education, which has occurred since the implementation of Education White Paper 6 Special Needs Education; Building an inclusive education and training system. This inevitable change has resulted in many challenges for both educators and educational institutions. According to this policy, educators are expected to cater for all diverse needs of learners in the classroom including learners with epilepsy. Research indicates that educators find it difficult to cope with the demands of these learners and often experience frustration and failure. Educators have received little or no training to provide meaningful support for these learners. Despite policy changes the needs of learners with epilepsy are not met in the classroom. In this research the support programme is developed to provide practical and comprehensive guidelines to assist educators to support learners with epilepsy. / Social work / M. Ed. (Guidance and Counselling)

Epilepsy is the most common, chronic, serious neurological disease in the world, with an estimated 65 million people affected worldwide. Recent studies on people diagnosed with epilepsy suggest that stress might trigger epileptic seizures. Interventions aimed at lowering stress might be able to reduce the risk for epileptic seizures among epileptics. In an attempt to explore this possibility, I conducted a systematic review addressing the efficacy of behavioral interventions targeted at lowering stress on seizure frequency among an epileptic population. This article also investigated the efficacy of these interventions on lowering self-perceived stress in the same population. Three databases were searched for obtaining 54 references. After a systematic filtering process, a set of 2 studies was retained after the full search procedure. The results suggest stress-reducing behavioral interventions do not have any statistically significant effects on lowering seizure frequency but have a statistically significant effect on lowering self-perceived stress ratings among an epileptic population. The small but promising results from trials and systematic reviews not included in this review warrant further research into the topic. Limitations regarding search procedure included studies and consideration for further research and reading for the presented topics are discussed.

Inclusive education is one of the major changes in education, which has occurred since the implementation of Education White Paper 6 Special Needs Education; Building an inclusive education and training system. This inevitable change has resulted in many challenges for both educators and educational institutions. According to this policy, educators are expected to cater for all diverse needs of learners in the classroom including learners with epilepsy. Research indicates that educators find it difficult to cope with the demands of these learners and often experience frustration and failure. Educators have received little or no training to provide meaningful support for these learners. Despite policy changes the needs of learners with epilepsy are not met in the classroom. In this research the support programme is developed to provide practical and comprehensive guidelines to assist educators to support learners with epilepsy. / Social work / M. Ed. (Guidance and Counselling)

A study of the relevant theoretical concepts and empirical research was undertaken to explore the role of the social worker pertaining to the problem of epilepsy in the black community of Mamelodi. The sample comprised 40 families in which there was a person with epilepsy. Data were obtained through an interview schedule administered by the researcher. The literature study highlighted the phenomenon epilepsy, causes of epilepsy/ psychosocial effects of epilepsy on the epileptic and his family and the treatment of the epileptic. However/ it became quite clear that a multi-disciplinary team approach is vital importance in the treatment of an epileptic Furthermore/ significant others like traditional healers, faith healers, priests, relatives and friends were identified as some of the important informal support systems. Although the findings of study cannot be generalised to the entire population they can be of great significance for further research. / 'n Studie van die relevante konsepte asook empiriese navorsing is gedoen om die rol van die maatskaplike werker met betrekking tot die probleem van epilepsie in die swart gemeenskap van Mamelodi te eksploreer. Die steekproef is saamgestel uit 'n groep van 40 gesinne met 'n epileptikus in hul midde. Inlighting is verkry deur groep van onderhoudskedule. Die literatuurstudie beklemtoon die volgende: die verskynsel van epilepsie, oorsake van epilepsie, psigososiale gevolge van epilepsie op die per soon met epilepsie en sy gesin en die behandeling van die epileptikus. Dit het egter duidelik na vore gekom dat 'n multi-dissiplinere spanbenadering van die uiterste belang is in die behandeling van die epilepsielyer. Dit het ook duidelik geword dat betekenisvolle ander persone soos tradisionele genesers, geloofsgenesers priesters, familie en vriende van die mees belangrike steunstelsels is. Alhoewel bevindinge van die studie nie veralgemeen kan word en van toepassing gemaak kan word op die bevolking as geheel nie, kan dit egter van groot belang vir verdere navorsing wees. / Social Work / M.A. (Social Science)

A study of the relevant theoretical concepts and empirical research was undertaken to explore the role of the social worker pertaining to the problem of epilepsy in the black community of Mamelodi. The sample comprised 40 families in which there was a person with epilepsy. Data were obtained through an interview schedule administered by the researcher. The literature study highlighted the phenomenon epilepsy, causes of epilepsy/ psychosocial effects of epilepsy on the epileptic and his family and the treatment of the epileptic. However/ it became quite clear that a multi-disciplinary team approach is vital importance in the treatment of an epileptic Furthermore/ significant others like traditional healers, faith healers, priests, relatives and friends were identified as some of the important informal support systems. Although the findings of study cannot be generalised to the entire population they can be of great significance for further research. / 'n Studie van die relevante konsepte asook empiriese navorsing is gedoen om die rol van die maatskaplike werker met betrekking tot die probleem van epilepsie in die swart gemeenskap van Mamelodi te eksploreer. Die steekproef is saamgestel uit 'n groep van 40 gesinne met 'n epileptikus in hul midde. Inlighting is verkry deur groep van onderhoudskedule. Die literatuurstudie beklemtoon die volgende: die verskynsel van epilepsie, oorsake van epilepsie, psigososiale gevolge van epilepsie op die per soon met epilepsie en sy gesin en die behandeling van die epileptikus. Dit het egter duidelik na vore gekom dat 'n multi-dissiplinere spanbenadering van die uiterste belang is in die behandeling van die epilepsielyer. Dit het ook duidelik geword dat betekenisvolle ander persone soos tradisionele genesers, geloofsgenesers priesters, familie en vriende van die mees belangrike steunstelsels is. Alhoewel bevindinge van die studie nie veralgemeen kan word en van toepassing gemaak kan word op die bevolking as geheel nie, kan dit egter van groot belang vir verdere navorsing wees. / Social Work / M.A. (Social Science)