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Jeong JW, Lee MH, Behen M, Uda H, Gjolaj N, Luat A, Asano E, Juhász C. Quantitative phenotyping of verbal and non-verbal cognitive impairment using diffusion-weighted MRI connectome: Preliminary study of the crowding effect in children with left hemispheric epilepsy. Epilepsy Behav 2024; 160:110009. [PMID: 39241639 DOI: 10.1016/j.yebeh.2024.110009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 07/22/2024] [Accepted: 08/20/2024] [Indexed: 09/09/2024]
Abstract
The "crowding" effect (CE), wherein verbal functions are preserved presumably at the expense of nonverbal functions, which diminish following inter-hemispheric transfer of language functions, is recognized as a specific aspect of functional reorganization, offering an insight about neural plasticity in children with neural insult to the dominant hemisphere. CE is hypothesized as a marker for language preservation or improvement after left-hemispheric injury, yet it remains challenging to fully discern it in preoperative evaluation. We present a novel DWI connectome (DWIC) approach to predict the presence of CE in 24 drug-resistant epilepsy (DRE) patients with a left-hemispheric focus and 29 young healthy controls. Psychometry-driven DWIC analysis was applied to create verbal and non-verbal modular networks. Local efficiency (LE) was assessed at individual regions of the two networks and its Z-score was compared to predict the presence of CE. Compared with a traditional organization (TO) group, wherein verbal functions are adversely affected, while non-verbal functions are preserved, the CE group showed significantly higher Z-scores in verbal network and significantly lower Z-scores in non-verbal network, corresponding to network reorganization in CE. A larger number of antiseizure drugs was significantly associated with more decreased Z-score in the right non-verbal network of the CE group and left verbal network of the TO group. These findings hold great potential to identify DRE patients whose verbal/language skills may over time be preserved due to effective inter-hemispheric reorganization and identify those whose verbal/language impairments may persist due to lack of inter-hemispheric reorganization.
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Affiliation(s)
- Jeong-Won Jeong
- Department of Pediatrics, Wayne State University, Detroit, MI, United States; Translational Imaging Laboratory, University Health Center, Detroit, MI, United States; Department of Neurology, Wayne State University, Detroit, MI, United States; Translational Neuroscience Program, Wayne State University, Detroit, MI, United States.
| | - Min-Hee Lee
- Department of Pediatrics, Wayne State University, Detroit, MI, United States; Translational Imaging Laboratory, University Health Center, Detroit, MI, United States
| | - Michael Behen
- Department of Pediatrics, Wayne State University, Detroit, MI, United States; Department of Neurology, Wayne State University, Detroit, MI, United States
| | - Hiroshi Uda
- Department of Pediatrics, Wayne State University, Detroit, MI, United States
| | - Nore Gjolaj
- Department of Pediatrics, Wayne State University, Detroit, MI, United States
| | - Aimee Luat
- Department of Neurology, Wayne State University, Detroit, MI, United States; Department of Pediatrics, Central Michigan University, Mt. Pleasant, MI, United States
| | - Eishi Asano
- Department of Pediatrics, Wayne State University, Detroit, MI, United States; Translational Imaging Laboratory, University Health Center, Detroit, MI, United States; Department of Neurology, Wayne State University, Detroit, MI, United States; Translational Neuroscience Program, Wayne State University, Detroit, MI, United States
| | - Csaba Juhász
- Department of Pediatrics, Wayne State University, Detroit, MI, United States; Translational Imaging Laboratory, University Health Center, Detroit, MI, United States; Department of Neurology, Wayne State University, Detroit, MI, United States; Translational Neuroscience Program, Wayne State University, Detroit, MI, United States
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Pasquini L, Di Napoli A, Rossi-Espagnet MC, Visconti E, Napolitano A, Romano A, Bozzao A, Peck KK, Holodny AI. Understanding Language Reorganization With Neuroimaging: How Language Adapts to Different Focal Lesions and Insights Into Clinical Applications. Front Hum Neurosci 2022; 16:747215. [PMID: 35250510 PMCID: PMC8895248 DOI: 10.3389/fnhum.2022.747215] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 01/18/2022] [Indexed: 12/13/2022] Open
Abstract
When the language-dominant hemisphere is damaged by a focal lesion, the brain may reorganize the language network through functional and structural changes known as adaptive plasticity. Adaptive plasticity is documented for triggers including ischemic, tumoral, and epileptic focal lesions, with effects in clinical practice. Many questions remain regarding language plasticity. Different lesions may induce different patterns of reorganization depending on pathologic features, location in the brain, and timing of onset. Neuroimaging provides insights into language plasticity due to its non-invasiveness, ability to image the whole brain, and large-scale implementation. This review provides an overview of language plasticity on MRI with insights for patient care. First, we describe the structural and functional language network as depicted by neuroimaging. Second, we explore language reorganization triggered by stroke, brain tumors, and epileptic lesions and analyze applications in clinical diagnosis and treatment planning. By comparing different focal lesions, we investigate determinants of language plasticity including lesion location and timing of onset, longitudinal evolution of reorganization, and the relationship between structural and functional changes.
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Affiliation(s)
- Luca Pasquini
- Neuroradiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
- Neuroradiology Unit, NESMOS Department, Sant’Andrea Hospital, La Sapienza University, Rome, Italy
| | - Alberto Di Napoli
- Neuroradiology Unit, NESMOS Department, Sant’Andrea Hospital, La Sapienza University, Rome, Italy
- Radiology Department, Castelli Hospital, Rome, Italy
- IRCCS Fondazione Santa Lucia, Rome, Italy
| | | | - Emiliano Visconti
- Neuroradiology Unit, Cesena Surgery and Trauma Department, M. Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Antonio Napolitano
- Medical Physics Department, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Andrea Romano
- Neuroradiology Unit, NESMOS Department, Sant’Andrea Hospital, La Sapienza University, Rome, Italy
| | - Alessandro Bozzao
- Neuroradiology Unit, NESMOS Department, Sant’Andrea Hospital, La Sapienza University, Rome, Italy
| | - Kyung K. Peck
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Andrei I. Holodny
- Neuroradiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
- Department of Radiology, Weill Medical College of Cornell University, New York, NY, United States
- Department of Neuroscience, Weill-Cornell Graduate School of the Medical Sciences, New York, NY, United States
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Fatoorechi S, Westerveld M, Lee GP. Atypical language representation as a protective factor against verbal memory decline following epilepsy surgery. Epilepsy Behav 2020; 112:107451. [PMID: 32956944 DOI: 10.1016/j.yebeh.2020.107451] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 08/20/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE An important role of neuropsychology in the preoperative evaluation of epilepsy surgery candidates is to assess risk for postoperative memory decline. One factor associated with postoperative verbal memory decline is surgery in the language-dominant temporal lobe (TL). The aim of the study was to determine whether atypical language representation has a protective effect against verbal memory decline following left temporal, frontotemporal, or hippocampal excision. METHODS Data from 61 patients with medically refractory epilepsy, Wada testing, and pre- and postsurgical memory assessment from four comprehensive epilepsy surgery centers were gathered and examined for pre- to postsurgical memory change. Wada testing was used to determine language dominance (left vs. atypical [bilateral + right]). Postoperative memory change was examined at both the individual (using nonparametric analyses) and group (using parametric analyses) levels for the two language dominance groups. RESULTS Significant postoperative verbal memory decline was observed in the left hemisphere language-dominant group, while the atypical language group showed verbal memory improvement. Individuals with left hemisphere language dominance were more likely to show postoperative declines in verbal memory, whereas individuals with atypical language dominance were significantly less likely to decline. As expected, there were no significant differences between language groups with regard to postoperative visuospatial memory outcome. CONCLUSION Patients with atypical language dominance had better verbal memory outcomes following left hemisphere resections than those with left hemisphere language dominance suggesting that typical memory substrates likely reorganized along with language. Thus, atypical cerebral organization of language may be considered a protective factor against verbal memory decline following epilepsy surgery involving the left TL.
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Affiliation(s)
| | | | - Gregory P Lee
- Barrow Neurological Institute, United States of America.
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Abstract
Since the seminal work on the patient HM, who in his adulthood presented an acquired amnesic syndrome following the resection of the bilateral temporal lobe, other research has described several cases of isolated memory dysfunction in children. This chapter presents developmental and long-lasting memory disorders emerging from an organic or neurologic cause at birth or in infancy. More notably, we focus on developmental amnesic syndrome caused by neonatal bihippocampal damage and memory dysfunction caused by medial temporal developmental epilepsy. We describe these two pediatric populations and present the consequences of hippocampal/medial temporal lobe damage in the development of memory systems. We review episodic memory deficits in children with developmental amnesia and temporal lobe epilepsy and highlight their impact on new learning, personal memories, and independent life. Finally, we provide a brief overview of some of the insights and debates emerging from classic work and recent advances in the context of episodic memory dysfunction displayed by children with hippocampal/medial temporal lobe amnesia and propose new perspectives in child neuropsychology of memory, suggesting new avenues for more ecologic memory assessment and rehabilitation.
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Burns TG, Semmel ES, Reisner A. A longitudinal evaluation of a penetrating traumatic brain injury: Theories of plasticity and vulnerability. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:881-886. [PMID: 32546024 DOI: 10.1080/23279095.2020.1780239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Penetrating traumatic brain injury (TBI) is uncommon in infancy. The consequences may be devastating, especially when the injury is extensive and affects eloquent areas of the brain. There is the potential for neuropsychological dysfunction that may impact the individual's development and well-being into adulthood. In the context of early brain injury, the developing brain is both remarkably resilient and vulnerable. The present case study describes a patient who experienced a penetrating TBI at 9 days of age, subsequently developed intractable seizures, and underwent left hemispherectomy. Neuropsychological testing at ages 5, 10, 11, and 19 years are presented alongside fMRI and Wada testing. While the patient initially developed cognitive functions in the low-average range by age 5, scores on neuropsychological assessments began to decrease thereafter. This case is discussed with attention to vulnerability and plasticity theories. It highlights the ability of the brain to reorganize and allow the development of functions that would normally be sub-served by damaged areas and the limits of plasticity. Further, this case illustrates the vulnerability of the early brain to insult, the potential to grow into deficits, and the need to consider a variety of factors when predicting outcomes for cases of pediatric brain injury.
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Affiliation(s)
- Thomas G Burns
- Department of Neuropsychology, Emory University School of Medicine, Atlanta, GA, USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Eric S Semmel
- Department of Psychology & The Neuroscience Institute, Georgia State University, Atlanta, GA, USA
| | - Andrew Reisner
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Children's Healthcare of Atlanta, Atlanta, GA, USA.,Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
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Gould L, Wu A, Tellez-Zenteno JF, Neudorf J, Kress S, Gibb K, Ekstrand C, Dabirzadeh H, Ahmed SU, Borowsky R. Atypical language localization in right temporal lobe epilepsy: An fMRI case report. Epilepsy Behav Rep 2020; 14:100364. [PMID: 32462137 PMCID: PMC7243043 DOI: 10.1016/j.ebr.2020.100364] [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: 09/27/2019] [Revised: 03/03/2020] [Accepted: 03/06/2020] [Indexed: 11/25/2022] Open
Abstract
We report a 41- year-old, left-handed patient with drug-resistant right temporal lobe epilepsy (TLE). Presurgical fMRI was conducted to examine whether the patient had language functioning in the right hemisphere given that left-handedness is associated with a higher prevalence of right hemisphere dominance for language. The fMRI results revealed bilateral activation in Broca's and Wernicke's areas and activation of eloquent cortex near the region of planned resection in the right temporal lobe. Due to right temporal language-related activation, the patient underwent an awake right-sided temporal lobectomy with intraoperative language mapping. Intraoperative direct cortical stimulation (DCS) was conducted in the regions corresponding to the fMRI activation, and the patient showed language abnormalities, such as paraphasic errors, and speech arrest. The decision was made to abort the planned anterior temporal lobe procedure, and the patient instead underwent a selective amygdalohippocampectomy via the Sylvian fissure at a later date. Post-operatively the patient was seizure-free with no neurological deficits. Taken together, the results support previous findings of right hemisphere language activation in left-handed individuals, and should be considered in cases in which presurgical localization is conducted for left-hand dominant patients undergoing neurosurgical procedures. The report evaluates evidence for the possibility of right hemisphere language activation in a left-handed right TLE patient The results of the fMRI tasks showed bilateral speech regions, such as left and right Broca's area and Wernicke's area The results support previous findings of right hemisphere language activation in left-handed individuals The report discusses the value of fMRI of language tasks for presurgical planning in epilepsy cases Report highlights how fMRI findings can alter surgical strategy and how intraoperative brain mapping validates these findings
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Affiliation(s)
- Layla Gould
- Department of Surgery, Division of Neurosurgery, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
- Correspondence to: L. Gould, Department of Surgery, University of Saskatchewan, SK S7N 5A5, Canada.
| | - Adam Wu
- Department of Surgery, Division of Neurosurgery, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
| | - Jose F. Tellez-Zenteno
- Department of Medicine, Division of Neurology, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
| | - Josh Neudorf
- Department of Psychology, University of Saskatchewan, 9 Campus Drive, Saskatoon, SK S7N 5A5, Canada
| | - Shaylyn Kress
- Department of Psychology, University of Saskatchewan, 9 Campus Drive, Saskatoon, SK S7N 5A5, Canada
| | - Katherine Gibb
- Department of Psychology, University of Saskatchewan, 9 Campus Drive, Saskatoon, SK S7N 5A5, Canada
| | - Chelsea Ekstrand
- Department of Psychology, University of Saskatchewan, 9 Campus Drive, Saskatoon, SK S7N 5A5, Canada
| | - Hamid Dabirzadeh
- Department of Medical Imaging, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK S7N 0W8, Canada
| | - Syed Uzair Ahmed
- Department of Surgery, Division of Neurosurgery, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
| | - Ron Borowsky
- Department of Psychology, University of Saskatchewan, 9 Campus Drive, Saskatoon, SK S7N 5A5, Canada
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Gonzalez LM, Wrennall JA. A neuropsychological model for the pre-surgical evaluation of children with focal-onset epilepsy: An integrated approach. Seizure 2020; 77:29-39. [DOI: 10.1016/j.seizure.2018.12.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/28/2018] [Accepted: 12/17/2018] [Indexed: 12/20/2022] Open
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Danguecan AN, Smith ML. Re-examining the crowding hypothesis in pediatric epilepsy. Epilepsy Behav 2019; 94:281-287. [PMID: 30904421 DOI: 10.1016/j.yebeh.2019.01.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 01/29/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE In adults with left-sided epilepsy, reorganized language may "crowd out" right-hemisphere visual-spatial skills, with relative sparing of language (i.e., the crowding hypothesis). However, this effect has not consistently been demonstrated in pediatric epilepsy studies. The objective of this study was to investigate the crowding hypothesis using a heterogeneous sample of children with intractable epilepsy and typical (left) language dominance or atypical (right or bilateral) language dominance. We examined the relative contributions of seizure onset (before or after age 5), handedness (right versus left), seizure localization (temporal versus extratemporal), as well as language dominance on verbal versus visual cognitive skills. METHOD We retrospectively analyzed neuropsychology assessment results from a sample of 91 children who completed presurgical evaluation at the Hospital for Sick Children in Toronto, Canada (34 with typical language, 57 with atypical language, mean age = 12 years). We considered a selection of verbal skills (naming, vocabulary knowledge, verbal abstract reasoning) and visual skills (visual-motor integration, block construction, visual abstract reasoning). RESULTS Consistent with several previous adult studies supporting the crowding hypothesis, univariate analyses showed that the typical and atypical language groups were comparable on the measures of vocabulary knowledge and abstract verbal reasoning whereas the atypical language group produced lower scores across visual measures. Multivariate analyses (taking into account language dominance and associated factors) showed that language dominance was the strongest predictor of performance on two of three visual measures whereas language dominance was not a significant predictor of performance on most verbal measures. Unexpectedly, both sets of analyses indicated that the atypical language group had poorer naming abilities than the typical language group. SIGNIFICANCE Our data provide some evidence of right-hemisphere functional crowding effects in a heterogeneous sample of children with intractable left-sided epilepsy. Specifically, those with atypical versus typical language dominance showed poorer visual-motor integration and visual-motor problem-solving skills, with comparable scores on certain verbal measures. It is critical that potential crowding effects be considered when interpreting the neuropsychological profiles of children being evaluated for epilepsy surgery.
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Affiliation(s)
- Ashley N Danguecan
- Department of Psychology, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada.
| | - Mary Lou Smith
- Department of Psychology, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada; Department of Psychology, University of Toronto Mississauga, Mississauga, Canada; Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, Canada.
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Morrison CE, MacAllister WS, Barr WB. Neuropsychology Within a Tertiary Care Epilepsy Center. Arch Clin Neuropsychol 2018; 33:354-364. [PMID: 29718083 DOI: 10.1093/arclin/acx134] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 12/04/2017] [Indexed: 11/12/2022] Open
Abstract
Epilepsy is a prevalent condition characterized by variations in its clinical presentation, etiology, and amenability to treatment. Through history, neuropsychologists have played a significant role in performing research studies on changes in language, memory, and executive functioning in patients with epilepsy, including those undergoing surgical treatment for medically refractory seizures. These studies provided a foundation for establishing neuropsychologists as critical members of interdisciplinary clinical teams specializing in evaluation and treatment of epilepsy. This article describes a number of elements of specialized neuropsychological practice that have evolved over the years within a tertiary care epilepsy center. Through diagnostic interview and objective testing, the neuropsychologist is able to provide a more complete and objective understanding of a patient's cognitive and behavioral functioning than what is obtained by other clinicians through brief office visits. While assessment of cognition, mood, and behavior is the most commonly provided service to patients with epilepsy from all age groups, there are many instances when neuropsychologists in surgical settings are called to perform more specialized procedures, including the intracarotid amytal (Wada) procedure, electrocortical stimulation mapping of language eloquent brain regions, and functional brain imaging procedures. While working as a neuropsychologist on an interdisciplinary epilepsy care team requires specialized knowledge and clinical training, it is extremely satisfying due to the diversity of the patient population and the particular challenges resulting from the often unique manner that cognition and behavior can be affected in patients with epilepsy across the lifespan.
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Affiliation(s)
- Chris E Morrison
- New York University School of Medicine, Department of Neurology, New York, NY, USA
| | | | - William B Barr
- New York University School of Medicine, Department of Neurology, New York, NY, USA
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Luat AF, Behen ME, Chugani HT, Juhász C. Cognitive and motor outcomes in children with unilateral Sturge-Weber syndrome: Effect of age at seizure onset and side of brain involvement. Epilepsy Behav 2018; 80:202-207. [PMID: 29414553 PMCID: PMC5845773 DOI: 10.1016/j.yebeh.2018.01.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/05/2018] [Accepted: 01/08/2018] [Indexed: 01/06/2023]
Abstract
PURPOSE Most children with Sturge-Weber syndrome (SWS) develop seizures that may contribute to neurocognitive status. In this study, we tested the hypothesis that very early seizure onset has a particularly detrimental effect on the cognitive and/or motor outcomes of children with unilateral SWS. We also tested whether side of SWS brain involvement modulates the effect of seizure variables on the pattern of cognitive abnormalities. METHODS Thirty-four children (22 girls; mean age 6.1years) with unilateral SWS and history of epilepsy in a longitudinal cohort underwent neurological and cognitive evaluations. Global intelligent quotient (GIQ), verbal intelligent quotient (VIQ), nonverbal intelligent quotient (IQ), and motor function were correlated with epilepsy variables, side and extent of brain involvement on magnetic resonance imaging (MRI). RESULTS Mean age at seizure onset was 1.3years (0.1-6years) and mean IQ at follow-up was 86 (45-118). Age at seizure onset showed a logarithmic association with IQ, with maximum impact of seizures starting before age 1year, both in uni- and multivariate regression analyses. In the left SWS group (N=20), age at seizure onset was a strong predictor of nonverbal IQ (p=0.001); while early seizure onset in the right-hemispheric group had a more global effect on cognitive functions (p=0.02). High seizure frequency and long epilepsy duration also contributed to poor outcome IQ independently in multivariate correlations. Children with motor involvement started to have seizures at/before 7months of age, while frontal lobe involvement was the strongest predictor of motor deficit in a multivariate analysis (p=0.017). CONCLUSION These findings suggest that seizure onset prior to age 1year has a profound effect on severity of cognitive and motor dysfunction in children with SWS; however, the effect of seizures on the type of cognitive deficit is influenced by laterality of brain involvement.
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Affiliation(s)
- Aimee F Luat
- Departments of Pediatrics and Neurology, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit Medical Center, 3901 Beaubien St., Detroit, MI 48201, USA.
| | - Michael E Behen
- Departments of Pediatrics and Neurology, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit Medical Center, 3901 Beaubien St., Detroit, MI 48201, USA
| | - Harry T Chugani
- Departments of Pediatrics and Neurology, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit Medical Center, 3901 Beaubien St., Detroit, MI 48201, USA; Department of Neurology, School of Medicine, Thomas Jefferson University, Philadelphia, PA, USA; Division of Pediatric Neurology, Nemours A.I. DuPont Hospital for Children, 1600 Rockland Rd., Wilmington, Delaware, 19803, USA
| | - Csaba Juhász
- Departments of Pediatrics and Neurology, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit Medical Center, 3901 Beaubien St., Detroit, MI 48201, USA
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Helmstaedter C, Pandolfo RV, Hoppe C, Witt JA. Cognitive-behavioral correlates of proxy reports on cognitive capabilities in pediatric patients with epilepsy. Seizure 2017; 51:193-199. [DOI: 10.1016/j.seizure.2017.08.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 08/22/2017] [Accepted: 08/24/2017] [Indexed: 10/18/2022] Open
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12
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Age-related language lateralization assessed by fMRI: The effects of sex and handedness. Brain Res 2017; 1674:20-35. [PMID: 28830770 DOI: 10.1016/j.brainres.2017.08.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 08/14/2017] [Accepted: 08/16/2017] [Indexed: 11/21/2022]
Abstract
Previous studies focusing on the relationship between lateralization of language function and age suffer from lack of a balanced distribution of age and handedness among participants, especially in the extremes of age. This limits our understanding of the influence of these factors on lateralization of language circuitry. The hemispheric asymmetry reduction in older adults (HAROLD) model suggests that under similar circumstances, involvement in cognitive processes of prefrontal (and potentially other) cortical areas tends to be less lateralized with age. In this study, we aimed to investigate the link between age, gender, and language lateralization in a large group of healthy participants with a relatively even distribution of age and handedness in order to further test the HAROLD model. 99 healthy men (33 left-handed; age range 18-74years) and 125 women (44 left-handed; age range 19-76) were recruited. All participants underwent fMRI at 3T with a semantic decision and a verb generation tasks and received a battery of linguistic tests. Lateralization indexes (LI) were calculated for each participant based on fMRI results for each task separately. LIs were found to be significantly decreasing with age only in right-handed men and only in temporo-parietal cortical area. LIs did not change with age in other brain regions or in left-handed subjects. Our results do not support the HAROLD model and suggest a potentially different relationship between aging and lateralization of language functions.
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Bulteau C, Jambaqué I, Chiron C, Rodrigo S, Dorfmüller G, Dulac O, Hertz-Pannier L, Noulhiane M. Language plasticity after hemispherotomy of the dominant hemisphere in 3 patients: Implication of non-linguistic networks. Epilepsy Behav 2017; 69:86-94. [PMID: 28236728 DOI: 10.1016/j.yebeh.2017.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 01/04/2017] [Accepted: 01/06/2017] [Indexed: 10/20/2022]
Abstract
The neural networks involved in language recovery following hemispherotomy of the dominant hemisphere after language acquisition in children remain poorly known. Twelve hemispherotomized children (mean age at surgery: 11.3years) with comparable post-operative neuropsychological patterns underwent multi-task language functional MRI. Three of them had recovered from an initial postoperative aphasia i.e., hemispherotomy was performed on the language-dominant hemisphere. Our main results revealed (1) perisylvian activations in all patients after either left or right hemispherotomy; (2) no differences in activations between groups regarding the side of hemispherotomy; (3) additional activations in pre-frontal (3/3) and hippocampal/parahippocampal and occipito-parietal (2/3) areas, when comparing language activation in each of the three subjects with hemispherotomy of the language-dominant hemisphere to the group of 9 non-dominant hemispherotomized patients. These neural networks support the stronger engagement of learning and memory during language recovery in a hemisphere that was not initially actively subserving language.
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Affiliation(s)
- Christine Bulteau
- INSERM U1129 "Infantile Epilepsies and Brain Plasticity", Paris, France; Université Paris Descartes, Sorbonne Paris Cité, France; CEA, Gif sur Yvette, France; Rothschild Foundation Hospital, Pediatric Neurosurgery Department, Paris, France.
| | - Isabelle Jambaqué
- INSERM U1129 "Infantile Epilepsies and Brain Plasticity", Paris, France; Université Paris Descartes, Sorbonne Paris Cité, France; CEA, Gif sur Yvette, France; Rothschild Foundation Hospital, Pediatric Neurosurgery Department, Paris, France
| | - Catherine Chiron
- INSERM U1129 "Infantile Epilepsies and Brain Plasticity", Paris, France; Université Paris Descartes, Sorbonne Paris Cité, France; CEA, Gif sur Yvette, France; CEA, I2BM, Neurospin & Orsay, and IFR 49, Saclay, France
| | - Sebastian Rodrigo
- INSERM U1129 "Infantile Epilepsies and Brain Plasticity", Paris, France; Université Paris Descartes, Sorbonne Paris Cité, France; CEA, Gif sur Yvette, France; CEA, I2BM, Neurospin & Orsay, and IFR 49, Saclay, France
| | - Georg Dorfmüller
- Rothschild Foundation Hospital, Pediatric Neurosurgery Department, Paris, France
| | - Olivier Dulac
- INSERM U1129 "Infantile Epilepsies and Brain Plasticity", Paris, France; Université Paris Descartes, Sorbonne Paris Cité, France; CEA, Gif sur Yvette, France
| | - Lucie Hertz-Pannier
- INSERM U1129 "Infantile Epilepsies and Brain Plasticity", Paris, France; Université Paris Descartes, Sorbonne Paris Cité, France; CEA, Gif sur Yvette, France; CEA, I2BM, Neurospin & Orsay, and IFR 49, Saclay, France
| | - Marion Noulhiane
- INSERM U1129 "Infantile Epilepsies and Brain Plasticity", Paris, France; Université Paris Descartes, Sorbonne Paris Cité, France; CEA, Gif sur Yvette, France; CEA, I2BM, Neurospin & Orsay, and IFR 49, Saclay, France
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14
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Whitman L, Scharaga EA, Blackmon K, Wiener J, Bender HA, Weiner HL, MacAllister WS. Material specificity of memory deficits in children with temporal tumors and seizures: A case series. APPLIED NEUROPSYCHOLOGY-CHILD 2016; 6:335-344. [PMID: 27366934 DOI: 10.1080/21622965.2016.1197126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In adults, left temporal lobe pathology is typically associated with verbal memory deficits, whereas right temporal lobe pathology is thought to produce visual memory deficits in right-handed individuals. However, in children and adolescents with temporal lobe pathology, conclusions regarding material specificity of memory deficits remain unclear. The goal of the present case series is to examine the profile of verbal and visual memory impairment in children with temporal lobe tumors. Three patients with identified right temporal tumors and three patients with left temporal tumors are included. The Wide Range Assessment of Memory and Learning-Second Edition (WRAML-2) was administered as part of a larger neuropsychological battery. As anticipated, participants with right temporal lesions showed impaired visual memory relative to intact verbal memory. Interestingly, although the discrepancies between verbal and visual indices were less extreme, those with left temporal lesions showed a similar memory profile. These seemingly counterintuitive findings among left temporal tumor patients likely reflect less hemispheric specialization in children in comparison to adults and the fact that early developmental lesions in the left hemisphere may lead to functional reorganization of language-based skills.
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Affiliation(s)
| | - Elyssa A Scharaga
- b Ferkauf Graduate School of Psychology at Yeshiva University , New York , New York
| | - Karen Blackmon
- c Department of Neurology , New York University School of Medicine , New York , New York
| | - Jennifer Wiener
- c Department of Neurology , New York University School of Medicine , New York , New York
| | - Heidi Allison Bender
- d Mount Sinai Center for Cognitive Health, Icahn School of Medicine at Mount Sinai , New York , New York
| | - Howard L Weiner
- e Department of Neurosurgery , Baylor College of Medicine , Houston , Texas
| | - William S MacAllister
- f NYU Comprehensive Epilepsy Center, New York University School of Medicine , New York , New York
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15
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Korostenskaja M, Wilson AJ, Rose DF, Brunner P, Schalk G, Leach J, Mangano FT, Fujiwara H, Rozhkov L, Harris E, Chen PC, Seo JH, Lee KH. Real-time functional mapping with electrocorticography in pediatric epilepsy: comparison with fMRI and ESM findings. Clin EEG Neurosci 2014; 45:205-11. [PMID: 24293161 PMCID: PMC4418423 DOI: 10.1177/1550059413492960] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
SIGFRIED (SIGnal modeling For Real-time Identification and Event Detection) software provides real-time functional mapping (RTFM) of eloquent cortex for epilepsy patients preparing to undergo resective surgery. This study presents the first application of paradigms used in functional magnetic resonance (fMRI) and electrical cortical stimulation mapping (ESM) studies for shared functional cortical mapping in the context of RTFM. Results from the 3 modalities are compared. A left-handed 13-year-old male with intractable epilepsy participated in functional mapping for localization of eloquent language cortex with fMRI, ESM, and RTFM. For RTFM, data were acquired over the frontal and temporal cortex. Several paradigms were sequentially presented: passive (listening to stories) and active (picture naming and verb generation). For verb generation and story processing, fMRI showed atypical right lateralizing language activation within temporal lobe regions of interest and bilateral frontal activation with slight right lateralization. Left hemisphere ESM demonstrated no eloquent language areas. RTFM procedures using story processing and picture naming elicited activity in the right lateral and basal temporal regions. Verb generation elicited strong right lateral temporal lobe activation, as well as left frontal lobe activation. RTFM results confirmed atypical language lateralization evident from fMRI and ESM. We demonstrated the feasibility and usefulness of a new RTFM stimulation paradigm during presurgical evaluation. Block design paradigms used in fMRI may be optimal for this purpose. Further development is needed to create age-appropriate RTFM test batteries.
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Affiliation(s)
- Milena Korostenskaja
- Functional Brain Mapping and Brain-Computer Interface Lab, Center for Pediatric Research and Outcomes & Comprehensive Pediatric Epilepsy Center, Florida Hospital for Children, Orlando, FL, USA
| | - Adam J. Wilson
- Department of Neurosurgery, University of Cincinnati, Cincinnati, OH, USA
| | - Douglas F. Rose
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Peter Brunner
- The Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Gerwin Schalk
- The Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - James Leach
- Division of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Francesco T. Mangano
- Department of Neurosurgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Hisako Fujiwara
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Leonid Rozhkov
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Elana Harris
- Department of Child Psychiatry, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Po-Ching Chen
- Functional Brain Mapping and Brain-Computer Interface Lab, Center for Pediatric Research and Outcomes & Comprehensive Pediatric Epilepsy Center, Florida Hospital for Children, Orlando, FL, USA
| | - Joo-Hee Seo
- Comprehensive Pediatric Epilepsy Center, Florida Hospital for Children, Orlando, FL, USA
| | - Ki H. Lee
- Comprehensive Pediatric Epilepsy Center, Florida Hospital for Children, Orlando, FL, USA
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16
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Powell JL, Kemp GJ, García-Finaña M. Association between language and spatial laterality and cognitive ability: An fMRI study. Neuroimage 2012; 59:1818-29. [DOI: 10.1016/j.neuroimage.2011.08.040] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 07/26/2011] [Accepted: 08/15/2011] [Indexed: 10/17/2022] Open
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17
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Everts R, Harvey AS, Lillywhite L, Wrennall J, Abbott DF, Gonzalez L, Kean M, Jackson GD, Anderson V. Language lateralization correlates with verbal memory performance in children with focal epilepsy. Epilepsia 2009; 51:627-38. [PMID: 19958383 DOI: 10.1111/j.1528-1167.2009.02406.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Assessment of language dominance with functional magnetic resonance imaging (fMRI) and neuropsychological evaluation is often used prior to epilepsy surgery. This study explores whether language lateralization and cognitive performance are systematically related in young patients with focal epilepsy. METHODS Language fMRI and neuropsychological data (language, visuospatial functions, and memory) of 40 patients (7-18 years of age) with unilateral, refractory focal epilepsy in temporal and/or frontal areas of the left (n = 23) or right hemisphere (n = 17) were analyzed. fMRI data of 18 healthy controls (7-18 years) served as a normative sample. A laterality index was computed to determine the lateralization of activation in three regions of interest (frontal, parietal, and temporal). RESULTS Atypical language lateralization was demonstrated in 12 (30%) of 40 patients. A correlation between language lateralization and verbal memory performance occurred in patients with left-sided epilepsy over all three regions of interest, with bilateral or right-sided language lateralization being correlated with better verbal memory performance (Word Pairs Recall: frontal r = -0.4, p = 0.016; parietal r = -0.4, p = 0.043; temporal r = -0.4, p = 0.041). Verbal memory performance made the largest contribution to language lateralization, whereas handedness and side of seizures did not contribute to the variance in language lateralization. DISCUSSION This finding reflects the association between neocortical language and hippocampal memory regions in patients with left-sided epilepsy. Atypical language lateralization is advantageous for verbal memory performance, presumably a result of transfer of verbal memory function. In children with focal epilepsy, verbal memory performance provides a better idea of language lateralization than handedness and side of epilepsy and lesion.
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Affiliation(s)
- Regula Everts
- Critical Care and Neuroscience, Murdoch Children's Research Institute, Melbourne, Australia.
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18
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Leunen D, Caroff X, Chmura S, Fohlen M, Delalande O, Jambaqué I. Verbal and spatial learning after temporal lobe excisions in children: an adaptation of the Grober and Buschke procedure. Epilepsy Behav 2009; 16:534-8. [PMID: 19837004 DOI: 10.1016/j.yebeh.2009.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Revised: 09/01/2009] [Accepted: 09/06/2009] [Indexed: 10/20/2022]
Abstract
Using an adaptation of Grober and Buschke's procedure, we assessed verbal and visuospatial learning abilities in 16 children after left or right anteromesial temporal resection and 16 healthy controls to evaluate material-specific memory deficits. All children had relatively well-preserved verbal and spatial learning capacities after unilateral temporal resection. Children who had left temporal resection showed impaired verbal memory performance despite semantic control by cued recall. No memory deficits with visual material were detected in children who underwent right anteromesial temporal resection. Grober and Buschke's procedure appears relevant for the detection of verbal memory disorders in children with left-sided temporal resection.
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Affiliation(s)
- Dorothée Leunen
- Laboratoire de Psychologie et Neurosciences Cognitives (UMR CNRS 8189), Université Paris Descartes, Institut de Psychologie, Paris, France
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19
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Kadis DS, Kerr EN, Rutka JT, Snead III OC, Weiss SK, Smith ML. Pathology type does not predict language lateralization in children with medically intractable epilepsy. Epilepsia 2009; 50:1498-504. [DOI: 10.1111/j.1528-1167.2008.02014.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Jambaqué I. Chirurgie de l’épilepsie : études neuropsychologiques chez l’enfant. Neurochirurgie 2008; 54:245-52. [DOI: 10.1016/j.neuchi.2008.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Accepted: 02/13/2008] [Indexed: 11/25/2022]
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21
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Abstract
Using functional magnetic resonance imaging during a verbal memory task, we investigated correlations of signal fluctuations within the hippocampus and ipsilateral frontal as well as temporal areas in temporal lobe epilepsy patients. Declarative memory abilities were additionally examined before and after temporal lobe epilepsy surgery. A significant difference exists in functional connectivity between patients whose mnemonic functions deteriorated and those who remained stable or improved. Univariate analyses showed significantly higher preoperative coupling between the hippocampus and Brodmann area 22 for the group that decreased in verbal learning. We suggest greater coupling to reflect higher functional network integrity. Postoperatively reduced learning ability in patients with higher preoperative coupling underlines the importance of hippocampal interaction with cortical areas for successful memory formation.
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22
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Abstract
Seizure disorders are relatively common in childhood, and the International League Against Epilepsy (ILAE) provides a hierarchical classification system to define seizure types. At the final level of classification, specific epilepsy syndromes are defined that represent a complex of signs and symptoms unique to an epilepsy condition. The present review discusses the issues related to several of these epilepsy syndromes in childhood, including those classified as generalized idiopathic epilepsies (e.g., childhood absence epilepsy, juvenile absence epilepsy, juvenile myoclonic epilepsy), focal epilepsies (benign rolandic epilepsy, occipital epilepsy, temporal lobe epilepsy, frontal lobe epilepsy) and the "epileptic encephalopathies," including Dravet's Syndrome, West Syndrome, Lennox-Gastaut Syndrome, Myoclonic Astatic Epilepsy, and Landau-Kleffner Syndrome. For each syndrome, the epidemiology, clinical manifestations, treatments, and neuropsychological findings are discussed.
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23
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MacAllister WS, Schaffer SG. Neuropsychological deficits in childhood epilepsy syndromes. Neuropsychol Rev 2007; 17:427-44. [PMID: 17963043 DOI: 10.1007/s11065-007-9048-4] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2007] [Accepted: 10/04/2007] [Indexed: 11/24/2022]
Abstract
Seizure disorders are relatively common in childhood, and the International League Against Epilepsy (ILAE) provides a hierarchical classification system to define seizure types. At the final level of classification, specific epilepsy syndromes are defined that represent a complex of signs and symptoms unique to an epilepsy condition. The present review discusses the issues related to several of these epilepsy syndromes in childhood, including those classified as generalized idiopathic epilepsies (e.g., childhood absence epilepsy, juvenile absence epilepsy, juvenile myoclonic epilepsy), focal epilepsies (benign rolandic epilepsy, occipital epilepsy, temporal lobe epilepsy, frontal lobe epilepsy) and the "epileptic encephalopathies," including Dravet's Syndrome, West Syndrome, Lennox-Gastaut Syndrome, Myoclonic Astatic Epilepsy, and Landau-Kleffner Syndrome. For each syndrome, the epidemiology, clinical manifestations, treatments, and neuropsychological findings are discussed.
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Affiliation(s)
- William S MacAllister
- New York University Comprehensive Epilepsy Center, 403 East 34th Street, 4th floor, New York, NY, 10016, USA.
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24
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Jambaqué I, Dellatolas G, Fohlen M, Bulteau C, Watier L, Dorfmuller G, Chiron C, Delalande O. Memory functions following surgery for temporal lobe epilepsy in children. Neuropsychologia 2007; 45:2850-62. [PMID: 17612579 DOI: 10.1016/j.neuropsychologia.2007.05.008] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Revised: 05/03/2007] [Accepted: 05/11/2007] [Indexed: 11/27/2022]
Abstract
Surgical treatment appears to improve the cognitive prognosis in children undergoing surgery for temporal lobe epilepsy (TLE). The beneficial effects of surgery on memory functions, particularly on material-specific memory, are more difficult to assess because of potentially interacting factors such as age range, intellectual level, left-handedness, type of surgery and seizure outcome. This study investigated memory functions in 20 right-handed children who had left or right-temporal lobe surgery - including hippocampectomy - and became seizure-free. The neuropsychological evaluation included tests measuring verbally and visually mediated episodic memory, everyday memory as well as attention/working memory and language/semantic memory. We also assessed the relationships between age of seizure onset, general cognitive ability and memory functions. Children with TLE showed poor memory efficiency before surgery that tended to improve about 1 year after surgery. We found a material-specific memory effect, especially after surgery-9 (out of 12) children with left TLE had worse verbal memory results while 5 (out of 8) with right TLE had worse visual memory results. Post-operatively, most children had poor everyday memory performance on the Rivermead Behavioural Memory Test. No significant relationship was observed between episodic memory scores and age of epilepsy onset but children with early onset remained with lower Performance IQ values, Rey's figure copy scores and naming performances after surgery. Surgery significantly improved all the attention/working memory scores, some verbal episodic memory tasks and naming test performances. A different pattern of episodic and semantic memory limitations related to left or right TLE was observed.
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Affiliation(s)
- Isabelle Jambaqué
- Université Paris Descartes, Institut de Psychologie, Laboratoire Psychologie et Neurosciences Cognitives, CNRS FRE 2987, 71 Avenue Edouard Vaillant 92774, Boulogne Billancourt Cedex F-92100, France.
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25
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Gleissner U, Sassen R, Schramm J, Elger CE, Helmstaedter C. Greater functional recovery after temporal lobe epilepsy surgery in children. ACTA ACUST UNITED AC 2005; 128:2822-9. [PMID: 16014650 DOI: 10.1093/brain/awh597] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The purpose of our study is to evaluate whether children recover better than adults from memory deficits as a consequence of temporal lobe surgery. We compared 3 and 12 month outcomes obtained in children and adults with medically refractory epilepsy. Each candidate underwent temporal lobe resection for seizure control and children were matched with regard to pathology, onset of epilepsy, side of surgery and type of surgery with adults (N = 30 for each group, mean age at surgery 13 versus 30 years). Three months after surgery, both left-resected groups displayed a significant decline in verbal learning capacity. During the following 9 months, only the children recovered and were able to reach their preoperative level 1 year after surgery. The left-resected adults remained, for the most part, on their low level and one year after surgery, they were still significantly worse than at the time of their preoperative examination. The right-resected adults experienced a deterioration in visual memory 1 year after surgery relative to the results of the short-term follow-up; the children improved. The children also had a better outcome with regard to attentional functions and, as a trend, a better seizure outcome (Engel Outcome I--1 year after surgery: 63% adults, 80% paediatric patients). Our neuropsychological data provide evidence of greater plasticity and compensational capacity in childhood. The results can be taken as a strong argument for early surgical intervention.
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Affiliation(s)
- U Gleissner
- Department of Epileptology, University of Bonn, Bonn, Germany.
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26
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Breier JI, Castillo EM, Simos PG, Billingsley-Marshall RL, Pataraia E, Sarkari S, Wheless JW, Papanicolaou AC. Atypical language representation in patients with chronic seizure disorder and achievement deficits with magnetoencephalography. Epilepsia 2005; 46:540-8. [PMID: 15816948 DOI: 10.1111/j.0013-9580.2005.48904.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To characterize the relation between hemispheric asymmetries in language-specific brain activity and reading/spelling achievement by using magnetoencephalography (MEG). METHODS Patients (n = 83) with medically intractable complex partial seizures of either left- or right-hemisphere origin were classified as having reading and/or spelling deficits (RS) or as not impaired (NI) by using standard achievement tests. All patients had undergone noninvasive functional mapping of receptive language cortex by using MEG as part of a preoperative seizure surgery evaluation. RESULTS RS patients with left-hemisphere seizure onset exhibited relatively greater activation and earlier onset of late, language-specific MEG activity in posterior temporal and inferior parietal areas of the right as compared with the left hemisphere than did NI patients. These findings also were evident on an individual basis and were independent of global intellectual abilities. CONCLUSIONS Reading and spelling achievement deficits in patients with complex partial seizures of left-hemisphere origin are associated with atypical language organization, possibly secondary to reorganization of language function to right-hemisphere areas that are not as efficient as homotopic areas in the left hemisphere in supporting reading and spelling functions.
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Affiliation(s)
- Joshua I Breier
- Vivian L. Smith Center for Neurologic Research, Department of Neurosurgery, Division of Clinical Neurosciences, The University of Texas Health Science Center at Houston, Texas 77030, USA.
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