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Objective: Language lateralization is a major concern in some patients with pharmacoresistant epilepsy who will face surgery; in these patients, hemispheric dominance testing is essential to avoid further complications. The Wada test is considered the gold standard examination for language localization, but is invasive and requires many human and material resources. Functional MRI and tractography with diffusion tensor imaging (DTI) have demonstrated that they could be useful for locating language in epilepsy surgery, but there is no evidence of the correlation between the Wada test and DTI MRI in language dominance., Methods: The authors performed a retrospective review of patients who underwent a Wada test before epilepsy surgery at their institution from 2012 to 2017. The authors retrospectively analyzed fractional anisotropy (FA), number and length of fibers, and volume of the arcuate fasciculus and uncinate fasciculus, comparing dominant and nondominant hemispheres., Results: Ten patients with temporal lobe epilepsy were reviewed. Statistical analysis showed that the mean FA of the arcuate fasciculus in the dominant hemisphere was higher than in the nondominant hemisphere (0.369 vs 0.329, p = 0.049). Also, the number of fibers in the arcuate fasciculus was greater in the dominant hemisphere (881.5 vs 305.4, p = 0.003). However, no differences were found in the FA of the uncinate fasciculus or number of fibers between hemispheres. The length of fibers of the uncinate fasciculus was longer in the dominant side (74.4 vs 50.1 mm, p = 0.05). Volume in both bundles was more prominent in the dominant hemisphere (12.12 vs 6.48 cm3, p = 0.004, in the arcuate fasciculus, and 8.41 vs 4.16 cm3, p = 0.018, in the uncinate fasciculus). Finally, these parameters were compared in patients in whom the seizure focus was situated in the dominant hemisphere: FA (0.37 vs 0.30, p = 0.05), number of fibers (114.4 vs 315.6, p = 0.014), and volume (12.58 vs 5.88 cm3, p = 0.035) in the arcuate fasciculus were found to be statistically significantly higher in the dominant hemispheres. Linear discriminant analysis of FA, number of fibers, and volume of the arcuate fasciculus showed a correct discrimination in 80% of patients (p = 0.024)., Conclusions: The analysis of the arcuate fasciculus and other tract bundles by DTI could be a useful tool for language location testing in the preoperative study of patients with refractory epilepsy.

Introduction: University students tend to suffer from problems of sleep regularity, quantity and quality, which can affect their academic performance. These problems are related to changes typical of the phase of the life cycle in which they find themselves due to maturational, psychosocial development (associated with the processes of individuation and socialisation) and academic factors. The study of the relationship between sleep and academic performance in university students is an area of research of growing interest, which has started to be studied over the last two decades., Aim: To conduct a systematic review of the existing literature on the relationship between sleep and academic performance in university students., Subjects and Methods: The articles included in the PubMed database were selected, following the PRISMA guidelines. Studies evaluating samples of subjects with an average age between 18 and 26 years, published in English or Spanish during the period 2000-2019 were included. Subsequently, the quality of the selected articles was evaluated according to the STROBE standard., Results: Thirty studies were identified, which were grouped according to different aspects of sleep: drowsiness, duration, experience of total sleep deprivation, sleep quality, chronotype, regularity and sleep disorders., Conclusion: The results of these studies suggest that inadequate sleep has a negative effect on the academic performance of university students.

Introduction: Cognitive impairments are common in Parkinson's disease (PD) patients without dementia. These deficits are quite heterogeneous, which makes it difficult to recognize and treat them. For this reason, many authors have attempted to classify patients into more homogeneous groups with diverse results. The present study was designed to analyze the cognitive heterogeneity in PD patients using a novel data-driven approach, latent profile analysis (LPA), to classify patients according to cognitive characteristics. This methodology, which has been used in previous studies focused on motor and psychiatric symptomatology, seems to be better than traditional cluster analysis for the establishment and comparison between different subgroups because it does not require prior decision making about some theoretical or methodological aspects., Method: LPA was applied to 71 PD patients evaluated with a broad neuropsychological battery including different memory and executive function tests. The clusters obtained from the analysis were described by making comparisons with a control group of 51 healthy subjects matched in age, sex, and educational level., Results: The LPA resulted in a four-cluster solution, which could be described as: (a) executive dysfunction (32.4%), (b) memory and executive dysfunction (28.2%), (c) memory dysfunction (23.9%), and (d) noncognitive dysfunction (15.5%). These four PD cluster differ in age and Mini-Mental State Examination (MMSE) score. However, there were no differences between clusters in disease duration, clinical impression of severity index, depression, and cognitive reserve., Conclusions: LPA is a very interesting method for the establishment of more homogeneous groups of PD patients based on their neuropsychological characteristics. Moreover, the distinction between different cognitive profiles will allow us to design interventions better adapted to each patient.

Objective: Executive functions (EF) in multiple sclerosis (MS) have been only partially studied, mainly trough the evaluation of subfunctions. The main objective was to analyse the EF alteration profile in a patients with MS sample., Participants and Methods: Case-control study, 100 patients with MS and 30 controls were evaluated by the following tests: Comprehensive Trail Making Test, Stroop Test, Wisconsin Card Sorting Test, picture completion, letter-number sequencing, comprehension and similarities of the WAIS-III scale, phonological and semantic fluency, zoo map test, temporal judgment and behavioural Dysexecutive Questionnaire (DEX-Q) of the Behavioural Assessment of the Dysexecutive Syndrome. Scores below normative values were considered pathological. Factorial analysis was used to simplify the deficits, and multiple regression and ANOVA statistics were used to analyse the relationship between clinical and cognitive variables., Results: Seventy-four patients had a recurrent-relapsing course, the mean degree of disability by Expanded disability Status Scale (EDSS) was 2.7 and the mean time of evolution was 9.94 years. Eighty-five per cent presented alterations in 3 or more EF tests and 71% in 5 or more. In the factorial analysis, three groups of functions were involved: (i) cognitive flexibility (ii) inhibition and (iii) abstraction ability. Patients with a progressive course and a high EDSS had a significantly worse performance (P < 0.05). The patients showed a low awareness of their deficit in the DEX-Q., Conclusions: Cognitive flexibility, inhibition and abstraction ability were the three components of EF most deficient. The patients with the worst performance were those with progressive forms and a high EDSS., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Facial expression recognition impairment has been reported in Parkinson's disease. While some authors have referred to specific emotional disabilities, others view them as secondary to executive deficits frequently described in the disease, such as working memory. The present study aims to analyze the relationship between working memory and facial expression recognition abilities in Parkinson's disease. We observed 50 patients with Parkinson's disease and 49 healthy controls by means of an n-back procedure with four types of stimuli: emotional facial expressions, gender, spatial locations, and non-sense syllables. Other executive and visuospatial neuropsychological tests were also administered. Results showed that Parkinson's disease patients with high levels of disability performed worse than healthy individuals on the emotional facial expression and spatial location tasks. Moreover, spatial location task performance was correlated with executive neuropsychological scores, but emotional facial expression was not. Thus, working memory seems to be altered in Parkinson's disease, particularly in tasks that involve the appreciation of spatial relationships in stimuli. Additionally, non-executive, facial emotional recognition difficulty seems to be present and related to disease progression.

Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system very heterogeneous in its characteristics. In contrast to the well known sensitive/motor deficits, the cognitive dysfunction has only been analyzed in the last few decades. Attention, executive function, and memory were assessed in 28 patients with recurrent-remittent MS (RRMS) (duration, median 7 years; EDSS median 2) by means of a specific neuropsychological battery. Depression (BDI), anxiety (STAI) and fatigue (FSS) were also assessed. Twenty-five of these patients were selected for statistical study because they presented deficits in some cognitive areas. Twenty-four percent of the patients displayed memory deficits and 80% showed attention and executive function deficits related to prefrontal lobe function. No global memory difficulties were found, except for immediate visual memory of complex elements (immediate recall of the Rey figure), although the visual reproduction I subtest of the WMS-R was unaffected. In RRMS patients with a relatively short duration and low level of incapacity, cognitive impairments mainly affected prefrontal functions. The difficulties in immediate visual memory of complex elements could also be explained by a failure in these areas, due to the alteration of the organization and strategic use of the material to be encoded.

Previous studies have shown that in the so-called opaque languages (those in which spelling does not correspond to pronunciation), there are relatively independent routes for lexical and nonlexical processing, that is, for words and nonwords, both in spoken and in written language. On the other hand, in the so-called transparent languages (those in which pronunciation corresponds to written forms), empirical evidence is scarcer. In this study of a neurological patient (parieto-temporal lesion), speaker of a transparent language (Spanish) showing a specific deficit in nonlexical reading processing, linguistic analysis for words was relatively preserved. This finding suggests the use of various routes in the processing of transparent languages.

Aim: To report our experience in the surgical treatment of temporal-lobe epilepsy., Patients and Methods: An analysis was performed of the outcomes of 137 patients submitted to surgery between 1990 and 2001, with a follow-up of more than two years. A study was conducted of the percentages of successful detection by the different complementary tests--MRI, EEG, interictal SPECT, video-EEG with foramen ovale electrodes (FOE), neuropsychological study (NPS)--and the precision with which they reported the epileptogenic focus., Results and Conclusions: Successful surgical outcomes (Engel grades I-II): 73.4%. No surgical mortality occurred, although some mild, reversible morbidity was observed. Surgical outcomes were not affected by sex, age, age of onset and the length of time the patient had had the disease, or the frequency of the seizures. No association was found between seizures in the immediate post-operative period and a poorer long term control of the epilepsy. MR images were normal in 25% of patients; in these cases the surgical outcomes (Engel grades I-II at two years: 62%) were significantly poorer than in cases of tumours/cavernomas (86%); RMI studies of other types of lesions gave intermediate results (72%). With respect to the capacity of the different tests to lateralise/locate the epileptogenic focus, video-EEG-FOE proved to be the best, followed by MRI, SPECT, EEG and NPS.

Introduction: Characteristic symptoms of autistic disorder (AD) can be the result of cognitive impairment which can be produced by specific neurological irregularities. Up until now a specific cognitive deficit in autism has not been found, although the majority of people with autism show intellectual impairment, verbal scores lower than manipulative measures and executive dysfunctions., Aims: A neuropsychological evaluation of children with AD was planned. These children had intellectual abilities in the normal range. They were compared with two other groups, one with pervasive developmental disorder not otherwise specified (PDD-NS), and the other from the general population., Subjects and Methods: A battery of neuropsychological tests was carried out on five boys AD, five boys PDD-NS, and five boys of the general population. All of them were between 9 and 15 years old and their intellectual abilities were within the normal range., Results: The children AD obtained verbal scores lower than their visual-perception scores. They also showed good dynamic coordination of movement. Scores in episodic memory tasks where executive strategies are needed were low., Conclusion: The characteristics described in the paper do not demonstrate a specific profile of the AD, but they can be useful in diagnoses and in planning treatment.

Paroxysmal discharges have been observed in non epileptic children who, at the same time, display learning disorders. In this study our aim is to determine whether the association between sub clinical discharges (SCD) and learning disorders reflects specific neuropsychological deficiencies and, more particularly, whether the possible deficits are defined according to the brain hemisphere in which the paroxysmal activity is located. Neuropsychological evaluation was performed in 17 children between the ages of 8 and 15, with unspecific learning disorders, who presented sub clinical paroxysmal discharges localised in the left hemisphere (nine cases) or in the right hemisphere (eight cases). The children with paroxysmal activity in the left hemisphere obtained similar results to those in which it was found on the right, except in the tests that evaluate visuo constructive skills, in which their scores were higher, and in the executive function tasks, in which they displayed a deficit that was not observed in the children with paroxysmal activity in the right hemisphere. We interpreted the presence of SCD discharges in the left hemisphere as reflecting a slower or more deficient process of brain maturation, which could be compensated with a suitable programme of neuropsychological intervention.

In general terms, epileptic patients with temporal lobe epilepsy (TLE) show mnesic deficits. In the case of medically intractable epilepsy (around 20%) the neurosurgery intervention is a widely accepted treatment. The cognitive effects of surgery have been reported in last years; they emphasize the mnesic positive changes of contralateral area. In the same sense they have reported a negative change on mnesic modality in ipsilateral area. This paper present a study in which the mnesic deficits of twenty eight pharmaco resistant epileptic patients have been evaluated and followed up. These patients have been submittes to a surgical treatment at the Epilepsy Surgical Unit of the Hospital de La Princesa (Madrid). The assessment pre and postoperative tested six months apart. The most common cognitive deficit affect bimodally to mnesic functions: so in the verbal as in the visospatial modality. This deficit correlated with the years epilepsy. Meanwhile, the following up study indicates that a relevant numbers of these patients show an improvement in the function of the contralateral hemisphere with respect to the area surgically treated. This finding probably is the consequence of seizure free.