A Neuropsychology

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A Neuropsychology perspective on care
Dr. Ben Newman Wright B.Sc.(Hons), Cert.HE,
M.Sc., Ph.D. ( M.Res. modules), CPsychol,
MBPsS Email bennewmanwright_at_gmail.com Website
http//www.bennewmanwright.com
Neuro Talk 2011
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A Psychiatry/Psychology perspective on care

• Addiction
• Biological bases
• Community
• Cross-cultural/Global
• Eating disorders
• Forensic
• Geriatric/Paediatric
• Neuro.

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A Psychiatry/Psychology perspective on care

• Disorders
• Organic mental disorders
• Due to psychoactive substances
• Schizotypal and delusional
• Affective/mood
• Neurotic and somatoform
• Physiological and physical
• Due to personality and behaviour
• Mental retardation
• Psychological development
• Childhood behavioural/emotional.

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A Neurology perspective on care
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A Neurology perspective on care
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A Neurology perspective on care
Diagnosis
MRI
EEG
Blood tests
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A Neurology perspective on care
Management
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A Neuropsychology perspective on care
Neuroscience

Psychobiology
Cognition
Personality
Social
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A Neuropsychology perspective on care
Vision Perception
Audition
Language
Cognition
Attention memory
Proprioception kinaesthesia
Executive function
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A Neuropsychology perspective on care

• Wernicke Korsakoff syndrome
• Characteristics
• Confusion
• Abnormal nystagmus
• Ophthalmoplaegia
• Anisocoria
• Ataxia
• Sluggish pupil reflexes
• Anterograde amnesia
• Retrograde amnesia
• Confabulation
• Hallucinations.

Diagnosis
MRI
EEG
Blood tests
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A Neuropsychology perspective on care
Diagnosis
Psychological tests
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A Neuropsychology perspective on care
Vision Perception
Audition
Language
Cognition
Attention memory
Proprioception kinaesthesia
Executive function
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A Neuropsychology perspective on care
Stroke
Neglect
Brain damage
Agnosia prosopagnosia
Alcoholism
Stroke/trauma
Wernicke- Korsakoff syndrome
Brocas aphasia
Cognition
Wernickes aphasia
Parkinsons disease
Executive dysfunction
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A Neuropsychology perspective on care
Management
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A Neuropsychology perspective on care
Perfectly adjusted human being???
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A Neuropsychology perspective on care
Diagnosis
Newman Wright, B. (2008). Visual function
in patients with multiple sclerosis. Ph.D.
thesis, University of Essex
Research
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A Neuropsychology perspective on care
Diagnosis
Chapter 1 Aetiology, Epidemiology, Pathology
Chapter 2 Diagnosis and diagnostic tests
Chapter 3 Optometric investigations
Chapter 4 Colorimetry and NIRS investigation
Chapter 5 Visual Quality of Life
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A Neuropsychology perspective on care
Diagnosis
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A Social Neuroscience perspective on care
Diagnosis
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Thank you
Dr. Ben Newman Wright B.Sc.(Hons), Cert.HE,
M.Sc., Ph.D. ( M.Res. modules), CPsychol,
MBPsS Email bennewmanwright_at_gmail.com Website
http//www.bennewmanwright.com
Neuro Talk 2011
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A Hyperbaric Oxygen perspective on care
Diagnosis
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Childhood Epilepsy
Dr. Ben Newman Wright http//www.bennewmanwright.c
om Neuro Talk 2011
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Introduction

• AD/HD
• Epidemiology, pathology, diagnosis
• Childhood Epilepsy
• Childhood Epilepsy ADHD

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AD/HD
ADHD controversial since first reported in the
1970s
Most common paediatric psychiatric disorder
ADHD affects 3-5 of children under age 19
globally
2-16 of school age children have received a
diagnosis
Symptoms begin before age 7
A diagnosis is 2-4x more common in boys than in
girls
30-50 of diagnosed cases remain symptomatic
into adulthood
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Epidemiology
More frequently diagnosed in North American
children than those in Africa and the Middle East
Rates of diagnosis much higher on the East Coast
of the United States than on the West Coast
In the United Kingdom an estimated 0.5 per
1,000 children received a diagnosis in the 1970s
while 3 per 1,000 received medications in the
late 1990s
In the United States an estimated 12 per 1,000
children received a diagnosis in the 1970s while
34 per 1,000 received a diagnosis in the late
1990s
10 of males and 4 of females receive a
diagnosis of ADHD in the United States
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Pathology I
There is a general reduction of cerebral tissue
volume, typically with proportionally greater
reduction in the dorsolateral prefrontal cortex
MRI of the prefrontal cortex has indicated that
the impulse control lag ranges between ages 3 and
5
There is also delay in the temporal lobe,
alongside prefrontal delay indicating impaired
ability to control and focus thinking
A faster than normal maturation of the motor
cortex indicates that both slower development of
behavioural control and advanced motor
development are important
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Pathology II
Other brain regions have been implicated,
particularly the cerebellum and/or
posterior-inferior cerebellar vermis (the
termination of spinocerebellar pathways
that carry subconscious proprioception)
Some reports implicate atrophy in the corpus
callosum or caudate (impairing learning and
memory)
Abnormalities appear to be static and
non-progressive
Particular disruption of frontal-striatal and
frontal- parietal circuitry is consistent with
prominent impaired executive function in
neuropsychological investigations
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Pathology III
Converging lines of evidence from
neuroimaging, neuropsychology and neurochemistry
implicate four fronto-striatal regions the
lateral prefrontal cortex dorsal anterior
cingulate cortex caudate putamen (which
regulates movements and influences learning)
Involvement of the 7-repeat variant of the
dopamine D4 receptor gene may account for about
30 of the genetic risk
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AD/HD Subtypes

• Predominantly hyperactive-impulsive
• fidgeting and dashing around
• talking non-stop
• blurting out inappropriate comments
• showing emotions without restraint
• touching anything and everything in sight.

• Predominantly inattentive
• moving slowly
• easily distracted
• appearing not to listen
• forgetful
• daydreaming.

Combined hyperactive-impulsive and inattentive
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AD/HD Diagnosis
Symptoms must be observed in two different
settings for at least six months to a greater
degree than in other children of the same age

• ADHD may accompany other disorders
• Anxiety
• Depression
• Antisocial personality disorder
• Obsessive-compulsive disorder
• Sensory integration dysfunction.

Complex post-traumatic stress disorder can result
in inattention problems that mimic ADHD
Primary sleep disorders may play a role in
presentation
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Childhood Epilepsy
Epilepsy is a common disorder characterised by
seizures
About 50 million people worldwide have received
a diagnosis, epilepsy affects 5-10 per 1,000
people
Two of every three new cases are identified in
a developing country
It is more likely to occur in young children,
particularly in boys, and people aged over 65

• Cognitive and behavioural impairments affect
• Attention, memory, mental speed and language
• Executive processing and social functions
• Anxiety, depression, fatigue and psychosis.

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Childhood Epilepsy AD/HD I
ADHD may be a common co-morbid condition
despite being associated with neither demographic
or clinical epilepsy characteristics nor with
potential risk factors during gestation and birth
In 1955 Ounstead described a hyperkinetic
syndrome in children with epilepsy that closely
approximates our current definition of ADHD
Rutters 1970 Isle of Wight study documented
mental health problems in 7 of children in the
general population, 12 of children with
non-neurological physical disorders, 29 in
children with uncomplicated epilepsy and 58 in
complicated epilepsy with structural brain
abnormalities and seizures
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Childhood Epilepsy AD/HD II
Remarkably similar results were obtained
approximately 30 years later in Davies 2003
independent population- based United Kingdom
epidemiological investigation
Temporal lobe epilepsy may most frequently
be complicated by cognitive and behavioural
problems
However patients with benign rolandic,
childhood absence, juvenile myoclonic and frontal
lobe epilepsies may experience cognitive and
behavioural problems
A psychiatric disorder has been found in a
large proportion of children with epilepsy, most
commonly depression and ADHD
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Childhood Epilepsy AD/HD III
However,
The clinical overlap between ADHD and
epilepsy has received relatively little attention
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AD/HD Epilepsy Aetiology I
Carlton-Ford et al. (1955) found impulsivity in
39 of children with a history of epilepsy versus
11 of controls
Barkley (1990) reported that 20-30 of children
with epilepsy also had ADHD
In a population-based study McDermott et al.
(1995) found hyperactive behaviour in 28 of
children with epilepsy, 13 of cardiac patients
and in 5 of controls
Antisocial behaviour was found in 18 of patients
with Epilepsy, 12 of cardiac patients and in 9
of controls
Hauser et al. (1998) reported a prevalence of
37 epilepsy among newly diagnosed ADHD Icelandic
patients
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AD/HD Epilepsy Aetiology II
Dunn (2003) found that, of 33 patients with
complex partial epilepsy and ADHD, 11 had the
combined type and 24 the inattentive type
The prevalence of EEG epileptiform abnormalities
in children with ADHD is higher than in normal
paediatric patients if both hyperventilation and
photic stimulation are used as activation
procedures
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AD/HD Epilepsy Pathology I
MRI indicates that ADHD in childhood epilepsy
is associated with significantly increased grey
matter in distributed regions of the frontal lobe
and significantly smaller brainstem volume
The frequency of rolandic spikes in children with
ADHD is significantly higher than expected from
epidemiology
Holtmann et al. (2003) demonstrated that visual
EEG evaluation showed increased theta activity in
approx. every fourth patient in both ADHD groups
indicating a delay in functional cortical
maturation
The frequency and lateralisation of discharges
were not related to co-morbidity
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AD/HD Epilepsy Pathology II
Which disorder appears first, ADHD or epilepsy?
Austin et al. (2001) found that a history of
attention problems is twice as common in children
seen after their first seizure versus controls
Community-based studies have indicated a
2.5-fold increase in pre-existing ADHD,
predominantly of the inattentive subtype, among
children with new-onset seizures compared to
control children
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Thank you!!!
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References
Austin, J. K., Hareslak, J., Dunn, D. W. et al.
(2001). Behaviour problems in children before
first recognised seizure. Paediatrics, 107,
115-122 Barkley, R. A. (1990). Attention deficit
hyperactivity disorder A handbook for diagnosis
and treatment. New York Guilford Carlton-Ford,
S., Miller, R., Brown, M. et al. (1955). Epilepsy
and childrens social and psychological
adjustment. Journal of Health and Social
Behaviour, 36, 285-301 Dunn, D. W. (2003).
Neuropsychiatric aspects of epilepsy in
children. Epilepsy and Behaviour, 4,
101-106 Hauser, W. A., Ludvigsson, P.,
Hesdorffer, D. C. et al. (1998).
Attention deficit disorder and hyperactivity are
risk factors for epilepsy in children. Epilepsia,
39, 222 Holtmann, M., Becker, K.,
Kentner-Figura, B. et al. (2003).
Increased frequency of rolandic spikes in ADHD
children. Epilepsia, 44, 1241-1244 McDermott,
S., Mani, S. Krishnaswami, S. (1995). A
population-based analysis of specific behaviour
problems associated with childhood
seizures. Journal of Epilepsy, 8, 110-118