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Sugano H, Iimura Y, Suzuki H, Tamrakar S, Mitsuhashi T, Higo T, Ueda T, Nishioka K, Karagiozov K, Nakajima M. Can intraoperative electrocorticography be used to minimize the extent of resection in patients with temporal lobe epilepsy associated with hippocampal sclerosis? J Neurosurg 2022; 137:419-426. [PMID: 34861650 DOI: 10.3171/2021.9.jns211925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/21/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Tailored surgery to extensively resect epileptogenic lesions using intraoperative electrocorticography (ioECoG) may improve seizure outcomes. However, resection of large areas is associated with decreased memory function postoperatively. The authors assessed whether ioECoG could provide useful information on how to minimize the focus resection and obtain better seizure outcomes without memory deterioration. They examined the postoperative seizure-free period and memory alteration in a retrospective cohort of patients with mesial temporal lobe epilepsy (TLE) due to hippocampal sclerosis (HS) in whom the extent of removal was determined using ioECoG findings. METHODS The authors enrolled 82 patients with TLE associated with HS who were treated surgically. Transsylvian amygdalohippocampectomy was indicated as the first step. When visual inspection identified interictal epileptic discharges from the lateral temporal lobe on ioECoG, anterior temporal lobectomy (ATL) was eventually performed. The patients were divided into the selective amygdalohippocampectomy (SA, n = 40) and ATL (n = 42) groups. Postoperative seizure outcomes were assessed at 1, 2, 3, 5, and 7 years postoperatively using the International League Against Epilepsy classification. The Kaplan-Meier survival analysis was applied to evaluate the period of seizure recurrence between the SA and ATL groups. Factors attributed to seizure recurrence were analyzed using the Cox proportional hazards model, and they were as follows: epileptic focal laterality; age at seizure onset (< 10 or ≥ 10 years old); seizure frequency (more than weekly or less than weekly seizures); history of focal to bilateral tonic-clonic seizure; infectious etiology; and surgical procedure. The Wechsler Memory Scale-Revised was used to evaluate memory function pre- and postoperatively. RESULTS Seizure outcomes were significantly worse in the SA group than in the ATL group at 2 years postoperatively (p = 0.045). The International League Against Epilepsy class 1 outcomes at 7 years postoperatively in the SA and ATL groups were 63% and 81%, respectively. Kaplan-Meier analysis showed that seizure recurred significantly earlier in the SA group than in the ATL group (p = 0.031). The 2-way ANOVA analysis was used to compare the SA and ATL groups in each memory category, and revealed that there was no significant difference regardless of the side of surgery. CONCLUSIONS Visual assessment of ioECoG cannot be used as an indicator to minimize epileptic focus resection in patients with TLE associated with HS. ATL is more effective in obtaining seizure-free outcomes; however, both ATL and SA can preserve memory function.
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Kim D, Kim JS, Jeong W, Shin MS, Chung CK. Critical area for memory decline after mesial temporal resection in epilepsy patients. J Neurosurg 2021; 134:659-677. [PMID: 31899884 DOI: 10.3171/2019.10.jns191932] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 10/25/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Mesial temporal lobe epilepsy (MTLE) surgery is associated with a risk of memory decline after surgery, but the effect of the extent and locus of temporal resection on postoperative memory function are controversial. The authors' aim in this study was to confirm if selective resection is effective in preserving memory function and identify critical areas for specific memory decline after temporal resection. METHODS In this single-center retrospective study, the authors investigated data from patients who underwent unilateral MTLE surgery between 2005 and 2015. Data from 74 MTLE patients (60.8% of whom were female; mean [SD] age at surgery 32 years [8.91 years] and duration of epilepsy 16 years [9.65 years]) with histologically proven hippocampal sclerosis were included. Forty-two patients underwent left-sided surgery. The resection area was manually delineated on each patient's postoperative T1-weighted images. Mapping was performed to see if the resected group, compared with the nonresected group, had worse postoperative memory in various memory domains, including verbal item, verbal associative, and figural memory. RESULTS Overall, 95.9% had a favorable epilepsy outcome. In verbal item memory, resection of the left lateral temporal area was related to postoperative decline in immediate and delayed recall scores of word lists. In verbal associative memory, resection of the anterior part of the left hippocampus, left parahippocampal area, and left lateral temporal area was related to postoperative decline in immediate recall scores of word pairs. Resection of the posterior part of the left hippocampus, left parahippocampal area, and left lateral temporal area was related to delayed recall scores of the same task. Similarly, in the figural memory, postoperative decline of immediate recall scores was associated with the resection of the anterior part of the right hippocampus, amygdala, parahippocampal area, and superior temporal area, and decline of delayed recall scores was related to resection of the posterior part of the right hippocampus and parahippocampal area. CONCLUSIONS Using voxel-based analysis, which accounts for the individual differences in the resection, the authors found a critical region for postoperative memory decline that is not revealed in the region-of-interest or groupwise comparison. Particularly, resection of the hippocampus was related to associative memory. In both verbal and visual memory, resection of the anterior part of the hippocampus was associated with immediate recall, and resection of the posterior part of the hippocampus was associated with delayed recall. Therefore, the authors' results suggest that selective resection may be effective in preserving postoperative memory decline.
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Affiliation(s)
- Dahye Kim
- 1Department of Brain and Cognitive Sciences and
| | - June Sic Kim
- 2Research Institute of Basic Sciences, Seoul National University College of Natural Sciences
| | - Woorim Jeong
- 3Department of Neurosurgery, Seoul National University Hospital; and
- 4Neuroscience Research Institute and
| | - Min-Sup Shin
- 5Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chun Kee Chung
- 1Department of Brain and Cognitive Sciences and
- 3Department of Neurosurgery, Seoul National University Hospital; and
- 4Neuroscience Research Institute and
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Martino J, Gomez E, de Lucas EM, Mato D, Vázquez-Bourgon J. Intraoperative Identification and Preservation of Verbal Memory in Diffuse Gliomas: A Matched-Pair Cohort Study. Neurosurgery 2019; 83:1209-1218. [PMID: 29351666 DOI: 10.1093/neuros/nyx617] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 12/08/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Recent glioma surgery series with intraoperative electrical stimulation (IES) language mapping have demonstrated high rates of postoperative memory impairment, raising a question regarding the efficacy of this approach to preserve memory. OBJECTIVE To evaluate if intraoperative identification and preservation of verbal memory sites with IES mapping in diffuse gliomas in eloquent areas consistently protect patients from long-term postoperative decline in short-term memory. METHODS A cohort of 16 subjects with diffuse low-grade or anaplastic gliomas that were operated with IES and intraoperative evaluation of language and verbal memory (cohort A) was matched by tumor side, pathology, and radiotherapy with a cohort of 16 subjects that were operated with IES and evaluation of language (cohort B). Detailed neuropsychological assessment was performed before and 6 mo after surgery. RESULTS Intraoperative memory mapping was a strong predictor of verbal memory prognosis. In cohort A, 4 patients (26.7%) had a decline of at least one of the 4 short-term memory tests evaluated. In cohort B, 11 patients (73.3%) had a decline of at least one of the 4 tests. This difference was statistically significant in multivariate analysis (P = .022; odds ratio = 9.88; 95% confidence interval = 1.39-70.42). CONCLUSION Verbal memory areas identified intraoperatively with the current paradigm are critically involved in verbal memory, as memory impairment can be significantly reduced by adapting the resection to avoid those memory areas. Incorporation of verbal memory evaluation in stimulation mapping protocols might assist in reducing postoperative sequelae and preserving the patient's quality of life.
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Affiliation(s)
- Juan Martino
- Department of Neurological Surgery, Hospital Universitario Marqués de Valdecilla (HUMV), Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), Avda, Valdecilla s/n, Santander, Cantabria, Spain
| | - Elsa Gomez
- Department of Psychiatry, Hospital Universitario Marqués de Valdecilla (HUMV), Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL) and Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Avda, Valdecilla s/n, Santander, Cantabria, Spain
| | - Enrique Marco de Lucas
- Department of Radiology, Hospital Universitario Marqués de Valdecilla (HUMV), Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), Avda, Valdecilla s/n, Santander, Cantabria, Spain
| | - David Mato
- Department of Neurological Surgery, Hospital Universitario Marqués de Valdecilla (HUMV), Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), Avda, Valdecilla s/n, Santander, Cantabria, Spain
| | - Javier Vázquez-Bourgon
- Department of Psychiatry, Hospital Universitario Marqués de Valdecilla (HUMV), Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL) and Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Avda, Valdecilla s/n, Santander, Cantabria, Spain
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Sheikh SR, Nair D, Gross RE, Gonzalez‐Martinez J. Tracking a changing paradigm and the modern face of epilepsy surgery: A comprehensive and critical review on the hunt for the optimal extent of resection in mesial temporal lobe epilepsy. Epilepsia 2019; 60:1768-1793. [DOI: 10.1111/epi.16310] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/13/2019] [Accepted: 07/14/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Shehryar R. Sheikh
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University Cleveland Ohio
| | - Dileep Nair
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University Cleveland Ohio
- Epilepsy Center Cleveland Clinic Foundation Cleveland Ohio
| | | | - Jorge Gonzalez‐Martinez
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University Cleveland Ohio
- Epilepsy Center Cleveland Clinic Foundation Cleveland Ohio
- Department of Neurosurgery Cleveland Clinic Foundation Cleveland Ohio
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Krámská L, Lukavský J, Vojtěch Z. A neuropsychologist's view: Outcome after RF-ablation for mTLE. Epilepsy Res 2017; 142:167-169. [PMID: 29031865 DOI: 10.1016/j.eplepsyres.2017.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 09/28/2017] [Accepted: 10/06/2017] [Indexed: 11/18/2022]
Abstract
Concern about postoperative worsening of cognitive functions after temporal lobe epilepsy surgery is an important issue. In this article we review our data on neuropsychological outcome after radiofrequency (RF) ablation of amygdalohippocampal complex (AHC). On a group level we found initial improvement in intelligence domains and unchanged memory scores one year after the surgery. During longitudinal follow-up, we found improvement in both intellectual and memory domains. This improvement was most pronounced up to two years after surgery. On an individual level, no patient worsened in any intellectual domain and most patients improved in memory. We hypothesize that this favorable outcome may be a consequence of minimization of collateral damage and incomplete destruction of target structures. We also summarize our experience with psychiatric complications of the procedure.
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Affiliation(s)
- Lenka Krámská
- Na Homolce Hospital, Epilepsy Center, Prague, Czech Republic; University of New York in Prague, Londýnská 41, 120 00 Prague 2, Czech Republic.
| | - Jiří Lukavský
- Institute of Psychology, Academy of Sciences of the Czech Republic, Hybernská 8, 110 00 Prague 1, Czech Republic
| | - Zdeněk Vojtěch
- Na Homolce Hospital, Epilepsy Center, Prague, Czech Republic
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Jin H, Li W, Dong C, Wu J, Zhao W, Zhao Z, Ma L, Ma F, Chen Y, Liu Q. Hippocampal deep brain stimulation in nonlesional refractory mesial temporal lobe epilepsy. Seizure 2016; 37:1-7. [DOI: 10.1016/j.seizure.2016.01.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 01/28/2016] [Accepted: 01/29/2016] [Indexed: 11/28/2022] Open
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Sidhu MK, Stretton J, Winston GP, McEvoy AW, Symms M, Thompson PJ, Koepp MJ, Duncan JS. Memory network plasticity after temporal lobe resection: a longitudinal functional imaging study. Brain 2016; 139:415-30. [PMID: 26754787 PMCID: PMC4805088 DOI: 10.1093/brain/awv365] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 10/30/2015] [Indexed: 11/13/2022] Open
Abstract
Anterior temporal lobe resection can control seizures in up to 80% of patients with temporal lobe epilepsy. Memory decrements are the main neurocognitive complication. Preoperative functional reorganization has been described in memory networks, but less is known of postoperative reorganization. We investigated reorganization of memory-encoding networks preoperatively and 3 and 12 months after surgery. We studied 36 patients with unilateral medial temporal lobe epilepsy (19 right) before and 3 and 12 months after anterior temporal lobe resection. Fifteen healthy control subjects were studied at three equivalent time points. All subjects had neuropsychological testing at each of the three time points. A functional magnetic resonance imaging memory-encoding paradigm of words and faces was performed with subsequent out-of-scanner recognition assessments. Changes in activations across the time points in each patient group were compared to changes in the control group in a single flexible factorial analysis. Postoperative change in memory across the time points was correlated with postoperative activations to investigate the efficiency of reorganized networks. Left temporal lobe epilepsy patients showed increased right anterior hippocampal and frontal activation at both 3 and 12 months after surgery relative to preoperatively, for word and face encoding, with a concomitant reduction in left frontal activation 12 months postoperatively. Right anterior hippocampal activation 12 months postoperatively correlated significantly with improved verbal learning in patients with left temporal lobe epilepsy from preoperatively to 12 months postoperatively. Preoperatively, there was significant left posterior hippocampal activation that was sustained 3 months postoperatively at word encoding, and increased at face encoding. For both word and face encoding this was significantly reduced from 3 to 12 months postoperatively. Patients with right temporal lobe epilepsy showed increased left anterior hippocampal activation on word encoding from 3 to 12 months postoperatively compared to preoperatively. On face encoding, left anterior hippocampal activations were present preoperatively and 12 months postoperatively. Left anterior hippocampal and orbitofrontal cortex activations correlated with improvements in both design and verbal learning 12 months postoperatively. On face encoding, there were significantly increased left posterior hippocampal activations that reduced significantly from 3 to 12 months postoperatively. Postoperative changes occur in the memory-encoding network in both left and right temporal lobe epilepsy patients across both verbal and visual domains. Three months after surgery, compensatory posterior hippocampal reorganization that occurs is transient and inefficient. Engagement of the contralateral hippocampus 12 months after surgery represented efficient reorganization in both patient groups, suggesting that the contralateral hippocampus contributes to memory outcome 12 months after surgery.
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Affiliation(s)
- Meneka K Sidhu
- 1 Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK 2 Epilepsy Society MRI Unit, Chesham Lane, Chalfont St. Peter SL9 0RJ, Buckinghamshire, UK
| | - Jason Stretton
- 1 Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK 2 Epilepsy Society MRI Unit, Chesham Lane, Chalfont St. Peter SL9 0RJ, Buckinghamshire, UK 3 MRC Cognition and Brain Science Unit, Chaucer Road, Cambridge, CB2 7EF, UK
| | - Gavin P Winston
- 1 Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK 2 Epilepsy Society MRI Unit, Chesham Lane, Chalfont St. Peter SL9 0RJ, Buckinghamshire, UK
| | - Andrew W McEvoy
- 1 Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK 2 Epilepsy Society MRI Unit, Chesham Lane, Chalfont St. Peter SL9 0RJ, Buckinghamshire, UK
| | - Mark Symms
- 1 Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK 2 Epilepsy Society MRI Unit, Chesham Lane, Chalfont St. Peter SL9 0RJ, Buckinghamshire, UK
| | - Pamela J Thompson
- 1 Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK 2 Epilepsy Society MRI Unit, Chesham Lane, Chalfont St. Peter SL9 0RJ, Buckinghamshire, UK
| | - Matthias J Koepp
- 1 Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK 2 Epilepsy Society MRI Unit, Chesham Lane, Chalfont St. Peter SL9 0RJ, Buckinghamshire, UK
| | - John S Duncan
- 1 Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK 2 Epilepsy Society MRI Unit, Chesham Lane, Chalfont St. Peter SL9 0RJ, Buckinghamshire, UK
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Malikova H, Kramska L, Vojtech Z, Sroubek J, Lukavsky J, Liscak R. Relationship between remnant hippocampus and amygdala and memory outcomes after stereotactic surgery for mesial temporal lobe epilepsy. Neuropsychiatr Dis Treat 2015; 11:2927-33. [PMID: 26640379 PMCID: PMC4657808 DOI: 10.2147/ndt.s95497] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND PURPOSE Mesial temporal structures play an important role in human memory. In mesial temporal lobe epilepsy (MTLE), seizure activity is generated from the same structures. Surgery is the definitive treatment for medically intractable MTLE. In addition to standard temporal lobe microsurgical resection, stereotactic radiofrequency amygdalohippocampectomy (SAHE) is used as an alternative MTLE treatment. While memory impairments after standard epilepsy surgery are well known, it has been shown that memory decline is not a feature of SAHE. The aim of the present study was to correlate the volume of the remnant hippocampus and amygdala in patients treated by SAHE with changes in memory parameters. MATERIALS AND METHODS Thirty-seven MTLE patients treated by SAHE (ten right, 27 left) were included. Patients underwent magnetic resonance imaging examinations including hippocampal and amygdalar volumetry and neuropsychological evaluation preoperatively and 1 year after surgery. RESULTS Using Spearman correlation analyses, larger left-sided hippocampal reductions were associated with lower verbal memory performance (ρ=-0.46; P=0.02). On the contrary, improvement of global memory quotient (MQ) was positively correlated with larger right-sided hippocampal reduction (ρ=0.66; P=0.04). Similarly, positive correlations between the extent of right amygdalar reduction and verbal MQ (ρ=0.74; P=0.02) and global MQ change (ρ=0.69; P=0.03) were found. Thus, larger right hippocampal and amygdalar reduction was associated with higher global and verbal MQ change after SAHE. CONCLUSION Larger left-sided hippocampal reductions were associated with lower verbal memory performance. This finding is in accordance with the material-specific model of human memory, which states that the dominant hemisphere is specialized for the learning and recall of verbal information. We hypothesize that larger right-sided ablations enable the left temporal lobe to support memory more effectively, perhaps as a consequence of epileptiform discharges spreading from remnants of right mesiotemporal structures to the left.
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Affiliation(s)
- Hana Malikova
- Department of Radiology, Na Homolce Hospital, Prague, Czech Republic ; Institute of Anatomy, Second Medical Faculty, Charles University in Prague, Prague, Czech Republic
| | - Lenka Kramska
- Department of Clinical Psychology, Na Homolce Hospital, Prague, Czech Republic
| | - Zdenek Vojtech
- Department of Neurology, Na Homolce Hospital, Prague, Czech Republic ; Department of Neurology, 3rd Medical Faculty, Charles University in Prague, Prague, Czech Republic
| | - Jan Sroubek
- Department of Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Jiri Lukavsky
- Institute of Psychology, Academy of Sciences of the Czech Republic, Prague, Czech Republic
| | - Roman Liscak
- Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
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DeWitt I, Rauschecker JP. Wernicke's area revisited: parallel streams and word processing. BRAIN AND LANGUAGE 2013; 127:181-91. [PMID: 24404576 PMCID: PMC4098851 DOI: 10.1016/j.bandl.2013.09.014] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Auditory word-form recognition was originally proposed by Wernicke to occur within left superior temporal gyrus (STG), later further specified to be in posterior STG. To account for clinical observations (specifically paraphasia), Wernicke proposed his sensory speech center was also essential for correcting output from frontal speech-motor regions. Recent work, in contrast, has established a role for anterior STG, part of the auditory ventral stream, in the recognition of species-specific vocalizations in nonhuman primates and word-form recognition in humans. Recent work also suggests monitoring self-produced speech and motor control are associated with posterior STG, part of the auditory dorsal stream. Working without quantitative methods or evidence of sensory cortex' hierarchical organization, Wernicke co-localized functions that today appear dissociable. "Wernicke's area" thus may be better construed as two cortical modules, an auditory word-form area (AWFA) in the auditory ventral stream and an "inner speech area" in the auditory dorsal stream.
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Guerrini R, Scerrati M, Rubboli G, Esposito V, Colicchio G, Cossu M, Marras CE, Tassi L, Tinuper P, Paola Canevini M, Quarato P, Giordano F, Granata T, Villani F, Giulioni M, Scarpa P, Barbieri V, Bottini G, Del Sole A, Vatti G, Spreafico R, Lo Russo G. Overview of presurgical assessment and surgical treatment of epilepsy from the Italian League Against Epilepsy. Epilepsia 2013; 54 Suppl 7:35-48. [DOI: 10.1111/epi.12308] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Renzo Guerrini
- Pediatric Neurology Unit and Laboratories; Children's Hospital A. Meyer-University of Florence; Florence Italy
| | - Massimo Scerrati
- Neurosurgery; University Hospital - Polytechnic University of Marche; Ancona Italy
| | - Guido Rubboli
- IRCCS Institute of Neurological Sciences; Bellaria Hospital; Bologna Italy
- Danish Epilepsy Center; Epilepsy Hospital, Dianalund Denmark
| | - Vincenzo Esposito
- Neurosurgery; I.R.C.C.S. Neuromed; Pozzilli (IS) Italy
- Department of Neurology and Psychiatry; Sapienza University of Rome; Rome Italy
| | | | - Massimo Cossu
- C. Munari Epilepsy Surgery Center; Niguarda Hospital; Milan Italy
| | - Carlo Efisio Marras
- Neurosurgery Unit; Department of Neuroscience e Neurorehabilitation; Bambino Gesù Children Hospital; Rome Italy
| | - Laura Tassi
- C. Munari Epilepsy Surgery Center; Niguarda Hospital; Milan Italy
| | - Paolo Tinuper
- Neurological Clinic; Bellaria Hospital IRCCS Institute of Neurological Sciences of Bologna and Department of Biomedical and Neuromotor Sciences; University of Bologna; Bologna Italy
| | - Maria Paola Canevini
- Epilepsy Center; San Paolo Hospital and Department of Health Sciences; University of Milan; Milan Italy
| | - Pierpaolo Quarato
- Epilepsy Surgery Unit; Department of Neurological Sciences; IRCCS “NEUROMED”; Pozzilli (IS) Italy
| | - Flavio Giordano
- Pediatric Neurosurgery Unit; Children's Hospital Meyer-University of Florence; Florence Italy
| | - Tiziana Granata
- Department of Pediatric Neuroscience; Carlo Besta Neurological Institute; Milan Italy
| | - Flavio Villani
- Clinical Epileptology and Experimental Neurophysiology Unit; Carlo Besta Neurological Institute; Milan Italy
| | - Marco Giulioni
- Division of Neurosurgery; IRCCS Institute of Neurological Sciences of Bologna; Bellaria Hospital; Bologna Italy
| | - Pina Scarpa
- Cognitive Neuropsychology Centre; Niguarda Hospital; Milan Italy
| | - Valentina Barbieri
- Psychiatric Branch; Department of Medicine, Surgery and Dentistry; University of Milan and San Paolo Hospital; Milan Italy
| | - Gabriella Bottini
- Cognitive Neuropsychology Centre; Niguarda Hospital; Milan Italy
- Department of Psychology; University of Pavia; Pavia Italy
| | - Angelo Del Sole
- Department of Diagnostic Services; Unit of Nuclear Medicine; San Paolo Hospital and Department of Health Sciences; University of Milan; Milan Italy
| | - Giampaolo Vatti
- Department of Neurological and Sensorial Sciences; University of Siena; Siena Italy
| | - Roberto Spreafico
- Clinical Epileptology and Experimental Neurophysiology Unit; Carlo Besta Neurological Institute; Milan Italy
| | - Giorgio Lo Russo
- C. Munari Epilepsy Surgery Center; Niguarda Hospital; Milan Italy
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Elliott RE, Bollo RJ, Berliner JL, Silverberg A, Carlson C, Geller EB, Barr WB, Devinsky O, Doyle WK. Anterior temporal lobectomy with amygdalohippocampectomy for mesial temporal sclerosis: predictors of long-term seizure control. J Neurosurg 2013; 119:261-72. [DOI: 10.3171/2013.4.jns121829] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
In this paper the authors' goal was to identify preoperative variables that predict long-term seizure freedom among patients with mesial temporal sclerosis (MTS) after single-stage anterior temporal lobectomy and amygdalohippocampectomy (ATL-AH).
Methods
The authors retrospectively reviewed 116 consecutive patients (66 females, mean age at surgery 40.7 years) with refractory seizures and pathologically confirmed MTS who underwent ATL-AH with at least 2 years of follow-up. All patients underwent preoperative MRI and video-electroencephalography (EEG); 106 patients (91.4%) underwent Wada testing and 107 patients (92.2%) had neuropsychological evaluations. The authors assessed the concordance of these 4 studies (defined as test consistent with the side of eventual surgery) and analyzed the impact of preoperative variables on seizure freedom.
Results
The median follow-up after surgery was 6.7 years (mean 6.9 years). Overall, 103 patients (89%) were seizure free, and 109 patients (94%) had Engel Class I or II outcome. Concordant findings were highest for video-EEG (100%), PET (100%), MRI (99.0%), and Wada testing (90.4%) and lowest for SPECT (84.6%) and neuropsychological testing (82.5%). Using binary logistic regression analysis (seizure free or not) and Cox proportional hazard analysis (seizure-free survival), less disparity in the Wada memory scores between the ipsilateral and contralateral sides was associated with persistent seizures.
Conclusions
Seizure freedom of nearly 90% can be achieved with ATL-AH in properly selected patients with MTS and concordant preoperative studies. The low number of poor outcomes and exclusion of multistage patients limit the statistical power to determine preoperative variables that predict failure. Strong Wada memory lateralization was associated with excellent long-term outcome and adds important localization information to structural and neurophysiological data in predicting outcome after ATL-AH for MTS.
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Affiliation(s)
| | - Robert J. Bollo
- 2Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine, Houston, Texas
| | | | - Alyson Silverberg
- 3Departments of Neurosurgery,
- 4Neurology, Comprehensive Epilepsy Center, and
| | | | - Eric B. Geller
- 5Institute of Neurology & Neurosurgery, Saint Barnabas Medical Center, Livingston, New Jersey
| | - William B. Barr
- 4Neurology, Comprehensive Epilepsy Center, and
- 6Psychiatry, New York University Langone Medical Center, New York, New York; and
| | - Orrin Devinsky
- 4Neurology, Comprehensive Epilepsy Center, and
- 5Institute of Neurology & Neurosurgery, Saint Barnabas Medical Center, Livingston, New Jersey
- 6Psychiatry, New York University Langone Medical Center, New York, New York; and
| | - Werner K. Doyle
- 3Departments of Neurosurgery,
- 4Neurology, Comprehensive Epilepsy Center, and
- 5Institute of Neurology & Neurosurgery, Saint Barnabas Medical Center, Livingston, New Jersey
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Bonelli SB, Thompson PJ, Yogarajah M, Powell RHW, Samson RS, McEvoy AW, Symms MR, Koepp MJ, Duncan JS. Memory reorganization following anterior temporal lobe resection: a longitudinal functional MRI study. ACTA ACUST UNITED AC 2013; 136:1889-900. [PMID: 23715092 PMCID: PMC3673465 DOI: 10.1093/brain/awt105] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Anterior temporal lobe resection controls seizures in 50-60% of patients with intractable temporal lobe epilepsy but may impair memory function, typically verbal memory following left, and visual memory following right anterior temporal lobe resection. Functional reorganization can occur within the ipsilateral and contralateral hemispheres. We investigated the reorganization of memory function in patients with temporal lobe epilepsy before and after left or right anterior temporal lobe resection and the efficiency of postoperative memory networks. We studied 46 patients with unilateral medial temporal lobe epilepsy (25/26 left hippocampal sclerosis, 16/20 right hippocampal sclerosis) before and after anterior temporal lobe resection on a 3 T General Electric magnetic resonance imaging scanner. All subjects had neuropsychological testing and performed a functional magnetic resonance imaging memory encoding paradigm for words, pictures and faces, testing verbal and visual memory in a single scanning session, preoperatively and again 4 months after surgery. Event-related analysis revealed that patients with left temporal lobe epilepsy had greater activation in the left posterior medial temporal lobe when successfully encoding words postoperatively than preoperatively. Greater pre- than postoperative activation in the ipsilateral posterior medial temporal lobe for encoding words correlated with better verbal memory outcome after left anterior temporal lobe resection. In contrast, greater postoperative than preoperative activation in the ipsilateral posterior medial temporal lobe correlated with worse postoperative verbal memory performance. These postoperative effects were not observed for visual memory function after right anterior temporal lobe resection. Our findings provide evidence for effective preoperative reorganization of verbal memory function to the ipsilateral posterior medial temporal lobe due to the underlying disease, suggesting that it is the capacity of the posterior remnant of the ipsilateral hippocampus rather than the functional reserve of the contralateral hippocampus that is important for maintaining verbal memory function after anterior temporal lobe resection. Early postoperative reorganization to ipsilateral posterior or contralateral medial temporal lobe structures does not underpin better performance. Additionally our results suggest that visual memory function in right temporal lobe epilepsy is affected differently by right anterior temporal lobe resection than verbal memory in left temporal lobe epilepsy.
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Affiliation(s)
- Silvia B Bonelli
- Epilepsy Society MRI Unit, Epilepsy Society, Chalfont St Peter, SL9 0RJ, UK
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Malikova H, Kramska L, Liscak R, Vojtech Z, Prochazka T, Mareckova I, Lukavsky J, Druga R. Stereotactic radiofrequency amygdalohippocampectomy for the treatment of temporal lobe epilepsy: Do good neuropsychological and seizure outcomes correlate with hippocampal volume reduction? Epilepsy Res 2012; 102:34-44. [DOI: 10.1016/j.eplepsyres.2012.04.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 03/28/2012] [Accepted: 04/21/2012] [Indexed: 11/26/2022]
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Falowski SM, Wallace D, Kanner A, Smith M, Rossi M, Balabanov A, Ouyang B, Byrne RW. Tailored Temporal Lobectomy for Medically Intractable Epilepsy. Neurosurgery 2012; 71:703-9; discussion 709. [DOI: 10.1227/neu.0b013e318262161d] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
There have been only a few large series that have used a tailored temporal lobectomy.
OBJECTIVE:
To clarify whether tailoring a temporal lobe resection will lead to equivalent epilepsy outcomes or have the same predictive factors for success when compared with standard resections.
METHODS:
Retrospective analysis of 222 patients undergoing a tailored temporal lobe resection. Demographic measures and typical factors influencing outcome were evaluated.
RESULTS:
Pathology included 222 cases. With a mean follow-up of 5.4 years, 70% of patients achieved Engel class I outcome. A significant factor predicting Engel class I outcome on multivariate analysis was lesional pathology (P = .04). Among patients with hippocampal sclerosis, extent of lateral neocortical resection and hippocampal resection were not statistically associated with Engel class I outcome (P = .93 and P = .24). However, an analysis of Engel class subgroups a to d showed that patients who had a complete hippocampectomy in the total series were more likely to achieve an Engel class Ia outcome (P = .04). This was also true among patients with hippocampal sclerosis (P = .03). Secondarily, generalized seizure (P = .01) predicted outcome less than Engel class I. Predictive of poor outcome was the need for preoperative electrodes (P = .02). Complications included superior quadrant visual field defects, 2 cases of permanent dysphasia, and 3 wound infections.
CONCLUSION:
Predictors of successful seizure outcome for a tailored temporal lobectomy are similar to standard lobectomy. Patients with secondarily generalized epilepsy and cases in which preoperative subdural electrodes were thought necessary were less likely to achieve class I outcome. Among Engel class I cases, those who had a complete hippocampectomy were more likely to achieve Engel class Ia outcome.
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Affiliation(s)
| | - David Wallace
- Department of Neurosurgery, Rush University, Chicago, Illinois
| | - Andres Kanner
- Department of Neurology, Rush University, Chicago, Illinois
| | - Michael Smith
- Department of Neurology, Rush University, Chicago, Illinois
| | - Michael Rossi
- Department of Neurology, Rush University, Chicago, Illinois
| | | | - Bichun Ouyang
- Department of Neurology, Rush University, Chicago, Illinois
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Helmstaedter C, Witt JA. Clinical neuropsychology in epilepsy: theoretical and practical issues. HANDBOOK OF CLINICAL NEUROLOGY 2012; 107:437-459. [PMID: 22938988 DOI: 10.1016/b978-0-444-52898-8.00036-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Barker ED, Tremblay RE, van Lier PAC, Vitaro F, Nagin DS, Assaad JM, Séguin JR. The neurocognition of conduct disorder behaviors: specificity to physical aggression and theft after controlling for ADHD symptoms. Aggress Behav 2011; 37:63-72. [PMID: 21046606 DOI: 10.1002/ab.20373] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There is growing evidence that among the different conduct disorder (CD) behaviors, physical aggression, but not theft, links to low neurocognitive abilities. Specifically, physical aggression has consistently been found to be negatively related to neurocognitive abilities, whereas theft has been shown to be either positively or not related to neurocognition. The specificity of these links needs further examination because attention deficit hyperactivity disorder (ADHD) links to both physical aggression and neurocognitive variation. The development of self-reported physical aggression and theft, from age 11 to 17 years, was studied in a prospective at-risk male cohort via a dual process latent growth curve model. Seven neurocognitive tests at age 20 were regressed on the growth parameters of physical aggression and theft. The links between neurocognition and the growth parameters of physical aggression and theft were adjusted for ADHD symptoms at ages 11 and 15 (parent, child and teacher reports). Results indicated that verbal abilities were negatively related to physical aggression while they were positively associated with theft. However, inductive reasoning was negatively associated with increases in theft across adolescence. Symptoms of ADHD accounted for part of the neurocognitive test links with physical aggression but did not account for the associations with theft. These differences emphasize the importance of examining specific CD behaviors to better understand their neurodevelopmental mechanisms. They also suggest that youth who engage in different levels of physical aggression or theft behaviors may require different preventive and corrective interventions.
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Affiliation(s)
- Edward D Barker
- Department of Psychological Sciences, University of London, United Kingdom.
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Shamim S, Wiggs E, Heiss J, Sato S, Liew C, Solomon J, Theodore WH. Temporal lobectomy: resection volume, neuropsychological effects, and seizure outcome. Epilepsy Behav 2009; 16:311-4. [PMID: 19703792 PMCID: PMC2785019 DOI: 10.1016/j.yebeh.2009.07.040] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Revised: 07/15/2009] [Accepted: 07/26/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The goal of the work described here was to evaluate relationships among resection volume, seizure outcome, and cognitive morbidity after temporal lobectomy for intractable epilepsy. METHODS Thirty patients with mesial temporal sclerosis were evaluated pre- and postoperatively with the Wechsler Adult Intelligence Scale III, Wechsler Memory Scale III, and three-dimensional coronal spoiled gradient recall acquisition MRI. Preoperative whole-brain volumes were calculated with Statistical Parametric Mapping. Resection volume was calculated by manual tracing. Systat was used for statistical analysis. RESULTS All resections included the temporal tip, at least 1cm of the superior temporal gyrus, and 3 to 5cm of the middle and inferior temporal gyri. Left were significantly smaller than right temporal resections. Seizure-free patients had significantly larger resections. Immediate verbal memory was significantly worse after left temporal lobectomy. Surgical outcome and resection volume did not affect postoperative neuropsychological results. CONCLUSIONS Dominant temporal lobe resections are associated with immediate verbal memory deficits. Larger resection volume was associated with improved seizure control but not worse cognitive outcome.
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Affiliation(s)
- Sadat Shamim
- Clinical Epilepsy Section, NINDS, NIH, Bethesda, MD 20892-1408
| | - Edythe Wiggs
- Office of the Clinical Director, NINDS, NIH, Bethesda, MD 20892-1404
| | - John Heiss
- Surgical Neurology Branch, NINDS, NIH, Bethesda, MD 20892-1414
| | - Susumu Sato
- EEG Section, OCD, NINDS, NIH, Bethesda, MD 20892-1404
| | - Clarissa Liew
- Clinical Epilepsy Section, NINDS, NIH, Bethesda, MD 20892-1408., EEG Section, OCD, NINDS, NIH, Bethesda, MD 20892-1404
| | - Jeffrey Solomon
- Medical Numerics 20410 Observation Drive Suite 210 Germantown, MD 20876
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Schramm J. Temporal lobe epilepsy surgery and the quest for optimal extent of resection: a review. Epilepsia 2008; 49:1296-307. [PMID: 18410360 DOI: 10.1111/j.1528-1167.2008.01604.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The efficacy of surgery to treat drug-resistant temporal lobe epilepsy (TLE) has been demonstrated in a prospective randomized trial. It remains controversial which resection method gives best results for seizure freedom and neuropsychological function. This review of 53 studies addressing extent of resection in surgery for TLE identified seven prospective studies of which four were randomized. There is considerable variability between the intended resection and the volumetrically assessed end result. Even leaving hippocampus or amygdalum behind can result in seizure freedom rates around 50%. Most authors found seizure outcome in selective amygdalohippocampectomy (SAH) to be similar to that of lobectomy and there is considerable evidence for better neuropsychological outcome in SAH. Studies varied in the relationship between extent of mesial resection and seizure freedom, most authors finding no positive correlation to larger mesial resection. Electrophysiological tailoring saw no benefit from larger resection in 6 of 10 studies. It must be concluded that class I evidence concerning seizure outcome related to type and extent of resection of mesial temporal lobe structures is rare. Many studies are only retrospective and do not use MRI volumetry. SAH appears to have similar seizure outcome and a better cognitive outcome than TLR. It remains unclear whether a larger mesial resection extent leads to better seizure outcome.
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Affiliation(s)
- Johannes Schramm
- Department of Neurosurgery, Bonn University Medical Center, University of Bonn, Bonn, Germany.
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