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Hageboutros K, Hewitt KC, Lee GP, Bansal A, Block C, Pedersen NP, Willie JT, Loring DW, Schoenberg MR, Smith KA, Giller CA, Gross RE, Drane DL. Comparison of minimally invasive to standard temporal lobectomy approaches to epilepsy surgery: Seizure relief and visual confrontation naming outcomes. Epilepsy Behav 2024; 155:109669. [PMID: 38663142 DOI: 10.1016/j.yebeh.2024.109669] [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: 09/27/2023] [Revised: 01/05/2024] [Accepted: 01/23/2024] [Indexed: 05/28/2024]
Abstract
The purpose of this study was to systematically examine three different surgical approaches in treating left medial temporal lobe epilepsy (mTLE) (viz., subtemporal selective amygdalohippocampectomy [subSAH], stereotactic laser amygdalohippocampotomy [SLAH], and anterior temporal lobectomy [ATL]), to determine which procedures are most favorable in terms of visual confrontation naming and seizure relief outcome. This was a retrospective study of 33 adults with intractable mTLE who underwent left temporal lobe surgery at three different epilepsy surgery centers who also underwent pre-, and at least 6-month post-surgical neuropsychological testing. Measures included the Boston Naming Test (BNT) and the Engel Epilepsy Surgery Outcome Scale. Fisher's exact tests revealed a statistically significant decline in naming in ATLs compared to SLAHs, but no other significant group differences. 82% of ATL and 36% of subSAH patients showed a significant naming decline whereas no SLAH patient (0%) had a significant naming decline. Significant postoperative naming improvement was seen in 36% of SLAH patients in contrast to 9% improvement in subSAH patients and 0% improvement in ATLs. Finally, there were no statistically significant differences between surgical approaches with regard to seizure freedom outcome, although there was a trend towards better seizure relief outcome among the ATL patients. Results support a possible benefit of SLAH in preserving visual confrontation naming after left TLE surgery. While result interpretation is limited by the small sample size, findings suggest outcome is likely to differ by surgical approach, and that further research on cognitive and seizure freedom outcomes is needed to inform patients and providers of potential risks and benefits with each.
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Affiliation(s)
- Karine Hageboutros
- Neuropsychology Department, Barrow Neurological Institute, Phoenix, AZ 85013, USA
| | - Kelsey C Hewitt
- Department of Neurology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Gregory P Lee
- Neuropsychology Department, Barrow Neurological Institute, Phoenix, AZ 85013, USA; Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Aastha Bansal
- Emory College of Arts and Sciences, Atlanta, GA 30322, USA
| | - Cady Block
- Department of Neurology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Nigel P Pedersen
- Department of Neurology, University of California Davis, Sacramento, CA 95816, USA
| | - Jon T Willie
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - David W Loring
- Department of Neurology, Emory University School of Medicine, Atlanta, GA 30322, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Mike R Schoenberg
- Department of Neurosurgery, University of South Florida, Tampa, FL 33606, USA
| | - Kris A Smith
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ 85013, USA
| | - Cole A Giller
- Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Robert E Gross
- Department of Neurological Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Daniel L Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, GA 30322, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA; Department of Neurology, University of Washington School of Medicine, Seattle, WA 98195, USA.
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Sabadell V, Trébuchon A, Alario FX. An exploration of anomia rehabilitation in drug-resistant temporal lobe epilepsy. Epilepsy Behav Rep 2024; 27:100681. [PMID: 38881885 PMCID: PMC11178986 DOI: 10.1016/j.ebr.2024.100681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/15/2024] [Accepted: 05/27/2024] [Indexed: 06/18/2024] Open
Abstract
Around 40% of patients who undergo a left temporal lobe epilepsy (LTLE) surgery suffer from anomia (word-finding difficulties), a condition that negatively impacts quality of life. Despite these observations, language rehabilitation is still understudied in LTLE. We assessed the effect of a four-week rehabilitation on four drug-resistant LTLE patients after their surgery. The anomia rehabilitation was based on cognitive descriptions of word finding deficits in LTLE. Its primary ingredients were psycholinguistic tasks and a psychoeducation approach to help patients cope with daily communication issues. We repeatedly assessed naming skills for trained and untrained words, before and during the therapy using an A-B design with follow-up and replication. Subjective anomia complaint and standardized language assessments were also collected. We demonstrated the effectiveness of the rehabilitation program for trained words despite the persistence of seizures. Furthermore, encouraging results were observed for untrained items. Variable changes in anomia complaint were observed. One patient who conducted the protocol as self-rehabilitation responded similarly to the others, despite the different manner of intervention. These results open promising avenues for helping epileptic patients suffering from anomia. For example, this post-operative program could easily be adapted to be conducted preoperatively.
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Affiliation(s)
| | - Agnès Trébuchon
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
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Kocsis Z, Jenison RL, Taylor PN, Calmus RM, McMurray B, Rhone AE, Sarrett ME, Deifelt Streese C, Kikuchi Y, Gander PE, Berger JI, Kovach CK, Choi I, Greenlee JD, Kawasaki H, Cope TE, Griffiths TD, Howard MA, Petkov CI. Immediate neural impact and incomplete compensation after semantic hub disconnection. Nat Commun 2023; 14:6264. [PMID: 37805497 PMCID: PMC10560235 DOI: 10.1038/s41467-023-42088-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 09/28/2023] [Indexed: 10/09/2023] Open
Abstract
The human brain extracts meaning using an extensive neural system for semantic knowledge. Whether broadly distributed systems depend on or can compensate after losing a highly interconnected hub is controversial. We report intracranial recordings from two patients during a speech prediction task, obtained minutes before and after neurosurgical treatment requiring disconnection of the left anterior temporal lobe (ATL), a candidate semantic knowledge hub. Informed by modern diaschisis and predictive coding frameworks, we tested hypotheses ranging from solely neural network disruption to complete compensation by the indirectly affected language-related and speech-processing sites. Immediately after ATL disconnection, we observed neurophysiological alterations in the recorded frontal and auditory sites, providing direct evidence for the importance of the ATL as a semantic hub. We also obtained evidence for rapid, albeit incomplete, attempts at neural network compensation, with neural impact largely in the forms stipulated by the predictive coding framework, in specificity, and the modern diaschisis framework, more generally. The overall results validate these frameworks and reveal an immediate impact and capability of the human brain to adjust after losing a brain hub.
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Affiliation(s)
- Zsuzsanna Kocsis
- Department of Neurosurgery, University of Iowa, Iowa City, IA, USA.
- Biosciences Institute, Newcastle University Medical School, Newcastle upon Tyne, UK.
- Neuroscience Institute, Carnegie Mellon University, Pittsburgh, PA, USA.
| | - Rick L Jenison
- Departments of Neuroscience and Psychology, University of Wisconsin, Madison, WI, USA
| | - Peter N Taylor
- CNNP Lab, Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle upon Tyne, UK
- UCL Institute of Neurology, Queen Square, London, UK
| | - Ryan M Calmus
- Department of Neurosurgery, University of Iowa, Iowa City, IA, USA
- Biosciences Institute, Newcastle University Medical School, Newcastle upon Tyne, UK
| | - Bob McMurray
- Department of Psychological and Brain Science, University of Iowa, Iowa City, IA, USA
| | - Ariane E Rhone
- Department of Neurosurgery, University of Iowa, Iowa City, IA, USA
| | | | | | - Yukiko Kikuchi
- Biosciences Institute, Newcastle University Medical School, Newcastle upon Tyne, UK
| | - Phillip E Gander
- Department of Neurosurgery, University of Iowa, Iowa City, IA, USA
- Department of Radiology, University of Iowa, Iowa City, IA, USA
- Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, USA
| | - Joel I Berger
- Department of Neurosurgery, University of Iowa, Iowa City, IA, USA
| | | | - Inyong Choi
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA, USA
| | | | - Hiroto Kawasaki
- Department of Neurosurgery, University of Iowa, Iowa City, IA, USA
| | - Thomas E Cope
- Department of Clinical Neurosciences, Cambridge University, Cambridge, UK
- MRC Cognition and Brain Sciences Unit, Cambridge University, Cambridge, UK
| | - Timothy D Griffiths
- Biosciences Institute, Newcastle University Medical School, Newcastle upon Tyne, UK
| | - Matthew A Howard
- Department of Neurosurgery, University of Iowa, Iowa City, IA, USA
| | - Christopher I Petkov
- Department of Neurosurgery, University of Iowa, Iowa City, IA, USA.
- Biosciences Institute, Newcastle University Medical School, Newcastle upon Tyne, UK.
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Xu F, Xu Y, Wang Y, Niu K, Li Y, Wang P, Li Y, Sun J, Chen Q, Wang X. Language-related brain areas in childhood epilepsy with centrotemporal spikes studied with MEG. Clin Neurophysiol 2023; 152:11-21. [PMID: 37257319 DOI: 10.1016/j.clinph.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/05/2023] [Accepted: 05/10/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Children with self-limited epilepsy with centrotemporal spikes (SeLECTS) typically indicate cognitive impairment with widespread speech impairment. We explored how epilepsy affects language-related brain areas and areas in their vicinity. METHODS Twenty-two children with SeLECTS and declined verbal comprehension (DVC), 21 with SeLECTS and normal verbal comprehension (NVC), and 23 healthy controls (HCs) underwent high-sampling magnetoencephalography recordings. According to a previous study, 24 language-related regions of interest were selected bilaterally, and the relative spectral power was estimated using a minimum norm estimate. RESULTS The highest mean power spectral density was observed in the delta band for the DVC group, in the theta band for the NVC group, and in the alpha band for HCs within language-specific brain regions. The distinctions between the DVC and NVC groups in the delta and theta frequency bands were primarily concentrated in the right linguistic brain area. CONCLUSIONS Children with SeLECTS may have developmental problems in language-related brain areas, with different developmental levels observed in the DVC, NVC, and HC groups. The DVC group could have inferior speech comprehension due to a more significant number of seizures and more left-sided spike locations. SIGNIFICANCE Children having SeLECTS showed impaired brain maturation, leading to associated language impairment.
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Affiliation(s)
- Fengyuan Xu
- Country Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yue Xu
- Country Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yingfan Wang
- Country Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Kai Niu
- Country Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yihan Li
- Country Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Pengfei Wang
- Country Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yanzhang Li
- Country Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jintao Sun
- Country Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Qiqi Chen
- Country MEG Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaoshan Wang
- Country Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China.
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Xu MX, Ju XD. Abnormal Brain Structure Is Associated with Social and Communication Deficits in Children with Autism Spectrum Disorder: A Voxel-Based Morphometry Analysis. Brain Sci 2023; 13:brainsci13050779. [PMID: 37239251 DOI: 10.3390/brainsci13050779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
Structural magnetic resonance imaging (sMRI) studies have shown abnormalities in the brain structure of ASD patients, but the relationship between structural changes and social communication problems is still unclear. This study aims to explore the structural mechanisms of clinical dysfunction in the brain of ASD children through voxel-based morphometry (VBM). After screening T1 structural images from the Autism Brain Imaging Data Exchange (ABIDE) database, 98 children aged 8-12 years old with ASD were matched with 105 children aged 8-12 years old with typical development (TD). Firstly, this study compared the differences in gray matter volume (GMV) between the two groups. Then, this study evaluated the relationship between GMV and the subtotal score of communications and social interaction on the Autism Diagnostic Observation Schedule (ADOS) in ASD children. Research has found that abnormal brain structures in ASD include the midbrain, pontine, bilateral hippocampus, left parahippocampal gyrus, left superior temporal gyrus, left temporal pole, left middle temporal gyrus and left superior occipital gyrus. In addition, in ASD children, the subtotal score of communications and social interaction on the ADOS were only significantly positively correlated with GMV in the left hippocampus, left superior temporal gyrus and left middle temporal gyrus. In summary, the gray matter structure of ASD children is abnormal, and different clinical dysfunction in ASD children is related to structural abnormalities in specific regions.
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Affiliation(s)
- Ming-Xiang Xu
- School of Psychology, Northeast Normal University, Changchun 130024, China
| | - Xing-Da Ju
- School of Psychology, Northeast Normal University, Changchun 130024, China
- Jilin Provincial Key Laboratory of Cognitive Neuroscience and Brain Development, Changchun 130024, China
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The Processing Differences between Chinese Proper Nouns and Common Nouns in the Left and Right Hemispheres of the Brain. Brain Sci 2023; 13:brainsci13030424. [PMID: 36979234 PMCID: PMC10046069 DOI: 10.3390/brainsci13030424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 02/21/2023] [Accepted: 02/26/2023] [Indexed: 03/05/2023] Open
Abstract
In this study, we investigated whether there were differences between the processing of Chinese proper nouns and common nouns in the left and that in the right hemispheres of the brain by using a visual half-field technique. The experimental materials included four types of proper nouns (people’s names, landmark names, country names, and brand names), four types of common nouns (animals, fruits and vegetables, tools, and abstract nouns), and pseudowords. Participants were asked to judge whether target words that had been quickly presented in their left or right visual field were meaningful words. The results showed that there was a distinction between the processing of the two types of words in the left and right hemispheres. There was no significant difference in the processing of the two types of nouns in the right hemisphere, but the left hemisphere processed common nouns more effectively than proper nouns. Furthermore, the processing difference of proper nouns between the two hemispheres was less than that of common nouns, suggesting that proper nouns have a smaller lateralization effect than common nouns.
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Massot-Tarrús A, Mirsattari SM. Roles of fMRI and Wada tests in the presurgical evaluation of language functions in temporal lobe epilepsy. Front Neurol 2022; 13:884730. [PMID: 36247757 PMCID: PMC9562037 DOI: 10.3389/fneur.2022.884730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 08/26/2022] [Indexed: 11/21/2022] Open
Abstract
Surgical treatment of pharmacoresistant temporal lobe epilepsy (TLE) carries risks for language function that can significantly affect the quality of life. Predicting the risks of decline in language functions before surgery is, consequently, just as important as predicting the chances of becoming seizure-free. The intracarotid amobarbital test, generally known as the Wada test (WT), has been traditionally used to determine language lateralization and to estimate their potential decline after surgery. However, the test is invasive and it does not localize the language functions. Therefore, other noninvasive methods have been proposed, of which functional magnetic resonance (fMRI) has the greatest potential. Functional MRI allows localization of language areas. It has good concordance with the WT for language lateralization, and it is of predictive value for postsurgical naming outcomes. Consequently, fMRI has progressively replaced WT for presurgical language evaluation. The objective of this manuscript is to review the most relevant aspects of language functions in TLE and the current role of fMRI and WT in the presurgical evaluation of language. First, we will provide context by revising the language network distribution and the effects of TLE on them. Then, we will assess the functional outcomes following various forms of TLE surgery and measures to reduce postoperative language decline. Finally, we will discuss the current indications for WT and fMRI and the potential usefulness of the resting-state fMRI technique.
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Affiliation(s)
| | - Seyed M. Mirsattari
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
- Department of Medical Biophysics, Western University, London, ON, Canada
- Department of Medical Imaging, Western University, London, ON, Canada
- Department of Psychology, Western University, London, ON, Canada
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8
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Banjac S, Roger E, Cousin E, Mosca C, Minotti L, Krainik A, Kahane P, Baciu M. Mapping of Language-and-Memory Networks in Patients With Temporal Lobe Epilepsy by Using the GE2REC Protocol. Front Hum Neurosci 2022; 15:752138. [PMID: 35069148 PMCID: PMC8772037 DOI: 10.3389/fnhum.2021.752138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 12/13/2021] [Indexed: 11/17/2022] Open
Abstract
Preoperative mapping of language and declarative memory functions in temporal lobe epilepsy (TLE) patients is essential since they frequently encounter deterioration of these functions and show variable degrees of cerebral reorganization. Due to growing evidence on language and declarative memory interdependence at a neural and neuropsychological level, we propose the GE2REC protocol for interactive language-and-memory network (LMN) mapping. GE2REC consists of three inter-related tasks, sentence generation with implicit encoding (GE) and two recollection (2REC) memory tasks: recognition and recall. This protocol has previously been validated in healthy participants, and in this study, we showed that it also maps the LMN in the left TLE (N = 18). Compared to healthy controls (N = 19), left TLE (LTLE) showed widespread inter- and intra-hemispheric reorganization of the LMN through reduced activity of regions engaged in the integration and the coordination of this meta-network. We also illustrated how this protocol could be implemented in clinical practice individually by presenting two case studies of LTLE patients who underwent efficient surgery and became seizure-free but showed different cognitive outcomes. This protocol can be advantageous for clinical practice because it (a) is short and easy to perform; (b) allows brain mapping of essential cognitive functions, even at an individual level; (c) engages language-and-memory interaction allowing to evaluate the integrative processes within the LMN; (d) provides a more comprehensive assessment by including both verbal and visual modalities, as well as various language and memory processes. Based on the available postsurgical data, we presented preliminary results obtained with this protocol in LTLE patients that could potentially inform the clinical practice. This implies the necessity to further validate the potential of GE2REC for neurosurgical planning, along with two directions, guiding resection and describing LMN neuroplasticity at an individual level.
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Affiliation(s)
- Sonja Banjac
- Université Grenoble Alpes, CNRS LPNC UMR 5105, Grenoble, France
| | - Elise Roger
- Université Grenoble Alpes, CNRS LPNC UMR 5105, Grenoble, France
| | - Emilie Cousin
- Université Grenoble Alpes, CNRS LPNC UMR 5105, Grenoble, France
- Université Grenoble Alpes, UMS IRMaGe CHU Grenoble, Grenoble, France
| | - Chrystèle Mosca
- Université Grenoble Alpes, Grenoble Institute of Neuroscience ‘Synchronisation et modulation des réseaux neuronaux dans l’épilepsie’ & Neurology Department, Grenoble, France
| | - Lorella Minotti
- Université Grenoble Alpes, Grenoble Institute of Neuroscience ‘Synchronisation et modulation des réseaux neuronaux dans l’épilepsie’ & Neurology Department, Grenoble, France
| | - Alexandre Krainik
- Université Grenoble Alpes, UMS IRMaGe CHU Grenoble, Grenoble, France
| | - Philippe Kahane
- Université Grenoble Alpes, Grenoble Institute of Neuroscience ‘Synchronisation et modulation des réseaux neuronaux dans l’épilepsie’ & Neurology Department, Grenoble, France
| | - Monica Baciu
- Université Grenoble Alpes, CNRS LPNC UMR 5105, Grenoble, France
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Abstract
OBJECTIVE The National Neuropsychology Network (NNN) is a multicenter clinical research initiative funded by the National Institute of Mental Health (NIMH; R01 MH118514) to facilitate neuropsychology's transition to contemporary psychometric assessment methods with resultant improvement in test validation and assessment efficiency. METHOD The NNN includes four clinical research sites (Emory University; Medical College of Wisconsin; University of California, Los Angeles (UCLA); University of Florida) and Pearson Clinical Assessment. Pearson Q-interactive (Q-i) is used for data capture for Pearson published tests; web-based data capture tools programmed by UCLA, which serves as the Coordinating Center, are employed for remaining measures. RESULTS NNN is acquiring item-level data from 500-10,000 patients across 47 widely used Neuropsychology (NP) tests and sharing these data via the NIMH Data Archive. Modern psychometric methods (e.g., item response theory) will specify the constructs measured by different tests and determine their positive/negative predictive power regarding diagnostic outcomes and relationships to other clinical, historical, and demographic factors. The Structured History Protocol for NP (SHiP-NP) helps standardize acquisition of relevant history and self-report data. CONCLUSIONS NNN is a proof-of-principle collaboration: by addressing logistical challenges, NNN aims to engage other clinics to create a national and ultimately an international network. The mature NNN will provide mechanisms for data aggregation enabling shared analysis and collaborative research. NNN promises ultimately to enable robust diagnostic inferences about neuropsychological test patterns and to promote the validation of novel adaptive assessment strategies that will be more efficient, more precise, and more sensitive to clinical contexts and individual/cultural differences.
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Bolocan M, Iacob CI, Avram E. Working Memory and Language Contribution to Verbal Learning and Memory in Drug-Resistant Unilateral Focal Temporal Lobe Epilepsy. Front Neurol 2021; 12:780086. [PMID: 34956061 PMCID: PMC8692669 DOI: 10.3389/fneur.2021.780086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/09/2021] [Indexed: 11/13/2022] Open
Abstract
We aimed to investigate the working memory (WM) and language separate contributions to verbal learning and memory in patients with unilateral drug-resistant temporal lobe epilepsy (drTLE); additionally, we explored the mediating role of WM on the relationship between the number of antiepileptic drugs (AEDs) and short-term verbal memory. We retrospectively enrolled 70 patients with left (LTLE; n = 44) and right (RTLE; n = 26) drTLE. About 40 similar (age and education) healthy controls were used to determine impairments of groups at WM, language (naming and verbal fluency), and verbal learning and memory (five trials list-learning, story memory-immediate recall). To disentangle the effect of learning from the short-term memory, we separately analyzed performances at the first trial, last trial, and delayed-recall list-learning measures, in addition to the total learning capacity (the sum of the five trials). Correlation and regression analyses were used to assess the contribution of potential predictors while controlling for main clinical and demographic variables, and ascertain the mediating role of WM. All patients were impaired at WM and story memory, whereas only LTLE showed language and verbal learning deficits. In RTLE, language was the unique predictor for the most verbal learning performances, whereas WM predicted the results at story memory. In LTLE, WM was the sole predictor for short-term verbal learning (list-learning capacity; trial 1) and mediated the interaction between AED number and the performance at these measures, whereas language predicted the delayed-recall. Finally, WM confounded the performance at short-term memory in both groups, although at different measures. WM is impaired in drTLE and contributes to verbal memory and learning deficits in addition to language, mediating the relationship between AED number and short-term verbal memory in LTLE. Clinicians should consider this overlap when interpreting poor performance at verbal learning and memory in drTLE.
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Affiliation(s)
- Monica Bolocan
- Laboratory of Health Psychology and Clinical Neuropsychology, Department of Applied Psychology and Psychotherapy, Faculty of Psychology and Educational Sciences, University of Bucharest, Bucharest, Romania
| | - Claudia I Iacob
- Laboratory of Health Psychology and Clinical Neuropsychology, Department of Applied Psychology and Psychotherapy, Faculty of Psychology and Educational Sciences, University of Bucharest, Bucharest, Romania
| | - Eugen Avram
- Laboratory of Health Psychology and Clinical Neuropsychology, Department of Applied Psychology and Psychotherapy, Faculty of Psychology and Educational Sciences, University of Bucharest, Bucharest, Romania
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Zekelman LR, Zhang F, Makris N, He J, Chen Y, Xue T, Liera D, Drane DL, Rathi Y, Golby AJ, O'Donnell LJ. White matter association tracts underlying language and theory of mind: An investigation of 809 brains from the Human Connectome Project. Neuroimage 2021; 246:118739. [PMID: 34856375 PMCID: PMC8862285 DOI: 10.1016/j.neuroimage.2021.118739] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 10/20/2021] [Accepted: 11/15/2021] [Indexed: 12/24/2022] Open
Abstract
Language and theory of mind (ToM) are the cognitive capacities that allow for the successful interpretation and expression of meaning. While functional MRI investigations are able to consistently localize language and ToM to specific cortical regions, diffusion MRI investigations point to an inconsistent and sometimes overlapping set of white matter tracts associated with these two cognitive domains. To further examine the white matter tracts that may underlie these domains, we use a two-tensor tractography method to investigate the white matter microstructure of 809 participants from the Human Connectome Project. 20 association white matter tracts (10 in each hemisphere) are uniquely identified by leveraging a neuroanatomist-curated automated white matter tract atlas. The fractional anisotropy (FA), mean diffusivity (MD), and number of streamlines (NoS) are measured for each white matter tract. Performance on neuropsychological assessments of semantic memory (NIH Toolbox Picture Vocabulary Test, TPVT) and emotion perception (Penn Emotion Recognition Test, PERT) are used to measure critical subcomponents of the language and ToM networks, respectively. Regression models are constructed to examine how structural measurements of left and right white matter tracts influence performance across these two assessments. We find that semantic memory performance is influenced by the number of streamlines of the left superior longitudinal fasciculus III (SLF-III), and emotion perception performance is influenced by the number of streamlines of the right SLF-III. Additionally, we find that performance on both semantic memory & emotion perception is influenced by the FA of the left arcuate fasciculus (AF). The results point to multiple, overlapping white matter tracts that underlie the cognitive domains of language and ToM. Results are discussed in terms of hemispheric dominance and concordance with prior investigations.
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Affiliation(s)
- Leo R Zekelman
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, USA; Speech and Hearing Bioscience and Technology, Harvard Medical School, Boston, USA.
| | - Fan Zhang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Nikos Makris
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, USA; Center for Morphometric Analysis, Department of Psychiatry and Neurology, A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Psychiatric Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Jianzhong He
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA; Institution of Information Processing and Automation, Zhejiang University of Technology, Hangzhou, China
| | - Yuqian Chen
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA; School of Computer Science, University of Sydney, NSW, Australia
| | - Tengfei Xue
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA; School of Computer Science, University of Sydney, NSW, Australia
| | | | - Daniel L Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurology, University of Washington School of Medicine, Seattle, WA, US
| | - Yogesh Rathi
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA; Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Alexandra J Golby
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Lauren J O'Donnell
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
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12
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Guglielmi G, Eschbach KL, Alexander AL. Smaller Knife, Fewer Seizures? Recent Advances in Minimally Invasive Techniques in Pediatric Epilepsy Surgery. Semin Pediatr Neurol 2021; 39:100913. [PMID: 34620456 DOI: 10.1016/j.spen.2021.100913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 02/02/2023]
Abstract
Children with drug-resistant epilepsy are at high risk for developmental delay, increased mortality, psychiatric comorbidities, and requiring assistance with activities of daily living. Despite the advent of new and effective pharmacologic therapies, about one in 5 children will develop drug-resistant epilepsy, and most of these children continue to have seizures despite trials of other medication. Epilepsy surgery is often a safe and effective option which may offer seizure freedom or at least a significant reduction in seizure burden in many children. However, despite published evidence of safety and efficacy, epilepsy surgery remains underutilized in the pediatric population. Patient and family fears about the risks of surgery may contribute to this gap. Less invasive surgical techniques may be more palatable to children with epilepsy and their caregivers. In this review, we present recent advances in minimally invasive techniques for the surgical treatment of epilepsy as well as intriguing possibilities for the future. We describe the indications for, benefits of, and limits to minimally-invasive techniques including Stereo-encephalography, laser interstitial thermal ablation, deep brain stimulation, focused ultrasound, stereo-encephalography-guided radiofrequency ablation, endoscopic disconnections, and responsive neurostimulation.
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Affiliation(s)
- Gina Guglielmi
- Graduate Medical Education, Neurological Surgery Residency, Carle BroMenn Medical Center, Normal IL; Section of Pediatric Neurology, Children's Hospital Colorado, Aurora CO; Department of Pediatrics, University of Colorado Anschutz School of Medicine, Aurora CO; Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora CO; Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora CO
| | - Krista L Eschbach
- Graduate Medical Education, Neurological Surgery Residency, Carle BroMenn Medical Center, Normal IL; Section of Pediatric Neurology, Children's Hospital Colorado, Aurora CO; Department of Pediatrics, University of Colorado Anschutz School of Medicine, Aurora CO; Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora CO; Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora CO
| | - Allyson L Alexander
- Graduate Medical Education, Neurological Surgery Residency, Carle BroMenn Medical Center, Normal IL; Section of Pediatric Neurology, Children's Hospital Colorado, Aurora CO; Department of Pediatrics, University of Colorado Anschutz School of Medicine, Aurora CO; Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora CO; Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora CO.
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13
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Wolff L, Benge JF, Ortiz-Hernandez S, Beevers S, Armitage A, Park J, Drane DL. Apathy and actions- another consideration when theorizing about embodied nature of language in Parkinson's disease. JOURNAL OF COMMUNICATION DISORDERS 2021; 93:106144. [PMID: 34365120 PMCID: PMC8936005 DOI: 10.1016/j.jcomdis.2021.106144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 07/09/2021] [Accepted: 07/19/2021] [Indexed: 06/13/2023]
Abstract
Objectives Individuals with Parkinson's disease (PD) have difficulty processing actions or verbs relative to nouns. Verb difficulties are thought to represent the coupling of language and motor networks. However, those with PD also frequently experience apathy. The overlap between apathy and action language difficulties is to date unexplored. Furthermore, whether verb/action fluency difficulty represents verb degradation (semantic/conceptual) or a selective lexical retrieval difficulty has not been determined. Methods In the current study, 20 individuals with PD without dementia completed cued action (verb) and animal (noun) fluency tasks in addition to assessments of apathy, cognition, and motor functioning. Results Individuals who exhibited impairments on action and animal fluency improved around 50% with the provision of cueing. The degree to which action fluency improved with cueing was correlated with behavioral/initiation apathy (rs=.56) as well as motor dysfunction (rs=-.57), while no similar relationship was found between those factors and nouns. Conclusions These findings suggest that impaired retrieval of actions and nouns are present in PD, but may have different underlying neuropsychological underpinnings. This provides preliminary support for grounded cognition models, which suggest the brain organizes information around motor, perceptual, and other networks. MESH terms Parkinson Disease, Neurocognitive Disorders, Apathy, Language Disorders, Neuropsychological Tests, Cognition.
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Affiliation(s)
- Logan Wolff
- Department of Neurology and Plummer Movement Disorders Center, 2401 S. 31(st) Street, Temple, TX, United States 76508; Present Address: Capitol Hill Mental Health, Kaiser Permanente, 310 15(th) Ave E, Seattle WA 98112, United States
| | - Jared F Benge
- Department of Neurology and Plummer Movement Disorders Center, 2401 S. 31(st) Street, Temple, TX, United States 76508; Department of Neurology, University of Texas at Austin, 1601 Trinity St., Bldg. B, Stop Z0700, Austin, TX 78712, United States.
| | - Samia Ortiz-Hernandez
- Department of Neurology and Plummer Movement Disorders Center, 2401 S. 31(st) Street, Temple, TX, United States 76508; Washington DC VA Medical Center 50 Irving St NW, GC-211N, Washington, DC 20422, United States
| | - Samantha Beevers
- Baylor Scott and White Research Institute, 2401 S. 31(st) Street, Temple, TX 76508, United States
| | - Alexandra Armitage
- Department of Neurology and Plummer Movement Disorders Center, 2401 S. 31(st) Street, Temple, TX, United States 76508
| | - Jungjun Park
- Department of Communication Sciences and Disorders, Baylor University, One Bear Place #97332, Waco, TX 76798, United States
| | - Daniel L Drane
- Departments of Neurology and Pediatrics, Emory University School of Medicine, Woodruff Memorial Research Building, Suite 6111, 101 Woodruff Circle, Atlanta, GA 30322, United States; Department of Neurology, University of Washington School of Medicine, Seattle, WA 98105, United States
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14
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Banjac S, Roger E, Cousin E, Perrone-Bertolotti M, Haldin C, Pichat C, Lamalle L, Minotti L, Kahane P, Baciu M. Interactive mapping of language and memory with the GE2REC protocol. Brain Imaging Behav 2021; 15:1562-1579. [PMID: 32761343 PMCID: PMC8286228 DOI: 10.1007/s11682-020-00355-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Previous studies have highlighted the importance of considering cognitive functions from a dynamic and interactive perspective and multiple evidence was brought for a language and memory interaction. In this study performed with healthy participants, we present a new protocol entitled GE2REC that interactively accesses the neural representation of language-and-memory network. This protocol consists of three runs related to each other, providing a link between tasks, in order to assure an interactive measure of linguistic and episodic memory processes. GE2REC consists of a sentence generation (GE) in the auditory modality and two recollecting (2REC) memory tasks, one recognition performed in the visual modality, and another one recall performed in the auditory modality. Its efficiency was evaluated in 20 healthy volunteers using a 3T MR imager. Our results corroborate the ability of GE2REC to robustly activate fronto-temporo-parietal language network as well as temporal mesial, prefrontal and parietal cortices in encoding during sentence generation and recognition. GE2REC is useful because it: (a) requires simultaneous and interactive language-and-memory processes and jointly maps their neural basis; (b) explores encoding and retrieval, managing to elicit activation of mesial temporal structures; (c) is easy to perform, hence being suitable for more restrictive settings, and (d) has an ecological dimension of tasks and stimuli. GE2REC may be useful for studying neuroplasticity of cognitive functions, especially in patients with temporal lobe epilepsy who show reorganization of both language and memory networks. Overall, GE2REC can provide valuable information in terms of the practical foundation of exploration language and memory interconnection.
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Affiliation(s)
- Sonja Banjac
- Univ. Grenoble Alpes, CNRS LPNC UMR 5105, F-38000, Grenoble, France
| | - Elise Roger
- Univ. Grenoble Alpes, CNRS LPNC UMR 5105, F-38000, Grenoble, France
| | - Emilie Cousin
- Univ. Grenoble Alpes, CNRS LPNC UMR 5105, F-38000, Grenoble, France.,Univ. Grenoble Alpes, UMS IRMaGe CHU Grenoble, F-38000, Grenoble, France
| | | | - Célise Haldin
- Univ. Grenoble Alpes, CNRS LPNC UMR 5105, F-38000, Grenoble, France
| | - Cédric Pichat
- Univ. Grenoble Alpes, CNRS LPNC UMR 5105, F-38000, Grenoble, France
| | - Laurent Lamalle
- Univ. Grenoble Alpes, UMS IRMaGe CHU Grenoble, F-38000, Grenoble, France
| | - Lorella Minotti
- Univ. Grenoble Alpes, GIN, Synchronisation et modulation des Réseaux Neuronaux dans l'Epilepsie' and Neurology Department, F-38000, Grenoble, France
| | - Philippe Kahane
- Univ. Grenoble Alpes, GIN, Synchronisation et modulation des Réseaux Neuronaux dans l'Epilepsie' and Neurology Department, F-38000, Grenoble, France
| | - Monica Baciu
- Univ. Grenoble Alpes, CNRS LPNC UMR 5105, F-38000, Grenoble, France.
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15
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Drane DL, Pedersen NP, Sabsevitz DS, Block C, Dickey AS, Alwaki A, Kheder A. Cognitive and Emotional Mapping With SEEG. Front Neurol 2021; 12:627981. [PMID: 33912122 PMCID: PMC8072290 DOI: 10.3389/fneur.2021.627981] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/04/2021] [Indexed: 02/05/2023] Open
Abstract
Mapping of cortical functions is critical for the best clinical care of patients undergoing epilepsy and tumor surgery, but also to better understand human brain function and connectivity. The purpose of this review is to explore existing and potential means of mapping higher cortical functions, including stimulation mapping, passive mapping, and connectivity analyses. We examine the history of mapping, differences between subdural and stereoelectroencephalographic approaches, and some risks and safety aspects, before examining different types of functional mapping. Much of this review explores the prospects for new mapping approaches to better understand other components of language, memory, spatial skills, executive, and socio-emotional functions. We also touch on brain-machine interfaces, philosophical aspects of aligning tasks to brain circuits, and the study of consciousness. We end by discussing multi-modal testing and virtual reality approaches to mapping higher cortical functions.
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Affiliation(s)
- Daniel L. Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
- Emory Epilepsy Center, Atlanta, GA, United States
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, United States
| | - Nigel P. Pedersen
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
- Emory Epilepsy Center, Atlanta, GA, United States
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - David S. Sabsevitz
- Department of Psychology and Psychiatry, Mayo Clinic, Jacksonville, FL, United States
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, United States
| | - Cady Block
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - Adam S. Dickey
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - Abdulrahman Alwaki
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - Ammar Kheder
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
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16
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Whitten A, Jacobs ML, Englot DJ, Rogers BP, Levine KK, González HFJ, Morgan VL. Resting-state hippocampal networks related to language processing reveal unique patterns in temporal lobe epilepsy. Epilepsy Behav 2021; 117:107834. [PMID: 33610102 PMCID: PMC8035309 DOI: 10.1016/j.yebeh.2021.107834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/22/2021] [Accepted: 01/26/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Patients with temporal lobe epilepsy (TLE) commonly experience a broad range of language impairments. These deficits are thought to arise from repeated seizure activity that damages language regions. However, connectivity between the seizure onset region in the hippocampus and regions related to language processing has rarely been studied, and could also have a strong impact on language function. The purpose of this study was to use resting-state functional connectivity (FC) measures to assess hippocampal network patterns and their relation to language abilities in patients with right TLE (RLTE), left TLE (LTLE), and healthy controls. METHODS Presurgical resting-state 3T functional MRI data were acquired from 40 patients with mesial TLE (27 RTLE, 13 LTLE) and 54 controls. The regions of interest were the anterior and posterior bilateral hippocampi and eleven regions grouped by frontal or temporo-parietal locations, including large areas of language-related cortex. FC values were computed with the right/left anterior and posterior hippocampi as the seeds and frontal and temporo-parietal regions as targets. Resting-state lateralization indices were also calculated (LI-Rest), and all FC measures were correlated to neuropsychological language scores and measures related to manifestation of epilepsy including age of onset, duration of disease, monthly seizure frequency, and hippocampal volume. RESULTS We found significant group differences between the anterior hippocampi and temporo-parietal regions closest to the seizure focus, in which RTLE and LTLE showed stronger connectivity to their contralateral hippocampus, while controls showed similar connectivity to both hippocampi. In addition, LI-Rest demonstrated significantly more right lateralization in LTLE compared to RTLE for temporo-parietal regions only. In LTLE, we found significant associations between stronger hippocampal network resting-state FC and later age of onset and decreased left anterior hippocampal volume. SIGNIFICANCE The results of our study indicate that the presence of TLE impacts hippocampal-temporo-parietal networks relevant to language processing.
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Affiliation(s)
- Allison Whitten
- Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, USA
| | - Monica L Jacobs
- Department of Neurological Surgery, Vanderbilt University Medical Center, USA
| | - Dario J Englot
- Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, USA; Department of Neurological Surgery, Vanderbilt University Medical Center, USA; Department of Biomedical Engineering, Vanderbilt University, USA
| | - Baxter P Rogers
- Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, USA; Department of Biomedical Engineering, Vanderbilt University, USA
| | - Kaela K Levine
- Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, USA
| | - Hernán F J González
- Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, USA; Department of Biomedical Engineering, Vanderbilt University, USA
| | - Victoria L Morgan
- Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, USA; Department of Neurological Surgery, Vanderbilt University Medical Center, USA; Department of Biomedical Engineering, Vanderbilt University, USA.
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17
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Karami M, Mehvari Habibabadi J, Nilipour R, Barekatain M, Gaillard WD, Soltanian-Zadeh H. Presurgical Language Mapping in Patients With Intractable Epilepsy: A Review Study. Basic Clin Neurosci 2021; 12:163-176. [PMID: 34925713 PMCID: PMC8672671 DOI: 10.32598/bcn.12.2.2053.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/10/2020] [Accepted: 11/08/2020] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION about 20% to 30% of patients with epilepsy are diagnosed with drug-resistant epilepsy and one third of these are candidates for epilepsy surgery. Surgical resection of the epileptogenic tissue is a well-established method for treating patients with intractable focal epilepsy. Determining language laterality and locality is an important part of a comprehensive epilepsy program before surgery. Functional Magnetic Resonance Imaging (fMRI) has been increasingly employed as a non-invasive alternative method for the Wada test and cortical stimulation. Sensitive and accurate language tasks are essential for any reliable fMRI mapping. METHODS The present study reviews the methods of presurgical fMRI language mapping and their dedicated fMRI tasks, specifically for patients with epilepsy. RESULTS Different language tasks including verbal fluency are used in fMRI to determine language laterality and locality in different languages such as Persian. there are some considerations including the language materials and technical protocols for task design that all presurgical teams should take into consideration. CONCLUSION Accurate presurgical language mapping is very important to preserve patients language after surgery. This review was the first part of a project for designing standard tasks in Persian to help precise presurgical evaluation and in Iranian PWFIE.
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Affiliation(s)
- Mahdieh Karami
- Institute for Cognitive Science Studies (ICSS), Tehran, Iran
| | | | - Reza Nilipour
- Department of Speech Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Majid Barekatain
- Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - William D. Gaillard
- Center for Neuroscience and Behavioral Health, Children’s National Medical Center, George Washington University, Washington, D.C. USA
| | - Hamid Soltanian-Zadeh
- Departments of Communication, School of Electrical and Computer Engineering, University of Tehran, Tehran, Iran
- Departments of Radiology and Research Administration, Henry Ford Health System, Detroit, MI, USA
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18
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Wozniak BD, Loman MM, Koop JI. Assessing risk: Characterizing language performance in pediatric patients with intractable epilepsy pre- and post-surgical resection. Epilepsy Behav 2021; 115:107603. [PMID: 33334716 DOI: 10.1016/j.yebeh.2020.107603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/27/2020] [Accepted: 10/24/2020] [Indexed: 02/06/2023]
Abstract
Neuropsychologists play an important role in assessing risk for post-surgical cognitive decline in pediatric patients with medically refractory epilepsy. Families, neurologists, and neurosurgeons are particularly concerned about the possibility for language decline for patients with a dominant, most often left, hemisphere epileptic focus and planned surgical resection. This study aims to describe language functioning in pediatric epilepsy patients following resection and evaluate the accuracy of a clinical approach of assessing risk. This study proposes a risk assessment method that considers a patient's pattern of lateralized dysfunction across cognitive domains, suspected neuroanatomical reorganization of language functions, and planned site of resection. Pediatric patients (N = 47) were dichotomized as being at minimal risk or at greater risk for post-surgical language decline based on the proposed risk assessment method. Retrospective chart review was utilized to obtain neuropsychological (Boston Naming Test and Weschler Vocabulary subtest) and clinical variables of interest. Patients in the minimal risk group demonstrated significantly improved BNT scores at post-surgery. Most patients remained stable in their Vocabulary knowledge. The proposed risk assessment method correctly classified patients 77% of the time based on BNT performance. Cluster analysis examining the individual components of the proposed method revealed three distinct patient subgroups. Clinical implications are discussed.
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Affiliation(s)
| | - Michelle M Loman
- Division of Neuropsychology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer I Koop
- Division of Neuropsychology, Medical College of Wisconsin, Milwaukee, WI, USA
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19
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Poch C, Toledano R, García-Morales I, Alemán-Gómez Y, Gil-Nagel A, Campo P. Contributions of left and right anterior temporal lobes to semantic cognition: Evidence from patients with small temporopolar lesions. Neuropsychologia 2020; 152:107738. [PMID: 33383038 DOI: 10.1016/j.neuropsychologia.2020.107738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 12/04/2020] [Accepted: 12/24/2020] [Indexed: 11/18/2022]
Abstract
Decades of research have increased the understanding of the contribution of the anterior temporal lobes (ATLs) to semantic cognition. Nonetheless, whether semantic processing of different types of information show a selective relationship with left and right ATLs, or whether semantic processing in the ATLs is independent of the modality of the input is currently unknown. There exists evidence supporting each of these alternatives. A fundamental objection to these findings is that they were obtained from studies with patients with brain damage affecting extensive regions, sometimes bilaterally. In the current study, we assessed a group of 38 temporal lobe epilepsy (TLE) patients with either left or right small epileptogenic lesions with a battery of commonly used semantic tasks that tested verbal and non-verbal semantic processing. We found that left TLE patients exhibited worse performance than controls on the verbal semantic tasks, as expected, but also on the non-verbal semantic task. On the other hand, performance of the right TLE group did not differ from controls on the non-verbal task, but was worse on a semantic fluency task. When performance between patient groups was compared, we found that left TLE not only did worse than right TLE on the naming task, but also on the non-verbal associative memory task. When considered together, current data do not support a strong view of input modality differences between left and right ATLs. Additionally, they provide evidence indicating that the left and right ATLs do not make similar contributions to a singular functional system for semantic representation.
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Affiliation(s)
- Claudia Poch
- Facultad de Lenguas y Educación, Universidad Nebrija, Spain
| | - Rafael Toledano
- Hospital Ruber Internacional, Epilepsy Unit, Neurology Department, Madrid, Spain; University Hospital of Ramón y Cajal, Epilepsy Unit, Neurology Department, Madrid, Spain
| | - Irene García-Morales
- Hospital Ruber Internacional, Epilepsy Unit, Neurology Department, Madrid, Spain; University Hospital of San Carlos, Epilepsy Unit, Neurology Department, Madrid, Spain
| | - Yasser Alemán-Gómez
- Center for Psychiatric Neuroscience, Department of Psychiatry, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland; Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland; Medical Image Analysis Laboratory (MIAL), Centre D'Imagerie BioMédicale (CIBM), Lausanne, Switzerland
| | - Antonio Gil-Nagel
- Hospital Ruber Internacional, Epilepsy Unit, Neurology Department, Madrid, Spain
| | - Pablo Campo
- Department of Basic Psychology, Autonoma University of Madrid, Madrid, Spain.
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20
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Trébuchon A, Liégeois-Chauvel C, Gonzalez-Martinez JA, Alario FX. Contributions of electrophysiology for identifying cortical language systems in patients with epilepsy. Epilepsy Behav 2020; 112:107407. [PMID: 33181892 DOI: 10.1016/j.yebeh.2020.107407] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/10/2020] [Accepted: 08/10/2020] [Indexed: 11/26/2022]
Abstract
A crucial element of the surgical treatment of medically refractory epilepsy is to delineate cortical areas that must be spared in order to avoid clinically relevant neurological and neuropsychological deficits postoperatively. For each patient, this typically necessitates determining the language lateralization between hemispheres and language localization within hemisphere. Understanding cortical language systems is complicated by two primary challenges: the extent of the neural tissue involved and the substantial variability across individuals, especially in pathological populations. We review the contributions made through the study of electrophysiological activity to address these challenges. These contributions are based on the techniques of magnetoencephalography (MEG), intracerebral recordings, electrical-cortical stimulation (ECS), and the electrovideo analyses of seizures and their semiology. We highlight why no single modality alone is adequate to identify cortical language systems and suggest avenues for improving current practice.
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Affiliation(s)
- Agnès Trébuchon
- Aix-Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Catherine Liégeois-Chauvel
- Aix-Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France; Department of Neurological Surgery, School of Medicine, University of Pittsburgh (PA), USA
| | | | - F-Xavier Alario
- Department of Neurological Surgery, School of Medicine, University of Pittsburgh (PA), USA; Aix-Marseille Univ, CNRS, LPC, Marseille, France.
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21
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Foesleitner O, Sigl B, Schmidbauer V, Nenning KH, Pataraia E, Bartha-Doering L, Baumgartner C, Pirker S, Moser D, Schwarz M, Hainfellner JA, Czech T, Dorfer C, Langs G, Prayer D, Bonelli S, Kasprian G. Language network reorganization before and after temporal lobe epilepsy surgery. J Neurosurg 2020; 134:1694-1702. [PMID: 32619977 DOI: 10.3171/2020.4.jns193401] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 04/07/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Epilepsy surgery is the recommended treatment option for patients with drug-resistant temporal lobe epilepsy (TLE). This method offers a good chance of seizure freedom but carries a considerable risk of postoperative language impairment. The extremely variable neurocognitive profiles in surgical epilepsy patients cannot be fully explained by extent of resection, fiber integrity, or current task-based functional MRI (fMRI). In this study, the authors aimed to investigate pathology- and surgery-triggered language organization in TLE by using fMRI activation and network analysis as well as considering structural and neuropsychological measures. METHODS Twenty-eight patients with unilateral TLE (16 right, 12 left) underwent T1-weighted imaging, diffusion tensor imaging, and task-based language fMRI pre- and postoperatively (n = 15 anterior temporal lobectomy, n = 11 selective amygdalohippocampectomy, n = 2 focal resection). Twenty-two healthy subjects served as the control cohort. Functional connectivity, activation maps, and laterality indices for language dominance were analyzed from fMRI data. Postoperative fractional anisotropy values of 7 major tracts were calculated. Naming, semantic, and phonematic verbal fluency scores before and after surgery were correlated with imaging parameters. RESULTS fMRI network analysis revealed widespread, bihemispheric alterations in language architecture that were not captured by activation analysis. These network changes were found preoperatively and proceeded after surgery with characteristic patterns in the left and right TLEs. Ipsilesional fronto-temporal connectivity decreased in both left and right TLE. In left TLE specifically, preoperative atypical language dominance predicted better postoperative verbal fluency and naming function. In right TLE, left frontal language dominance correlated with good semantic verbal fluency before and after surgery, and left fronto-temporal language laterality predicted good naming outcome. Ongoing seizures after surgery (Engel classes ID-IV) were associated with naming deterioration irrespective of seizure side. Functional findings were not explained by the extent of resection or integrity of major white matter tracts. CONCLUSIONS Functional connectivity analysis contributes unique insight into bihemispheric remodeling processes of language networks after epilepsy surgery, with characteristic findings in left and right TLE. Presurgical contralateral language recruitment is associated with better postsurgical language outcome in left and right TLE.
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Affiliation(s)
| | - Benjamin Sigl
- Departments of1Biomedical Imaging and Image-guided Therapy
| | | | | | | | | | | | - Susanne Pirker
- 4General Hospital Hietzing with Neurological Center Rosenhuegel, Vienna; and
| | | | | | | | - Thomas Czech
- 6Department of Neurosurgery, Medical University of Vienna, Austria
| | - Christian Dorfer
- 6Department of Neurosurgery, Medical University of Vienna, Austria
| | - Georg Langs
- Departments of1Biomedical Imaging and Image-guided Therapy
| | - Daniela Prayer
- Departments of1Biomedical Imaging and Image-guided Therapy
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22
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Ono KE, Bearden DJ, Adams E, Doescher J, Koh S, Eksioglu Y, Gross RE, Drane DL. Cognitive and behavioral outcome of stereotactic laser amydalohippocampotomy in a pediatric setting. Epilepsy Behav Rep 2020; 14:100370. [PMID: 32642637 PMCID: PMC7334373 DOI: 10.1016/j.ebr.2020.100370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/16/2020] [Accepted: 05/18/2020] [Indexed: 11/28/2022] Open
Abstract
We present neuropsychological and functional outcome data in a teenager undergoing stereotactic laser amygdalohippocampotomy (SLAH) who had drug-resistant mesial temporal lobe epilepsy due to left hippocampal sclerosis. Given strong baseline cognitive performance, there was concern for post-operative declines in language and verbal memory were this patient to undergo open resection. She was evaluated pre- and post-ablation with clinical and experimental neuropsychological measures including semantic memory, category-specific object/face recognition and naming, spatial learning, and socio-emotional processing. The patient became seizure-free following SLAH and experienced significant improvements in school performance and social engagement. She experienced improvement in recognition and naming of multiple object categories, memory functions, and verbal fluency. In contrast, the patient declined significantly in her ability to recognize emotional tone from facial expressions, a socio-emotional process that had been normal prior to surgery. We believe this decline was related to surgical disruption of the limbic system, an area highly involved in emotional processing, and suspect such deficits are an under-assessed and unrecognized risk for all surgeries involving the amygdalohippocampal complex and broader limbic system regions. We hope this positive SLAH outcome will serve as impetus for group level research to establish its safety and efficacy in the pediatric setting. Stereotactic laser ablation can be used successfully in pediatric epilepsy. At risk cognitive abilities did not decline after focal ablation in this teenager. Functional improvement was observed that paralleled gains in seizure status and cognition. Deficits still occurred in select areas related to focal structures ablated. Socio-emotional deficits can result from surgeries restricted to the amygdalohippocampal complex.
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Affiliation(s)
- Kim E Ono
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Children's Hospital of Atlanta, Atlanta, GA, USA
| | - Donald J Bearden
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Children's Hospital of Atlanta, Atlanta, GA, USA
| | - Elizabeth Adams
- Department of Neurology, Minnesota Epilepsy Group, Minneapolis, MN, USA
| | - Jason Doescher
- Department of Neurology, Minnesota Epilepsy Group, Minneapolis, MN, USA
| | - Sookyong Koh
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Children's Hospital of Atlanta, Atlanta, GA, USA
| | - Yaman Eksioglu
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Children's Hospital of Atlanta, Atlanta, GA, USA
| | - Robert E Gross
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA.,Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.,Coulter Department of Biomedical Engineering, Emory University, GA, USA
| | - Daniel L Drane
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.,Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA
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23
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Swanson SJ, Conant LL, Humphries CJ, LeDoux M, Raghavan M, Mueller WM, Allen L, Gross WL, Anderson CT, Carlson CE, Busch RM, Lowe M, Tivarus ME, Drane DL, Loring DW, Jacobs M, Morgan VL, Szaflarski J, Bonilha L, Bookheimer S, Grabowski T, Phatak V, Vannest J, Binder JR. Changes in description naming for common and proper nouns after left anterior temporal lobectomy. Epilepsy Behav 2020; 106:106912. [PMID: 32179500 PMCID: PMC7195239 DOI: 10.1016/j.yebeh.2020.106912] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/10/2020] [Accepted: 01/11/2020] [Indexed: 11/28/2022]
Abstract
Numerous studies have shown that surgical resection of the left anterior temporal lobe (ATL) is associated with a decline in object naming ability (Hermann et al., 1999). In contrast, few studies have examined the effects of left ATL surgery on auditory description naming (ADN) or category-specific naming. Compared with object naming, which loads heavily on visual recognition processes, ADN provides a more specific measure of concept retrieval. The present study examined ADN declines in a large group of patients who were tested before and after left ATL surgery, using a 2 × 2 × 2 factorial manipulation of uniqueness (common vs. proper nouns), taxonomic category (living vs. nonliving things), and time (pre- vs. postsurgery). Significant declines occurred across all categories but were substantially larger for proper living (PL) concepts, i.e., famous individuals. The disproportionate decline in PL noun naming relative to other conditions is consistent with the notion that the left ATL is specialized not only for retrieval of unique entity concepts, but also plays a role in processing social concepts and person-specific features.
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Affiliation(s)
- Sara J. Swanson
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI
| | - Lisa L Conant
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI
| | | | - Megan LeDoux
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI
| | - Manoj Raghavan
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI
| | - Wade M. Mueller
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI
| | - Linda Allen
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI
| | - William L. Gross
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI
| | | | - Chad E. Carlson
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI
| | - Robyn M. Busch
- Department of Neurology, Cleveland Clinic, Cleveland, OH
| | - Mark Lowe
- Department of Radiology, Cleveland Clinic, Cleveland, OH
| | | | | | | | - Monica Jacobs
- Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN
| | - Victoria L. Morgan
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN
| | | | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, Charleston, SC
| | - Susan Bookheimer
- Department of Neurology, University of California, Los Angeles, CA
| | | | - Vaishali Phatak
- Department of Neurology, University of Washington, Seattle, WA
| | - Jennifer Vannest
- Department of Neurology, University of Cincinnati, Cincinnati, OH
| | - Jeffrey R. Binder
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI
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24
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Calderón-Garcidueñas L, Torres-Jardón R, Kulesza RJ, Mansour Y, González-González LO, Gónzalez-Maciel A, Reynoso-Robles R, Mukherjee PS. Alzheimer disease starts in childhood in polluted Metropolitan Mexico City. A major health crisis in progress. ENVIRONMENTAL RESEARCH 2020; 183:109137. [PMID: 32006765 DOI: 10.1016/j.envres.2020.109137] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/12/2020] [Accepted: 01/13/2020] [Indexed: 05/20/2023]
Abstract
Exposures to fine particulate matter (PM2.5) and ozone (O3) above USEPA standards are associated with Alzheimer's disease (AD) risk. Metropolitan Mexico City (MMC) youth have life time exposures to PM2.5 and O3 above standards. We focused on MMC residents ≤30 years and reviewed 134 consecutive autopsies of subjects age 20.03 ± 6.38 y (range 11 months to 30 y), the staging of Htau and ß amyloid, the lifetime cumulative PM2.5 (CPM 2.5) and the impact of the Apolipoprotein E (APOE) 4 allele, the most prevalent genetic risk for AD. We also reviewed the results of the Montreal Cognitive Assessment (MoCA) and the brainstem auditory evoked potentials (BAEPs) in clinically healthy young cohorts. Mobile sources, particularly from non-regulated diesel vehicles dominate the MMC pollutant emissions exposing the population to PM2.5 concentrations above WHO and EPA standards. Iron-rich,magnetic, highly oxidative, combustion and friction-derived nanoparticles (CFDNPs) are measured in the brain of every MMC resident. Progressive development of Alzheimer starts in childhood and in 99.25% of 134 consecutive autopsies ≤30 years we can stage the disease and its progression; 66% of ≤30 years urbanites have cognitive impairment and involvement of the brainstem is reflected by auditory central dysfunction in every subject studied. The average age for dementia using MoCA is 20.6 ± 3.4 y. APOE4 vs 3 carriers have 1.26 higher odds of committing suicide. PM2.5 and CFDNPs play a key role in the development of neuroinflammation and neurodegeneration in young urbanites. A serious health crisis is in progress with social, educational, judicial, economic and overall negative health impact for 25 million residents. Understanding the neural circuitry associated with the earliest cognitive and behavioral manifestations of AD is needed. Air pollution control should be prioritised-including the regulation of diesel vehicles- and the first two decades of life ought to be targeted for neuroprotective interventions. Defining paediatric environmental, nutritional, metabolic and genetic risk factor interactions is a multidisciplinary task of paramount importance to prevent Alzheimer's disease. Current and future generations are at risk.
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Affiliation(s)
| | - Ricardo Torres-Jardón
- Centro de Ciencias de la Atmósfera, Universidad Nacional Autónoma de México, 04310, Ciudad de México, Mexico
| | - Randy J Kulesza
- Auditory Research Center, Lake Erie College of Osteopathic Medicine, Erie, PA, 16509, USA
| | - Yusra Mansour
- Auditory Research Center, Lake Erie College of Osteopathic Medicine, Erie, PA, 16509, USA
| | | | | | | | - Partha S Mukherjee
- Interdisciplinary Statistical Research Unit, Indian Statistical Institute, 700108, Kolkata, India
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25
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Kaestner E, Balachandra AR, Bahrami N, Reyes A, Lalani SJ, Macari AC, Voets NL, Drane DL, Paul BM, Bonilha L, McDonald CR. The white matter connectome as an individualized biomarker of language impairment in temporal lobe epilepsy. Neuroimage Clin 2019; 25:102125. [PMID: 31927128 PMCID: PMC6953962 DOI: 10.1016/j.nicl.2019.102125] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 12/10/2019] [Accepted: 12/13/2019] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The distributed white matter network underlying language leads to difficulties in extracting clinically meaningful summaries of neural alterations leading to language impairment. Here we determine the predictive ability of the structural connectome (SC), compared with global measures of white matter tract microstructure and clinical data, to discriminate language impaired patients with temporal lobe epilepsy (TLE) from TLE patients without language impairment. METHODS T1- and diffusion-MRI, clinical variables (CVs), and neuropsychological measures of naming and verbal fluency were available for 82 TLE patients. Prediction of language impairment was performed using a robust tree-based classifier (XGBoost) for three models: (1) a CV-model which included demographic and epilepsy-related clinical features, (2) an atlas-based tract-model, including four frontotemporal white matter association tracts implicated in language (i.e., the bilateral arcuate fasciculus, inferior frontal occipital fasciculus, inferior longitudinal fasciculus, and uncinate fasciculus), and (3) a SC-model based on diffusion MRI. For the association tracts, mean fractional anisotropy was calculated as a measure of white matter microstructure for each tract using a diffusion tensor atlas (i.e., AtlasTrack). The SC-model used measurement of cortical-cortical connections arising from a temporal lobe subnetwork derived using probabilistic tractography. Dimensionality reduction of the SC was performed with principal components analysis (PCA). Each model was trained on 49 patients from one epilepsy center and tested on 33 patients from a different center (i.e., an independent dataset). Randomization was performed to test the stability of the results. RESULTS The SC-model yielded a greater area under the curve (AUC; .73) and accuracy (79%) compared to both the tract-model (AUC: .54, p < .001; accuracy: 70%, p < .001) and the CV-model (AUC: .59, p < .001; accuracy: 64%, p < .001). Within the SC-model, lateral temporal connections had the highest importance to model performance, including connections similar to language association tracts such as links between the superior temporal gyrus to pars opercularis. However, in addition to these connections many additional connections that were widely distributed, bilateral and interhemispheric in nature were identified as contributing to SC-model performance. CONCLUSION The SC revealed a white matter network contributing to language impairment that was widely distributed, bilateral, and lateral temporal in nature. The distributed network underlying language may be why the SC-model has an advantage in identifying sub-components of the complex fiber networks most relevant for aspects of language performance.
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Affiliation(s)
- Erik Kaestner
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA
| | - Akshara R Balachandra
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA
| | - Naeim Bahrami
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA
| | - Anny Reyes
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Sanam J Lalani
- Department of Neurology, University of California - San Francisco, San Francisco, CA, USA
| | - Anna Christina Macari
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA
| | - Natalie L Voets
- Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Daniel L Drane
- Departments of Neurology and Pediatrics, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurology, University of Washington, Seattle, WA, USA
| | - Brianna M Paul
- Department of Neurology, University of California - San Francisco, San Francisco, CA, USA
| | - Leonardo Bonilha
- Medical University of South Carolina, Department of Neurology, USA
| | - Carrie R McDonald
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA.
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26
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Brissart H, Planton M, Bilger M, Bulteau C, Forthoffer N, Guinet V, Hennion S, Kleitz C, Laguitton V, Mirabel H, Mosca C, Pécheux N, Pradier S, Samson S, Tramoni E, Voltzenlogel V, Denos M, Boutin M. French neuropsychological procedure consensus in epilepsy surgery. Epilepsy Behav 2019; 100:106522. [PMID: 31627076 DOI: 10.1016/j.yebeh.2019.106522] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/05/2019] [Accepted: 08/24/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Neuropsychological assessment is an integral component of the surgical procedure in patients with epilepsy. As no French consensus for neuropsychological assessment was available, the main goal of this work was to define French neuropsychological procedure consensus in regard to literature review. METHOD A panel of expert in neuropsychology was created within the framework of the French League Against Epilepsy. A systematic search of publications from 1950 to 2017 listed in PubMed database was conducted leading to a classification of articles according to their level of scientific evidence. French neuropsychological procedure consensus was then carried out with an expert panel of expert. RESULTS Low scientific evidence of neuropsychological data was reported. A panel of expert proposed a comprehensive neuropsychological assessment procedure including the exploration of intellectual efficiency, long-term memory, short-term and working memory, attention, executive functions, processing speed and motor skills, language, visual processing, praxis, psychobehavioral, and social cognition. DISCUSSION A common procedure for assessing cognitive and psychobehavioral function is now available in patients with epilepsy undergoing surgical evaluation have been established, they may help to improve the quality of care and the patient experience. This work highlights the need of furthers investigations and the necessity to develop specific tools with normative data.
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Affiliation(s)
- H Brissart
- Université de Lorraine, CNRS, CRAN, F-54000 Nancy, France; Université de Lorraine, CHRU-Nancy, Service de Neurologie, F-54000 Nancy, France.
| | - M Planton
- Neurology Department, Hôpital Pierre-Paul Riquet, CHU de Toulouse, Toulouse, France; Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
| | - M Bilger
- Neurology Department, Hôpital Hautepierre, CHRU Strasbourg, Strasbourg, France
| | - C Bulteau
- Pediatric Neurosurgery Department, Rothschild Foundation Hospital, Paris, France; Memory, Brain and Cognition (MC2Lab, EA 7536), Institute of Psychology Sorbonne Paris Cité University, Boulogne Billancourt, France
| | - N Forthoffer
- Université de Lorraine, CNRS, CRAN, F-54000 Nancy, France
| | - V Guinet
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Lyon, France
| | - S Hennion
- Reference Center Rare Epilepsies, Epilepsy Unit, Univ. Lille, INSERM, CHU Lille, U1171 Degenerative and vascular cognitive disorders, Lille, France
| | - C Kleitz
- Neurology Department, Hôpital Hautepierre, CHRU Strasbourg, Strasbourg, France
| | - V Laguitton
- CINAPSE, Hôpital Henri Gastaut Centre Saint Paul, 13009 Marseille, France
| | - H Mirabel
- Neurology Department, Hôpital Pierre-Paul Riquet, CHU de Toulouse, Toulouse, France
| | - C Mosca
- Epilepsy Unit, CHU, Grenoble-Alpes, France
| | | | - S Pradier
- Functional Explorations of the Nervous System, Clinical Neurosciences Center, University Hospital Center Pellegrin, Bordeaux, France
| | - S Samson
- Neurology Department, APHP, Paris, France; Equipe Neuropsychologie: Audition, Cognition et Action (EA 4072), UFR de psychologie, Université Lille-Nord de France, Villeneuve d'Ascq, France
| | - E Tramoni
- INSERM U 751, Marseille, France; Aix-Marseille Université, Faculté de Médecine, Marseille, France
| | - V Voltzenlogel
- Centre d'Etudes et de Recherches en Psychopathologie et Psychologie de la Santé, Université de Toulouse, UT2J, Toulouse, France
| | - M Denos
- Neurology Department, APHP, Paris, France
| | - M Boutin
- GHU-Paris Pôle Neuro-Sainte-Anne - Neurosurgery Unity 1, rue Cabanis, PARIS, France
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27
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Baumgartner C, Koren JP, Britto-Arias M, Zoche L, Pirker S. Presurgical epilepsy evaluation and epilepsy surgery. F1000Res 2019; 8. [PMID: 31700611 PMCID: PMC6820825 DOI: 10.12688/f1000research.17714.1] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2019] [Indexed: 12/21/2022] Open
Abstract
With a prevalence of 0.8 to 1.2%, epilepsy represents one of the most frequent chronic neurological disorders; 30 to 40% of patients suffer from drug-resistant epilepsy (that is, seizures cannot be controlled adequately with antiepileptic drugs). Epilepsy surgery represents a valuable treatment option for 10 to 50% of these patients. Epilepsy surgery aims to control seizures by resection of the epileptogenic tissue while avoiding neuropsychological and other neurological deficits by sparing essential brain areas. The most common histopathological findings in epilepsy surgery specimens are hippocampal sclerosis in adults and focal cortical dysplasia in children. Whereas presurgical evaluations and surgeries in patients with mesial temporal sclerosis and benign tumors recently decreased in most centers, non-lesional patients, patients requiring intracranial recordings, and neocortical resections increased. Recent developments in neurophysiological techniques (high-density electroencephalography [EEG], magnetoencephalography, electrical and magnetic source imaging, EEG-functional magnetic resonance imaging [EEG-fMRI], and recording of pathological high-frequency oscillations), structural magnetic resonance imaging (MRI) (ultra-high-field imaging at 7 Tesla, novel imaging acquisition protocols, and advanced image analysis [post-processing] techniques), functional imaging (positron emission tomography and single-photon emission computed tomography co-registered to MRI), and fMRI significantly improved non-invasive presurgical evaluation and have opened the option of epilepsy surgery to patients previously not considered surgical candidates. Technical improvements of resective surgery techniques facilitate successful and safe operations in highly delicate brain areas like the perisylvian area in operculoinsular epilepsy. Novel less-invasive surgical techniques include stereotactic radiosurgery, MR-guided laser interstitial thermal therapy, and stereotactic intracerebral EEG-guided radiofrequency thermocoagulation.
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Affiliation(s)
- Christoph Baumgartner
- Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria.,Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Johannes P Koren
- Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria.,Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria
| | - Martha Britto-Arias
- Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria.,Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria
| | - Lea Zoche
- Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria.,Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria
| | - Susanne Pirker
- Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria.,Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria
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28
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Kinney MO, Kovac S, Diehl B. Structured testing during seizures: A practical guide for assessing and interpreting ictal and postictal signs during video EEG long term monitoring. Seizure 2019; 72:13-22. [PMID: 31546090 DOI: 10.1016/j.seizure.2019.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 08/01/2019] [Accepted: 08/17/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Ictal and postictal testing carried out in long-term epilepsy monitoring units is often sub-optimal. Recently, a European consensus protocol for testing patients during and after seizures was developed by a joint taskforce of the International League Against Epilepsy - Commission on European Affairs and the European Epilepsy Monitoring Unit Association. AIM Using this recently developed standardised assessment battery as a framework, the goal of this narrative review is to outline the proposed testing procedure in detail and explain the rationale for each individual component, focusing on the underlying neurobiology. This is intended to serve as an educational resource for staff working in epilepsy monitoring units. METHODS A literature review of PubMed was performed; using the search terms "seizure", "ictal", "postictal", "testing", "examination", and "interview". Relevant literature was reviewed and relevant references were chosen. The work is presented as a narrative review. RESULTS The proposed standardised assessment battery provides a comprehensive and user-friendly format for ictal-postictal testing, and examines consciousness, language, motor, sensory, and visual function. CONCLUSION The standardised approach proposed has the potential to make full use of data recorded during video EEG increasing the diagnostic yield with regards to lateralisation and localisation, aiding both presurgical and diagnostic studies.
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Affiliation(s)
- Michael Owen Kinney
- Department of Clinical Neurophysiology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
| | - Stjepana Kovac
- Department of Neurology, University of Münster, Münster, Germany
| | - Beate Diehl
- Department of Clinical Neurophysiology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Department of Clinical and Experimental Epilepsy, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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29
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Kaestner E, Reyes A, Macari AC, Chang YH, Paul B, Hermann B, McDonald CR. Identifying the neural basis of a language-impaired phenotype of temporal lobe epilepsy. Epilepsia 2019; 60:1627-1638. [PMID: 31297795 PMCID: PMC6687533 DOI: 10.1111/epi.16283] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/17/2019] [Accepted: 06/17/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To identify neuroimaging and clinical biomarkers associated with a language-impaired phenotype in refractory temporal lobe epilepsy (TLE). METHODS Eighty-five patients with TLE were characterized as language-impaired (TLE-LI) or non-language-impaired (TLE-NLI) based on comprehensive neuropsychological testing. Structural magnetic resonance imaging (MRI), diffusion tensor imaging, and functional MRI (fMRI) were obtained in patients and 47 healthy controls (HC). fMRI activations and cortical thickness were calculated within language regions of interest, and fractional anisotropy (FA) was calculated within deep white matter tracts associated with language. Analyses of variance were performed to test for differences among the groups in imaging measures. Receiver operator characteristic curves were used to determine how well different clinical versus imaging measures discriminated TLE-LI from TLE-NLI. RESULTS TLE-LI patients showed significantly less activation within left superior temporal cortex compared to HC and TLE-NLI, regardless of side of seizure onset. TLE-LI also showed decreased FA in the inferior longitudinal fasciculus and arcuate fasciculus compared to HC. Cortical thickness did not differ between groups in any region. A model that included language-related fMRI activations within the superior temporal gyrus, age at onset, and demographic variables was the most predictive of language impairment (area under the curve = 0.80). SIGNIFICANCE These findings demonstrate a unique imaging signature associated with a language-impaired phenotype in TLE, characterized by functional and microstructural alterations within the language network. Reduced left superior temporal activation combined with compromise to language association tracts underlies this phenotype, extending our previous work on cognitive phenotypes that could have implications for treatment-planning or cognitive progression in TLE.
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Affiliation(s)
- Erik Kaestner
- Center for Multimodal Imaging and Genetics, University of California, San Diego
| | - Anny Reyes
- Center for Multimodal Imaging and Genetics, University of California, San Diego
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego
| | | | - Yu-Hsuan Chang
- Center for Multimodal Imaging and Genetics, University of California, San Diego
| | - Brianna Paul
- Department of Neurology, University of California – San Francisco, San Francisco
- UCSF Comprehensive Epilepsy Center, San Francisco
| | - Bruce Hermann
- Matthews Neuropsychology Section, University of Wisconsin
| | - Carrie R. McDonald
- Center for Multimodal Imaging and Genetics, University of California, San Diego
- UCSD Comprehensive Epilepsy Center, San Diego
- Department of Psychiatry, University of California, San Diego
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30
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Bonilha L, Small SS, Lin JJ. Editorial for the special issue on language and epilepsy. BRAIN AND LANGUAGE 2019; 193:1-3. [PMID: 30929763 DOI: 10.1016/j.bandl.2019.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, Charleston, SC, United States.
| | - Steven S Small
- Department of Neurology, School of Medicine, University of California Irvine, Irvine, CA, United States
| | - Jack J Lin
- Department of Neurology, School of Medicine, University of California Irvine, Irvine, CA, United States; Department of Biomedical Engineering, The Henry Samueli School of Engineering, University of California Irvine, Irvine, CA, United States
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