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Smith ML, Risse G, Sziklas V, Banks S, Small D, Frasnelli J, Klein D. Neurophysiology, Neuropsychology, Epilepsy, 2022: Hills We Have Climbed and the Hills Ahead. Cognition and Sensory Systems in Healthy and Diseased Subjects. Epilepsy Behav 2023; 140:109119. [PMID: 36804713 DOI: 10.1016/j.yebeh.2023.109119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/22/2023] [Accepted: 01/29/2023] [Indexed: 02/18/2023]
Abstract
This article summarizes selected presentations from a session titled "Cognition and Sensory Systems in Healthy and Diseased Subjects", held to highlight and honor the work of Dr. Marilyn Jones-Gotman. The session was part of a two-day symposium, "Neurophysiology, Neuropsychology, Epilepsy, 2022: Hills We Have Climbed and the Hills Ahead". The session presented research on epilepsy and sensory systems by colleagues and former trainees of Dr. Jones-Gotman. The extended summaries provide an overview of historical and current work in the neuropsychology of epilepsy, neuropsychological and neuroimaging approaches to understanding brain organization, sex differences in brain mechanisms underlying neurological disorders, dietary influences on brain function and cognition, and expertise in olfactory training and language experiences and their implications for brain organization and structure.
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Affiliation(s)
- Mary Lou Smith
- Department of Psychology, University of Toronto Mississauga; Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, ON, Canada.
| | - Gail Risse
- Minnesota Epilepsy Group, Roseville, MN, USA; Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - Viviane Sziklas
- Department of Neurology and Neurosurgery; Department of Psychology, McGill University, Montreal, QC, Canada
| | - Sarah Banks
- Departments of Neuroscience and Psychiatry, University of California, San Diego, CA, USA
| | - Dana Small
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Johannes Frasnelli
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Denise Klein
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
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Anyanwu C, Motamedi GK. Diagnosis and Surgical Treatment of Drug-Resistant Epilepsy. Brain Sci 2018; 8:E49. [PMID: 29561756 PMCID: PMC5924385 DOI: 10.3390/brainsci8040049] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 03/12/2018] [Accepted: 03/16/2018] [Indexed: 11/29/2022] Open
Abstract
Despite appropriate trials of at least two antiepileptic drugs, about a third of patients with epilepsy remain drug resistant (intractable; refractory). Epilepsy surgery offers a potential cure or significant improvement to those with focal onset drug-resistant seizures. Unfortunately, epilepsy surgery is still underutilized which might be in part because of the complexity of presurgical evaluation. This process includes classifying the seizure type, lateralizing and localizing the seizure onset focus (epileptogenic zone), confirming the safety of the prospective brain surgery in terms of potential neurocognitive deficits (language and memory functions), before devising a surgical plan. Each one of the above steps requires special tests. In this paper, we have reviewed the process of presurgical evaluation in patients with drug-resistant focal onset epilepsy.
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Affiliation(s)
- Chinekwu Anyanwu
- Department of Neurology, Virginia Tech Carilion School of Medicine, Roanoke, VA 24016, USA.
| | - Gholam K Motamedi
- Department of Neurology, Georgetown University Medical Center, Washington, DC 20007, USA.
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Imaging memory and predicting postoperative memory decline in temporal lobe epilepsy: Insights from functional imaging. Rev Neurol (Paris) 2015; 171:307-14. [PMID: 25726354 DOI: 10.1016/j.neurol.2014.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 12/23/2014] [Accepted: 12/29/2014] [Indexed: 11/24/2022]
Abstract
After medial temporal lobe epilepsy (MTLE) surgery, there is considerable individual variation in the extent, nature and direction of postoperative memory change. Before surgery, epileptic patients who are surgery candidates need precise information about the potential cognitive after effects, and particularly in temporal lobe epilepsy, postoperative memory changes. Clinical and neuropsychological data may bring useful information to predict the postoperative memory outcome, but, these data are not always sufficient to replace the Wada test, considered for a long time, as the gold standard to predict postoperative decline following surgery. In any case, numerous studies demonstrate that the Wada procedure can be nowadays reliably replaced by functional MRI (fMRI) activation studies. A vast majority of fMRI studies suggest that it is the functional adequacy of the resected hippocampus rather than the functional reserve of the contralateral hippocampus that determines the extent of postoperative memory decline. In addition, new functional neuroimaging procedures that explore more widespread network disruptions commonly found in MTLE such as diffusion-tensor imaging (DTI) or connectivity studies could in the future constitute a reliable approach combined with fMRI activation studies to significantly improve the prediction of postsurgical memory decline.
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Alessio A, Pereira FRS, Sercheli MS, Rondina JM, Ozelo HB, Bilevicius E, Pedro T, Covolan RJM, Damasceno BP, Cendes F. Brain plasticity for verbal and visual memories in patients with mesial temporal lobe epilepsy and hippocampal sclerosis: an fMRI study. Hum Brain Mapp 2011; 34:186-99. [PMID: 22038783 DOI: 10.1002/hbm.21432] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 06/13/2011] [Accepted: 07/08/2011] [Indexed: 11/08/2022] Open
Abstract
We aimed to identify the brain areas involved in verbal and visual memory processing in normal controls and patients with unilateral mesial temporal lobe epilepsy (MTLE) associated with unilateral hippocampal sclerosis (HS) by means of functional magnetic resonance imaging (fMRI). The sample comprised nine normal controls, eight patients with right MTLE, and nine patients with left MTLE. All subjects underwent fMRI with verbal and visual memory paradigms, consisting of encoding and immediate recall of 17 abstract words and 17 abstract drawings. A complex network including parietal, temporal, and frontal cortices seems to be involved in verbal memory encoding and retrieval in normal controls. Although similar areas of activation were identified in both patient groups, the extension of such activations was larger in the left-HS group. Patients with left HS also tended to exhibit more bilateral or right lateralized encoding related activations. This finding suggests a functional reorganization of verbal memory processing areas in these patients due to the failure of left MTL system. As regards visual memory encoding and retrieval, our findings support the hypothesis of a more diffuse and bilateral representation of this cognitive function in the brain. Compared to normal controls, encoding in the left-HS group recruited more widespread cortical areas, which were even more widespread in the right-HS group probably to compensate for their right mesial temporal dysfunction. In contrast, the right-HS group exhibited fewer activated areas during immediate recall than the other two groups, probably related to their greater difficulty in dealing with visual memory content.
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Affiliation(s)
- Andréa Alessio
- Neuroimaging Laboratory, School of Medical Sciences, University of Campinas, Unicamp, Campinas, Brazil
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Dupont S, Duron E, Samson S, Denos M, Volle E, Delmaire C, Navarro V, Chiras J, Lehéricy S, Samson Y, Baulac M. Functional MR Imaging or Wada Test: Which Is the Better Predictor of Individual Postoperative Memory Outcome? Radiology 2010; 255:128-34. [PMID: 20308450 DOI: 10.1148/radiol.09091079] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sophie Dupont
- Epilepsy Unit, Neurology Clinic Paul Castaigne, Hôpital de la Pitié-Salpêtrière, APHP, 47 boulevard de l'Hôpital, 75651 Paris cedex 13, France.
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Dupont S. L’IRM fonctionnelle peut-elle remplacer le test de Wada ? Neurochirurgie 2008; 54:208-11. [DOI: 10.1016/j.neuchi.2008.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Accepted: 02/13/2008] [Indexed: 10/22/2022]
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Sanyal SK, Chandra PS, Gupta S, Tripathi M, Singh VP, Jain S, Padma MV, Mehta VS. Memory and intelligence outcome following surgery for intractable temporal lobe epilepsy: relationship to seizure outcome and evaluation using a customized neuropsychological battery. Epilepsy Behav 2005; 6:147-55. [PMID: 15710297 DOI: 10.1016/j.yebeh.2004.11.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2004] [Revised: 11/21/2004] [Accepted: 11/25/2004] [Indexed: 11/22/2022]
Abstract
The main objectives of this prospective study were to (1) assess memory and intelligence outcome following surgery for intractable temporal lobe epilepsy, (2) correlate this with seizure outcome and side of surgery, and (3) perform (1) and (2) using an indigenously developed battery customized to the Indian population. Prior to use in our epilepsy surgery program, the test-retest and interexaminer variance reliability of this battery had been established in both normal and cognitively compromised populations. The memory scores were overall rather than material-specific. The battery was administered to right-handed adults undergoing surgery for intractable temporal lobe epilepsy without any evidence of opposite temporal lobe abnormality, both presurgery and postsurgery at a mean follow-up of 8 months. Twenty-five consecutive patients were included; 13 underwent right and 12 underwent left temporal surgery. Seizure outcome was assessed using Engel's classification. Among 13 patients who underwent right temporal surgery, although 4 patients with poor seizure outcome had insignificant changes in scores, 7 of 9 patients with good seizure outcome exhibited considerable (> 20% over preoperative) improvement in their memory and intelligence scores. Statistical analysis using Student's t test and the Mann-Whitney test revealed that the patients who underwent right temporal surgery with good seizure outcome had significant improvement in both memory (P = 0.007) and intelligence (P = 0.043) scores compared with those with poor seizure outcome. In contrast, patients who underwent left temporal surgery had no significant change in cognitive scores irrespective of seizure outcome. Cognitive improvement seems to occur in patients with good seizure outcome following nondominant temporal lobe surgery for intractable epilepsy with no evidence of pathology in the opposite temporal lobe. The same finding was not observed in patients undergoing left temporal surgery.
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Affiliation(s)
- Sujoy K Sanyal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi 110 029, India
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Vingerhoets G, Deblaere K, Backes WH, Achten E, Boon P, Boon PJ, Hofman P, Vermeulen J, Vonck K, Wilmink J, Aldenkamp AP. Lessons for neuropsychology from functional MRI in patients with epilepsy. Epilepsy Behav 2004; 5 Suppl 1:S81-9. [PMID: 14725851 DOI: 10.1016/j.yebeh.2003.11.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This contribution aims to review the major findings of pre- and postsurgical functional magnetic resonance imaging (fMRI) in patients with refractory epilepsy from a neuropsychological perspective. We compared the contribution of fMRI with the intracarotid amytal procedure (IAP) with respect to functional mapping of language and memory in patients with therapy-resistant epilepsy. We conclude that using comprehensive language paradigms, fMRI has been able (1) to provide estimates of the degree of language lateralization including the degree of involvement of the nondominant hemisphere, (2) to provide information on the location of its activated network during expressive and receptive language, and (3) to help delineate eloquent language regions in the vicinity of the surgical target, thus preventing postoperative complications. The contribution of the frequently observed nondominant hemisphere activation to language should be explored and its clinical relevance determined. Evidence from fMRI studies is accumulating that reorganization of cognitive and motor function favors the activation of contralateral homotopic areas, although this process is far from understood. The exact functional contribution of atypical areas of activation should be investigated critically. In the presurgical evaluation process, detailed and reliable localization of language and memory functions of the individual patient is mandatory and should be the ultimate goal in the development of comprehensive clinical fMRI protocols.
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Affiliation(s)
- Guy Vingerhoets
- Laboratory for Neuropsychology, Ghent University, De Pintelaan 185, B-9000 Ghent, Belgium.
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Kubu CS, Girvin JP, McLachlan RS, Pavol M, Harnadek MC. Does the intracarotid amobarbital procedure predict global amnesia after temporal lobectomy? Epilepsia 2000; 41:1321-9. [PMID: 11051129 DOI: 10.1111/j.1528-1157.2000.tb04612.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE The intracarotid amobarbital procedure (IAP) is widely used to help predict who might be at risk for postoperative amnesia after unilateral temporal lobectomy for intractable seizures. We describe the memory outcome in 10 patients who underwent standard temporal lobectomy, including mesial temporal structures, despite failing the memory portion of the IAP after injections both ipsilateral and contralateral to the resected seizure focus. METHODS Data for seven of the study subjects were obtained through a retrospective review of patients assessed on a surgical epilepsy unit during a 15-year period who failed the Montreal Neurological Institute IAP memory protocol after both ipsilateral and contralateral injections and subsequently underwent unilateral temporal lobectomy. More recently, we have studied temporal lobectomy patients who failed the Medical College of Georgia memory protocol after both ipsilateral and contralateral injections (n = 3). Preoperative and postoperative memory test scores were compared, and data regarding seizure outcome and self-perception of postoperative memory were collected. RESULTS At follow-up, none of the patients presented with a pattern indicative of a global amnesia, and 80% demonstrated >90% improvement in their seizure disorder or were seizure-free. CONCLUSIONS These findings indicate that bilateral memory failure on the IAP does not preclude the removal of an epileptogenic temporal lobe or a successful surgical outcome. In addition, the findings raise questions regarding the validity of the IAP and the possibility that memory may be reorganized in patients with a long history of temporal lobe epilepsy.
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Affiliation(s)
- C S Kubu
- Psychological Services, London Health Sciences Centre, Ontario, Canada.
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Alpherts WC, Vermeulen J, van Veelen CW. The wada test: prediction of focus lateralization by asymmetric and symmetric recall. Epilepsy Res 2000; 39:239-49. [PMID: 10771250 DOI: 10.1016/s0920-1211(00)00097-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE The intracarotid amytal test is commonly used as a predictor of memory dysfunctioning after anterior temporal lobe resection (ATL) for intractable epilepsy. Asymmetry in memory scores can provide focus lateralizing information. In this study the predictive value of a set of Wada test parameters was analyzed, including patients with symmetrical memory scores. METHODS The Wada test was carried out in 226 patients undergoing ATL (94 L, 132 R). Data were collected on item recognition (five items), story recall, amytal dose, presentation time, EEG and arterial filling of amytal. A logistic regression analysis was performed on these data in order to find a set of variables which could best predict the side of seizure onset. RESULTS The analysis yielded four variables, i.e. both memory scores, story recall after right-sided injection and presentation time of stimuli after left-sided injection which could correctly predict seizure lateralization in 85% of the cases. Misclassification was lower for right foci than for left foci. Seizure outcome was four times more favourable in the correctly classified patients. CONCLUSIONS The results suggest that prediction of focus lateralization in temporal lobe epilepsy can be fairly exact even if left/right memory scores are equal. Performing the Wada test with only five memory items keeps the time window of active amytal short enough and gives accurate information about contralateral temporal lobe functioning. The classification scheme can be useful in predicting a lowered chance of seizure freedom.
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Affiliation(s)
- W C Alpherts
- Department of Neuropsychology, Epilepsy Centre 'Meer and Bosch', Stichting Epilepsie Instellingen Nederland, Achterweg 5, 2103 SW, Heemstede, The Netherlands.
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Jones-Gotman M, Harnadek MC, Kubu CS. Neuropsychological assessment for temporal lobe epilepsy surgery. Can J Neurol Sci 2000; 27 Suppl 1:S39-43; discussion S50-2. [PMID: 10830326 DOI: 10.1017/s0317167100000639] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Neuropsychological assessment consists of a comprehensive evaluation of cognitive functioning and most often some evaluation of motor skills and sensory status also. Cognitive functions sampled typically include "intelligence" (IQ tests), attention, language skills, visuospatial abilities, "executive skills" and other abilities associated with frontal-lobe function, and learning and memory. Thus, the assessment samples vary widely among a variety of functions, providing a comprehensive picture of an individual's strengths and weaknesses. The resulting pattern points to the probable site of epileptic focus. Neuropsychological findings also serve to predict the risk for postsurgical cognitive decline and, when performance before and after operation is compared, they provide data on the impact of surgery upon cognitive functioning. Comprehensive evaluation of learning and memory is particularly important in this context, because of the frequency of temporal lobe epilepsy and the prominence of memory dysfunction associated with it. In addition, patients slated for elective surgery may also undergo an intracarotid amobarbital procedure (IAP), which is performed to determine the side of cerebral dominance for language and to test the memory capabilities of each hemisphere alone. All of these specialized neuropsychological tools are discussed in this paper.
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Affiliation(s)
- M Jones-Gotman
- Department of Neuropsychology, Montreal Neurological Institute, Quebec, Canada
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McGlone J, Black SE, Evans J, Parkin A, Sadler M, Sita A, Squires E, Stuss D, Wilson BA. Criterion-based validity of an intracarotid amobarbital recognition-memory protocol. Epilepsia 1999; 40:430-8. [PMID: 10219268 DOI: 10.1111/j.1528-1157.1999.tb00737.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE We tested whether the behavioral components of an Intracarotid Amobarbital Protocol (IAP) had criterion validity. It was hypothesized that a recognition-memory test designed for intracarotid injections and used to predict the risk of global amnesia before an elective temporal lobectomy should also identify persons who are severely amnesic due to other neurologic causes. Divergent validity predicts that speech tasks would be unaffected by amnesia. Test-retest reliability also was measured. METHODS Fifteen persons with severe amnesia were administered four alternate forms of a yes/no recognition-memory protocol and a speech protocol. No drug injection occurred. Standardized neuropsychological tests were used to divide the amnesic group into those with Global Amnesia (i.e., retain no ongoing memories), Severe Amnesia (i.e., memory impaired), and Amnesia Plus (severe amnesia plus other neuropsychologic deficits). RESULTS Two persons with Global Amnesia obtained scores at or below chance (i.e., failed) on the memory protocol. Unexpectedly, 12 of 13 severely amnesic persons obtained near-perfect memory scores. Amnesia had no impact on the speech protocol. Pass/Fail outcomes were highly correlated across all four sets. CONCLUSIONS A four-item IAP memory protocol showed good reliability and criterion validity in identifying the rare condition of Global Amnesia, but it was insensitive to other disabling, severe amnesic disorders. This IAP memory protocol might have validity in predicting a postsurgical Global Amnesic disorder, but it did not identify and therefore could not predict other more common severe amnesic disorders.
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Affiliation(s)
- J McGlone
- Department of Psychology, Dalhousie University, Halifax, Nova Scotia, Canada
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