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Most research investigating auditory perception is conducted in controlled laboratory settings, potentially restricting its generalizability to the complex acoustic environment outside the lab. The present study, in contrast, investigated auditory attention with long-term recordings (> 6 h) beyond the lab using a fully mobile, smartphone-based ear-centered electroencephalography (EEG) setup with minimal restrictions for participants. Twelve participants completed iterations of two variants of an oddball task where they had to react to target tones and to ignore standard tones. A rapid variant of the task (tones every 2 s, 5 min total time) was performed seated and with full focus in the morning, around noon and in the afternoon under controlled conditions. A sporadic variant (tones every minute, 160 min total time) was performed once in the morning and once in the afternoon while participants followed their normal office day routine. EEG data, behavioral data, and movement data (with a gyroscope) were recorded and analyzed. The expected increased amplitude of the P3 component in response to the target tone was observed for both the rapid and the sporadic oddball. Miss rates were lower and reaction times were faster in the rapid oddball compared to the sporadic one. The movement data indicated that participants spent most of their office day at relative rest. Overall, this study demonstrated that it is feasible to study auditory perception in everyday life with long-term ear-EEG.

Most research investigating auditory perception is conducted in controlled laboratory settings, potentially restricting its generalizability to the complex acoustic environment outside the lab. The present study, in contrast, investigated auditory attention with long-term recordings (> 6 h) beyond the lab using a fully mobile, smartphone-based ear-centered electroencephalography (EEG) setup with minimal restrictions for participants. Twelve participants completed iterations of two variants of an oddball task where they had to react to target tones and to ignore standard tones. A rapid variant of the task (tones every 2 s, 5 min total time) was performed seated and with full focus in the morning, around noon and in the afternoon under controlled conditions. A sporadic variant (tones every minute, 160 min total time) was performed once in the morning and once in the afternoon while participants followed their normal office day routine. EEG data, behavioral data, and movement data (with a gyroscope) were recorded and analyzed. The expected increased amplitude of the P3 component in response to the target tone was observed for both the rapid and the sporadic oddball. Miss rates were lower and reaction times were faster in the rapid oddball compared to the sporadic one. The movement data indicated that participants spent most of their office day at relative rest. Overall, this study demonstrated that it is feasible to study auditory perception in everyday life with long-term ear-EEG. Supplementary Information The online version contains supplementary material available at (10.3758/s13428-021-01538-010.3758/s13428-021-01538-0).

Interictal epileptiform discharges (IEDs) are brief events (typically

To investigate whether theory of mind (ToM), an important requirement for adaptive social functioning, is different between children with pharmacologically refractory epilepsy who undergo epilepsy surgery and healthy control children, whether ToM is affected by epilepsy surgery in these children, and whether ToM is associated with demographic or epilepsy variables. The "ToM storybooks", a psychometrically sound ToM instrument designed for children, was administered shortly before and 0.5, one and two years after surgery as part of a neuropsychological assessment. Fifteen patients (mean age: 7.1 years) completed the ToM storybooks before and at least twice after surgery. Two sex- and age-matched healthy control children were included per patient. Linear mixed models were used to analyse differences between patients and controls. The association between ToM and demographic, epilepsy and surgical variables was explored. Patients had lower ToM scores than healthy control children, even when corrected for verbal intelligence quotient (VIQ). Epilepsy surgery had neither a harmful nor a favourable effect on ToM. Later epilepsy onset and temporal origin of epilepsy were associated with higher (better) ToM scores relative to earlier epilepsy onset and extra-temporal epilepsy (including hemispherotomy in one case). Children in whom the amygdala was resected had worse ToM scores. Children with refractory epilepsy have a ToM deficit that may not be accounted for by lower VIQ. Epilepsy surgery does not affect ToM functioning. Younger age at epilepsy onset is associated with poorer ToM, and temporal epilepsy with better ToM. Finally, the amygdala is implicated in ToM deficit. Patients and their parents should be educated about the possible consequences of epilepsy with regards to the development of social cognition and should be guided in order to help improve ToM.

The purpose of this study was to determine whether children with epilepsy surgery in their history are able to recognize emotions expressed by faces and whether this recognition is associated with demographic variables [age, sex, and verbal intelligence (VIQ)] and/or epilepsy variables (epilepsy duration, side of the surgery, surgery area, resection of the amygdala, etiology, antiepileptic drug use, and seizure freedom).Two years after epilepsy surgery, the Facial Expression of Emotion: Stimuli and Tests (FEEST) was administered to 41 patients (age: 4-20years, mean: 13.5years, 24 girls) and 82 age- and sex-matched healthy controls. Data obtained longitudinally (before surgery and 6, 12, and 24months after surgery) in a small subset (11 patients and 22 matched controls) were explored to obtain clues about the course of REEF from before surgery.Corrected for VIQ, REEF scored significantly lower in the 41 surgically treated patients than in matched control children. No significant relationship was found between REEF and any epilepsy variable. Only age at assessment predicted REEF score in both patients and controls. The longitudinal data revealed a 'dip' in emotion recognition at the first postsurgical assessment in the six younger patients (age:12.1years). The older patients (age: 13-17years) showed a continuous increase in REEF scores that was similar to that in controls. Two years after surgery, REEF of the younger patients recovered to, but did not exceed, the presurgical level.Neither poor REEF present two years after childhood epilepsy surgery, nor the aberrant course of REEF in younger patients (age:12.1years) was explained by epilepsy variables or poor verbal intelligence. Disentangling the mechanism of the abnormality is urgently needed, as recognizing emotional expressions is a key component in the development of more complex social perception skills.

Item does not contain fulltext Objective: To know whether change in the intelligence quotient (IQ) of children who undergo epilepsy surgery is associated with the educational level of their parents. Methods: Retrospective analysis of data obtained from a cohort of children who underwent epilepsy surgery between January 1996 and September 2010. We performed simple and multiple regression analyses to identify predictors associated with IQ change after surgery. In addition to parental education, six variables previously demonstrated to be associated with IQ change after surgery were included as predictors: age at surgery, duration of epilepsy, etiology, presurgical IQ, reduction of antiepileptic drugs, and seizure freedom. We used delta IQ (IQ 2 years after surgery minus IQ shortly before surgery) as the primary outcome variable, but also performed analyses with pre- and postsurgical IQ as outcome variables to support our findings. To validate the results we performed simple regression analysis with parental education as the predictor in specific subgroups. Results: The sample for regression analysis included 118 children (60 male; median age at surgery 9.73 years). Parental education was significantly associated with delta IQ in simple regression analysis (p = 0.004), and also contributed significantly to postsurgical IQ in multiple regression analysis (p = 0.008). Additional analyses demonstrated that parental education made a unique contribution to prediction of delta IQ, that is, it could not be replaced by the illness-related variables. Subgroup analyses confirmed the association of parental education with IQ change after surgery for most groups. Significance: Children whose parents had higher education demonstrate on average a greater increase in IQ after surgery and a higher postsurgical - but not presurgical - IQ than children whose parents completed at most lower secondary education. Parental education - and perhaps other environmental variables - should be considered in the prognosis of cognitive function after childhood epilepsy surgery. 9 p.

article i nfo Purpose: This study aimed to investigate parenting stress expressed by parents before and two years after their children's epilepsy surgery. Methods: Subjects: Parents of 31 consecutively included surgery patients with epilepsy and parents of 31 healthy sex- and age-matched control children were the subjects of this study. Materials and procedure: The question- naire 'Parenting Stress Index', which distinguishes a Parent domain (stress leading parents to feel themselves inadequate) from a Child domain (child features felt by parent to cause stress) was completed before surgery of the patients and two years thereafter. At both time points, intelligence examination of the child was part of a comprehensive neuropsychological assessment, as were evaluations of recent stress-enhancing life events and epilepsy severity. Results: Prior to surgery, total parenting stress was significantly higher in parents of patients than in parents of con- trols. Two years after surgery, total parenting stress had decreased significantly in parents of patients. The scores on parent-related subscales Role Restriction and Spouse and on the child-related subscale Distractibility/Hyperactivity, all relatively high before surgery, decreased significantly. Still, parents of patients experienced significantly more stress compared with parents of controls mainly because of persistently higher stress scores in par- ents of patients on the subscale Role Restriction (Parent domain) and on five of six subscales in the Child domain. Intelligence of the child was associated with parenting stress: the lower the child's intelligence, the higher the stress score on the subscale Distractibility/Hyperactivity and the lower the stress score on the subscale Mood. Stress decreased more in parents of patients who became seizure-free after surgery than in parents of patients with recurrent seizures. Conclusions: Parenting stress decreases but does not normalize in the first two years after epilepsy surgery. Parents should be offered counseling on epilepsy-related intricacies contributing to parenting stress, immediately after diagnosis as well as after epilepsy surgery, notwithstanding the resulting seizure status of the child.

Motor imagery (MI) with neurofeedback has been suggested as promising for motor recovery after stroke. Evidence suggests that regular training facilitates compensatory plasticity, but frequent training is difficult to integrate into everyday life. Using a wireless electroencephalogram (EEG) system, we implemented a frequent and efficient neurofeedback training at the patients' home. Aiming to overcome maladaptive changes in cortical lateralization patterns we presented a visual feedback, representing the degree of contralateral sensorimotor cortical activity and the degree of sensorimotor cortex lateralization. Three stroke patients practiced every other day, over a period of 4 weeks. Training-related changes were evaluated on behavioral, functional, and structural levels. All 3 patients indicated that they enjoyed the training and were highly motivated throughout the entire training regime. EEG activity induced by MI of the affected hand became more lateralized over the course of training in all three patients. The patient with a significant functional change also showed increased white matter integrity as revealed by diffusion tensor imaging, and a substantial clinical improvement of upper limb motor functions. Our study provides evidence that regular, home-based practice of MI neurofeedback has the potential to facilitate cortical reorganization and may also increase associated improvements of upper limb motor function in chronic stroke patients.

Summary This retrospective study evaluates the impact of postoperative antiepileptic drug (AED) withdrawal on psychomotor speed in seizure-free children, operated for medically refractory epilepsy. Post-surgical medication policy and neuropsychological assessments (performed shortly before and 6, 12 and 24 months after surgery), were evaluated in 57 children (32 female, median age at surgery 13 years). Patients were divided into a withdrawal ( n =29) and a no-withdrawal group ( n =28). Scores of four psychomotor tests performed at 12 and 24 months after surgery were compared with those of postoperative baseline measurements, performed 6 months after surgery. At 24 months, the withdrawal group had improved significantly more than the no-withdrawal group on three of four tests; reaction time to light ( p =0.031), reaction time to sound ( p =0.045) and tapping ( p =0.003). At 12 months, a non-significant tendency in the same direction was found for both reaction time tests. Drug withdrawal after surgery improves psychomotor speed and may unleash the potential for cognitive improvement.

Item does not contain fulltext Objective: Poor performance on confrontation naming tasks by children and adolescents with pharmacologically intractable epilepsy has been interpreted as indicating impairments of lexicon, that is, the store of words in long-term memory. However, confrontation naming performance crucially depends not only on word knowledge but also on other functions such as fluency. We applied an alternative method to assess lexicon with the aim of tracing deficits in lexicon before and after surgery in adolescents with pharmacologically intractable epilepsy. Method: Sixteen patients and 32 age- and sex-matched controls completed the Dutch version of the controlled oral word production task. Responses were used to calculate indices of lexical fluency (retrieval efficiency), lexical breadth (vocabulary size), and lexical depth (knowledge of word properties), as well as use of search strategies. Results: Adolescents with pharmacologically intractable epilepsy had lower lexical fluency scores than healthy peers, but did not differ from them on the dimensions of lexical breadth and lexical depth. Patients demonstrated reduced use of search strategies. In fact, the difference in lexical fluency between patients and controls disappeared after controlling for Full Scale IQ (obtained using the Dutch version of the 3rd edition of the Wechsler Intelligence Scale for Children (WISC–IIINL; Kort et al., 2005; Wechsler, 2002) or—for older children—the Dutch version of the first edition of the Kaufman Adult and Adolescent Intelligence Test (KAIT; Kaufman & Kaufman, 1993; Mulder, Dekker, & Dekker, 2004) and use of search strategies. In patients, changes in the use of the antiepileptic drug carbamazepine were associated with lexical fluency. Conclusion: Adolescents with pharmacologically intractable epilepsy differ from their healthy peers mainly in lexical fluency, rather than word knowledge per se. 9 p.

Background Motor imagery (MI) training, in particular in combination with EEG-based neurofeedback (MI-NF), has been suggested as a potential add-on therapy for rehabilitation of upper limb motor impairments after stroke. Most MI-NF implementations are based on the event-related desynchronization (ERD) in the 8–30 Hz frequency range that is typically observed over sensorimotor areas during motor execution and imagination. The amplitude and consistency of the ERD depends, among other things, on brain structure and function during motor imagery (e.g., Halder et al., 2013 , Zich et al., 2015 ). Because the vast majority of the research on MI-NF has been conducted with young healthy individuals, it is unclear to what degree changes regarding the relationship between MI-induced ERD, MI-induced functional magnetic resonance imaging (fMRI) activation and brain structure in stroke patients are due to normal aging and the stroke, respectively. Objectives (1) to investigate in healthy older adults (>45 years) associations of MI-induced ERD, MI-induced fMRI activation and diffusion tensor imaging (DTI) measures, and (2) to investigate differences in these measures between chronic stroke patients and healthy older adults matched for age and gender. Methods We included 12 chronic stroke patients with residual upper limb motor impairment (mean age 61.5 years – range 49–75 years; 3 females) and 17 healthy older adults (mean age 60.4 years – range 48–77 years; 9 females). All participants completed a 3T MRI session and a 96-electrode EEG session. The MRI session included a high-resolution anatomical scan, DTI, and fMRI during rest, motor execution and kinesthetic MI of repeated hand opening and closing. The EEG session consisted of three blocks: motor execution, kinesthetic MI and kinesthetic MI with real-time EEG-based visual feedback, all with the same hand movement as during fMRI. Each patient also completed a motor assessment consisting of the upper limb section of the Fugl-Mayer Assessment and the Modified Ashworth Scale. Results We will present preliminary results regarding the correlations of ERD and fMRI activation related to motor execution and imagination. Moreover, we will present the results of a replication of the analysis of Halder et al. (2013) that for young healthy adults indicated a significant association between MI-induced ERD and white matter integrity (fractional anisotropy) in subcortical structures.

We studied how children with epilepsy (CWE) who are candidates for epilepsy surgery, perceive themselves with respect to overarching personality traits and whether the traits change after surgery. We explored influences of demographic and illness variables. A total of 23 CWE [mean age at inclusion 12.8 (sd 2.3); 12 girls] participated. Using the Dutch Personality Questionnaire Juniors (DPQ-J), we assessed 20 of the CWE shortly before epilepsy surgery and compared the results to those of 39 age- and gender-matched healthy controls. Furthermore, we obtained follow-up scores 6, 12 and 24 months after epilepsy surgery from the clinical group. CWE who were candidates for epilepsy surgery scored above average in inadequacy, perseverance, social inadequacy and recalcitrance, whereas healthy peers scored average. Over the two years' period after epilepsy surgery we found no changes, apart from a decrease of social inadequacy. Sporadic illness and demographic variables were related to some personality traits. However, neither post-surgical seizure freedom nor cessation of AEDs did noticeably change the self-evaluations of CWE. Asking CWE to evaluate their personality themselves may offer a shared basis for individually tailored behavior intervention in order to help them adapting to their ameliorated circumstances after surgery.

Visual memory is vulnerable to epilepsy surgery in adults, but studies in children suggest no change or small improvements. We investigated visual memory after epilepsy surgery, both group-wise and in individual children, using two techniques to assess change: 1) repeated measures analysis of variance (ANOVA) and 2) an empirically based technique for detecting cognitive change [standardized regression-based (SRB) analysis]. A prospective cohort consisting of 21 children completed comprehensive assessments of memory both before surgery (T0) and 6 (T1), 12 (T2), and 24 months (T3) after surgery. For each patient, two age- and gender-matched controls were assessed with the same tests at the same intervals. Repeated measures ANOVA replicated the results of previous studies reporting no change or minor improvements after surgery. However, group analysis of SRB results eliminated virtually all improvements, indicating that the ANOVA results were confounded by practice effects. Standardized regression-based group results showed that in fact patients scored lower after surgery than would be predicted based on their presurgical performance. Analysis of individual SRB results showed that per visual memory measure, an average of 18% of patients obtained a significantly negative SRB score, whereas, on average, only 2% obtained a significantly positive SRB score. At T3, the number of significantly negative SRB scores outweighed the number of significantly positive SRB scores in 62% of patients. There were no clear associations of clinical variables (including side and site of surgery and postsurgical seizure freedom) with memory outcome. The present analysis revealed that given their individual presurgical functioning, many children obtained disappointing results on some visual memory tests after epilepsy surgery. Comparison of the SRB analysis with ANOVA results emphasizes the importance of empirically based techniques for detecting cognitive effects of epilepsy surgery in childhood.

Summary Purpose To investigate verbal memory after epilepsy surgery both group-wise and at the level of individual children, and to assess associations with side of surgery and removal of the temporal lobe. Methods A prospective controlled study in a consecutive sample of 21 children undergoing epilepsy surgery, with comprehensive assessments of verbal memory before surgery and six, 12 and 24 months after surgery. For each patient, two age- and gender-matched controls were tested at similar intervals. Standardized regression-based (SRB) analysis was applied to compare post-surgical change in individual patients with change in controls. Results Group-wise, average normed scores on verbal memory tests were higher after epilepsy surgery than before, corroborating earlier reports. By dint of empirically based SRB analysis, however, considerable individual differences in post-surgical change were revealed. Children with resections that included the left temporal lobe functioned significantly poorer than predicted on the basis of their pre-surgical performance. In contrast, verbal memory performance after surgery was consistent with pre-surgical baseline in the majority of children with resections that spared the left temporal lobe. Conclusions Despite cessation of epileptic seizures, verbal memory remains vulnerable in children who required surgery including the left temporal lobe. In most – but not all – children with other types of surgery, post-surgical verbal memory is consistent with their individual pre-surgical base level.

Chronic hemiparesis of an upper limp following stroke has been related to an over-involvement of the ipsilateral hemisphere that inhibits use of the affected limb. Interventions helping to shift back this altered lateralization have been suggested to positively affect upper limp functional recovery. One such intervention is the combination of motor imagery (MI) supported by EEG neurofeedback. However, cortical reorganization requires highly intensive practice. In this feasibility study this was achieved by implementing a mobile EEG neurofeedback system. The training regime consisted of 14 MI sessions over a time course of 4 weeks. Three chronic stroke patients practiced MI neurofeedback using kinaesthetic imagination of a power grip of either the affected or the unaffected hand. Neurofeedback was based on features extracted from the 8-30 Hz frequency range. MI training was conducted at the patients’ home using a fully mobile 24-channel EEG system. Before and after the training, motor functions were assessed using a modified version of the Fugl-Meyer Assessment (FMA) and the modified Motor Assessment Scale (MAS). Moreover, pre- and post-training 96-channel EEG recordings were performed for MI and movement execution (ME) of the power grip task that was used for the MI neurofeedback training. Event-related desynchronization (ERD) in the 8–30 Hz frequency range was extracted offline for a region of interest analysis. Analysis focused on contra- and ipsilateral ERD and on the lateralization of ERD, defined as the difference between contralateral and ipsilateral ERD. All patients remained motivated throughout the training and completed the training regime. During MI and ME with the unaffected hand, patients showed stronger contralateral than ipsilateral activity in both the pre- and the post-training sessions. For the affected hand, MI and ME were however associated with stronger ipsilateral than contralateral activity. Changes were observed over the course of training, that, on a descriptive level, suggest a reduction of the altered lateralization for the affected hand in all three patients during MI. Furthermore, for one patient a significant improvement in the FMA score was observed, which paralleled the changes in MI and ME induced ERD. This study demonstrates that home-based MI neurofeedback training is feasible and allows for highly intensive training regimes. The observations made are in line with the notion of an over-involvement of the ipsilateral hemisphere during activities of the affected limb. The described changes of lateralization with MI neurofeedback training encourage continuing this line of research with larger sample sizes and matched healthy controls, to see if home-based MI neurofeedback training can indeed help to shift MI- and ME-related activation towards the expected lateralization patterns.

A 15-year-old girl with complex partial epilepsy had subdural electrodes implanted. She was tested on reaching tasks during electrocortical stimulation prior to neurosurgery. MRI showed left mesial parietal dysplasia. Stimulation of the superior parietal cortex (electrode pair 37–45, figure, A) during line bisection and visually guided reaching resulted in movement arrest followed by the arm drifting upward (figure, B, …

To the Editor. — Recently, Anderson et al1 reported important and thought-provoking data concerning developmental and cognitive outcome after traumatic brain injury (TBI) in childhood. They claim that their results are explained by cerebral vulnerability rather than plasticity and propose that (1) more severe TBI predicts worse outcome and (2) for moderate and severe TBI, younger age at injury predicts worse outcome. We believe that …