In Clinical Case 9, Dr. Marc Norman presents a neuropsychological evaluation of a 48-year-old woman with a frontal lobe tumor.
A pdf of the transcript for this episode is available here.
Dr. Marc Norman is a board-certified neuropsychologist through ABPP. He received his doctorate from Brigham Young University, completed his internship at the University of California San Diego (UCSD)-VA Medical Center, and did an NIH funded postdoctoral fellowship with Dr. Dean Delis. Dr. Norman is a faculty member in Psychiatry at UCSD. He provides neuropsychological services to patients with a variety of neurological conditions including epilepsy, multiple sclerosis, traumatic brain injury, stroke, and brain neoplasm. His research is in the impact of medical disorders on cognition, normative issues in neuropsychology, and the influence of demographic factors on neuropsychological test performance. Dr. Normal has served on Advisory Boards for the Epilepsy Foundation of America and the Multiple Sclerosis Society. He has been active in providing mental health services to disaster victims and has served in a leadership capacity with the American Red Cross San Diego/Imperial Counties Chapter Disaster Mental Health Team. Dr. Norman is also the Executive Director of the International Neuropsychological Society (INS).
Hello did the try to switch the antiepileptic medication? Keppra can disinhibit and trigger aggressive behavior very strongly!
Best regards, great Show! Thank you So much!
Thanks so much for the question, and I’m very glad that you enjoyed the episode. Here is the reply from Dr. Norman:
“Thanks for the astute question. While I don’t recall the specifics of the flow in this case from many years ago, I can say that our teams routinely consider aggressive increases with Keppra. For this woman, there were several issues to consider. In general, she was not aggressive, but there was more of a tendency for disinhibition. It is impossible to parse out the contributions of aggression vs. disinhibition in this case, but as I recall, the Keppra was not considered to be a significant factor. I don’t recall if a different medication was used.”
Dr Norman has a very enjoyable style of presenting the case.
What I disliked were some of the comments by the hosts, apparently poking fun at the described patient by repeatedly referring to her uninhibited outburst at the hair salon.
You are very likely able to understand that these outbursts are the consequency of underlying neuropathology, not deliberate acts. Yet you saw it fit to turn the patient and her irritable behaviour into a butt of joke.
I understand that you identify and built your self-image heavily around your profession as neuropsychologists, which often puts you in the role of interacting with other humans in a doctor – patient or doctor – test subject relationship. Nevertheless, you should be able to see that beyond patients or test subjects, we still primarily deal with humans beings. Especially people who seek care and medical help after a severe medical condition should not be exposed to ignorance and disregard of their condition by the medical professionals they seek help from. This only fosters a bad therapeutic relationship in a patient populations already highly susceptible to feelings of mistrust.
Thank you for the feedback. We appreciate the constructive criticism and agree that Dr. Norman did a great job presenting the case. For clarification, we talked about the patient’s behavior at the hair salon precisely because it was very relevant to the underlying neuropathology and because the behavior is important for intervention and safety considerations. We strive to always respect our patients and we do not feel that the content was disrespectful or inappropriate. Again, we appreciate the feedback.
~John and Ryan
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