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Bruzsa AK, Walther K, Kasper BS, Gollwitzer S, Hamer H, Schwarz M. WADA test for postoperative memory prediction in left TLE. Is it still useful in the 21st century? Clin Neurol Neurosurg 2023; 225:107580. [PMID: 36638639 DOI: 10.1016/j.clineuro.2022.107580] [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: 11/22/2022] [Revised: 12/19/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Epilepsy surgery offers an effective treatment to achieve seizure freedom in refractory temporal lobe epilepsy. Since left temporal lobe surgery can be associated with verbal memory deterioration, control of cognitive decline is a main goal of therapy. This study analyzes the prognostic value of intracarotid amobarbital procedure (Wada test) in addition to specific neuropsychological and clinical variables for postoperative memory changes. METHOD Between 2013 and 2021 thirty-six patients (18 females, 18 males, mean age 41.0 years) from the Epilepsy Center Erlangen (ECE) with left hemispheric temporal lobe epilepsy underwent neuropsychological assessment preoperatively - including the Wada test - and six months postoperatively. In addition, a group of 92 patients (40 females, 52 males, mean age 36.1 years) with left or right hemispheric focus who underwent Wada test and surgery before 2013 was included as a standardization group. In all patients Wada test was carried out preoperatively to determine language dominance and memory capacity. RESULTS Postoperative verbal memory scores showed no significant difference from preoperative performance. Preoperative verbal memory performance as well as the hippocampal resection extent is particularly important in predicting postoperative verbal memory change. After left temporal lobe surgery, a significantly higher postoperative functional level was shown for figural memory. Specifically, a good contralateral hemispheric performance level assessed by the Wada test proved to be a compensatory factor for postoperative losses. CONCLUSION The Wada test is no longer necessary as a diagnostic tool for a broad group of patients with temporal lobe epilepsy. However, it can be useful for a subgroup of patients with clinical indicators such as nonspecific or incongruent preoperative verbal and figural memory impairments. In this study, Wada test data about the functional level of the contralateral hemisphere specifically allowed estimation of postoperative figural memory changes.
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Affiliation(s)
- Ann-Kathrin Bruzsa
- Department of Neurology, Epilepsy Center Erlangen, University Hospital Erlangen, Germany; Full member of ERN EpiCARE, Germany
| | - Katrin Walther
- Department of Neurology, Epilepsy Center Erlangen, University Hospital Erlangen, Germany; Full member of ERN EpiCARE, Germany
| | - Burkhard S Kasper
- Department of Neurology, Epilepsy Center Erlangen, University Hospital Erlangen, Germany; Full member of ERN EpiCARE, Germany
| | - Stefanie Gollwitzer
- Department of Neurology, Epilepsy Center Erlangen, University Hospital Erlangen, Germany; Full member of ERN EpiCARE, Germany
| | - Hajo Hamer
- Department of Neurology, Epilepsy Center Erlangen, University Hospital Erlangen, Germany; Full member of ERN EpiCARE, Germany
| | - Michael Schwarz
- Department of Neurology, Epilepsy Center Erlangen, University Hospital Erlangen, Germany; Full member of ERN EpiCARE, Germany.
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Lozano‐García A, Hampel KG, Garcés‐Sánchez M, Aparici‐Robles F, Rubio‐Sánchez P, González‐Bono E, Cano‐López I, Villanueva V. Drug load and memory during intracarotid amobarbital procedure in epilepsy. Acta Neurol Scand 2021; 144:585-591. [PMID: 34132388 DOI: 10.1111/ane.13491] [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: 02/02/2021] [Revised: 05/27/2021] [Accepted: 06/03/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Anti-seizure medications (ASMs) have been related to poor cognitive function, but their relationship with intracarotid amobarbital procedure (IAP) results remains unclear. AIMS OF THE STUDY To elucidate whether the number and drug load of ASMs are associated with memory scores of the IAP and the neuropsychological assessment. METHODS Fifty-nine adult patients with drug-resistant epilepsy (mean age = 36.1, SD = 11.6) underwent bilateral IAP (with drawings and words as memory items) and a neuropsychological assessment to assess the risk of post-surgical memory decline. Total ASM drug load was calculated by summing the daily dose/defined daily dose ratio of every ASM of each patient. Pearson's correlations and hierarchical regressions were computed. RESULTS Total IAP memory score was associated with total ASM drug load (r = -0.30, p = 0.02) and seizure frequency (r = -0.25, p = 0.05). After controlling clinical variables, total ASM drug load explained 16% of the variance of total IAP memory score. This relationship was especially prominent in patients with left hemisphere focus (r = -0.33, p = 0.04). The number of current ASMs was not related to IAP memory score (r = -0.16, p = 0.24). The number or drug load of ASMs were not related to neuropsychological assessment results (for all, p > 0.07). CONCLUSIONS Our findings suggest that total drug load can be a confounding variable in the IAP memory performance that could explain, at least in part, the reverse asymmetries reported in different studies.
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Affiliation(s)
| | - Kevin G. Hampel
- Refractory Epilepsy Unit, Department of Neurology Hospital Universitario y Politécnico La Fe Valencia Spain
| | - Mercedes Garcés‐Sánchez
- Refractory Epilepsy Unit, Department of Neurology Hospital Universitario y Politécnico La Fe Valencia Spain
| | - Fernando Aparici‐Robles
- Area of Medical Imaging Department of Radiology Hospital Universitario y Politécnico La Fe Valencia Spain
| | - Pilar Rubio‐Sánchez
- Department of Clinical Neurophysiology Hospital Universitario y Politécnico La Fe Valencia Spain
| | | | | | - Vicente Villanueva
- Refractory Epilepsy Unit, Department of Neurology Hospital Universitario y Politécnico La Fe Valencia Spain
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Baxendale S. Cognitive rehabilitation and prehabilitation in people with epilepsy. Epilepsy Behav 2020; 106:107027. [PMID: 32208338 DOI: 10.1016/j.yebeh.2020.107027] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/04/2020] [Accepted: 03/04/2020] [Indexed: 02/07/2023]
Abstract
Epilepsy is now recognized as a network disorder of the brain that can impact cognition beyond the periictal disturbance associated with seizures. While there is a large literature on the assessment of cognitive functions, particularly memory, in people with epilepsy, there are far fewer studies looking at the efficacy of treatments for cognitive dysfunction in this population. Reviews of the cognitive rehabilitation literature in epilepsy have begun to outnumber original studies. This paper examines the possible reasons for this unsatisfactory ratio in the literature and examines the unique challenges and opportunities for cognitive rehabilitation in this population, with a particular focus on epilepsy surgical candidates. The concept of prehabilitation in this population is described. While traditional cognitive rehabilitation is implemented after a patient has developed a neuropsychological deficit, in surgical candidates, prehabilitation uses intact functions before they are lost to establish compensatory strategies and routines prior to surgery in preparation for postoperative changes. The likely postoperative neuropsychological profile for individual patients can now be modeled using preoperative data. These predictions can guide and inform the prehabilitation process. Rather than concluding with a generic call for more research, the paper presents a framework for a rehabilitation program with practical solutions to address cognitive difficulties in both surgical and nonsurgical populations of people with epilepsy.
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Affiliation(s)
- Sallie Baxendale
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, UCL, UK; Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK; University College Hospital, London, UK.
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Tani N, Kishima H, Khoo HM, Yanagisawa T, Oshino S, Maruo T, Hosomi K, Hirata M, Kazui H, Nomura KT, Aly MM, Kato A, Yoshimine T. Electrical stimulation of the parahippocampal gyrus for prediction of posthippocampectomy verbal memory decline. J Neurosurg 2016; 125:1053-1060. [PMID: 26771851 DOI: 10.3171/2015.7.jns15408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Epilepsy surgery is of known benefit for drug-resistant temporal lobe epilepsy (TLE); however, a certain number of patients suffer significant decline in verbal memory after hippocampectomy. To prevent this disabling complication, a reliable test for predicting postoperative memory decline is greatly desired. Therefore, the authors assessed the value of electrical stimulation of the parahippocampal gyrus (PHG) as a provocation test of verbal memory decline after hippocampectomy on the dominant side. METHODS Eleven right-handed, Japanese-speaking patients with medically intractable left TLE participated in the study. Before surgery, they underwent provocative testing via electrical stimulation of the left PHG during a verbal encoding task. Their pre- and posthippocampectomy memory function was evaluated according to the Wechsler Memory Scale-Revised (WMS-R) and/or Mini-Mental State Examination (MMSE) before and 6 months after surgery. The relationship between postsurgical memory decline and results of the provocative test was evaluated. RESULTS Left hippocampectomy was performed in 7 of the 11 patients. In 3 patients with a positive provocative recognition test, verbal memory function, as assessed by the WMS-R, decreased after hippocampectomy, whereas in 4 patients with a negative provocative recognition test, verbal memory function, as assessed by the WMS-R or MMSE, was preserved. CONCLUSIONS Results of the present study suggest that electrical stimulation of the PHG is a reliable provocative test to predict posthippocampectomy verbal memory decline.
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Affiliation(s)
- Naoki Tani
- Departments of 1 Neurosurgery and.,Department of Neurosurgery, Osaka General Medical Center, Osaka
| | - Haruhiko Kishima
- Departments of 1 Neurosurgery and.,Epilepsy Center, Osaka University Hospital, Suita
| | - Hui Ming Khoo
- Departments of 1 Neurosurgery and.,Department of Neurosurgery, Yao Municipal Hospital, Yao
| | - Takufumi Yanagisawa
- Departments of 1 Neurosurgery and.,Epilepsy Center, Osaka University Hospital, Suita
| | - Satoru Oshino
- Departments of 1 Neurosurgery and.,Epilepsy Center, Osaka University Hospital, Suita
| | - Tomoyuki Maruo
- Departments of 1 Neurosurgery and.,Department of Neurosurgery, Otemae Hospital, Osaka
| | - Koichi Hosomi
- Departments of 1 Neurosurgery and.,Epilepsy Center, Osaka University Hospital, Suita
| | - Masayuki Hirata
- Departments of 1 Neurosurgery and.,Epilepsy Center, Osaka University Hospital, Suita
| | - Hiroaki Kazui
- Psychiatry, Osaka University Graduate School of Medicine, Suita
| | | | - Mohamed M Aly
- Department of Neurosurgery, Mansoura University Hospital, Mansoura, Egypt
| | - Amami Kato
- Department of Neurosurgery, Kinki University School of Medicine, Osaka-Sayama, Japan; and
| | - Toshiki Yoshimine
- Departments of 1 Neurosurgery and.,Epilepsy Center, Osaka University Hospital, Suita
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Passarelli V, Castro-Lima Filho H, Adda CC, Preturlon-Santos AP, Valerio RM, Jorge CL, Puglia-Jr P, Lyra K, Otaduy MG, Wen HT, Castro LH. Contralateral ictal electrographic involvement is associated with decreased memory performance in unilateral mesial temporal sclerosis. J Neurol Sci 2015; 359:241-6. [DOI: 10.1016/j.jns.2015.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 10/08/2015] [Accepted: 11/04/2015] [Indexed: 10/22/2022]
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Rathore C, Alexander A, Sarma PS, Radhakrishnan K. Memory outcome following left anterior temporal lobectomy in patients with a failed Wada test. Epilepsy Behav 2015; 44:207-12. [PMID: 25768711 DOI: 10.1016/j.yebeh.2015.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 02/09/2015] [Accepted: 02/09/2015] [Indexed: 11/15/2022]
Abstract
PURPOSE This study aimed to compare the memory outcome following left anterior temporal lobectomy (ATL) between patients with a failed Wada test and patients who passed the Wada test. METHODS From 1996 to 2002, we performed the Wada test on all patients with unilateral left mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) and concordant electroclinical data before ATL. We used a 12-item recognition paradigm for memory testing and awarded a score of +1 for each correct response and -0.5 for each incorrect response. No patient was denied surgery on the basis of Wada scores. We assessed cognitive and memory functions using the Wechsler Adult Intelligence Scale and the Wechsler Memory Scale preoperatively and at one year after ATL. We compared the number of patients who showed decline in memory scores, as per the published reliable change indices, between the patients with a failed Wada test and the patients who passed the Wada test. RESULTS Out of the 116 eligible patients with left MTLE-HS, 88 underwent bilateral Wada test, while 28 underwent ipsilateral Wada test. None of them developed postoperative amnesia. Approximately, one-third of patients with a failed Wada memory test when the failure was defined as a contralateral score of <4, as an ipsilateral score of >8, and as an asymmetry score of <0. The patients with Wada memory failure had a longer pre-ATL duration of epilepsy (p<0.003). The memory and quality-of-life outcomes did not differ between the group with a failed Wada memory test and the group who passed the Wada memory test. The results remained the same when analyses were repeated at various other cutoff points. CONCLUSION The patients with left MTLE-HS with concordant electroclinical, MRI, and neuropsychological data should not be denied ATL solely on the basis of Wada memory test results.
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Affiliation(s)
- Chaturbhuj Rathore
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Aley Alexander
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - P Sankara Sarma
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Kurupath Radhakrishnan
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
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Andelman F, Kipervasser S, Maimon S, Fried I, Parmet Y, Neufeld MY. A revised intracarotid etomidate memory (Wada) procedure. Acta Neurol Scand 2013; 127:97-102. [PMID: 22651814 DOI: 10.1111/j.1600-0404.2012.01685.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate unilateral memory function by the means of a modified Montreal etomidate speech and memory procedure (e-SAM) in epilepsy patients who were candidates for standard anterior temporal lobectomy involving resection of mesial temporal lobe structures. MATERIALS AND METHODS After the first three patients experienced significant side effects with the e-SAM procedure, we modified the procedure to a single bolus injection. The neuropsychological data of all 21 patients who underwent unilateral memory testing by means of intracarotid injection of etomidate were analyzed. RESULTS There was a significant difference in memory scores when injections were on the side ipsilateral to the epileptogenic focus compared with when the injections were on the contralateral side (P < 0.01), supposedly reflecting unilateral hippocampal memory function and dysfunction. In addition, the procedural modification resulted in eradication of all major side effects in the ensuing 18 patients. CONCLUSIONS The technical modification of the Montreal procedure from continuous to bolus injection effectively enabled the demonstration of the relative weakness of the memory function of the epileptogenic hemisphere. The revised etomidate procedure provided the clinical information on unilateral hippocampal memory function necessary for surgical decision.
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Affiliation(s)
- F. Andelman
- Functional Neurosurgery Unit, Department of Neurosurgery; Tel Aviv Medical Centre; Tel Aviv; Israel
| | | | - S. Maimon
- Department of Neurosurgery; Tel Aviv Medical Center; Tel Aviv; Israel
| | | | - Y. Parmet
- Department of Industrial Engineering and Management; Ben-Gurion University; Beersheba; Israel
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Neuropsychology in temporal lobe epilepsy: influences from cognitive neuroscience and functional neuroimaging. EPILEPSY RESEARCH AND TREATMENT 2012; 2012:925238. [PMID: 22957249 PMCID: PMC3420484 DOI: 10.1155/2012/925238] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 10/09/2011] [Indexed: 12/28/2022]
Abstract
Neuropsychologists assist in diagnosis (i.e., localization of dysfunction) and in prediction (i.e., how cognition may change following surgery) in individuals being considered for temporal lobe surgery. The current practice includes behavioural testing as well as mapping function via stimulation, inactivation, and (more recently) functional imaging. These methods have been providing valuable information in surgical planning for 60 years. Here, we discuss current assessment strategies and highlight how they are evolving, particularly with respect to integrating recent advances in cognitive neuroscience.
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Kovac S, Möddel G, Reinholz J, Alexopoulos AV, Syed T, Schuele SU, Lineweaver T, Loddenkemper T. Memory performance is related to language dominance as determined by the intracarotid amobarbital procedure. Epilepsy Behav 2009; 16:145-9. [PMID: 19682954 DOI: 10.1016/j.yebeh.2009.07.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Revised: 07/07/2009] [Accepted: 07/10/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The goal of this study was to explore the relationship between language and memory lateralization in patients with epilepsy undergoing the intracarotid amobarbital procedure. METHODS In 386 patients, language lateralization and memory lateralization as determined by laterality index (LI) were correlated with each other. RESULTS Language lateralization and memory lateralization were positively correlated (r=0.34, P<0.01). Correlations differed depending on the presence and type of lesion (chi(2)=7.98, P<0.05). LIs correlated significantly higher (z=2.82, P<0.05) in patients with cortical dysplasia (n=41, r=0.61, P<0.01) compared with the group without lesions (n=90, r=0.16, P>0.05), with patients with hippocampal sclerosis falling between these two groups. Both memory (P<0.01) and language (P<0.01) LIs were higher in right- compared with left-sided lesions. CONCLUSION Correlation of language and memory is more pronounced in patients with structural lesions as compared with patients without lesions on MRI.
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Affiliation(s)
- S Kovac
- Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
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