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Cavaco S, Moreira B, Dias D, Gonçalves A, Pinto C, Almeida E, Gomes F, Moreira I, Chaves J, Lopes J, Ramalheira J, Freitas J, Samões R, Rangel R, Martins da Silva A. Auditory verbal learning test can lateralize hippocampal sclerosis. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-7. [PMID: 35754382 DOI: 10.1080/23279095.2022.2090257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The ability of the Auditory Verbal Learning Test (AVLT) to lateralize hippocampal sclerosis (HS) in mesial temporal lobe epilepsy (MTLE) was explored in a sample of 50 patients with MTLE-HS (23 right and 27 left). Patients' AVLT scores were adjusted to the demographic characteristics of each individual in accordance with the Portuguese normative data. The laterality of the HS was determined by consensus by two neuroradiologists. ROC curves were used to identify the best AVLT cutoff scores to differentiate right vs. left HS. Diagnostic statistics were applied to different AVLT measures. The study results revealed that four AVLT scores can correctly classify the laterality of HS in the total sample and a sub-group of 39 right-handed patients (Edinburgh Laterality Inventory +100): delayed recall trial (76 and 80%, respectively), delayed recognition trial (64 and 67%, respectively), learning over trials index (64 and 74%, respectively), and long-term percent retention index (68 and 72%, respectively). In right-handed patients, the diagnostic capability of the delayed recall trial was improved by pairing it with the learning over trials index (accuracy of 85%). In sum, AVLT measures of verbal memory differentiate left from right HS in MTLE. The delayed recall trial demonstrated good diagnostic capacity.
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Affiliation(s)
- Sara Cavaco
- Neuropsychology Unit, Centro Hospitalar Universitario do Porto EPE, Porto, Portugal
- UMIB, Universidade do Porto Instituto de Ciencias Biomedicas Abel Salazar, Porto, Portugal
| | - Bruno Moreira
- Neuroradiology Department, Centro Hospitalar Universitario do Porto EPE, Porto, Portugal
| | - Daniel Dias
- Neuroradiology Department, Centro Hospitalar Universitario do Porto EPE, Porto, Portugal
| | - Alexandra Gonçalves
- Neuropsychology Unit, Centro Hospitalar Universitario do Porto EPE, Porto, Portugal
| | - Claudia Pinto
- Neuropsychology Unit, Centro Hospitalar Universitario do Porto EPE, Porto, Portugal
| | - Eduarda Almeida
- Neuropsychology Unit, Centro Hospitalar Universitario do Porto EPE, Porto, Portugal
| | - Filomena Gomes
- Neuropsychology Unit, Centro Hospitalar Universitario do Porto EPE, Porto, Portugal
| | - Inês Moreira
- Neuropsychology Unit, Centro Hospitalar Universitario do Porto EPE, Porto, Portugal
| | - João Chaves
- Neurology Department, Centro Hospitalar Universitario do Porto EPE, Porto, Portugal
| | - João Lopes
- Neurophysiology Department, Centro Hospitalar Universitario do Porto EPE, Porto, Portugal
| | - João Ramalheira
- Neurophysiology Department, Centro Hospitalar Universitario do Porto EPE, Porto, Portugal
| | - Joel Freitas
- Neurophysiology Department, Centro Hospitalar Universitario do Porto EPE, Porto, Portugal
| | - Raquel Samões
- Neurology Department, Centro Hospitalar Universitario do Porto EPE, Porto, Portugal
| | - Rui Rangel
- Department of Neurosurgery, Centro Hospitalar Universitario do Porto EPE, Porto, Portugal
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Thomas B, Aupy J, Penchet G, De Montaudouin M, Bartolomei F, Biraben A, Catenoix H, Chassoux F, Dupont S, Valton L, Michel V, Marchal C. Predictive factors of postoperative outcome in the elderly after resective epilepsy surgery. Rev Neurol (Paris) 2021; 178:609-615. [PMID: 34801264 DOI: 10.1016/j.neurol.2021.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/25/2021] [Accepted: 08/31/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the efficiency of resective epilepsy surgery (RES) in patients over 50 years and determine prognostic factors. RESULTS Over the 147 patients over 50 years (54.9±3.8 years [50-69]) coming from 8 specialized French centres for epilepsy surgery, 72.1%, patients were seizure-free and 91.2% had a good outcome 12 months after RES. Seizure freedom was not associated with the age at surgery or duration of epilepsy. In multivariate analysis, seizure freedom was associated with MRI and neuropathological hippocampal sclerosis (HS) (P=0.009 and P=0.028 respectively), PET hypometabolism (P=0.013), temporal epilepsy (P=0.01). On the contrary, the need for intracranial exploration was associated with a poorer prognosis (P=0.001). Postoperative number of antiepileptic drugs was significantly lower in the seizure-free group (P=0.001). Neurological adverse event rate after surgery was 21.1% and 11.7% of patients had neuropsychological adverse effects overall transient. CONCLUSIONS RES is effective procedure in the elderly. Even safe it remains at higher risk of complication and population should be carefully selected. Nevertheless, age should not be considered as a limiting factor, especially when good prognostic factors are identified.
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Affiliation(s)
- B Thomas
- Department of Clinical Neurosciences, Bordeaux University Hospital, Bordeaux, France
| | - J Aupy
- Department of Clinical Neurosciences, Bordeaux University Hospital, Bordeaux, France; IMN, UMR CNRS 5293, University of Bordeaux, Bordeaux Neurocampus, Bordeaux, France.
| | - G Penchet
- Department of Neurosurgery, Bordeaux University Hospital, Bordeaux, France
| | - M De Montaudouin
- Department of Clinical Neurosciences, Bordeaux University Hospital, Bordeaux, France
| | - F Bartolomei
- Clinical Neurophysiology and Epileptology Department, APHM, Timone Hospital, Marseille, France; INS, Institut de Neurosciences des Systèmes, Aix-Marseille University, Marseille, France
| | - A Biraben
- Department of Neurology, University Hospital of Rennes, Rennes, France
| | - H Catenoix
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Lyon, France
| | - F Chassoux
- Department of Neurosurgery, Sainte-Anne Hospital Centre, Paris, France
| | - S Dupont
- Epilepsy Unit, La Pitié-Salpêtrière University Hospital, AP-HP, Paris, France
| | - L Valton
- Department of Neurology, Toulouse University Hospital, Toulouse, France
| | - V Michel
- Department of Clinical Neurosciences, Bordeaux University Hospital, Bordeaux, France
| | - C Marchal
- Department of Clinical Neurosciences, Bordeaux University Hospital, Bordeaux, France
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Janecek JK, Binder JR, Mueller WM, Swanson SJ. Cognitive and functional outcomes following a traumatic brain injury sustained 22 years after epilepsy surgery: A case report. Epilepsy Behav Rep 2021; 16:100482. [PMID: 34693245 PMCID: PMC8515403 DOI: 10.1016/j.ebr.2021.100482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/20/2021] [Accepted: 09/08/2021] [Indexed: 11/30/2022] Open
Abstract
Long-term outcomes were presented for a patient status post epilepsy surgery and TBI. Cognitive stability was documented over a 22-year follow-up period. Good cognitive and functional outcomes were demonstrated in late life. Protective factors include seizure outcome, cognitive reserve, and medical status.
Anterior temporal lobectomy (ATL) is an effective treatment for drug-resistant epilepsy, and risk for post-surgical naming and verbal memory decline after dominant hemisphere ATL is well-established. However, less is known about later life cognitive and functional outcomes following ATL performed in early or mid-life, as there are few studies that report very long-term outcomes, and the intersection of epilepsy and the aging process is not well-understood. Factors that may promote healthy cognitive aging or confer increased risk for cognitive decline in late life for those with seizure onset in early or mid-life have yet to be determined. This case report describes an individual with drug-resistant epilepsy who was treated with left ATL in mid-life, and then subsequently sustained a moderate traumatic brain injury 22 years later. The excellent recovery and remarkable stability of cognitive performance over time may be associated with several protective factors such as favorable seizure outcome, high cognitive reserve, and the absence of co-occurring medical conditions. This case also highlights the clinical utility of serial neuropsychological testing at multiple timepoints across the lifespan for those with epilepsy, and the importance of considering the clinical significance, or functional impact, of cognitive deficits in this population.
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Affiliation(s)
- Julie K. Janecek
- Department of Neurology, Medical College of Wisconsin, 8701 W. Watertown Plank Rd., Milwaukee, WI 53226, USA
- Corresponding author at: Division of Neuropsychology, Department of Neurology, Medical College of Wisconsin, 8701 W. Watertown Plank Rd., Milwaukee, WI 53226, USA.
| | - Jeffrey R. Binder
- Department of Neurology, Medical College of Wisconsin, 8701 W. Watertown Plank Rd., Milwaukee, WI 53226, USA
| | - Wade M. Mueller
- Department of Neurosurgery, Medical College of Wisconsin, 8701 W. Watertown Plank Rd., Milwaukee, WI 53226, USA
| | - Sara J. Swanson
- Department of Neurology, Medical College of Wisconsin, 8701 W. Watertown Plank Rd., Milwaukee, WI 53226, USA
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The Impact of Right Temporal Lobe Epilepsy On Nonverbal Memory: Meta-regression of Stimulus- and Task-related Moderators. Neuropsychol Rev 2021; 32:537-557. [PMID: 34559363 DOI: 10.1007/s11065-021-09514-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 05/24/2021] [Indexed: 11/08/2022]
Abstract
Nonverbal memory tests have great potential value for detecting the impact of lateralized pathology and predicting the risk of memory loss following right temporal lobe resection (TLR) for temporal lobe epilepsy (TLE) patients, but this potential has not been realized. Previous reviews suggest that stimulus type moderates the capacity of nonverbal memory tests to detect right-lateralized pathology (i.e., faces > designs), but the roles of other task-related factors have not been systematically explored. We address these limitations using mixed model meta-regression (k = 158) of right-lateralization effects (right worse than left TLE) testing the moderating effects of: 1) stimulus type (designs, faces, spatial), 2) learning format (single trial, repeated trials), 3) testing delay (immediate or long delay), and 4) testing format (recall, recognition) for three patient scenarios: 1) presurgical, 2) postsurgical, and 3) postsurgical change. Stimulus type significantly moderated the size of the right-lateralization effect (faces > designs) for postsurgical patients, test format moderated the size of the right-lateralization effect for presurgical-postsurgical change (recognition > recall) but learning format and test delay had no right-lateralization effect for either sample. For presurgical patients, none of the task-related factors significantly increased right-lateralization effects. This comprehensive review reveals the value of recognition testing in gauging the risk of nonverbal memory decline.
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Alexandratou I, Patrikelis P, Messinis L, Alexoudi A, Verentzioti A, Stefanatou M, Nasios G, Panagiotopoulos V, Gatzonis S. Long-Term Neuropsychological Outcomes Following Temporal Lobe Epilepsy Surgery: An Update of the Literature. Healthcare (Basel) 2021; 9:healthcare9091156. [PMID: 34574930 PMCID: PMC8466433 DOI: 10.3390/healthcare9091156] [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: 07/21/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 11/22/2022] Open
Abstract
We present an update of the literature concerning long-term neuropsychological outcomes following surgery for refractory temporal lobe epilepsy (TLE). A thorough search was conducted through the PubMed and Medline electronic databases for studies investigating neuropsychological function in adult patients undergoing resective TLE surgery and followed for a mean/median > five years period. Two independent reviewers screened citations for eligibility and assessed relevant studies for the risk of bias. We found eleven studies fulfilling the above requirements. Cognitive function remained stable through long-term follow up despite immediate post-surgery decline; a negative relation between seizure control and memory impairment has emerged and a possible role of more selective surgery procedures is highlighted.
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Affiliation(s)
- Ioanna Alexandratou
- Department of Neurology, Evangelismos Hospital, Ipsilantou 45-47, 10676 Athens, Greece
- Correspondence:
| | - Panayiotis Patrikelis
- First Department of Neurosurgery, School of Medicine, National and Kapodistrian University of Athens, 10676 Athens, Greece; (P.P.); (A.A.); (A.V.); (M.S.); (S.G.)
| | - Lambros Messinis
- Lab of Cognitive Neuroscience, Department of Psychology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
- Department of Psychiatry, University of Patras Medical School, 26504 Patras, Greece
| | - Athanasia Alexoudi
- First Department of Neurosurgery, School of Medicine, National and Kapodistrian University of Athens, 10676 Athens, Greece; (P.P.); (A.A.); (A.V.); (M.S.); (S.G.)
| | - Anastasia Verentzioti
- First Department of Neurosurgery, School of Medicine, National and Kapodistrian University of Athens, 10676 Athens, Greece; (P.P.); (A.A.); (A.V.); (M.S.); (S.G.)
| | - Maria Stefanatou
- First Department of Neurosurgery, School of Medicine, National and Kapodistrian University of Athens, 10676 Athens, Greece; (P.P.); (A.A.); (A.V.); (M.S.); (S.G.)
| | - Grigorios Nasios
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, 45500 Ioannina, Greece;
| | | | - Stylianos Gatzonis
- First Department of Neurosurgery, School of Medicine, National and Kapodistrian University of Athens, 10676 Athens, Greece; (P.P.); (A.A.); (A.V.); (M.S.); (S.G.)
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Forthoffer N, Brissart H, Tyvaert L, Maillard L. Long-term cognitive outcomes in patient with epilepsy. Rev Neurol (Paris) 2020; 176:448-455. [PMID: 32414533 DOI: 10.1016/j.neurol.2020.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 11/28/2022]
Abstract
In contrast to short-term cognitive outcomes, long-term cognitive outcomes (over 5 years) has been scarcely assessed so far. Yet, predicting long-term outcomes at any time point of the epilepsy, from initial diagnosis, to medically intractability is very important for therapeutic decision-making, patient information, and orientation. Assessing long-term cognitive outcomes in patients with epilepsy would ideally require longitudinal studies and a comparison with a healthy controls group. This issue has been addressed extensively, but with controversial results. However, there is a general consensus about the fact that cognitive outcome is not the same in all groups of patients with epilepsy. Possible prognostic factors include age at onset, duration of epilepsy, syndrome and etiology, seizure outcome and therapeutics. The multiplicity of factors makes it very difficult to assess their relative weight in individuals. Although long-term cognitive outcome studies are scarce, this issue has been specifically studied in newly diagnosed epilepsies and in focal drug-resistant epilepsies. In the first clinical setting, i.e. newly diagnosed epilepsy, it appears that cognitive deficits are already present at epilepsy onset in a significant proportion of patients but seem to remain stable over time. In focal drug-resistant epilepsies, cognitive deficits (mainly verbal memory) were generally shown to remain stable provided that seizures were controlled either by medication or by surgery. Beyond the possible correlation between seizure and cognitive outcome, no causal link however has been demonstrated between these two important outcomes.
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Affiliation(s)
- N Forthoffer
- Service de Neurologie, Centre Hospitalier Universitaire de Nancy, Nancy, France; LNCA, UMR 7364, CNRS, Université de Strasbourg, 67000 Strasbourg, France.
| | - H Brissart
- Service de Neurologie, Centre Hospitalier Universitaire de Nancy, Nancy, France; CRAN, UMR 7039, CNRS, université de Lorraine, Vandoeuvre-lès-Nancy, France
| | - L Tyvaert
- Service de Neurologie, Centre Hospitalier Universitaire de Nancy, Nancy, France; CRAN, UMR 7039, CNRS, université de Lorraine, Vandoeuvre-lès-Nancy, France
| | - L Maillard
- Service de Neurologie, Centre Hospitalier Universitaire de Nancy, Nancy, France; CRAN, UMR 7039, CNRS, université de Lorraine, Vandoeuvre-lès-Nancy, France
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7
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Bremm FJ, Hendriks MPH, Bien CG, Grewe P. Pre- and postoperative verbal memory and executive functioning in frontal versus temporal lobe epilepsy. Epilepsy Behav 2019; 101:106538. [PMID: 31678807 DOI: 10.1016/j.yebeh.2019.106538] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/01/2019] [Accepted: 09/02/2019] [Indexed: 01/26/2023]
Abstract
There is accumulating evidence for considerable overlap in preoperatively affected cognitive functions in patients with temporal lobe epilepsy (TLE) and frontal lobe epilepsy (FLE). The current study investigated whether it is possible to differentiate between patients with FLE and TLE prior to surgery, based on measures of verbal memory and executive functioning. Furthermore, the postoperative cognitive development was compared. Pre- and postoperative data from 109 patients with FLE and 194 patients with TLE were retrospectively analyzed. Preoperatively, there were no differences in verbal memory, and postoperatively, no distinctive cognitive change was found between patients with FLE and TLE. However, patients with FLE performed worse on a cognitive switching task. Notably, irrespective of localization, patients with a presumed epileptogenic area in the language-dominant hemisphere performed worse than patients with seizures that originated in the nonlanguage-dominant hemisphere on measures of verbal memory, both pre- and postoperatively. In sum, the results suggest that verbal memory scores may be less valuable for differentiation between TLE and FLE, while measures of executive functioning may help identify patients with FLE. Additionally, rather than the localization, epilepsy lateralization critically impacts the evaluation of verbal memory functioning in both TLE and FLE. The results are discussed in light of the current frameworks of functional disturbances in epileptic networks.
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Affiliation(s)
- Florian J Bremm
- Epilepsy-Center Bethel, Krankenhaus Mara, Maraweg 17-21, 33617 Bielefeld, Germany; Radboud University, Donders Institute for Brain, Cognition, and Behavior, Nijmegen, Montessorilaan 3, 6525 HR Nijmegen, the Netherlands.
| | - Marc P H Hendriks
- Radboud University, Donders Institute for Brain, Cognition, and Behavior, Nijmegen, Montessorilaan 3, 6525 HR Nijmegen, the Netherlands; Academic Centre of Epileptology, Kempenhaeghe, Heeze Sterkselseweg 65, 5590 AB Heeze, the Netherlands.
| | - Christian G Bien
- Epilepsy-Center Bethel, Krankenhaus Mara, Maraweg 17-21, 33617 Bielefeld, Germany.
| | - Philip Grewe
- Epilepsy-Center Bethel, Krankenhaus Mara, Maraweg 17-21, 33617 Bielefeld, Germany.
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8
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Very long-term outcome in resected and non-resected patients with temporal lobe epilepsy with medial temporal lobe sclerosis: A multiple case-study. Seizure 2019; 67:30-37. [DOI: 10.1016/j.seizure.2019.02.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 02/18/2019] [Accepted: 02/19/2019] [Indexed: 11/20/2022] Open
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9
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Helmstaedter C, Elger C, Vogt V. Cognitive outcomes more than 5 years after temporal lobe epilepsy surgery: Remarkable functional recovery when seizures are controlled. Seizure 2018; 62:116-123. [DOI: 10.1016/j.seizure.2018.09.023] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/25/2018] [Accepted: 09/27/2018] [Indexed: 11/16/2022] Open
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10
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Schmid E, Thomschewski A, Taylor A, Zimmermann G, Kirschner M, Kobulashvili T, Brigo F, Rados M, Helmstaedter C, Braun K, Trinka E. Diagnostic accuracy of functional magnetic resonance imaging, Wada test, magnetoencephalography, and functional transcranial Doppler sonography for memory and language outcome after epilepsy surgery: A systematic review. Epilepsia 2018; 59:2305-2317. [PMID: 30374948 DOI: 10.1111/epi.14588] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/27/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The European Union-funded E-PILEPSY project was launched to develop guidelines and recommendations for epilepsy surgery. In this systematic review, we aimed to assess the diagnostic accuracy of functional magnetic resonance imaging (fMRI), Wada test, magnetoencephalography (MEG), and functional transcranial Doppler sonography (fTCD) for memory and language decline after surgery. METHODS The literature search was conducted using PubMed, Embase, and CENTRAL. The diagnostic accuracy was expressed in terms of sensitivity and specificity for postoperative language or memory decline, as determined by pre- and postoperative neuropsychological assessments. If two or more estimates of sensitivity or specificity were extracted from a study, two meta-analyses were conducted, using the maximum ("best case") and the minimum ("worst case") of the extracted estimates, respectively. RESULTS Twenty-eight papers were eligible for data extraction and further analysis. All tests for heterogeneity were highly significant, indicating large between-study variability (P < 0.001). For memory outcomes, meta-analyses were conducted for Wada tests (n = 17) using both memory and language laterality quotients. In the best case, meta-analyses yielded a sensitivity estimate of 0.79 (95% confidence interval [CI] = 0.67-0.92) and a specificity estimate of 0.65 (95% CI = 0.47-0.83). For the worst case, meta-analyses yielded a sensitivity estimate of 0.65 (95% CI = 0.48-0.82) and a specificity estimate of 0.46 (95% CI = 0.28-0.65). The overall quality of evidence, which was assessed using Grading of Recommendations Assessment, Development, and Evaluation methodology, was rated as very low. Meta-analyses concerning diagnostic accuracy of fMRI, fTCD, and MEG were not feasible due to small numbers of studies (fMRI, n = 4; fTCD, n = 1; MEG, n = 0). This also applied to studies concerning language outcomes (Wada test, n = 6; fMRI, n = 2; fTCD, n = 1; MEG, n = 0). SIGNIFICANCE Meta-analyses could only be conducted in a few subgroups for the Wada test with low-quality evidence. Thus, more evidence from high-quality studies and improved data reporting are required. Moreover, the large between-study heterogeneity underlines the necessity for more homogeneous and thus comparable studies in future research.
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Affiliation(s)
- Elisabeth Schmid
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Department of Psychology, Paris Lodron University of Salzburg, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg, Salzburg, Austria
| | - Aljoscha Thomschewski
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Department of Psychology, Paris Lodron University of Salzburg, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg, Salzburg, Austria.,Center for Cognitive Neuroscience, Salzburg, Austria
| | - Alexandra Taylor
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Department of Psychology, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Georg Zimmermann
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg, Salzburg, Austria.,Department of Mathematics, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Margarita Kirschner
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Teia Kobulashvili
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Francesco Brigo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,Department of Neurology, Franz Tappeiner Hospital, Merano, Italy
| | - Matea Rados
- Department of Child Neurology, University Medical Center, Utrecht, The Netherlands
| | | | - Kees Braun
- Department of Child Neurology, University Medical Center, Utrecht, The Netherlands
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg, Salzburg, Austria.,Center for Cognitive Neuroscience, Salzburg, Austria
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11
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Ljung H, Strandberg MC, Björkman-Burtscher IM, Psouni E, Källén K. Test-specific differences in verbal memory assessments used prior to surgery in temporal lobe epilepsy. Epilepsy Behav 2018; 87:18-24. [PMID: 30153652 DOI: 10.1016/j.yebeh.2018.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 07/28/2018] [Accepted: 08/12/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To study the relationship between two commonly used verbal memory tests in presurgical evaluation for temporal lobe epilepsy (TLE) in Sweden, the Claeson-Dahl Test for verbal learning and retention (CDT) and the Swedish version of the Rey Auditory Verbal Learning Test (RAVLT). METHODS Fifty-nine patients with TLE (male: 41%, mean: age 41.7 ± 12.3 years; epilepsy onset at mean age: 18.3 ± 13.1 years) previously tested with the CDT, the RAVLT, and three nonverbal memory tests on the same occasion were included. We performed (1) a principal component analysis (PCA) on test performances in the CDT and the RAVLT as well as in nonverbal memory tests; (2) a Pearson's correlation analysis for memory components, biological age, education, age at epilepsy onset, and self-rating scores for depression and anxiety; and (3) an estimation of clinically significant verbal memory impairment in patients with left TLE and left-sided hippocampal sclerosis. RESULTS The PCAs showed coherence between the learning variables of the CDT and the RAVLT and divergence between the recall variables of the two tests. The RAVLT delayed recall variable was correlated to four out of five nonverbal memory measures. Both tests showed 70-80% clinically significant impairment of verbal memory in patients with left TLE, with or without hippocampal sclerosis, similar to other cohorts with resistant TLE. CONCLUSIONS The construct structure of the two verbal memory differs. It was shown that the RAVLT correlated with visuospatial memory, whereas the CDT did not. The study highlights that there are important nonoverlapping features regarding verbal recall of the two tests, indicating that these tests cannot fully replace one another.
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Affiliation(s)
- Hanna Ljung
- Skåne University Hospital, Department of Neurology and Rehabilitation Medicine, Lund, Sweden; Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Division of Clinical Sciences Helsingborg, Sweden; Lund University, Faculty of Medicine, Department of Clinical Neurosciences, Division of Neurology, Lund, Sweden.
| | - Maria Compagno Strandberg
- Skåne University Hospital, Department of Neurology and Rehabilitation Medicine, Lund, Sweden; Lund University, Faculty of Medicine, Department of Clinical Neurosciences, Division of Neurology, Lund, Sweden
| | - Isabella M Björkman-Burtscher
- Lund University, Department of Diagnostic Radiology, Clinical Sciences Lund, Lund University BioImaging Center, Lund, Sweden; Skåne University Hospital, Department of Medical Imaging and Physiology, Lund, Sweden
| | - Elia Psouni
- Lund University, Faculty of Social Sciences, Department of Psychology, Lund, Sweden
| | - Kristina Källén
- Skåne University Hospital, Department of Neurology and Rehabilitation Medicine, Lund, Sweden; Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Division of Clinical Sciences Helsingborg, Sweden; Lund University, Faculty of Medicine, Department of Clinical Neurosciences, Division of Neurology, Lund, Sweden
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12
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Sidhu MK, Thompson PJ, Wandschneider B, Foulkes A, de Tisi J, Stretton J, Perona M, Thom M, Bonelli SB, Burdett J, Williams E, Duncan JS, Matarin M. The impact of brain-derived neurotrophic factor Val66Met polymorphism on cognition and functional brain networks in patients with intractable partial epilepsy. CNS Neurosci Ther 2018; 25:223-232. [PMID: 29952080 DOI: 10.1111/cns.13003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/04/2018] [Accepted: 06/05/2018] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Medial temporal lobe epilepsy (mTLE) is the most common refractory focal epilepsy in adults. Around 30%-40% of patients have prominent memory impairment and experience significant postoperative memory and language decline after surgical treatment. BDNF Val66Met polymorphism has also been associated with cognition and variability in structural and functional hippocampal indices in healthy controls and some patient groups. AIMS We examined whether BDNF Val66Met variation was associated with cognitive impairment in mTLE. METHODS In this study, we investigated the association of Val66Met polymorphism with cognitive performance (n = 276), postoperative cognitive change (n = 126) and fMRI activation patterns during memory encoding and language paradigms in 2 groups of patients with mTLE (n = 37 and 34). RESULTS mTLE patients carrying the Met allele performed more poorly on memory tasks and showed reduced medial temporal lobe activation and reduced task-related deactivations within the default mode networks in both the fMRI memory and language tasks than Val/Val patients. CONCLUSIONS Although cognitive impairment in epilepsy is the result of a complex interaction of factors, our results suggest a role of genetic factors on cognitive impairment in mTLE.
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Affiliation(s)
- Meneka K Sidhu
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK.,Epilepsy Society MRI Unit, Chesham Lane, Buckinghamshire, UK
| | - Pamela J Thompson
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK.,Epilepsy Society MRI Unit, Chesham Lane, Buckinghamshire, UK
| | - Britta Wandschneider
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK
| | - Alexandra Foulkes
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK
| | - Jane de Tisi
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK
| | - Jason Stretton
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK.,Epilepsy Society MRI Unit, Chesham Lane, Buckinghamshire, UK
| | - Marina Perona
- Department of Radiobiology (CAC), National Atomic Energy Commission (CNEA), National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.,Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
| | - Maria Thom
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK
| | | | - Jane Burdett
- Epilepsy Society MRI Unit, Chesham Lane, Buckinghamshire, UK
| | - Elaine Williams
- Epilepsy Society MRI Unit, Chesham Lane, Buckinghamshire, UK
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK.,Epilepsy Society MRI Unit, Chesham Lane, Buckinghamshire, UK
| | - Mar Matarin
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK.,Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
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13
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Hansen N, Ernst L, Rüber T, Widman G, Becker AJ, Elger CE, Helmstaedter C. Pre- and long-term postoperative courses of hippocampus-associated memory impairment in epilepsy patients with antibody-associated limbic encephalitis and selective amygdalohippocampectomy. Epilepsy Behav 2018; 79:93-99. [PMID: 29253681 DOI: 10.1016/j.yebeh.2017.10.033] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/25/2017] [Accepted: 10/26/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Limbic encephalitis (LE) is defined by mesiotemporal lobe structure abnormalities, seizures, memory, and psychiatric disturbances. This study aimed to identify the long-term clinical and neuropsychological outcome of selective amygdalohippocampectomy (sAH) in drug-resistant patients with temporal lobe epilepsy due to known or later diagnosed subacute LE not responding to immunotherapy associated with neuronal autoantibodies. METHODS In seven patients with temporal lobe epilepsy due to antibody positive LE (glutamic acid decarboxylase (GAD65): n=5; voltage-gated potassium channel complex (VGKC), N-methyl d-aspartate receptor (NMDAR): n=1; Ma-2/Ta: n=1) sAH (6 left, 1 right) was performed. Those patients underwent repeated electroencephalography (EEG) recordings, magnetic resonance imaging (MRI) volumetry of the amygdala and hippocampus, and neuropsychological examinations and were followed up for 6-7years on average. RESULTS Verbal memory and figural memory were affected in 57% of patients at baseline and 71% at the last follow-up. At the last follow-up, 14% of the patients had declined in verbal memory and figural memory. We observed improved memory in 43% of patients regarding figural memory, but not in a single patient regarding verbal memory. Repeated evaluations across the individual courses reveal cognitive and MRI dynamics that appear to be unrelated to surgery and drug treatment. Three of the seven patients with LE with different antibodies (NMDAR: n=1, Ma-2/Ta: n=1 and GAD65: n=1) achieved persistent seizure freedom along with no accelerated memory decline after surgery. Two of the five GAD65-antibody patients positive with LE showed progressive memory decline and a long-term tendency to contralateral hippocampus atrophy. CONCLUSIONS While memory demonstrated some decline in the long run, what is most important is that a progressive decline in memory is seldom found after sAH in patients with LE. Moreover, the dynamics in performance and MRI before and after surgery reveal disease dynamics independent of surgery. Selective amygdalohippocampectomy can lead to seizure freedom, but should be considered as a last resort treatment option for drug-resistant patients with temporal lobe epilepsy due to LE. Particular caution is recommended in patients with GAD65-LE.
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Affiliation(s)
- Niels Hansen
- Department of Epileptology, University of Bonn, Sigmund Freud Str. 25, 53127 Bonn, Germany.
| | - Leon Ernst
- Department of Epileptology, University of Bonn, Sigmund Freud Str. 25, 53127 Bonn, Germany
| | - Theodor Rüber
- Department of Epileptology, University of Bonn, Sigmund Freud Str. 25, 53127 Bonn, Germany
| | - Guido Widman
- Department of Epileptology, University of Bonn, Sigmund Freud Str. 25, 53127 Bonn, Germany
| | - Albert J Becker
- Department of Neuropathology, University of Bonn, Sigmund Freud Str. 25, 53127 Bonn, Germany
| | - Christian E Elger
- Department of Epileptology, University of Bonn, Sigmund Freud Str. 25, 53127 Bonn, Germany
| | - Christoph Helmstaedter
- Department of Epileptology, University of Bonn, Sigmund Freud Str. 25, 53127 Bonn, Germany
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Ljung H, Nordlund A, Strandberg M, Bengzon J, Källén K. Verbal memory decline from hippocampal depth electrodes in temporal lobe surgery for epilepsy. Epilepsia 2017; 58:2143-2152. [PMID: 29105058 DOI: 10.1111/epi.13931] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To explore whether patients with refractory mesial temporal lobe epilepsy risk aggravated verbal memory loss from intracranial electroencephalography (EEG) recording with longitudinal hippocampal electrodes in the language-dominant hemisphere. METHODS A long-term neuropsychological follow-up (mean 61.5 months, range 22-111 months) was performed in 40 patients after ictal registration with left hippocampal depth electrodes (study group, n = 16) or no invasive EEG, only extracranial registration (reference group, n = 24). The groups were equal with respect to education, age at seizure onset, epilepsy duration, and prevalence of pharmacoresistant temporal lobe epilepsy (TLE; 75%) versus seizure freedom (25%). Retrospective neuropsychological data from preoperative surgical workup (T1) and prospective follow-up neuropsychological data (T2) were compared. A ≥1 SD intrapatient decline was considered as clinically relevant deterioration of verbal memory. RESULTS Significant decline in verbal memory was seen in 56% of the patients in the study group compared to 21% in the reference group. At T1, there were no statistical between-group differences in memory performance. At T2, between-group comparison showed significantly greater verbal memory decline for the study group (Claeson Dahl Learning and Retention Test, Verbal Learning: p = 0.05; Rey Auditory Verbal Learning Test, Total Learning: p = 0.04; Claeson Dahl Learning and Retention Test, Verbal Retention: p = 0.04). An odds ratio (OR) of 7.1 (90% confidence interval [CI] 1.3-37.7) for verbal memory decline was seen if right temporal lobe resection (R TLR) had been performed between T1 and T2. The difference between groups remained unchanged when patients who had undergone R TLR were excluded from the analysis, with a remaining aggravated significant decline in verbal memory performance for the study group compared to the reference group. SIGNIFICANCE Our results suggest a risk of verbal memory deterioration after the use of depth electrodes along the longitudinal axis of the hippocampus. Until this issue is further investigated, caution regarding depth electrodes in the language-dominant hemisphere hippocampus seems advisable.
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Affiliation(s)
- Hanna Ljung
- Department of Neurology and Rehabilitation Medicine, Lund University Hospital, Lund, Sweden.,Division of Clinical Sciences Helsingborg, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden.,Division of Neurology, Department of Clinical Neurosciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
| | - Arto Nordlund
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Maria Strandberg
- Department of Neurology and Rehabilitation Medicine, Lund University Hospital, Lund, Sweden.,Division of Neurology, Department of Clinical Neurosciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
| | - Johan Bengzon
- Division of Neurosurgery, Department of Clinical Neurosciences Lund, Faculty of Medicine, Lund University, Lund, Sweden.,Department of Neurosurgery, Skåne University Hospital, Lund, Sweden
| | - Kristina Källén
- Department of Neurology and Rehabilitation Medicine, Lund University Hospital, Lund, Sweden.,Division of Clinical Sciences Helsingborg, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden.,Division of Neurology, Department of Clinical Neurosciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
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15
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Cano-López I, Vázquez JF, Campos A, Gutiérrez A, Garcés M, Gómez-Ibáñez A, Conde R, González-Bono E, Villanueva V. Age at surgery as a predictor of cognitive improvements in patients with drug-resistant temporal epilepsy. Epilepsy Behav 2017; 70:10-17. [PMID: 28407524 DOI: 10.1016/j.yebeh.2017.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 12/16/2016] [Accepted: 03/04/2017] [Indexed: 10/19/2022]
Abstract
Temporal lobe epilepsy (TLE) surgery is an effective procedure that can produce cognitive changes. However, the prognostic factors related with cognitive outcomes need to be better understood. The aim of the present study is to know if age at surgery is a reliable predictor of verbal memory competence and considering factors such as: hemisphere; type of surgery; pre-surgical seizure frequency; and epilepsy duration. Sixty-one typically dominant patients with drug-resistant TLE (34 with left TLE [L-TLE] and 27 with right TLE [R-TLE]) underwent a neuropsychological assessment before and a year after surgery. Results showed that R-TLE patients had better evolution in short- and long-term verbal memory and naming than L-TLE patients (for all, p >.04). L-TLE patients also more frequently showed a strong and reliable decline in these functions than R-TLE patients. No effects for gender or type of surgery were found. From a multivariate approach, patients with improvements in verbal competence underwent surgery at earlier ages and suffered epilepsy for less time (for all, p <0.4). The relevance of age at surgery was confirmed as a predictor of long-term verbal memory changes, although the frequency of partial seizures also explains, at least partially, these changes. In addition, the frequency of partial seizures explains short-term verbal memory changes. These results emphasize the importance of early intervention, independently of the resected hemisphere, in order to minimize the cognitive side-effects of epilepsy treatment, as well the need to consider cognitive functions as related processes and network dependent.
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Affiliation(s)
- Irene Cano-López
- Department of Psychobiology/IDOCAL, University of Valencia, Spain; Multidisciplinary Epilepsy Unit/Neurology Service, Hospital Universitario y Politécnico La Fe, Spain
| | - Juan Francisco Vázquez
- Multidisciplinary Epilepsy Unit/Neurology Service, Hospital Universitario y Politécnico La Fe, Spain
| | - Anabel Campos
- Multidisciplinary Epilepsy Unit/Neurology Service, Hospital Universitario y Politécnico La Fe, Spain
| | - Antonio Gutiérrez
- Multidisciplinary Epilepsy Unit/Neurology Service, Hospital Universitario y Politécnico La Fe, Spain
| | - Mercedes Garcés
- Multidisciplinary Epilepsy Unit/Neurology Service, Hospital Universitario y Politécnico La Fe, Spain
| | - Asier Gómez-Ibáñez
- Multidisciplinary Epilepsy Unit/Neurology Service, Hospital Universitario y Politécnico La Fe, Spain
| | - Rebeca Conde
- Multidisciplinary Epilepsy Unit/Neurology Service, Hospital Universitario y Politécnico La Fe, Spain
| | | | - Vicente Villanueva
- Multidisciplinary Epilepsy Unit/Neurology Service, Hospital Universitario y Politécnico La Fe, Spain.
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16
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Abstract
OBJECTIVES Little is known about the very long-term cognitive outcome in patients with childhood-onset epilepsy. The aim of this unique prospective population-based cohort study was to examine cognitive outcomes in aging participants with childhood-onset epilepsy (mean onset age=5.3 years) five decades later (mean age at follow-up=56.5 years). METHODS The sample consisted of 48 participants with childhood-onset epilepsy and 48 age-matched healthy controls aged 48-63 years. Thirty-six epilepsy participants were in remission and 12 continued to have seizures. Cognitive function was examined with 11 neuropsychological tests measuring language and semantic function, episodic memory, and learning, visuomotor function, executive function, and working memory. RESULTS The risk of cognitive impairment was very high in participants with continuing seizures; odds ratio (OR)=11.7 (95% confidence interval [CI] (2.8, 49.6), p=.0008). They exhibited worse performances across measures of language and semantic function, and visuomotor function compared to participants with remitted epilepsy and healthy controls. In the participants with remitted epilepsy, the risk of cognitive impairment was somewhat elevated, but not statistically significant; OR=2.6 (95% CI [0.9, 7.5], p=.08). CONCLUSIONS Our results showed that the distinction of continued versus discontinued seizures was critical for determining long-term cognitive outcome in childhood-onset epilepsy. Few participants in remission exhibited marked cognitive impairment compared to age-matched peers. However, a subgroup of participants with decades long active epilepsy, continuous seizure activity and anti-epileptic drug (AED) medication, showed clinically significant cognitive impairment and are thus in a more precarious position when entering older age. (JINS, 2017, 23, 332-340).
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17
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Gooneratne IK, Mannan S, de Tisi J, Gonzalez JC, McEvoy AW, Miserocchi A, Diehl B, Wehner T, Bell GS, Sander JW, Duncan JS. Somatic complications of epilepsy surgery over 25 years at a single center. Epilepsy Res 2017; 132:70-77. [PMID: 28324680 DOI: 10.1016/j.eplepsyres.2017.02.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 01/27/2017] [Accepted: 02/26/2017] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Epilepsy surgery is an effective treatment for refractory focal epilepsy. Risks of surgery need to be considered when advising individuals of treatment options. We describe the frequency and nature of physical adverse events associated with epilepsy surgery in a single center. MATERIAL AND METHODS We reviewed the prospectively maintained records of adults who underwent epilepsy surgery at our center between 1990 and 2014 to identify peri/postsurgical adverse events. These were categorized into neurological deficits and those related to surgery (e.g. wound infections). Neurological deficits were categorized as expected or unexpected and into transient (≤3 months) or persistent (>3 months), RESULTS: There were 911 procedures with no peri-operative deaths. Persistent neurological adverse events were seen following 157 (17.2%) procedures. The most common persistent expected complication was quadrantanopia after temporal lobe resections (72/764, 9.4%). Unexpected persistent neurological complications occurred in 20 procedures (2.2%) and included: quadrantanopia (6, 0.7%); hemianopia (2, 0.2%); hemi/mono-paresis/sensory loss (9, 1%); dysphasia (10, 1%); frontalis muscle weakness (2, 0.2%); and oculomotor weakness (1, 0.1%). 106 surgery related adverse events occurred in 83 procedures, with severe infections requiring bone-flap removal in 24 (2.6%) procedures and intracranial infections in 8 (0.9%). The risk of post-resective severe infection increased by 4 fold (OR 4.32, 95% CI 2.1-8.9, p<0.001) with use of subdural EEG monitoring prior to resection. In consequence, in August 2011 we introduced antibiotic coverage in all individuals undergoing intracranial monitoring. Also, after August 2011 there was greater use of Stereo-EEG (SEEG) than subdural (OR 9.0 CI 0.36-224.2, p=0.18ns). One complicated by severe infection. Other surgical complications included haematoma (0.3%), hydrocephalus (0.3%) and CSF leak (1.2%). None had permanent complications. CONCLUSIONS Adverse event rates are similar to other series. Epilepsy surgery carries well defined surgical and neurological risks. The risks of somatic adverse events, in addition to neuropsychiatric and neuropsychological complications need to be made clear to individuals considering this treatment option.
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Affiliation(s)
- Inuka K Gooneratne
- NIHR UCL Hospitals Biomedical Research Centre, Department of Clinical & Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, & Epilepsy Society, Chalfont St Peter, SL9 0RJ, UK, UK; Kegalle District General Hospital, Kegalle, Sri Lanka.
| | - Shahidul Mannan
- NIHR UCL Hospitals Biomedical Research Centre, Department of Clinical & Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, & Epilepsy Society, Chalfont St Peter, SL9 0RJ, UK, UK
| | - Jane de Tisi
- NIHR UCL Hospitals Biomedical Research Centre, Department of Clinical & Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, & Epilepsy Society, Chalfont St Peter, SL9 0RJ, UK, UK
| | - Juan C Gonzalez
- NIHR UCL Hospitals Biomedical Research Centre, Department of Clinical & Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, & Epilepsy Society, Chalfont St Peter, SL9 0RJ, UK, UK; Stichting Epilepsie Instellingen Nederland - SEIN, Achterweg 5, Heemstede 2103SW, Netherlands; Kegalle District General Hospital, Kegalle, Sri Lanka
| | - Andrew W McEvoy
- NIHR UCL Hospitals Biomedical Research Centre, Department of Clinical & Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, & Epilepsy Society, Chalfont St Peter, SL9 0RJ, UK, UK
| | - Anna Miserocchi
- NIHR UCL Hospitals Biomedical Research Centre, Department of Clinical & Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, & Epilepsy Society, Chalfont St Peter, SL9 0RJ, UK, UK
| | - Beate Diehl
- NIHR UCL Hospitals Biomedical Research Centre, Department of Clinical & Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, & Epilepsy Society, Chalfont St Peter, SL9 0RJ, UK, UK
| | - Tim Wehner
- NIHR UCL Hospitals Biomedical Research Centre, Department of Clinical & Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, & Epilepsy Society, Chalfont St Peter, SL9 0RJ, UK, UK
| | - Gail S Bell
- NIHR UCL Hospitals Biomedical Research Centre, Department of Clinical & Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, & Epilepsy Society, Chalfont St Peter, SL9 0RJ, UK, UK
| | - Josemir W Sander
- NIHR UCL Hospitals Biomedical Research Centre, Department of Clinical & Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, & Epilepsy Society, Chalfont St Peter, SL9 0RJ, UK, UK; Stichting Epilepsie Instellingen Nederland - SEIN, Achterweg 5, Heemstede 2103SW, Netherlands
| | - John S Duncan
- NIHR UCL Hospitals Biomedical Research Centre, Department of Clinical & Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, & Epilepsy Society, Chalfont St Peter, SL9 0RJ, UK, UK
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18
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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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19
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Goldman AM, LaFrance WC, Benke T, Asato M, Drane D, Pack A, Syed T, Doss R, Lhatoo S, Fureman B, Dingledine R. 2014 Epilepsy Benchmarks Area IV: Limit or Prevent Adverse Consequence of Seizures and Their Treatment Across The Lifespan. Epilepsy Curr 2016; 16:198-205. [PMID: 27330453 PMCID: PMC4913859 DOI: 10.5698/1535-7511-16.3.198] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Alica M. Goldman
- Associate Professor, Department of Neurology, Baylor College of Medicine, One Baylor Plaza, NB222, Houston, TX, USA
| | - W. Curt LaFrance
- Associate Professor, Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Providence RI 02903-4923 USA
| | - Tim Benke
- Associate Professor, Departments of Pediatrics, Neurology, Pharmacology and Otolaryngology, University of Colorado School of Medicine, Aurora, CO
| | - Miya Asato
- Associate Professor, Pediatrics and Psychiatry, Divisionof Child Neurology, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Dan Drane
- Assistant Professor, Departments of Neurology and Pediatrics, Emory University School of Medicine and Department of Neurology, University of Washington School of Medicine
| | - Alison Pack
- Associate Professor of Neurology, Department of Neurology, Columbia University Medical Center, New York, NY
| | - Tanvir Syed
- Assistant Professor of Neurology, University Hospitals Case Medical Center, Cleveland, OH
| | - Robert Doss
- Clinical Neuropsychologist, Minnesota Epilepsy Group, P.A., St. Paul, MN and Department of Neurology, University of Minnesota-Twin Cities, MN
| | - Samden Lhatoo
- Professor and Chair, Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Brandy Fureman
- Program Director, Channels Synapses and Circuits Cluster, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Ray Dingledine
- Professor and Chair, Department of Pharmacology, Emory University, Atlanta GA
| | - for the American Epilepsy Society (AES)/National Institute of Neurological Disorders and Stroke (NINDS) Epilepsy Benchmark Stewards.
- Associate Professor, Department of Neurology, Baylor College of Medicine, One Baylor Plaza, NB222, Houston, TX, USA
- Associate Professor, Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Providence RI 02903-4923 USA
- Associate Professor, Departments of Pediatrics, Neurology, Pharmacology and Otolaryngology, University of Colorado School of Medicine, Aurora, CO
- Associate Professor, Pediatrics and Psychiatry, Divisionof Child Neurology, Children's Hospital of Pittsburgh, Pittsburgh, PA
- Assistant Professor, Departments of Neurology and Pediatrics, Emory University School of Medicine and Department of Neurology, University of Washington School of Medicine
- Associate Professor of Neurology, Department of Neurology, Columbia University Medical Center, New York, NY
- Assistant Professor of Neurology, University Hospitals Case Medical Center, Cleveland, OH
- Clinical Neuropsychologist, Minnesota Epilepsy Group, P.A., St. Paul, MN and Department of Neurology, University of Minnesota-Twin Cities, MN
- Professor and Chair, Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH
- Program Director, Channels Synapses and Circuits Cluster, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
- Professor and Chair, Department of Pharmacology, Emory University, Atlanta GA
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20
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Sidhu MK, Stretton J, Winston GP, McEvoy AW, Symms M, Thompson PJ, Koepp MJ, Duncan JS. Memory network plasticity after temporal lobe resection: a longitudinal functional imaging study. Brain 2016; 139:415-30. [PMID: 26754787 PMCID: PMC4805088 DOI: 10.1093/brain/awv365] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 10/30/2015] [Indexed: 11/13/2022] Open
Abstract
Anterior temporal lobe resection can control seizures in up to 80% of patients with temporal lobe epilepsy. Memory decrements are the main neurocognitive complication. Preoperative functional reorganization has been described in memory networks, but less is known of postoperative reorganization. We investigated reorganization of memory-encoding networks preoperatively and 3 and 12 months after surgery. We studied 36 patients with unilateral medial temporal lobe epilepsy (19 right) before and 3 and 12 months after anterior temporal lobe resection. Fifteen healthy control subjects were studied at three equivalent time points. All subjects had neuropsychological testing at each of the three time points. A functional magnetic resonance imaging memory-encoding paradigm of words and faces was performed with subsequent out-of-scanner recognition assessments. Changes in activations across the time points in each patient group were compared to changes in the control group in a single flexible factorial analysis. Postoperative change in memory across the time points was correlated with postoperative activations to investigate the efficiency of reorganized networks. Left temporal lobe epilepsy patients showed increased right anterior hippocampal and frontal activation at both 3 and 12 months after surgery relative to preoperatively, for word and face encoding, with a concomitant reduction in left frontal activation 12 months postoperatively. Right anterior hippocampal activation 12 months postoperatively correlated significantly with improved verbal learning in patients with left temporal lobe epilepsy from preoperatively to 12 months postoperatively. Preoperatively, there was significant left posterior hippocampal activation that was sustained 3 months postoperatively at word encoding, and increased at face encoding. For both word and face encoding this was significantly reduced from 3 to 12 months postoperatively. Patients with right temporal lobe epilepsy showed increased left anterior hippocampal activation on word encoding from 3 to 12 months postoperatively compared to preoperatively. On face encoding, left anterior hippocampal activations were present preoperatively and 12 months postoperatively. Left anterior hippocampal and orbitofrontal cortex activations correlated with improvements in both design and verbal learning 12 months postoperatively. On face encoding, there were significantly increased left posterior hippocampal activations that reduced significantly from 3 to 12 months postoperatively. Postoperative changes occur in the memory-encoding network in both left and right temporal lobe epilepsy patients across both verbal and visual domains. Three months after surgery, compensatory posterior hippocampal reorganization that occurs is transient and inefficient. Engagement of the contralateral hippocampus 12 months after surgery represented efficient reorganization in both patient groups, suggesting that the contralateral hippocampus contributes to memory outcome 12 months after surgery.
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Affiliation(s)
- Meneka K Sidhu
- 1 Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK 2 Epilepsy Society MRI Unit, Chesham Lane, Chalfont St. Peter SL9 0RJ, Buckinghamshire, UK
| | - Jason Stretton
- 1 Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK 2 Epilepsy Society MRI Unit, Chesham Lane, Chalfont St. Peter SL9 0RJ, Buckinghamshire, UK 3 MRC Cognition and Brain Science Unit, Chaucer Road, Cambridge, CB2 7EF, UK
| | - Gavin P Winston
- 1 Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK 2 Epilepsy Society MRI Unit, Chesham Lane, Chalfont St. Peter SL9 0RJ, Buckinghamshire, UK
| | - Andrew W McEvoy
- 1 Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK 2 Epilepsy Society MRI Unit, Chesham Lane, Chalfont St. Peter SL9 0RJ, Buckinghamshire, UK
| | - Mark Symms
- 1 Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK 2 Epilepsy Society MRI Unit, Chesham Lane, Chalfont St. Peter SL9 0RJ, Buckinghamshire, UK
| | - Pamela J Thompson
- 1 Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK 2 Epilepsy Society MRI Unit, Chesham Lane, Chalfont St. Peter SL9 0RJ, Buckinghamshire, UK
| | - Matthias J Koepp
- 1 Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK 2 Epilepsy Society MRI Unit, Chesham Lane, Chalfont St. Peter SL9 0RJ, Buckinghamshire, UK
| | - John S Duncan
- 1 Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK 2 Epilepsy Society MRI Unit, Chesham Lane, Chalfont St. Peter SL9 0RJ, Buckinghamshire, UK
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Voets NL, Menke RAL, Jbabdi S, Husain M, Stacey R, Carpenter K, Adcock JE. Thalamo-Cortical Disruption Contributes to Short-Term Memory Deficits in Patients with Medial Temporal Lobe Damage. Cereb Cortex 2015; 25:4584-95. [PMID: 26009613 PMCID: PMC4816801 DOI: 10.1093/cercor/bhv109] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Short-term (STM) and long-term memory (LTM) have largely been considered as separate brain systems reflecting fronto-parietal and medial temporal lobe (MTL) functions, respectively. This functional dichotomy has been called into question by evidence of deficits on aspects of working memory in patients with MTL damage, suggesting a potentially direct hippocampal contribution to STM. As the hippocampus has direct anatomical connections with the thalamus, we tested the hypothesis that damage to thalamic nuclei regulating cortico-cortical interactions may contribute to STM deficits in patients with hippocampal dysfunction. We used diffusion-weighted magnetic resonance imaging-based tractography to identify anatomical subdivisions in patients with MTL epilepsy. From these, we measured resting-state functional connectivity with detailed cortical divisions of the frontal, temporal, and parietal lobes. Whereas thalamo-temporal functional connectivity reflected LTM performance, thalamo-prefrontal functional connectivity specifically predicted STM performance. Notably, patients with hippocampal volume loss showed thalamic volume loss, most prominent in the pulvinar region, not detected in patients with normal hippocampal volumes. Aberrant thalamo-cortical connectivity in the epileptic hemisphere was mirrored in a loss of behavioral association with STM performance specifically in patients with hippocampal atrophy. These findings identify thalamo-cortical disruption as a potential mechanism contributing to STM deficits in the context of MTL damage.
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Affiliation(s)
- Natalie L Voets
- FMRIB Centre, Nuffield Department of Clinical Neurosciences Epilepsy Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | | | - Saad Jbabdi
- FMRIB Centre, Nuffield Department of Clinical Neurosciences
| | - Masud Husain
- FMRIB Centre, Nuffield Department of Clinical Neurosciences Epilepsy Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK Department of Experimental Psychology, University of Oxford, Oxford OX1 3UD, UK
| | - Richard Stacey
- Department of Neurosurgery, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | | | - Jane E Adcock
- FMRIB Centre, Nuffield Department of Clinical Neurosciences Epilepsy Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
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Long-term memory performance after surgical treatment of unilateral temporal lobe epilepsy (TLE). Epilepsy Res 2014; 108:1228-37. [DOI: 10.1016/j.eplepsyres.2014.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 04/23/2014] [Accepted: 05/03/2014] [Indexed: 11/20/2022]
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Long-term postoperative atrophy of contralateral hippocampus and cognitive function in unilateral refractory MTLE with unilateral hippocampal sclerosis. Epilepsy Behav 2014; 36:108-14. [PMID: 24907496 DOI: 10.1016/j.yebeh.2014.04.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 04/26/2014] [Accepted: 04/30/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study aimed to evaluate long-term atrophy in contralateral hippocampal volume after surgery for unilateral MTLE, as well as the cognitive outcome for patients submitted to either selective transsylvian amygdalohippocampectomy (SelAH) or anterior temporal lobe resection (ATL). METHODS We performed a longitudinal study of 47 patients with MRI signs of unilateral hippocampal sclerosis (23 patients with right-sided hippocampal sclerosis) who underwent surgical treatment for MTLE. They underwent preoperative/postoperative high-resolution MRI as well as neuropsychological assessment for memory and estimated IQ. To investigate possible changes in the contralateral hippocampus of patients, we included 28 controls who underwent two MRIs at long-term intervals. RESULTS The volumetry using preoperative MRI showed significant hippocampal atrophy ipsilateral to the side of surgery when compared with controls (p<0.0001) but no differences in contralateral hippocampal volumes. The mean postoperative follow-up was 8.7 years (± 2.5 SD; median=8.0). Our patients were classified as Engel I (80%), Engel II (18.2%), and Engel III (1.8%). We observed a small but significant reduction in the contralateral hippocampus of patients but no volume changes in controls. Most of the patients presented small declines in both estimated IQ and memory, which were more pronounced in patients with left TLE and in those with persistent seizures. Different surgical approaches did not impose differences in seizure control or in cognitive outcome. CONCLUSIONS We observed small declines in cognitive scores with most of these patients, which were worse in patients with left-sided resection and in those who continued to suffer from postoperative seizures. We also demonstrated that manual volumetry can reveal a reduction in volume in the contralateral hippocampus, although this change was mild and could not be detected by visual analysis. These new findings suggest that dynamic processes continue to act after the removal of the hippocampus, and further studies with larger groups may help in understanding the underlying mechanisms.
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Duchowny M, Bhatia S. Epilepsy: preserving memory in temporal lobectomy-are networks the key? Nat Rev Neurol 2014; 10:245-6. [PMID: 24752125 DOI: 10.1038/nrneurol.2014.67] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Michael Duchowny
- Department of Neurology, Miami Children's Hospital, 3200 SW 60th Court, Miami, FL 33155, USA
| | - Sanjiv Bhatia
- Department of Neurosurgery, Miami Children's Hospital, 3200 SW 60th Court, Miami, FL 33155, USA
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Andersson-Roswall L, Engman E, Samuelsson H, Malmgren K. Psychosocial status 10 years after temporal lobe resection for epilepsy, a longitudinal controlled study. Epilepsy Behav 2013; 28:127-31. [PMID: 23673235 DOI: 10.1016/j.yebeh.2013.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 02/27/2013] [Accepted: 03/02/2013] [Indexed: 11/16/2022]
Abstract
Knowledge about long-term psychosocial outcome of temporal lobe resection (TLR) for epilepsy is limited. The aims of this study were to describe vocational outcome 10 years after TLR and to analyze the effect on the vocational situation by seizures, laterality of resection, verbal memory, and mood. Fifty-one patients were prospectively followed 10 years after TLR. Psychosocial and neuropsychological data were ascertained at baseline and 10 years after surgery and at corresponding time points for 23 controls. Fewer patients worked 10 years post-operatively compared with controls (TLR patients: 61% and controls: 96%). However, seizure-free patients were more likely to retain employment (71%) than patients who had seizures (41%). The odds of working full-time were 9.5 times higher for patients with seizure freedom than for those with continuing seizures. There were no associations between working at 10 years and side of resection or mood, and impairment of verbal memory did not have an influence on vocational outcome.
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Affiliation(s)
- Lena Andersson-Roswall
- Institute of Neuroscience and Physiology, Epilepsy Research Group, University of Gothenburg, Sweden.
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26
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Current world literature. Curr Opin Anaesthesiol 2012; 25:629-38. [PMID: 22955173 DOI: 10.1097/aco.0b013e328358c68a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Andersson-Roswall L, Malmgren K, Engman E, Samuelsson H. Verbal memory decline is less frequent at 10 years than at 2 years after temporal lobe surgery for epilepsy. Epilepsy Behav 2012; 24:462-7. [PMID: 22789634 DOI: 10.1016/j.yebeh.2012.05.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Revised: 05/20/2012] [Accepted: 05/22/2012] [Indexed: 11/28/2022]
Abstract
We investigated individual short- and long-term verbal memory changes after temporal lobe resection for epilepsy. Fifty-one patients (23 operated on the speech-dominant temporal lobe, DTL and 28 on the non-dominant temporal lobe, NDTL) were tested on learning/immediate recall and delayed recall of word-list and word-pairs preoperatively, 2 years postoperatively and 10years postoperatively. Changes were defined using reliable change indices of 23 healthy controls assessed at corresponding intervals. Fewer patients had reliable declines at 10 years than at 2 years (DTL: 13-35% vs 35-44%; NDTL: 0-4% vs 7-21%). Four DTL patients (17%) had reliable declines in ≥2 tests at 10-year follow-up. More NDTL patients had improvement at 10 years than at 2 years (18-30% vs 4-22%). The only risk factor for decline both short and long term was DTL resection. In conclusion, most patients had stable verbal memory postoperatively. A few DTL patients had a lasting decline at long-term follow-up, but more patients showed partial recovery, especially in the NDTL group.
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Affiliation(s)
- Lena Andersson-Roswall
- Institute of Neuroscience and Physiology, Epilepsy Research Group, University of Gothenburg, Sweden.
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Yasuda CL, Cendes F. Neuroimaging for the prediction of response to medical and surgical treatment in epilepsy. ACTA ACUST UNITED AC 2012; 6:295-308. [PMID: 23480740 DOI: 10.1517/17530059.2012.683408] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Approximately 30% of patients with epilepsy do not respond to adequate medication and are candidates for surgical treatment. Outcome predictors can improve the selection of more suitable treatment options for each patient. Therefore, the authors aimed to review the role of neuroimaging studies in predicting outcomes for both clinical and surgical treatment of epilepsy. AREAS COVERED This review analyzes studies that investigated different neuroimaging techniques as predictors of clinical and surgical treatment outcome in epilepsy. Studies involving both structural (i.e., T1-weighted images and diffusion tensor images) and functional MRI (fMRI) were identified, as well as other modalities such as spectroscopy, PET, SPECT and MEG. The authors also evaluated the importance of fMRI in predicting memory outcome after surgical resections in temporal lobe epilepsy. EXPERT OPINION The identification of reliable biomarkers to predict response to medical and surgical treatments are much needed in order to provide more adequate patient counseling about prognosis and treatment options individually. Different neuroimaging techniques may provide combined measurements that potentially may become these biomarkers in the near future.
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Affiliation(s)
- Clarissa Lin Yasuda
- University of Campinas/UNICAMP, Department of Neurology, Neuroimaging Laboratory , Cidade Universitária Zeferino Vaz, Rua Tessália Vieira de Camargo, 126. Cx postal 6111, Campinas, SP. CEP 13083-970 , Brazil
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Vojtěch Z, Krámská L, Malíková H, Seltenreichová K, Procházka T, Kalina M, Liščák R. Cognitive outcome after stereotactic amygdalohippocampectomy. Seizure 2012; 21:327-33. [PMID: 22445176 DOI: 10.1016/j.seizure.2012.02.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Revised: 02/20/2012] [Accepted: 02/21/2012] [Indexed: 10/28/2022] Open
Abstract
PURPOSE We sought to determine the neuropsychological outcome after stereotactic radiofrequency amygdalohippocampectomy performed for intractable mesial temporal lobe epilepsy. METHODS The article describes the cases of 31 patients who were evaluated using the Wechsler Adult Intelligence Scale-Revised and the Wechsler Memory Scale-Revised prior to, and one year after, surgery. KEY FINDINGS Patients showed increases in their mean Full Scale, Verbal and Performance IQ scores of 4, 3 and 4 IQ points respectively (p<.05). 5 (17.2%), 4 (13.8%) and 4 (13.3%) patients improved in their Full-scale, Verbal and Performance IQ respectively. No significant changes were found in memory performance - with a mean increase of 1, 3 and 0 MQ points in Global, Verbal and Visual memory respectively (p<.05). Global memory improved in 3 (10.3%) patients, verbal memory in 1 (3.4%) and 1 patient (3.3%) showed deterioration in visual memory. SIGNIFICANCE Our results provide evidence for unchanged memory in patients with MTLE after the procedure. No verbal memory deterioration was detected in any of our patients, while improvements were found in intellectual performance. The results suggest that stereotactic radiofrequency amygdalahippocampectomy could be superior to open surgery in terms of its neurocognitive outcomes. A larger randomised trial of these approaches is justified.
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Affiliation(s)
- Zdeněk Vojtěch
- Department of Neurology, Na Homolce Hospital, Prague, Czech Republic.
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