If seizures left speechless: CA-P-S C-A-R-E, a proposal of a new ictal language evaluation protocol
- PDF / 679,265 Bytes
- 7 Pages / 595.276 x 790.866 pts Page_size
- 18 Downloads / 166 Views
ORIGINAL ARTICLE
If seizures left speechless: CA-P-S C-A-R-E, a proposal of a new ictal language evaluation protocol Lorenzo Ferri 1 & Luca Vignatelli 2 & Lara Alvisi 1,2 & Martina Fabbri 3 & Silvia Boscarato 4 & Corrado Zenesini 2 & Laura Licchetta 1,2 & Lorenzo Muccioli 1 & Paolo Tinuper 1,2 & Francesca Bisulli 1,2 Received: 6 August 2020 / Accepted: 29 October 2020 # The Author(s) 2020
Abstract Introduction We aimed to create standardized protocol for language examination in patients who underwent video-EEG recording and assessed its efficacy in the characterization of ictal language impairment, its ability to differentiate this from impaired awareness, and interobserver reliability in clinical practice. Methods From our database of video-EEG recordings, we selected a representative sample of 63 focal seizures with presumed language impairment. A multidisciplinary team of epileptologists, EEG technicians, and speech therapists analyzed the selected videos to highlight the critical issues of ordinary ictal language evaluation. We subsequently followed a multi-step process to develop the protocol and assess its interobserver reliability. Results A protocol based on seven tests in hierarchical succession was created, summed up in the acronym CA-P-S C-A-R-E (Closed Answers, Pro-speak question, Simple orders, Common object denomination, Audio repetition, Reading, Evoke). Following its preliminary administration for 5 months, we assessed the inter-observer reliability of 16 healthcare professionals in distinguishing between language impairment and impaired awareness among a sample of 10 seizures, finding a substantial agreement (kappa 0.61). Conclusion The proposed protocol, made of simple and easy to memorize tests, is an effective tool that evaluates multiple domains beyond language. Its use could help to recognize ictal aphasia effectively and differentiate it from impaired awareness, minimizing inter-examiner variability. Keywords Epilepsy . Ictal aphasia . Ictal testing . Standardized language protocol
Introduction Aphasia is a disturbance produced by the alteration of cortical areas involved in language skill elaboration, usually secondary to vascular, tumoral, or inflammatory lesions that disrupt a Supplementary Information The online version contains supplementary material available at https://doi.org/10.1007/s10072-02004872-x. * Francesca Bisulli [email protected] 1
Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy
2
IRCCS Istituto delle Scienze Neurologiche Bologna, Bologna, Italy
3
Alma Mater Studiorum, University of Bologna, Bologna, Italy
4
Sant’Orsola-Malpighi Hospital, Bologna, Italy
cortical network encompassing dominant fronto-temporalparietal regions and non-dominant temporal-parietal areas [1, 2]. An epileptic discharge involving primary language areas may induce transient and reversible aphasia, which may show similar aphasic manifestations as other aetiologies [3, 4]. The characterization of language deficits during ictal testing
Data Loading...
