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Leal-Conceição E, Muxfeldt Bianchin M, Vendramini Borelli W, Spencer Escobar V, Januário de Oliveira L, Bernardes Wagner M, Palmini A, Paglioli E, Radaelli G, Costa da Costa J, Wetters Portuguez M. Memory changes in patients with hippocampal sclerosis submitted to surgery to treat mesial temporal lobe epilepsy. Neurologia 2024; 39:399-407. [PMID: 38830719 DOI: 10.1016/j.nrleng.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/12/2021] [Indexed: 06/05/2024] Open
Abstract
PURPOSE This study was performed with the purpose of analysing the relationship between epileptological and surgical variables and post-operative memory performance, following surgery for refractory mesial temporal lobe epilepsy (MTLE) due to hippocampal sclerosis (HS). METHODS Logical memory (LM) and visual memory (VM) scores for immediate and late follow-up of 201 patients operated for MTLE/HS were reviewed. Scores were standardized with a control group of 54 healthy individuals matched for age and education. The Reliable Change Index (RCI) was calculated to verify individual memory changes for late LM and VM scores. A multiple linear regression analysis was carried out with the RCI, using LM and VM scores as well as the clinical variables. RESULTS A total of 112 (56%) patients had right HS. The RCI of the right HS group demonstrated that 6 (7%) patients showed improvement while 5 (6%) patients showed decreased scores in late LM; for late VM, 7 (8%) patients presented improvement, and 2 (3%) patients showed poorer scores. RCI of the left HS group showed that 3 (3%) individuals showed improved scores, while scores of 5 (4%) patients worsened for late LM; for late VM, 3 (3%) patients presented higher scores and 6 (5%) showed lower scores. Left HS and advanced age at onset of the first epileptic seizure were predictors of late LM loss (p<.05). CONCLUSION Left MTLE/HS and seizure onset at advanced ages were predictive factors for the worsening of late LM. We observed poorer baseline LM function in the left HS group and improvement of LM in some patients who had resection of the right MTL. Patients in the right HS group showed a higher percentage of reliable post-operative improvement for both VM and LM scores.
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Affiliation(s)
- E Leal-Conceição
- Epilepsy Surgery Program, Neurology, Neurosurgery and Neuropsychology Services, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Brain Institute of Rio Grande do Sul (BraIns), PUCRS, Porto Alegre, Brazil; Faculty of Medicine, UFRGS, Porto Alegre, Brazil.
| | - M Muxfeldt Bianchin
- Neurology Services, Hospital de Clínicas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Faculty of Medicine, UFRGS, Porto Alegre, Brazil
| | - W Vendramini Borelli
- Brain Institute of Rio Grande do Sul (BraIns), PUCRS, Porto Alegre, Brazil; School of Medicine, PUCRS, Porto Alegre, Brazil
| | - V Spencer Escobar
- Epilepsy Surgery Program, Neurology, Neurosurgery and Neuropsychology Services, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Brain Institute of Rio Grande do Sul (BraIns), PUCRS, Porto Alegre, Brazil
| | | | | | - A Palmini
- Epilepsy Surgery Program, Neurology, Neurosurgery and Neuropsychology Services, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Brain Institute of Rio Grande do Sul (BraIns), PUCRS, Porto Alegre, Brazil; School of Medicine, PUCRS, Porto Alegre, Brazil
| | - E Paglioli
- Epilepsy Surgery Program, Neurology, Neurosurgery and Neuropsychology Services, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; School of Medicine, PUCRS, Porto Alegre, Brazil
| | - G Radaelli
- Brain Institute of Rio Grande do Sul (BraIns), PUCRS, Porto Alegre, Brazil; School of Medicine, PUCRS, Porto Alegre, Brazil
| | - J Costa da Costa
- Epilepsy Surgery Program, Neurology, Neurosurgery and Neuropsychology Services, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Brain Institute of Rio Grande do Sul (BraIns), PUCRS, Porto Alegre, Brazil; School of Medicine, PUCRS, Porto Alegre, Brazil
| | - M Wetters Portuguez
- Epilepsy Surgery Program, Neurology, Neurosurgery and Neuropsychology Services, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Brain Institute of Rio Grande do Sul (BraIns), PUCRS, Porto Alegre, Brazil; School of Medicine, PUCRS, Porto Alegre, Brazil
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Peltola J, Surges R, Voges B, von Oertzen TJ. Expert opinion on diagnosis and management of epilepsy-associated comorbidities. Epilepsia Open 2024; 9:15-32. [PMID: 37876310 PMCID: PMC10839328 DOI: 10.1002/epi4.12851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 09/25/2023] [Indexed: 10/26/2023] Open
Abstract
Apart from seizure freedom, the presence of comorbidities related to neurological, cardiovascular, or psychiatric disorders is the largest determinant of a reduced health-related quality of life in people with epilepsy (PwE). However, comorbidities are often underrecognized and undertreated, and clinical management of comorbid conditions can be challenging. The focus of a comprehensive treatment regimen should maximize seizure control while optimizing clinical management of treatable comorbidities to improve a person's quality of life and overall health. A panel of four European epileptologists with expertise in their respective fields of epilepsy-related comorbidities combined the latest available scientific evidence with clinical expertise and collaborated to provide consensus practical advice to improve the identification and management of comorbidities in PwE. This review provides a critical evaluation for the diagnosis and management of sleep-wake disorders, cardiovascular diseases, cognitive dysfunction, and depression in PwE. Whenever possible, clinical data have been provided. The PubMed database was the main search source for the literature review. The deleterious pathophysiological processes underlying neurological, cardiovascular, or psychiatric comorbidities in PwE interact with the processes responsible for generating seizures to increase cerebral and physiological dysfunction. This can increase the likelihood of developing drug-resistant epilepsy; therefore, early identification of comorbidities and intervention is imperative. The practical evidence-based advice presented in this article may help clinical neurologists and other specialist physicians responsible for the care and management of PwE.
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Affiliation(s)
- Jukka Peltola
- Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland
- Department of NeurologyTampere University HospitalTampereFinland
| | - Rainer Surges
- Department of EpileptologyUniversity Hospital BonnBonnGermany
| | - Berthold Voges
- Department of Neurology, Epilepsy Center HamburgProtestant Hospital AlsterdorfHamburgGermany
| | - Tim J. von Oertzen
- Medical FacultyJohannes Kepler UniversityLinzAustria
- Department of Neurology 1, Neuromed CampusKepler University HospitalLinzAustria
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Baciu M, O'Sullivan L, Torlay L, Banjac S. New insights for predicting surgery outcome in patients with temporal lobe epilepsy. A systematic review. Rev Neurol (Paris) 2023:S0035-3787(23)00884-6. [PMID: 37003897 DOI: 10.1016/j.neurol.2023.02.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/16/2023] [Accepted: 02/22/2023] [Indexed: 04/03/2023]
Abstract
Resective surgery is the treatment of choice for one-third of adult patients with focal, drug-resistant epilepsy. This procedure is associated with substantial clinical and cognitive risks. In clinical practice, there is no validated model for epilepsy surgery outcome prediction (ESOP). Meta-analyses on ESOP studies assessing prognostic factors report discrepancies in terms of study design. Our review aims to systematically investigate methodological and analytical aspects of studies predicting clinical and cognitive outcomes after temporal lobe epilepsy surgery. A systematic review of ESOP studies published between 2000 and 2022 from three databases (MEDLINE, Web of Science, and PsycINFO) was completed by following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. It yielded 4867 articles. Among them, 21 corresponded to our inclusion criteria and were therefore retained in the final review. The risk of bias was assessed using A Tool to Assess Risk of Bias and Applicability of Prediction Model Studies (PROBAST). Data extracted from the 21 studies were analyzed using narrative synthesis and descriptive statistics. Our findings show an increase in the use of multimodal datasets and machine learning analyses in recent ESOP studies, although regression remained the most frequently used approach. We also identified a more frequent use of network notions in recent ESOP studies. Nevertheless, several methodological issues were noted, such as small sample sizes, lack of information on the follow-up period, variability in seizure outcome, and the definition of neuropsychological postoperative change. Of 21 studies, only one provided a clinical tool to anticipate the cognitive outcome after epilepsy surgery. We conclude that methodological issues should be overcome before we move towards more complete models to better predict clinical and cognitive outcomes after epilepsy surgery. Recommendations for future studies to harness the possibilities of multimodal datasets and data fusion, are provided. A stronger bridge between fundamental and clinical research may result in developing accessible clinical tools.
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Affiliation(s)
- M Baciu
- Université Grenoble Alpes, CNRS LPNC UMR 5105, 38000 Grenoble, France
| | - L O'Sullivan
- Université Grenoble Alpes, CNRS LPNC UMR 5105, 38000 Grenoble, France
| | - L Torlay
- Université Grenoble Alpes, CNRS LPNC UMR 5105, 38000 Grenoble, France
| | - S Banjac
- Université Grenoble Alpes, CNRS LPNC UMR 5105, 38000 Grenoble, France.
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Leal-Conceição E, Muxfeldt Bianchin M, Vendramini Borelli W, Spencer Escobar V, Januário de Oliveira L, Bernardes Wagner M, Palmini A, Paglioli E, Radaelli G, Costa da Costa J, Wetters Portuguez M. Memory changes in patients with hippocampal sclerosis submitted to surgery to treat mesial temporal lobe epilepsy. Neurologia 2021. [DOI: 10.1016/j.nrl.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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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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Ljunggren S, Andersson‐Roswall L, Imberg H, Samuelsson H, Malmgren K. Predicting verbal memory decline following temporal lobe resection for epilepsy. Acta Neurol Scand 2019; 140:312-319. [PMID: 31273754 DOI: 10.1111/ane.13146] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 06/26/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of the study was to develop a prediction model for verbal memory decline after temporal lobe resection (TLR) for epilepsy. The model will be used in the preoperative counselling of patients to give individualized information about risk for verbal memory decline. MATERIALS AND METHODS A sample of 110 consecutive patients who underwent TLR for epilepsy at Sahlgrenska University Hospital between 1987 and 2011 constituted the basis for the prediction model. They had all gone through a formal neuropsychological assessment before surgery and 2 years after. Penalized regression and 20 × 10-fold cross-validation were used in order to build a reliable model for predicting individual risks. RESULTS The final model included four predictors: side of surgery; inclusion or not of the hippocampus in the resection; preoperative verbal memory function; and presence/absence of focal to bilateral tonic-clonic seizures (TCS) the last year prior to the presurgical investigation. The impact of a history of TCS is a new finding which we interpret as a sign of a more widespread network disease which influences neuropsychological function and the cognitive reserve. The model correctly identified 82% of patients with post-operative decline in verbal memory, and the overall accuracy was 70%-85% depending on choice of risk thresholds. CONCLUSIONS The model makes it possible to provide patients with individualized prediction regarding the risk of verbal memory decline following TLR. This will help them make more informed decisions regarding treatment, and it will also enable the epilepsy surgery team to prepare them better for the rehabilitation process.
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Affiliation(s)
- Sofia Ljunggren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology Sahlgrenska Academy at the University of Gothenburg Gothenburg Sweden
| | - Lena Andersson‐Roswall
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology Sahlgrenska Academy at the University of Gothenburg Gothenburg Sweden
| | - Henrik Imberg
- Statistiska Konsultgruppen Gothenburg Sweden
- Department of Mathematical Sciences Chalmers University of Technology and the University of Gothenburg Gothenburg Sweden
| | - Hans Samuelsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology Sahlgrenska Academy at the University of Gothenburg Gothenburg Sweden
- Department of Psychology University of Gothenburg Gothenburg Sweden
| | - Kristina Malmgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology Sahlgrenska Academy at the University of Gothenburg Gothenburg Sweden
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Baumgartner C, Koren JP, Britto-Arias M, Zoche L, Pirker S. Presurgical epilepsy evaluation and epilepsy surgery. F1000Res 2019; 8. [PMID: 31700611 PMCID: PMC6820825 DOI: 10.12688/f1000research.17714.1] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2019] [Indexed: 12/21/2022] Open
Abstract
With a prevalence of 0.8 to 1.2%, epilepsy represents one of the most frequent chronic neurological disorders; 30 to 40% of patients suffer from drug-resistant epilepsy (that is, seizures cannot be controlled adequately with antiepileptic drugs). Epilepsy surgery represents a valuable treatment option for 10 to 50% of these patients. Epilepsy surgery aims to control seizures by resection of the epileptogenic tissue while avoiding neuropsychological and other neurological deficits by sparing essential brain areas. The most common histopathological findings in epilepsy surgery specimens are hippocampal sclerosis in adults and focal cortical dysplasia in children. Whereas presurgical evaluations and surgeries in patients with mesial temporal sclerosis and benign tumors recently decreased in most centers, non-lesional patients, patients requiring intracranial recordings, and neocortical resections increased. Recent developments in neurophysiological techniques (high-density electroencephalography [EEG], magnetoencephalography, electrical and magnetic source imaging, EEG-functional magnetic resonance imaging [EEG-fMRI], and recording of pathological high-frequency oscillations), structural magnetic resonance imaging (MRI) (ultra-high-field imaging at 7 Tesla, novel imaging acquisition protocols, and advanced image analysis [post-processing] techniques), functional imaging (positron emission tomography and single-photon emission computed tomography co-registered to MRI), and fMRI significantly improved non-invasive presurgical evaluation and have opened the option of epilepsy surgery to patients previously not considered surgical candidates. Technical improvements of resective surgery techniques facilitate successful and safe operations in highly delicate brain areas like the perisylvian area in operculoinsular epilepsy. Novel less-invasive surgical techniques include stereotactic radiosurgery, MR-guided laser interstitial thermal therapy, and stereotactic intracerebral EEG-guided radiofrequency thermocoagulation.
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Affiliation(s)
- Christoph Baumgartner
- Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria.,Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Johannes P Koren
- Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria.,Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria
| | - Martha Britto-Arias
- Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria.,Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria
| | - Lea Zoche
- Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria.,Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria
| | - Susanne Pirker
- Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria.,Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria
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Abstract
PURPOSE OF REVIEW This review provides an update and summary of recent neuropsychological findings in epilepsy focusing on three major clinical topics among the many developments in the field. We will critically outline the current state with regard to cognition in new-onset epilepsies, social cognition in epilepsy, and the long-term outcome of epilepsy surgery and the cognitive outcomes of superselective surgical procedures. RECENT FINDINGS Current studies indicate that neuropsychological impairments are prevalent already at the onset of epilepsy and even before, social cognition (i.e., emotion recognition and theory of mind) is impaired in different epilepsy populations, the long-term outcome of epilepsy surgery is mostly characterized by a stable or even improved cognitive status, and superselective epilepsy surgeries are associated with a promising neuropsychological outcome. SUMMARY The high prevalence of cognitive deficits around epilepsy onset challenges the assumption that epilepsy is the major cause of cognitive problems and calls for early neuropsychological diagnostics. Social cognition seems to be a relevant domain that is not yet routinely considered in epilepsy. The cognitive long-term outcome of epilepsy surgery is mostly positive. Stereotactic thermocoagulation and gamma knife surgery appear to be cognitively safe procedures.
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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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Helmstaedter C, Witt JA. Epilepsy and cognition – A bidirectional relationship? Seizure 2017; 49:83-89. [DOI: 10.1016/j.seizure.2017.02.017] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 12/09/2016] [Accepted: 02/28/2017] [Indexed: 11/29/2022] Open
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Krámská L, Vojtěch Z, Lukavský J, Stará M, Malíková H. Five-Year Neuropsychological Outcome after Stereotactic Radiofrequency Amygdalohippocampectomy for Mesial Temporal Lobe Epilepsy: Longitudinal Study. Stereotact Funct Neurosurg 2017; 95:149-157. [DOI: 10.1159/000468527] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 03/02/2017] [Indexed: 11/19/2022]
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Strandberg M, Mannfolk P, Stenberg L, Ljung H, Rorsman I, Larsson EM, van Westen D, Källén K. A Functional MRI-Based Model for Individual Memory Assessment in Patients Eligible for Anterior Temporal Lobe Resection. Open Neuroimag J 2017; 11:1-16. [PMID: 28567171 PMCID: PMC5420180 DOI: 10.2174/1874440001711010001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/21/2017] [Accepted: 02/27/2017] [Indexed: 11/22/2022] Open
Abstract
Title: A functional (f) MRI-based model for individual memory assessment in patients eligible for temporal lobe resection. Aim: To investigate if pre-operative fMRI memory paradigms, add predictive information with regard to post-surgical memory deficits. Methods: Fourteen pharmacoresistant Temporal Lobe Epilepsy (TLE) patients accepted for Anterior Temporal Lobe Resection (ATLR) were included. A clinical risk assessment score (RAS 0-3) was constructed from structural MRI, neuropsychological testing and hemisphere dominance. fMRI lateralization indices (LIs) over frontal language and medial temporal regions were calculated. Predictive value from clinical risk scoring and added value from fMRI LIs were correlated to post-surgical memory change scores (significant decline -1 SD). Verbal memory outcome was classified either as expected (RAS 2-3 and post-operative decline; RAS 0-1 and intact post-operative verbal memory) or as unexpected (RAS 2-3 and intact post-operative verbal memory post-surgery; RAS 0-1 and post-operative decline). Results: RAS for verbal memory decline exhibited a specificity of 67% and a sensitivity of 75%. Significant correlations were found between frontal language LIs and post-operative verbal memory (r = -0.802; p = 0.017) for left (L) TLE and between medial temporal lobe LIs and visuospatial memory (r = 0.829; p = 0.021), as well as verbal memory (r = 0.714; p = 0.055) for right (R) TLE. Ten patients had expected outcome and four patients had an unexpected outcome. In two MRI-negative RTLE patients that suffered significant verbal memory decline post-operatively, fMRI identified bilateral language and right lateralized medial temporal verbal encoding. In two LTLE patients with MRI pathology and verbal memory dysfunction, neither RAS nor fMRI identified the risk for aggravated verbal memory decline following ATLR. Conclusion: fMRI visualization of temporal-frontal network activation may add value to the pre-surgical work-up in epilepsy patients eligible for ATLR. Frontal language patterns are important for prediction in both L and RTLE. Strong left lateralized language in LTLE, as well as bilateral language combined with right lateralized encoding in RTLE, seems to indicate an increased risk for post-operative verbal memory decline.
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Affiliation(s)
- Maria Strandberg
- Department of Neurology and Clinical Sciences, Lund University Hospital, SE-221 85 Lund, Sweden
| | - Peter Mannfolk
- Diagnostic Radiology, Department of Clinical Sciences, Lund University Hospital, SE-221 85 Lund, Sweden
| | - Lars Stenberg
- Diagnostic Radiology, Department of Clinical Sciences, Lund University Hospital, SE-221 85 Lund, Sweden
| | - Hanna Ljung
- Department of Neurology and Clinical Sciences, Lund University Hospital, SE-221 85 Lund, Sweden
| | - Ia Rorsman
- Department of Neurology and Clinical Sciences, Lund University Hospital, SE-221 85 Lund, Sweden
| | - Elna-Marie Larsson
- Department of Radiology, Uppsala University Hospital, SE-75185, Uppsala, Sweden
| | - Danielle van Westen
- Diagnostic Radiology, Department of Clinical Sciences, Lund University Hospital, SE-221 85 Lund, Sweden
| | - Kristina Källén
- Department of Neurology and Clinical Sciences, Lund University Hospital, SE-221 85 Lund, Sweden
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Schipper S, Aalbers MW, Rijkers K, Lagiere M, Bogaarts JG, Blokland A, Klinkenberg S, Hoogland G, Vles JSH. Accelerated cognitive decline in a rodent model for temporal lobe epilepsy. Epilepsy Behav 2016; 65:33-41. [PMID: 27865173 DOI: 10.1016/j.yebeh.2016.08.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 08/20/2016] [Accepted: 08/25/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Cognitive impairment is frequently observed in patients with temporal lobe epilepsy. It is hypothesized that cumulative seizure exposure causes accelerated cognitive decline in patients with epilepsy. We investigated the influence of seizure frequency on cognitive decline in a rodent model for temporal lobe epilepsy. METHODS Neurobehavioral assessment was performed before and after surgery, after the induction of self-sustaining limbic status epilepticus (SSLSE), and in the chronic phase in which rats experienced recurrent seizures. Furthermore, we assessed potential confounders of memory performance. RESULTS Rats showed a deficit in spatial working memory after the induction of the SSLSE, which endured in the chronic phase. A progressive decline in recognition memory developed in SSLSE rats. Confounding factors were absent. Seizure frequency and also the severity of the status epilepticus were not correlated with the severity of cognitive deficits. SIGNIFICANCE The effect of the seizure frequency on cognitive comorbidity in epilepsy has long been debated, possibly because of confounders such as antiepileptic medication and the heterogeneity of epileptic etiologies. In an animal model of temporal lobe epilepsy, we showed that a decrease in spatial working memory does not relate to the seizure frequency. This suggests for other mechanisms are responsible for memory decline and potentially a common pathophysiology of cognitive deterioration and the occurrence and development of epileptic seizures. Identifying this common denominator will allow development of more targeted interventions treating cognitive decline in patients with epilepsy. The treatment of interictal symptoms will increase the quality of life of many patients with epilepsy.
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Affiliation(s)
- Sandra Schipper
- Department of Clinical Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands; Faculty of Health Medicine & Life Sciences, School of Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Marlien W Aalbers
- Faculty of Health Medicine & Life Sciences, School of Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Neurosurgery, The Netherlands
| | - Kim Rijkers
- Faculty of Health Medicine & Life Sciences, School of Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Neurosurgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Melanie Lagiere
- Faculty of Health Medicine & Life Sciences, School of Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jan G Bogaarts
- Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Arjan Blokland
- Department of Neuropsychology & Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Sylvia Klinkenberg
- Department of Clinical Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands; Faculty of Health Medicine & Life Sciences, School of Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Govert Hoogland
- Faculty of Health Medicine & Life Sciences, School of Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Johan S H Vles
- Department of Clinical Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands; Faculty of Health Medicine & Life Sciences, School of Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
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Skirrow C, Cross JH, Harrison S, Cormack F, Harkness W, Coleman R, Meierotto E, Gaiottino J, Vargha-Khadem F, Baldeweg T. Temporal lobe surgery in childhood and neuroanatomical predictors of long-term declarative memory outcome. ACTA ACUST UNITED AC 2014; 138:80-93. [PMID: 25392199 PMCID: PMC4285190 DOI: 10.1093/brain/awu313] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
See Berg (doi:10.1093/brain/awu320) for a scientific commentary on this article. In a long-term follow-up study of children who underwent temporal lobe surgery for treatment of epilepsy, Skirrow et al. identify no significant pre-to-post-surgery memory losses, but instead robust improvements in memory functions supported by the unoperated temporal lobe. The integrity of remaining temporal lobe structures places constraints on long-term memory outcomes. The temporal lobes play a prominent role in declarative memory function, including episodic memory (memory for events) and semantic memory (memory for facts and concepts). Surgical resection for medication-resistant and well-localized temporal lobe epilepsy has good prognosis for seizure freedom, but is linked to memory difficulties in adults, especially when the removal is on the left side. Children may benefit most from surgery, because brain plasticity may facilitate post-surgical reorganization, and seizure cessation may promote cognitive development. However, the long-term impact of this intervention in children is not known. We examined memory function in 53 children (25 males, 28 females) who were evaluated for epilepsy surgery: 42 underwent unilateral temporal lobe resections (25 left, 17 right, mean age at surgery 13.8 years), 11 were treated only pharmacologically. Average follow-up was 9 years (range 5–15). Post-surgical change in visual and verbal episodic memory, and semantic memory at follow-up were examined. Pre- and post-surgical T1-weighted MRI brain scans were analysed to extract hippocampal and resection volumes, and evaluate post-surgical temporal lobe integrity. Language lateralization indices were derived from functional magnetic resonance imaging. There were no significant pre- to postoperative decrements in memory associated with surgery. In contrast, gains in verbal episodic memory were seen after right temporal lobe surgery, and visual episodic memory improved after left temporal lobe surgery, indicating a functional release in the unoperated temporal lobe after seizure reduction or cessation. Pre- to post-surgical change in memory function was not associated with any indices of brain structure derived from MRI. However, better verbal memory at follow-up was linked to greater post-surgical residual hippocampal volumes, most robustly in left surgical participants. Better semantic memory at follow-up was associated with smaller resection volumes and greater temporal pole integrity after left temporal surgery. Results were independent of post-surgical intellectual function and language lateralization. Our findings indicate post-surgical, hemisphere-dependent material-specific improvement in memory functions in the intact temporal lobe. However, outcome was linked to the anatomical integrity of the temporal lobe memory system, indicating that compensatory mechanisms are constrained by the amount of tissue which remains in the operated temporal lobe. Careful tailoring of resections for children undergoing epilepsy surgery may enhance long-term memory outcome.
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Affiliation(s)
- Caroline Skirrow
- 1 Cognitive Neuroscience and Neuropsychiatry Section, Developmental Neurosciences Programme, Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK 2 Great Ormond Street Hospital NHS Trust, Great Ormond Street, WC1N 3JH, UK
| | - J Helen Cross
- 2 Great Ormond Street Hospital NHS Trust, Great Ormond Street, WC1N 3JH, UK 3 Clinical Neurosciences Section, Developmental Neurosciences Programme, Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
| | - Sue Harrison
- 1 Cognitive Neuroscience and Neuropsychiatry Section, Developmental Neurosciences Programme, Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK 2 Great Ormond Street Hospital NHS Trust, Great Ormond Street, WC1N 3JH, UK
| | - Francesca Cormack
- 4 Cognition and Brain Sciences Unit, 15 Chaucer Road, Cambridge, CB2 7EF, UK
| | - William Harkness
- 2 Great Ormond Street Hospital NHS Trust, Great Ormond Street, WC1N 3JH, UK
| | - Rosie Coleman
- 1 Cognitive Neuroscience and Neuropsychiatry Section, Developmental Neurosciences Programme, Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK 2 Great Ormond Street Hospital NHS Trust, Great Ormond Street, WC1N 3JH, UK
| | - Ellen Meierotto
- 1 Cognitive Neuroscience and Neuropsychiatry Section, Developmental Neurosciences Programme, Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK 5 Abteilung für Psychiatrie und Psychotherapie, Universitätsklinik Freiburg, Hugstetter Strasse 55, 29106 Freiburg, Germany
| | - Johanna Gaiottino
- 1 Cognitive Neuroscience and Neuropsychiatry Section, Developmental Neurosciences Programme, Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
| | - Faraneh Vargha-Khadem
- 1 Cognitive Neuroscience and Neuropsychiatry Section, Developmental Neurosciences Programme, Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK 2 Great Ormond Street Hospital NHS Trust, Great Ormond Street, WC1N 3JH, UK
| | - Torsten Baldeweg
- 1 Cognitive Neuroscience and Neuropsychiatry Section, Developmental Neurosciences Programme, Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK 2 Great Ormond Street Hospital NHS Trust, Great Ormond Street, WC1N 3JH, 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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Kanchanatawan B, Limothai C, Srikijvilaikul T, Maes M. Clinical predictors of 2-year outcome of resective epilepsy surgery in adults with refractory epilepsy: a cohort study. BMJ Open 2014; 4:e004852. [PMID: 24755212 PMCID: PMC4010813 DOI: 10.1136/bmjopen-2014-004852] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Resective epilepsy surgery is currently a standard treatment for intractable epilepsy. Seizure freedom and discontinuation of antiepileptic drugs are the ultimate goals of epilepsy treatment. This study was carried out to delineate (1) possible differences in the success rate of epilepsy surgery 6 and 24 months after surgery; and (2) the clinical predictors of a good response to surgery. SETTING This is a cohort study performed at a tertiary care unit of a university hospital. PARTICIPANTS In this cohort study, 189 adults with intractable epilepsy who underwent epilepsy surgery were included. We collected clinical data at three time points, that is, preoperative and 6 and 24 months after surgery. PRIMARY AND SECONDARY OUTCOME MEASURES Engel class I-IV classification was the primary outcome measure of epilepsy surgery. The authors statistically adjusted Engel class I-IV classification for postoperative changes in antiepileptic drugs and used this new classification as a secondary outcome variable. RESULTS The success rate was 78.8% 6 months after surgery and increased to 88.3% 24 months after surgery. This success rate was reflected not only by the reduced number of seizures postsurgery, but also by a reduced dosage and use of antiepileptic drugs. Logistic regression analysis showed that a successful outcome of surgery is predicted by having temporal rather than extratemporal lobe epilepsy and less than nine presurgery seizures per month, while a positive familial history of epilepsy, younger age and dysphoric symptoms, the first 3 months after surgery, significantly worsened the outcome of surgery. Duration of illness, age at onset, epilepsy location, type of lesions and the presence of psychosis were not significant in predicting treatment outcome. CONCLUSIONS These findings have clinical relevance in that a better selection of patients based on the significant clinical predictors will increase the success rate of epilepsy surgery and treatment.
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Affiliation(s)
- B Kanchanatawan
- Faculty of Medicine, Department of Psychiatry, Chulalongkorn University, Bangkok, Thailand
| | - C Limothai
- Faculty of Medicine, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - T Srikijvilaikul
- Department of Surgery, Prasat Neurological Institute, Bangkok, Thailand
| | - M Maes
- Faculty of Medicine, Department of Psychiatry, Chulalongkorn University, Bangkok, Thailand
- Department of Psychiatry, Deakin University, Geelong, Australia
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Stereotactic radiofrequency amygdalohippocampectomy: Two years of good neuropsychological outcomes. Epilepsy Res 2013; 106:423-32. [DOI: 10.1016/j.eplepsyres.2013.07.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 06/18/2013] [Accepted: 07/26/2013] [Indexed: 10/26/2022]
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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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