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Samudra N, Armour E, Gonzalez H, Mattingly D, Haas K, Singh P, Sonmezturk H, Gallagher M, Crudele A, Nobis W, Reddy S, Jacobs M, Aulino JM, Bick S, Morgan V, Englot D, Abou-Khalil B. Epilepsy with anterior temporal encephaloceles: Baseline characteristics, post-surgical outcomes, and comparison to mesial temporal sclerosis. Epilepsy Behav 2023; 139:109061. [PMID: 36587487 DOI: 10.1016/j.yebeh.2022.109061] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 11/18/2022] [Accepted: 12/11/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To review clinical and neuropsychological characteristics and natural history of a series of patients with temporal lobe epilepsy (TLE) and anterior temporal encephaloceles (ATE) and compare them to a similar series of TLE patients with mesial temporal sclerosis (MTS) to identify characteristics suggestive of ATE-related epilepsy. METHODS Patients with epilepsy and ATE were identified via clinic encounters and consensus epilepsy surgery conference at a Level 4 epilepsy center. The drug-resistant subset of these patients who underwent epilepsy surgery (twenty-two of thirty-five) were compared to age- and laterality-matched patients with MTS. Clinical, neuropsychological, electrophysiologic, and surgical data were abstracted through chart review. RESULTS In comparison with MTS, ATE patients were more often female, had significantly later onset of epilepsy, and did not have prior febrile seizures. In addition, ATE patients were more likely to have chronic headaches and other historical features consistent with idiopathic intracranial hypertension (IIH). Failure to identify ATE on initial imaging was common. Most patients had limited temporal cortical resections sparing mesial structures. Of the twenty ATE patients who had a long-term postsurgical follow-up, seventeen (85%) had International League Against Epilepsy (ILAE) Class 1 or 2 outcomes. SIGNIFICANCE A shorter duration of epilepsy, female gender, and lack of history of febrile seizures may suggest ATE as an etiology of refractory TLE in adults. Targeted encephalocele resections can result in seizure freedom, underscoring the importance of encephalocele identification.
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Affiliation(s)
- Niyatee Samudra
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eric Armour
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hernan Gonzalez
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Danielle Mattingly
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kevin Haas
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Pradumna Singh
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hasan Sonmezturk
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Martin Gallagher
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Angela Crudele
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - William Nobis
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shilpa Reddy
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Monica Jacobs
- Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joseph M Aulino
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah Bick
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Victoria Morgan
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dario Englot
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bassel Abou-Khalil
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.
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Kilpattu Ramaniharan A, Zhang MW, Selladurai G, Martin R, Ver Hoef L. Loss of hippocampal dentation in hippocampal sclerosis and its relationship to memory dysfunction. Epilepsia 2022; 63:1104-1114. [PMID: 35243619 DOI: 10.1111/epi.17211] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Hippocampal dentation (HD) is a "tooth-like" morphological feature observed on the inferior aspect of the human hippocampus. It has been found that HD varies dramatically in healthy adults and is positively associated with verbal and visual memory. In this work, we evaluate the loss of HD and its association to memory dysfunction in patients with temporal lobe epilepsy who have hippocampal sclerosis (HS). METHODS 58 unilateral HS patients with neuropsychological data were identified from a retrospective database. T1w MPRAGE images (~1mm resolution) were upsampled to 0.25mm and were processed using ASHS software to obtain ultra high resolution segmentations and 3D renderings. Dentes were counted on the epileptic and contralateral sides, and associations were tested between dentation on the epileptic versus contralateral sides and measures of verbal and visuospatial memory with respect to the dominant versus non-dominant hemisphere. RESULTS The median number of dentes in epileptic hippocampi was significantly lower than in contralateral hippocampi (p<0.0001). Among cases with HS in the dominant hemisphere, verbal memory was significantly correlated with contralateral non-dominant hemisphere dentation (r = 0.45, p = 0.02). Similarly, among cases of HS in the non-dominant hemisphere, visual memory was significantly correlated with contralateral dominant hemisphere dentation (r = 0.50, p = 0.03). All other analyses were not significant. SIGNIFICANCE This is the first study characterizing dentation in TLE patients with HS and its memory correlates. There is marked loss of dentation in sclerotic hippocampi compared to the unaffected contralateral hippocampi. Material-specific measures of memory performance are paradoxically correlated with dentation contralateral to the side with HS, suggesting that contralateral functional capacity explains some of the variation in memory across TLE patients. Hippocampal dentation is an important variable to consider in understanding memory loss in TLE.
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Affiliation(s)
| | - Mike Weng Zhang
- University of Alabama at Birmingham, Department of Neurology, Birmingham, Alabama, USA
| | - Goutham Selladurai
- University of Alabama at Birmingham, Department of Neurology, Birmingham, Alabama, USA
| | - Roy Martin
- University of Alabama at Birmingham, Department of Neurology, Birmingham, Alabama, USA
| | - Lawrence Ver Hoef
- University of Alabama at Birmingham, Department of Neurology, Birmingham, Alabama, USA.,Baptist Health Medical Group, Department of Neurology, Louisville, Kentucky, USA
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Samson S, Denos M. Neuropsychology of temporal lobe epilepsies. HANDBOOK OF CLINICAL NEUROLOGY 2022; 187:519-529. [PMID: 35964990 DOI: 10.1016/b978-0-12-823493-8.00012-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This chapter focuses on the neuropsychology of adults with temporal lobe epilepsy (TLE). First, a thorough description of the brain-behavior relationship characterizing focal TLE with and without hippocampal sclerosis is presented. Then, the aim and the specificity of the NPA in the care of epilepsy are described. Considering the high frequency of medically intractable TLE that can be treated by surgery, an assessment carried out in the context of pre- and postoperative evaluation is presented and discussed in light of insights from functional neuroimaging findings. Finally, we propose concluding remarks about the place of neuropsychology in the care of epilepsy in improving our understanding of the cognitive and emotional phenotypes associated with TLE.
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Affiliation(s)
- Séverine Samson
- Department of Psychology, University of Lille, Lille, France; Epilepsy Unit, Neurosciences Department, Hôpital de la Pitié-Salpêtrière, Paris, France.
| | - Marisa Denos
- Rehabilitation Unit, Neurosciences Department, Hôpital de la Pitié-Salpêtrière, Paris, France
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Drane DL, Willie JT, Pedersen NP, Qiu D, Voets NL, Millis SR, Soares BP, Saindane AM, Hu R, Kim MS, Hewitt KC, Hakimian S, Grabowski T, Ojemann JG, Loring DW, Meador KJ, Faught E, Miller JW, Gross RE. Superior Verbal Memory Outcome After Stereotactic Laser Amygdalohippocampotomy. Front Neurol 2021; 12:779495. [PMID: 34956059 PMCID: PMC8695842 DOI: 10.3389/fneur.2021.779495] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 11/05/2021] [Indexed: 11/30/2022] Open
Abstract
Objective: To evaluate declarative memory outcomes in medically refractory epilepsy patients who underwent either a highly selective laser ablation of the amygdalohippocampal complex or a conventional open temporal lobe resection. Methods: Post-operative change scores were examined for verbal memory outcome in epilepsy patients who underwent stereotactic laser amygdalohippocampotomy (SLAH: n = 40) or open resection procedures (n = 40) using both reliable change index (RCI) scores and a 1-SD change metric. Results: Using RCI scores, patients undergoing open resection (12/40, 30.0%) were more likely to decline on verbal memory than those undergoing SLAH (2/40 [5.0%], p = 0.0064, Fisher's exact test). Patients with language dominant procedures were much more likely to experience a significant verbal memory decline following open resection (9/19 [47.4%]) compared to laser ablation (2/19 [10.5%], p = 0.0293, Fisher's exact test). 1 SD verbal memory decline frequently occurred in the open resection sample of language dominant temporal lobe patients with mesial temporal sclerosis (8/10 [80.0%]), although it rarely occurred in such patients after SLAH (2/14, 14.3%) (p = 0.0027, Fisher's exact test). Memory improvement occurred significantly more frequently following SLAH than after open resection. Interpretation: These findings suggest that while verbal memory function can decline after laser ablation of the amygdalohippocampal complex, it is better preserved when compared to open temporal lobe resection. Our findings also highlight that the dominant hippocampus is not uniquely responsible for verbal memory. While this is at odds with our simple and common heuristic of the hippocampus in memory, it supports the findings of non-human primate studies showing that memory depends on broader medial and lateral TL regions.
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Affiliation(s)
- Daniel L. Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, United States
| | - Jon T. Willie
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Nigel P. Pedersen
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
- Coulter Department of Biomedical Engineering, Emory University, Atlanta, GA, United States
| | - Deqiang Qiu
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Natalie L. Voets
- Nuffield Department of Clinical Neurosciences, Oxford Centre for Functional MRI of the Brain, University of Oxford, Oxford, United Kingdom
| | - Scott R. Millis
- Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, MI, United States
| | - Bruno P. Soares
- Department of Radiology, University of Vermont Medical Center, Burlington, VT, United States
| | - Amit M. Saindane
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Ranliang Hu
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Michelle S. Kim
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, United States
| | - Kelsey C. Hewitt
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - Shahin Hakimian
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, United States
| | - Thomas Grabowski
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, United States
| | - Jeffrey G. Ojemann
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, WA, United States
| | - David W. Loring
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Kimford J. Meador
- Department of Neurology, Stanford University School of Medicine, Stanford, CA, United States
| | - Edward Faught
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - John W. Miller
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, United States
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, WA, United States
| | - Robert E. Gross
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
- Coulter Department of Biomedical Engineering, Emory University, Atlanta, GA, United States
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, United States
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Pitskhelauri D, Kudieva E, Kamenetskaya M, Kozlova A, Vlasov P, Dombaanai B, Eliseeva N, Shishkina L, Sanikidze A, Shults E, Moshev D, Pronin I, Melikyan A. Multiple hippocampal transections for mesial temporal lobe epilepsy. Surg Neurol Int 2021; 12:372. [PMID: 34513139 PMCID: PMC8422472 DOI: 10.25259/sni_350_2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/25/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The purpose of this study was to evaluate the effectiveness of multiple hippocampal transections (MHT) in the treatment of drug-resistant mesial temporal lobe epilepsy. Methods: Six patients underwent MHT at Burdenko Neurosurgery Center in 2018. The age of the patients varied from 18 to 43 years. All patients suffered from refractory epilepsy caused by focal lesions of the mesial temporal complex or temporal pole in dominant side. Postoperative pathology revealed neuronal-glial tumors in two patients, focal cortical dysplasia (FCD) of the temporal pole – in two patients, cavernous angioma – in one patient, and encephalocele of the preuncal area – in one patient. Results: All patients underwent surgery satisfactorily. There were no postoperative complications except for homonymous superior quadrantanopia. This kind of visual field loss was noted in four cases out of six. During the follow-up period five patients out of six had Engel Class I outcome (83.3%). In one case, seizures developed after 1 month in a patient with FCD in the uncus (Engel IVA). After surgery, three out of six patients developed significant nominative aphasia. Two patients relative to the preoperative level demonstrated improvement in delayed verbal memory after MHT. Two patients showed a decrease level in delayed verbal memory. In preoperative period, visual memory was below the normal in one patient. Delayed visual memory in two cases impaired compared to the preoperative level. Conclusion: MHT can be considered as an effective method of drug-resistant mesial temporal lobe epilepsy caused by tumors of the medial temporal complex. At the same time, MHT makes it possible to preserve memory in patients with structurally preserved hippocampus. However, MHT do not guarantee the preservation of memory after surgery.
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Affiliation(s)
- David Pitskhelauri
- Department of Neurosurgery, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Elina Kudieva
- Department of Neurosurgery, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Maria Kamenetskaya
- Department of Neuropsychiatric Research, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Antonina Kozlova
- Department of Neurophysiological Research, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Pavel Vlasov
- Department of Pediatric Neurosurgery, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Baiyr Dombaanai
- Department of Neurosurgery, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Natalia Eliseeva
- Department of Neuroophthalmological Research, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Lyudmila Shishkina
- Department of Neuropathology, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Alexander Sanikidze
- Department of Neurosurgery, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Evgeniy Shults
- Department of X-ray and Radioisotope Research, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Dmitriy Moshev
- Department of Neuroanesthesiology, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Igor Pronin
- Department of X-ray and Radioisotope Research, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Armen Melikyan
- Department of Pediatric Neurosurgery, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
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Samudra N, Jacobs M, Aulino JM, Abou-Khalil B. Baseline neuropsychological characteristics in patients with epilepsy with left temporal lobe encephaloceles compared with left mesial temporal sclerosis. Epilepsy Behav 2020; 112:107397. [PMID: 32919200 DOI: 10.1016/j.yebeh.2020.107397] [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: 05/14/2020] [Revised: 08/02/2020] [Accepted: 08/02/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Temporal lobe encephaloceles (TE) are increasingly recognized as a cause of drug-resistant temporal lobe epilepsy. Improved recognition of these lesions offers an opportunity to treat them with a limited resection sparing the hippocampus. However, as they can be difficult to identify on imaging, additional clues pointing to the diagnosis can be helpful. We sought to understand the baseline cognitive/neuropsychological profile in patients with left temporal lobe epilepsy caused by encephaloceles compared with that caused by mesial temporal sclerosis (MTS), a common entity in the differential diagnosis. METHODS Neuropsychological testing, including language (semantic and phonemic fluency and naming), verbal memory, intelligence quotient (IQ), and executive function measures were compared across two groups (five patients with left TE and five age- and gender-matched patients with left MTS). Other clinical variables related to cognition, including patient age, electroencephalographic characteristics, epilepsy duration, and factors related to antiseizure medication dosing, were also compared between groups. RESULTS More patients with left MTS had atypical language lateralization (3/5 with right-sided language in the group with MTS compared with 0/5 in the group with TE). Patients with MTS had significantly worse scores on the Verbal Comprehension Index (VCI) subscore of the Wechsler Adult Intelligence Scale (WAIS; p = 0.026). General IQ was also worse in patients with MTS (p = 0.028). There was a trend towards worse executive function in patients with MTS as measured on Trails B (p = 0.096). Other measures related to language and verbal memory did not differ significantly between the groups nor did other relevant clinical variables, except epilepsy duration, which was significantly longer in patients with MTS (p = 0.0001). CONCLUSIONS This pilot study demonstrates few significant differences between the groups with left MTS and TE surveyed. A higher rate of atypical language lateralization was noted in patients with left MTS. The higher baseline global IQ and VCI scores in patients with left TE compared with patients with MTS may be attributable to longer duration of epilepsy in patients with left MTS. Future work with a larger sample size will focus on establishing a unique neuropsychological profile related to epilepsy due to TE.
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Affiliation(s)
- Niyatee Samudra
- Department of Neurology, Vanderbilt University Medical Center, A-0118 Medical Center North, 1161 21st Avenue South, Nashville, TN 37232, United States
| | - Monica Jacobs
- Department of Neurology, Vanderbilt University Medical Center, A-0118 Medical Center North, 1161 21st Avenue South, Nashville, TN 37232, United States
| | - Joseph M Aulino
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Bassel Abou-Khalil
- Department of Neurology, Vanderbilt University Medical Center, A-0118 Medical Center North, 1161 21st Avenue South, Nashville, TN 37232, United States.
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Heitzer AM, Raghubar K, Ris MD, Minard CG, Gragert MN, Stancel HH, Orobio J, Xue J, Whitehead W, Okcu MF, Chintagumpala M, Kahalley LS. Neuropsychological functioning following surgery for pediatric low-grade glioma: a prospective longitudinal study. J Neurosurg Pediatr 2020; 25:251-259. [PMID: 31812134 PMCID: PMC9040333 DOI: 10.3171/2019.9.peds19357] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 09/16/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE High survival rates have led to an increased emphasis on the functional outcomes of children diagnosed with low-grade glioma. Most outcomes research has focused on risks associated with radiotherapy, but less is known about neuropsychological risks for patients treated with surgery alone. Here, the authors sought to examine the neuropsychological trajectories of children diagnosed with a low-grade glioma and monitored up to 6 years postsurgery. Secondarily, they explored demographic and clinical predictors of neuropsychological performance. METHODS The neuropsychological functioning of 32 patients (median age at diagnosis 10.0 years) was prospectively assessed annually for up to 6 years after surgery (median days from surgery at baseline = 72). Tumor location was predominately supratentorial (65.6%). A combination of performance-based and parent-reported measures was used to assess intelligence, memory, executive functioning, and fine motor control in all patients. RESULTS Binomial tests at the postoperative baseline revealed that the proportion of children falling below the average range (< 16th percentile) was significantly higher than the rate expected among healthy peers on measures of verbal memory, processing speed, executive functioning, and fine motor control (p < 0.05). Even so, linear mixed models indicated that neuropsychological functioning at the postoperative baseline did not significantly change over time for up to 6 years after surgery across all domains. A larger tumor size was associated with a slower reaction time (p < 0.01). A supratentorial tumor location and history of seizures were associated with more parent-reported executive difficulties (p < 0.01). CONCLUSIONS While radiotherapy is a known risk factor for neuropsychological deficits in pediatric brain tumor patients, findings in this study indicate that children treated for low-grade glioma with surgery alone (without radiotherapy or chemotherapy) remain susceptible to difficulties with memory, executive functioning, and motor functioning that persist over time. Over half of the children in the study sample required school support services to address neuropsychological weaknesses. Although low-grade glioma is often conceptualized as a benign tumor, children treated for this lesion require ongoing monitoring and intervention to address neuropsychological weaknesses resulting from the tumor itself as well as the surgery.
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Affiliation(s)
- Andrew M. Heitzer
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, Texas
| | - Kimberly Raghubar
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, Texas
| | - M. Douglas Ris
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, Texas
| | - Charles G. Minard
- Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas
| | - Marsha N. Gragert
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, Texas
| | - Heather H. Stancel
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, Texas
| | - Jessica Orobio
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, Texas
| | - Judy Xue
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, Texas
- Rice University, Houston, Texas
| | - William Whitehead
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - M. Fatih Okcu
- Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, Texas
| | - Murali Chintagumpala
- Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, Texas
| | - Lisa S. Kahalley
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, Texas
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Parra-Díaz P, García-Casares N. Evaluación de la memoria en la epilepsia del lóbulo temporal para predecir sus cambios tras la cirugía. Una revisión sistemática. Neurologia 2019; 34:596-606. [DOI: 10.1016/j.nrl.2017.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 02/12/2017] [Accepted: 02/17/2017] [Indexed: 10/19/2022] Open
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9
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Parra-Díaz P, García-Casares N. Memory assessment in patients with temporal lobe epilepsy to predict memory impairment after surgery: a systematic review. NEUROLOGÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.nrleng.2017.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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10
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Cabrera OS, Lehéricy S, Masson V, Samson S, Dupont S. Adapting a memory fMRI research protocol in clinical routine: Feasibility and results. Epilepsy Behav 2018; 81:49-54. [PMID: 29477011 DOI: 10.1016/j.yebeh.2017.11.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/10/2017] [Accepted: 11/19/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective of this study was to test the reliability of functional magnetic resonance imaging (fMRI) evaluation of memory function in clinical practice to predict postoperative memory decline in patients with refractory medial temporal lobe epilepsy (MTLE) candidate to surgery. METHODS Twenty-six consecutive patients with MTLE who underwent a complete presurgical evaluation were included. All patients underwent fMRI memory study and complete neuropsychological assessment. Lesions consisted in hippocampal sclerosis in 18 patients (12 right and 6 left), dysembryoplastic neuroepithelial tumor (DNET) in 5 cases (4 right, 1 left), epidermoid cyst in one patient (right). Two patients had no lesion (2 left). RESULTS Nineteen patients (73%) underwent surgery. The other seven patients (27%) declined surgery, mainly because of the risk of memory deficit. The fMRI procedure correctly predicted both verbal and nonverbal memory postoperative outcome in 13 of the patients (72%), failed to predict a postoperative memory worsening in only two patients (12%), and predicted worsening in three patients (17%) that remained stable (versus 44%, 39%, and 17% with the sole neuropsychological testing). The reliability of the fMRI procedure was not influenced by the type of lesion, the side of the epileptic focus, or the type of preoperative memory profile (typical or atypical). SIGNIFICANCE Appearing as a valuable clinical tool to predict postoperative memory outcome, fMRI may add information over and above other available tests.
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Affiliation(s)
- Ovidio Solano Cabrera
- Epilepsy unit, AP-HP Groupe hospitalier Pitié-Salpêtrière-Charles Foix, F-75013 Paris, France; Epilepsy Clinic, Neurology department, Social Security Salvadoran Institute, San Salvador, El Salvador
| | - Stéphane Lehéricy
- Neuroradiology unit, AP-HP Groupe hospitalier Pitié-Salpêtrière-Charles Foix, F-75013 Paris, France; Inserm U 1127, CNRS UMR 7225, UMR S 1127, Institut du Cerveau et de la Moelle épinière - ICM, Centre de Neuroimagerie de Recherche - CENIR, F-75013 Paris, France; Sorbonne University, UPMC Univ. Paris 06, F-75005 Paris, France
| | - Véronique Masson
- Epilepsy unit, AP-HP Groupe hospitalier Pitié-Salpêtrière-Charles Foix, F-75013 Paris, France
| | - Séverine Samson
- Laboratoire PSITEC (EA 4072), Université de Lille, F-59000 Lille, France
| | - Sophie Dupont
- Epilepsy unit, AP-HP Groupe hospitalier Pitié-Salpêtrière-Charles Foix, F-75013 Paris, France; Inserm U 1127, CNRS UMR 7225, UMR S 1127, Institut du Cerveau et de la Moelle épinière - ICM, Centre de Neuroimagerie de Recherche - CENIR, F-75013 Paris, France; Sorbonne University, UPMC Univ. Paris 06, F-75005 Paris, France; Rehabilitation unit, AP-HP Groupe hospitalier Pitié-Salpêtrière-Charles Foix, F-75013 Paris, France.
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Characterization of a Factual Knowledge–Associated Brain Memory Area by Functional Magnetic Resonance Imaging and Implementation in Tumor and Epilepsy Brain Surgery. World Neurosurg 2017; 107:291-301. [DOI: 10.1016/j.wneu.2017.07.176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 07/26/2017] [Accepted: 07/29/2017] [Indexed: 11/19/2022]
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Girgis F, Greil ME, Fastenau PS, Sweet J, Lüders H, Miller JP. Resection of Temporal Neocortex During Multiple Hippocampal Transections for Mesial Temporal Lobe Epilepsy Does not Affect Seizure or Memory Outcome. Oper Neurosurg (Hagerstown) 2017; 13:711-717. [DOI: 10.1093/ons/opx031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 01/31/2017] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Multiple hippocampal transection (MHT) is a surgical treatment for mesial temporal lobe epilepsy associated with improved postoperative neuropsychological outcomes compared with lobectomy.
OBJECTIVE
To determine whether resection of the amygdala and anterior temporal neocortex during MHT affects postoperative seizure/memory outcome.
METHODS
Seventeen patients with normal magnetic resonance imaging and stereo-electroencephalogram-proven drug-resistant dominant mesial temporal lobe epilepsy were treated with MHT. Nine patients underwent MHT alone (MHT–) and 8 patients underwent MHT plus removal of the amygdala and anterior 4.5 cm of temporal neocortex lateral to the fusiform gyrus (MHT+). Verbal and visual-spatial memory were assessed in all patients preoperatively and in 14 patients postoperatively using the Wechsler Memory Scale. Postoperative seizure control was assessed at 12 months for all patients.
RESULTS
Overall, 11 of 17 patients (64.7%) were Engel class 1 at 1 year (6/9 MHT–, 5/8 MHT+, P = .38), and 10 of 14 patients (71.4%) had no significant postoperative decline in either verbal or visual memory (6/8 MHT–, 4/6 MHT+, P = .42). Verbal memory declined in 2 of 8 MHT– and 1 of 6 MHT+ patients, and visual memory declined in 1 of 8 MHT– and 2 of 6 MHT+ patients. Two patients had improved visual memory postoperatively, both in the MHT+ group.
CONCLUSION
MHT on the dominant side is associated with high rates of seizure freedom and favorable memory preservation outcomes regardless of the extent of neocortical resection. Preservation of the temporal neocortex and amygdala during MHT does not appear to decrease the risk of postoperative memory decline, nor does it alter seizure outcome.
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Affiliation(s)
- Fady Girgis
- Department of Neurosurgery, University Hospital Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Madeline E Greil
- Department of Neurosurgery, University Hospital Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Philip S Fastenau
- Department of Neurology, University Hospital Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jennifer Sweet
- Department of Neurosurgery, University Hospital Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Hans Lüders
- Department of Neurology, University Hospital Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jonathan P Miller
- Department of Neurosurgery, University Hospital Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Declarative long-term memory and the mesial temporal lobe: Insights from a 5-year postsurgery follow-up study on refractory temporal lobe epilepsy. Epilepsy Behav 2016; 64:102-109. [PMID: 27736656 DOI: 10.1016/j.yebeh.2016.08.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 08/29/2016] [Accepted: 08/31/2016] [Indexed: 11/22/2022]
Abstract
It is largely recognized that the mesial temporal lobe and its substructure support declarative long-term memory (LTM). So far, different theories have been suggested, and the organization of declarative verbal LTM in the brain is still a matter of debate. In the current study, we retrospectively selected 151 right-handed patients with temporal lobe epilepsy with and without hippocampal sclerosis, with a homogeneous (seizure-free) clinical outcome. We analyzed verbal memory performance within a normalized scores context, by means of prose recall and word paired-associate learning tasks. Patients were tested at presurgical baseline, 6months, 2 and 5years after anteromesial temporal lobe surgery, using parallel versions of the neuropsychological tests. Our main finding revealed a key involvement of the left temporal lobe and, in particular, of the left hippocampus in prose recall rather than word paired-associate task. We also confirmed that shorter duration of epilepsy, younger age, and withdrawal of antiepileptic drugs would predict a better memory outcome. When individual memory performance was taken into account, data showed that females affected by left temporal lobe epilepsy for longer duration were more at risk of presenting a clinically pathologic LTM at 5years after surgery. Taken together, these findings shed new light on verbal declarative memory in the mesial temporal lobe and on the behavioral signature of the functional reorganization after the surgical treatment of temporal lobe epilepsy.
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Abstract
Multiple hippocampal transection (MHT) is a novel surgical procedure that serves to disrupt seizure propagation fibers within the hippocampus without impairing verbal memory or the loss of stem cells. Given the paucity of literature regarding the utility and long-term outcome of MHT, a review is presented of the current literature to support the utility of this procedure in the treatment of intractable temporal lobe epilepsy. Long-term outcome analysis of this technique has been reported by 2 independent groups. Both groups used intraoperative electrocorticography. All patients underwent multiple subpial transection on the neocortex and MHT on the hippocampus.
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Affiliation(s)
- Arun Angelo Patil
- Creighton University Medical Center, Division of Neurosurgery, 601 North 30th Street, Omaha, NE 68131, USA.
| | - Andrea Jennifer Chamczuk
- Creighton University Medical Center, Division of Neurosurgery, 601 North 30th Street, Omaha, NE 68131, USA
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15
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Imaging memory and predicting postoperative memory decline in temporal lobe epilepsy: Insights from functional imaging. Rev Neurol (Paris) 2015; 171:307-14. [PMID: 25726354 DOI: 10.1016/j.neurol.2014.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 12/23/2014] [Accepted: 12/29/2014] [Indexed: 11/24/2022]
Abstract
After medial temporal lobe epilepsy (MTLE) surgery, there is considerable individual variation in the extent, nature and direction of postoperative memory change. Before surgery, epileptic patients who are surgery candidates need precise information about the potential cognitive after effects, and particularly in temporal lobe epilepsy, postoperative memory changes. Clinical and neuropsychological data may bring useful information to predict the postoperative memory outcome, but, these data are not always sufficient to replace the Wada test, considered for a long time, as the gold standard to predict postoperative decline following surgery. In any case, numerous studies demonstrate that the Wada procedure can be nowadays reliably replaced by functional MRI (fMRI) activation studies. A vast majority of fMRI studies suggest that it is the functional adequacy of the resected hippocampus rather than the functional reserve of the contralateral hippocampus that determines the extent of postoperative memory decline. In addition, new functional neuroimaging procedures that explore more widespread network disruptions commonly found in MTLE such as diffusion-tensor imaging (DTI) or connectivity studies could in the future constitute a reliable approach combined with fMRI activation studies to significantly improve the prediction of postsurgical memory decline.
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16
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Brown FC, Westerveld M, Langfitt JT, Hamberger M, Hamid H, Shinnar S, Sperling MR, Devinsky O, Barr W, Tracy J, Masur D, Bazil CW, Spencer SS. Influence of anxiety on memory performance in temporal lobe epilepsy. Epilepsy Behav 2014; 31:19-24. [PMID: 24291525 PMCID: PMC3946774 DOI: 10.1016/j.yebeh.2013.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 10/04/2013] [Accepted: 10/08/2013] [Indexed: 11/19/2022]
Abstract
This study examined the degree to which anxiety contributed to inconsistent material-specific memory difficulties among 243 patients with temporal lobe epilepsy from the Multisite Epilepsy Study. Visual memory performance on the Rey Complex Figure Test (RCFT) was poorer for those with high versus low levels of anxiety but was not found to be related to the TLE side. The verbal memory score on the California Verbal Learning Test (CVLT) was significantly lower for patients with left-sided TLE than for patients with right-sided TLE with low anxiety levels but equally impaired for those with high anxiety levels. These results suggest that we can place more confidence in the ability of verbal memory tests like the CVLT to lateralize to left-sided TLE for those with low anxiety levels, but that verbal memory will be less likely to produce lateralizing information for those with high anxiety levels. This suggests that more caution is needed when interpreting verbal memory tests for those with high anxiety levels. These results indicated that RCFT performance was significantly affected by anxiety and did not lateralize to either side, regardless of anxiety levels. This study adds to the existing literature which suggests that drawing-based visual memory tests do not lateralize among patients with TLE, regardless of anxiety levels.
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Affiliation(s)
| | - Michael Westerveld
- Walt Disney Pavilion - Florida Hospital for Children, Winter Park, FL, USA
| | - John T Langfitt
- Department of Neurology, University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, NY, USA
| | - Marla Hamberger
- Department of Neurology, Columbia University, New York, NY 10032, USA
| | - Hamada Hamid
- Department of Neurology, Yale University, New Haven, CT, USA
| | - Shlomo Shinnar
- Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Michael R Sperling
- Department of Neurology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Orrin Devinsky
- Departments of Neurology, Neurosurgery, and Psychiatry, New York University Comprehensive Epilepsy Center, New York, NY, USA
| | - William Barr
- Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Joseph Tracy
- Department of Neurology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - David Masur
- Department of Neurology, Albert Einstein School of Medicine, Yeshiva University, Bronx, NY, USA
| | - Carl W Bazil
- Department of Neurology, Columbia University, New York, NY 10032, USA
| | - Susan S Spencer
- Department of Neurology, Yale University, New Haven, CT, USA.
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17
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Long term follow-up after multiple hippocampal transection (MHT). Seizure 2013; 22:731-4. [DOI: 10.1016/j.seizure.2013.05.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 05/17/2013] [Accepted: 05/22/2013] [Indexed: 12/14/2022] Open
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18
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Rektor I, Schachter SC, Arzy S, Baloyannis SJ, Bazil C, Brázdil M, Engel J, Helmstaedter G, Hesdorffer DC, Jones-Gotman M, Kesner L, Komárek V, Krämer G, Leppik IE, Mann MW, Mula M, Risse GL, Stoker GW, Kasteleijn-Nolst Trenité DGA, Trimble M, Tyrliková I, Korczyn AD. Epilepsy, behavior, and art (Epilepsy, Brain, and Mind, part 1). Epilepsy Behav 2013; 28:261-82. [PMID: 23764495 DOI: 10.1016/j.yebeh.2013.03.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2013] [Indexed: 01/22/2023]
Abstract
Epilepsy is both a disease of the brain and the mind. Brain diseases, structural and/or functional, underlie the appearance of epilepsy, but the notion of epilepsy is larger and cannot be reduced exclusively to the brain. We can therefore look at epilepsy from two angles. The first perspective is intrinsic: the etiology and pathophysiology, problems of therapy, impact on the brain networks, and the "mind" aspects of brain functions - cognitive, emotional, and affective. The second perspective is extrinsic: the social interactions of the person with epilepsy, the influence of the surrounding environment, and the influences of epilepsy on society. All these aspects reaching far beyond the pure biological nature of epilepsy have been the topics of two International Congresses of Epilepsy, Brain, and Mind that were held in Prague, Czech Republic, in 2010 and 2012 (the third Congress will be held in Brno, Czech Republic on April 3-5, 2014; www.epilepsy-brain-mind2014.eu). Here, we present the first of two papers with extended summaries of selected presentations of the 2012 Congress that focused on epilepsy, behavior, and art.
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Affiliation(s)
- Ivan Rektor
- Masaryk University, Brno Epilepsy Center, St. Anne's Hospital and School of Medicine, and Central European Institute of Technology (CEITEC), Brno, Czech Republic
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19
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Atypical neuropsychological profiles and cognitive outcome in mesial temporal lobe epilepsy. Epilepsy Behav 2013; 27:461-9. [PMID: 23611738 DOI: 10.1016/j.yebeh.2013.03.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 02/25/2013] [Accepted: 03/06/2013] [Indexed: 10/26/2022]
Abstract
Patients with left mesial temporal lobe epilepsy (MTLE) have deficits in verbal memory processes, while patients with right MTLE have visuospatial memory impairment. However, atypical cognitive phenotypes among patients with MTLE may occur. In this study, we analyzed preoperative memory deficits in a cohort of 426 right-handed patients with unilateral MTLE. We also evaluated the cognitive outcome after anterior temporal lobectomy (ATL) of patients with atypical profiles in comparison with those with typical memory profile. We found that 25% of our patients had a typical cognitive profile, with verbal memory deficits associated with left side hippocampal sclerosis (HS) and visuospatial memory deficits associated with right side HS. However, 75% of our patients had atypical memory profiles. Despite these atypical profiles, patients submitted to right ATL had no significant cognitive deficit after surgery. In patients submitted to left ATL, the higher the presurgical scores on verbal memory and naming tests, the higher the cognitive decline after surgery.
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20
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Patil AA, Andrews RV. Nonresective hippocampal surgery for epilepsy. World Neurosurg 2011; 74:645-9. [PMID: 21492634 DOI: 10.1016/j.wneu.2010.06.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Accepted: 06/15/2010] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Clinical experience with a new surgical procedure called multiple hippocampal transections is described. In this procedure, seizure circuits within the hippocampus are disrupted by making multiple cuts parallel to the hippocampal digitations; while the vertical functional fibers are preserved. METHODS Ten patients with temporal lobe epilepsy are described. The male/female ratio is 6:4, the ages of the patients were 20-53 years, and follow-up periods were 10-34 months, with a median of 21 months. Five patients had no hippocampal sclerosis, two had minimal sclerosis, and three had significant sclerosis. Six patients had surgery on the dominant side and five had failed the Wada test. Multiple hippocampal transections were made at 4-mm intervals. The neocortex was then treated with multiple subpial transections. In addition, six patients had resections of the temporal tip. RESULTS There were no permanent neurologic complications: seven patients are seizure-free, two have rare seizures, and one has 60% decrease in seizure frequency. Eight patients had both pre- and postoperative memory testing. Among these eight patients, five had improved verbal memory, three had improved visual memory, and three had a slight drop in visual memory. CONCLUSION This is a small series with a short follow-up period. However, the results are encouraging enough to warrant further trials. In addition, this may be an effective alternative procedure for those who fail the Wada test and do not have significant temporal lobe sclerosis or who have seizures originating from the dominant side.
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21
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Sunaga S, Morino M, Kusakabe T, Sugano H, Shimizu H. Efficacy of hippocampal transection for left temporal lobe epilepsy without hippocampal atrophy. Epilepsy Behav 2011; 21:94-9. [PMID: 21497556 DOI: 10.1016/j.yebeh.2011.02.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2010] [Revised: 02/18/2011] [Accepted: 02/24/2011] [Indexed: 11/30/2022]
Abstract
We describe a case of left temporal lobe epilepsy without hippocampal atrophy. A 31-year-old woman presented with typical symptoms of complex partial seizures. Magnetic resonance imaging demonstrated slightly obscure internal structures in the left hippocampus. Scalp electroencephalography revealed interictal epileptiform discharges in the left temporal lobe. A Wada test with propofol determined the language-dominant hemisphere to be the left. Intraoperative electrocorticography revealed active epileptic discharges in the hippocampus and the anterior temporal basal area. The hippocampal epileptic area was treated with multiple transection, which led to the complete cessation of epileptic discharges. After surgery, the Rey Auditory Verbal Learning Test score decreased from 12 to 9. However, it returned to the preoperative level 6months after surgery. We describe this case as a typical example demonstrating the efficacy of hippocampal transection for seizure control and the preservation of verbal memory.
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Affiliation(s)
- Shigeki Sunaga
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan.
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22
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Ouimet LA, Stewart A, Collins B, Schindler D, Bielajew C. Measuring neuropsychological change following breast cancer treatment: An analysis of statistical models. J Clin Exp Neuropsychol 2008; 31:73-89. [DOI: 10.1080/13803390801992725] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- L. A. Ouimet
- a University of Ottawa , Ottawa, Ontario, Canada
| | - A. Stewart
- a University of Ottawa , Ottawa, Ontario, Canada
| | - B. Collins
- b Ottawa Hospital , Ottawa, Ontario, Canada
| | - D. Schindler
- a University of Ottawa , Ottawa, Ontario, Canada
| | - C. Bielajew
- a University of Ottawa , Ottawa, Ontario, Canada
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Henry LC, Goertzen CD, Lee A, Teskey GC. Repeated seizures lead to altered skilled behaviour and are associated with more highly efficacious excitatory synapses. Eur J Neurosci 2008; 27:2165-76. [PMID: 18412634 DOI: 10.1111/j.1460-9568.2008.06153.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
People with epilepsy have a high incidence of interictal behavioural problems that appear to be related to the location of their seizure focus. This study investigated a novel test of the hypotheses that repeated seizures result in behavioural deficits and altered performance during the interictal state, and that those behaviours are related to the presence of more highly efficacious excitatory synapses. We tested these hypotheses by first repeatedly eliciting seizures with electric current through indwelling electrodes in the corpus callosum at the level of the caudal forelimb area of sensorimotor neocortex in the rat. We then assessed learned skilled behaviours that primarily utilize the forelimbs on tasks that are sensitive to the functional integrity of that structure. We observed both behavioural deficits and altered kinematic performance in rats that experienced repeated neocortical seizures relative to an electrode-implanted control group. From a separate set of rats, tissue was prepared for quantification of thickness and excitatory synaptic subtypes from neocortical layer V. We observed significantly increased numbers of perforated synapses that make their connections directly onto the dendritic shaft at 3 weeks following the last seizure. Altered reaching behaviours are likely due to neural reorganization in the neocortex including more efficacious synapses.
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Affiliation(s)
- Luke C Henry
- Behavioural Neuroscience Research Group, Department of Psychology, Epilepsy and Brain Circuits Program, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada T2N 1N4
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24
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Mintzer S, Sperling MR. When should a resection sparing mesial structures be considered for temporal lobe epilepsy? Epilepsy Behav 2008; 13:7-11. [PMID: 18359666 DOI: 10.1016/j.yebeh.2008.02.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 02/19/2008] [Accepted: 02/20/2008] [Indexed: 11/29/2022]
Abstract
Anteromesial temporal lobectomy (AMTL) is an effective and safe treatment for refractory temporal lobe epilepsy (TLE) caused by hippocampal sclerosis (HS). It is possible that modifications to this procedure could offer improved seizure control or a reduction in functional consequences in some patients. Reviewed here is the issue of when it might be appropriate to perform a resection for TLE that spares the mesial structures, particularly the hippocampus and parahippocampal gyrus. This issue is particularly important for dominant hemipshere TLE and for patients without obvious HS, as these are the patients at greatest risk for verbal memory decline following AMTL. Current evidence suggests that mesial structure-sparing resections may be worth consideration for two types of patients: those with temporal lobe foreign tissue lesions outside the mesial structures, and those with temporal lobe hypometabolism on fluorodeoxyglucose positron emission tomography but a normal MRI. Patients with dual pathology (i.e., HS plus another epileptogenic lesion) are unlikely to benefit from a resection that spares the mesial temporal lobe. There is little evidence to state whether resections of this kind are worthwhile for cryptogenic TLE, or for mesial TLE with preserved memory function. There is a clear need to move beyond the field's present focus on the hippocampus and investigate new approaches to TLE that may minimize the risks of functional consequences in patients without HS.
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Affiliation(s)
- Scott Mintzer
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
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25
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de Vanssay-Maigne A, Boutin M, Baudoin-Chial S. Facteurs de risque du déclin mnésique verbal après chirurgie du lobe temporal. Neurochirurgie 2008; 54:240-4. [DOI: 10.1016/j.neuchi.2008.02.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Accepted: 02/26/2008] [Indexed: 10/22/2022]
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Abstract
The field of epilepsy has contributed significantly to localization of neurologic function, particularly in the neocortex. Methodologies such as cortical stimulation, positron emission tomography, functional MRI, trans-cranial magnetic stimulation, surgical resection, and magnetoencephalography have been used successfully in patients with epilepsy to locate specific functions, primarily for the purpose of defining eloquent cortex before surgical resections. The left hemisphere serves language-related functions and verbal memory in most people, whereas the right hemisphere serves some language function in addition to perceiving most components of music and other forms of nonverbal material. Both hemispheres cooperate in understanding spatial relationships. Studies in patients with developmental abnormalities have enriched our understanding of localization of function within the cortex. Future studies may help us understand the sequence in which specific regions are activated during specific tasks and determine which regions are necessary for tasks and which are supplementary. The ability to predict preoperatively the effect of removal of specific tissues would benefit surgical planning for all patients who undergo cortical resections, including those with epilepsy.
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27
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Loring DW. It's about Time: Long-term Memory Outcome following Temporal Lobectomy. Epilepsy Curr 2007; 7:38-40. [PMID: 17505549 PMCID: PMC1867081 DOI: 10.1111/j.1535-7511.2007.00162.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Verbal Memory Decline after Temporal Epilepsy Surgery?: A 6-Year Multiple Assessments Follow-up Study. Alpherts WC, Vermeulen J, van Rijen PC, da Silva FH, van Veelen CW; Dutch Collaborative Epilepsy Surgery Program. Neurology 2006;67:626–631. Objective To assess the long-term effects of temporal lobe epilepsy surgery on verbal memory. Methods We assessed verbal memory performance as measured by a verbal learning test (“15 Words Test,” a Dutch adaptation of Rey's Auditory Verbal Learning Test) before surgery and at three specific times after surgery: 6 months, 2 years, and 6 years in 85 patients (34 left temporal lobe [LTL] vs. 51 right temporal lobe [RTL]). An amygdalo-hippocampectomy and a neocortical temporal resection between 2.5 and 8 cm were carried out in all patients. Results LTL patients showed an ongoing memory decline for consolidation and acquisition of verbal material (both 2/3 SDs) for up to 2 years after surgery. RTL patients at first showed a gain in both memory acquisition and consolidation, which vanished in the long term. Breaking the group up into a mesiotemporal (MTS) group and a non-MTS group showed clear differences. The group with pure MTS showed an overall lower verbal memory performance than the group without pure MTS, in the LTL group more pronounced than in the RTL group. After surgery, both pathology groups showed an ongoing decline for up to 2 years, but the degree of decline was greater for the LTL patients with MTS compared with the non-MTS group. Becoming and remaining seizure-free after surgery does not result in a better performance in the long term. Predictors of postoperative verbal memory performance at 6 years after surgery were side of surgery, preoperative memory score, and age. Conclusions The results provide evidence for a dynamic decline of verbal memory functions up to 2 years after left temporal lobectomy, which then levels off.
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Lineweaver TT, Morris HH, Naugle RI, Najm IM, Diehl B, Bingaman W. Evaluating the contributions of state-of-the-art assessment techniques to predicting memory outcome after unilateral anterior temporal lobectomy. Epilepsia 2007; 47:1895-903. [PMID: 17116030 DOI: 10.1111/j.1528-1167.2006.00807.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Although anterior temporal lobectomy (ATL) is an effective treatment for many patients with medically refractory temporal lobe epilepsy (TLE), one risk associated with this procedure is postsurgical decline in memory. A substantial number of past studies examined factors that predict memory decline after surgery, but few have investigated multiple predictors simultaneously or considered measures that are currently in use. METHODS This study compared the relative contributions made by presurgical neuropsychological test scores, MRI-based hippocampal volumetric analysis, and Wada test results to predicting memory outcome after ATL in a group of 87 patients. RESULTS Logistic regression analyses indicated that noninvasive procedures (neuropsychological testing and MRI) made significant contributions to improving the prediction of memory outcome in this sample. The results from the Wada procedure did not significantly improve prediction once these other factors were considered. The only exception was in predicting memory for visual information after a delay, in which Wada results improved prediction accuracy from 78% to 81%. CONCLUSIONS Current neuropsychological tests and MRI volumetric measures predict changes in verbal and visual memory after ATL. The relatively small change in correct classification rates when Wada memory scores are considered calls into question the benefits of using Wada test results to predict memory outcome when the results of noninvasive procedures are available.
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Affiliation(s)
- Tara T Lineweaver
- Psychology Department, Butler University, Indianapolis, Indiana 46208, USA.
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29
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Leritz EC, Grande LJ, Bauer RM. Temporal lobe epilepsy as a model to understand human memory: the distinction between explicit and implicit memory. Epilepsy Behav 2006; 9:1-13. [PMID: 16759913 DOI: 10.1016/j.yebeh.2006.04.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2005] [Revised: 03/10/2006] [Accepted: 04/15/2006] [Indexed: 11/27/2022]
Abstract
Decades of research have provided substantial evidence of memory impairments in patients with temporal lobe epilepsy (TLE), including deficits in the encoding, storage, and retrieval of new information. These findings are not surprising, given the associated underlying neuroanatomy, including the hippocampus and surrounding medial temporal lobe structures. Because of its associated anatomic and cognitive characteristics, TLE has provided an excellent model by which to examine specific aspects of human memory functioning, including classic distinctions such as that between explicit and implicit memory. Various clinical and experimental research studies have supported the idea that both conscious and unconscious processes support memory functioning, but the role of relevant brain structures has been the subject of debate. This review is concerned with a discussion of the current status of this research and, importantly, how TLE can inform future studies of memory distinctions.
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Affiliation(s)
- Elizabeth C Leritz
- Geriatric Research, Education, and Clinical Center (GRECC), Boston VA Healthcare System, Boston, MA, USA.
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30
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Meador K. Memory loss after left anterior temporal lobectomy in patients with mesial temporal lobe sclerosis. Epilepsy Curr 2006; 6:44-5. [PMID: 16604199 PMCID: PMC1408290 DOI: 10.1111/j.1535-7511.2006.00097.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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