Join Dr. Bermeo in a conversation with Dr. Jarrod E. Dalton, Dr. Bruce Hermann, and Dr. Samuel Terman, as they discuss the article, "Hiding in Plain Sight—Neighborhood Versus Individual Determinants of Psychological Outcomes in Patients With Epilepsy ".

Click here to read the article.

This podcast was sponsored by the American Epilepsy Society through a grant from the Centers for Disease Control (CDC).

These activities are supported by the Centers for Disease Control (CDC) and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $1,500,000 with 100% funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor are they an endorsement, by CDC/HHS, or the U.S. Government.

We'd also like to acknowledge contributing editor Dr. Rohit Marawar, and the team at Sage.

Summary

The podcast features a discussion on how environmental conditions, specifically neighborhood deprivation, affect cognitive outcomes and mood in individuals with pharmacoresistant temporal lobe epilepsy. Dr. Hermann & Dr. Dalton's study found that patients living in more deprived areas exhibited significantly lower cognitive performance and increased levels of anxiety and depression compared to those in less deprived areas. Dr. Terman's commentary critically assesses these findings, stressing the importance of considering environmental factors alongside biological ones in understanding and treating epilepsy.

Key Takeaways

Impact of Neighborhood Deprivation: The study highlighted a strong correlation between increased neighborhood deprivation and poorer cognitive outcomes as well as higher levels of anxiety and depression among epilepsy patients. This suggests that external environmental factors play a crucial role in the health outcomes of individuals with temporal lobe epilepsy.
Role of Area Deprivation Index (ADI): The ADI is utilized to quantify neighborhood deprivation, encompassing factors like income, education, and housing conditions. It provided a robust framework for analyzing the socioeconomic conditions impacting patient outcomes, underlining the relevance of broader social determinants in health disparities.
Implications for Clinical Practice: These findings underscore the need for clinicians to consider the socioeconomic environment of patients when diagnosing and treating epilepsy. Addressing environmental factors could enhance therapeutic outcomes and improve quality of life for patients.
Study Limitations and Future Research: Dr. Terman noted limitations such as the cross-sectional nature of the study, which complicates the ability to infer causation. He advocates for longitudinal studies to better understand how and when neighborhood factors impact patient health, potentially leading to more targeted interventions.
Potential for Broader Implications: The discussion extends beyond epilepsy, suggesting that similar environmental influences could be significant across other neurological and psychiatric conditions. Future research might explore how modifications in social policy and urban planning could mitigate these health disparities.

[00:00:00] Adriana Bermeo (Host): It is well known that individuals living with epilepsy are at risk of experiencing cognitive decline and psychiatric comorbidities. But did you know that the individual's home address plays a significant role in the cognitive and psychiatric outcomes of people living with temporal lobe epilepsy?

[00:00:18] Welcome to episode number six of Epilepsy Currents podcast. Today, we will be talking about the role of environmental factors on cognition and mood of patients with temporal lobe epilepsy. I am your host, Adriana Bermeo. I am the Senior Podcast Editor for Epilepsy Currents, the official journal of the American Epilepsy Society.

[00:00:40] I want to first welcome contributing editor, Dr. Samuel Terman, who wrote the commentary, Hiding in Plain Sight--Neighborhood vs. Individual Determinants of Psychological Outcomes in Patients with Epilepsy. This commentary was published on the March 2024 issue of Epilepsy Currents. [00:01:00] Dr. Terman is an Assistant Professor at the University of Michigan. Dr. Terman, welcome to Epilepsy Currents Podcast.

[00:01:07] Samuel W. Terman, MD, MS: Thanks so much. Happy to be here.

[00:01:09] Host: It is also my pleasure to welcome Dr. Bruce Hermann, who is the Senior Author of the work that inspired this commentary, titled Association of Neighborhood Deprivation with Cognitive and Mood Outcomes in Adults with Pharmacoresistant Temporal Lobe Epilepsy. Their paper was published in Neurology in June 2023. Dr. Hermann is Emeritus professor of Neuropsychology at the University of Wisconsin School of Medicine and Public Health. Welcome, Dr. Hermann. Thank you for being with us.

[00:01:39] Bruce Hermann: Thank you, and good afternoon.

[00:01:41] Host: We are also joined by Dr. Jarrod Dalton, who is co-author on the original paper. Dr. Dalton is an Associate Professor and the Director of the Center for Population Health Research at the Cleveland Clinic's Lerner Research Institute. Dr. Dalton, thank you for being with us today.

[00:01:58] Jerrod Dalton, PhD: And thank you.

[00:01:59] Host: While [00:02:00] neurologists and epileptologists are familiar with the effects of the biological characteristics of the lesions causing epilepsy, the neurophysiological findings of the treatments we use in the clinic, we are much less likely to consider their patient's immediate living environment, their access to healthy foods, exposure to violence, or their access to transportation as potential modifiable variables directly affecting someone's epilepsy outcomes.

[00:02:28] Dr. Hermann. Would you mind sharing with us a snapshot of the findings from your study in a way our listeners can grasp?

[00:02:35] Bruce Hermann: Dr. Busch and I have been collaborators for quite some time, and she was able to compile an amazing cohort of 800 patients with pharmacoresistant temporal lobe epilepsy who underwent neuropsychological assessment as part of their inpatient evaluations at the Cleveland Clinic. And then, she and Dr. Dalton extracted home addresses from the EMR and binned the patients into ADI quintiles. [00:03:00] And from the neuropsychological battery that was quite extensive, as is commonly the case in preoperative evaluations, the data was reduced to seven mean cognitive domains, things such as intelligence, language, visual perception, verbal and visual memory, executive function, processing speed. And then, secondarily classified all the patients into four cognitive phenotypes that range from intact, essentially unaffected, to generalized cognitive impairment.

[00:03:32] So, the core finding and most important finding was that examination of the relationship of the Area Deprivation index was closely aligned with the cognitive scores. So as deprivation increased, cognitive scores went down. This was seen across seven of the six cognitive domain scores, and greater deprivation was associated with the more abnormal cognitive phenotype. And increasing neighborhood deprivation was also associated with [00:04:00] greater anxiety and depression. So, it really was quite a signal that we were able to observe. And as Dr. Terman pointed out in his commentary, you can just take a look at IQ. Quintile 1, the least deprived group, had a mean IQ score of 100, which is dead average. And the most deprived quintile, Quintile 5, their mean IQ was 86, which is a full standard deviation below average. So, very reliable and fairly strong signal throughout these results.

[00:04:28] Host: Yeah. Really striking findings, which seem to point out that the deprivation that patients are exposed is almost as important as the biology of the condition. And I'm sure we will discuss that in length later. Dr. Dalton, the concept of the Area Deprivation Index, or ADI, plays a central role in the study. Can you please help us understand what does this measure? How do these quintiles work? And how is this measurement different from other measurements of socioeconomic status?

[00:04:59] Jerrod Dalton, PhD: [00:05:00] Sure. Yeah, the Area Deprivation Index is a tool that we use in our research in a lot of settings. We work with clinical specialties across Cleveland Clinic and use this as one tool for understanding place-based health disparities. Essentially, the Area Deprivation Index, it's a latent variable model or a factor model that produces an index that captures correlation among 17 neighborhood-level characteristics. The ADI was established at the National Cancer Institute in 2003 by a demographer and sociologist named Gopal Singh. It was designed as scale of neighborhood socioeconomic position as opposed to socioeconomic status, which I can...