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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 2024; 31:932-938. [PMID: 35754382 DOI: 10.1080/23279095.2022.2090257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
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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Baxendale S. Sex differences in the pre and postoperative neuropsychological function of epilepsy surgery candidates. Clin Neuropsychol 2024; 38:1441-1453. [PMID: 37975582 DOI: 10.1080/13854046.2023.2281706] [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: 06/04/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023]
Abstract
Objective: As programs expand globally, epilepsy surgery is becoming increasingly available as an effective treatment for some people with medically intractable seizures. Prospective candidates require careful neuropsychological evaluation and follow-up. The aim of this study was to examine the sex differences in neuropsychological function in presurgical presentation and postoperative outcomes in people with temporal lobe epilepsy referred for epilepsy surgery. Methods: Three hundred and seventy-two patients (202 Female; 170 Male) with a homogenous underlying pathology (hippocampal sclerosis) underwent a preoperative assessment on tests of intellectual, language, and memory function and were followed up one year after undergoing a unilateral temporal lobe resection; n = 169 Right (RTL), n = 203 Left (LTL). Results: There was no impact of sex or laterality of surgery on seizure outcome; 84% of males and 80% of females were seizure free at follow-up. Before surgery, sex effects were evident on tests of verbal memory with females performing better than males. Declines in verbal memory function following surgery were greater in females than males. Being female had a stronger association with postoperative decline on immediate prose recall (partial eta squared η2 = 0.029), than side of surgery (η2 = 0.018) albeit with a small effect size. Conclusions: There are subtle but significant sex differences in the neuropsychological profiles of people with temporal lobe epilepsy, before and following surgery. Whilst females generally perform better than males on tests of verbal memory function before surgery they demonstrate greater post-operative declines on these measures following surgery.
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Affiliation(s)
- Sallie Baxendale
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- University College Hospital, London, UK
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Zimmermann N, Pontes M, da Silva Fontana R, D'Andrea Meira I, Fonseca R, Delaere FJ. The modified Ruche visuospatial learning test (RUCHE-M) for the assessment of visuospatial episodic memory in patients with temporal lobe epilepsy: Preliminary evidence for the investigation of memory binding. APPLIED NEUROPSYCHOLOGY. ADULT 2024; 31:412-427. [PMID: 35133219 DOI: 10.1080/23279095.2022.2031200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The Ruche test is a visuospatial form of the Rey auditory verbal learning test (RAVLT), with initial evidence of utility in the diagnosis of temporal lobe epilepsy (TLE)-related memory disorders. AIMS To present the translation to Brazilian Portuguese and modification of the Ruche test (RUCHE-M) and compare the RUCHE-M and RAVLT performance between patients with right and left TLE. METHODS Twenty-five neuropsychologists participated in instrument adaptation. Thirty-seven patients with right (n = 19) and left (n = 18) TLE participated. Data were compared with the Mann-Whitney U test. RESULTS All specialists considered the final RUCHE-M to be adequate. The RUCHE-M forgetting speed index (FSI) score and several RAVLT scores differed significantly between patients with right and left TLE. CONCLUSION The RUCHE-M showed limited utility for the assessment of visuospatial episodic memory in patients with TLE. The manipulation of memory binding as demonstrated by FSI score seems to be a promising paradigm for the assessment of right hippocampal function.
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Affiliation(s)
- Nicolle Zimmermann
- Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
- Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil
| | - Monique Pontes
- Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil
| | | | | | - Rochele Fonseca
- Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
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Smetana RM, Batchala PP, Lee BG, Albataineh T, Broshek DK, Fountain NB, Abbas S, Quigg M. Multifocal hypometabolic correlates to deficits of verbal memory in mesial temporal lobe epilepsy. Epilepsy Behav 2023; 143:109244. [PMID: 37192585 DOI: 10.1016/j.yebeh.2023.109244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Neuropsychological research on mesial temporal lobe epilepsy (MTLE) often highlights material-specific memory deficits, but a lesion-focused model may not accurately reflect the underlying networks that support episodic memory in these patients. Our study evaluated the pathophysiology behind verbal learning/memory deficits as revealed by hypometabolism quantified through 18-fluorodeoxyglucose positron emission tomography (FDG-PET). METHODS This retrospective study included thirty presurgical patients with intractable unilateral MTLE who underwent interictal FDG-PET and verbal memory assessment (12 females, mean age: 38.73 years). Fluorodeoxyglucose-positron emission tomography mapping was performed with voxel-based mapping of glucose utilization to a database of age-matched controls to derive regional Z-scores. Neuropsychological outcome variables included scores on learning and recall trials of two distinct verbal memory measures validated for use in epilepsy research. Pearson's correlations evaluated relationships between clinical variables and verbal memory. Linear regression was used to relate regional hypometabolism and verbal memory assessment. Post hoc analyses assessed areas of FDG-PET hypometabolism (threshold Z ≤ -1.645 below mean) where verbal memory was impaired. RESULTS Verbal memory deficits correlated with hypometabolism in limbic structures ipsilateral to language dominance but also correlated with hypometabolism in networks involving the ipsilateral perisylvian cortex and contralateral limbic and nonlimbic structures. DISCUSSION We conclude that traditional models of verbal memory may not adequately capture cognitive deficits in a broader sample of patients with MTLE. This study has important implications for epilepsy surgery protocols that use neuropsychological data and FDG-PET to draw conclusions about surgical risks.
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Affiliation(s)
- Racheal M Smetana
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, USA.
| | - Prem P Batchala
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA.
| | - Bern G Lee
- Department of Neuropsychology, Ochsner Health, Baton Rouge, LA, USA.
| | - Tamer Albataineh
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA.
| | - Donna K Broshek
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, USA.
| | - Nathan B Fountain
- Comprehensive Epilepsy Program, Department of Neurology, University of Virginia, Charlottesville, VA, USA.
| | - Salma Abbas
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA.
| | - Mark Quigg
- Comprehensive Epilepsy Program, Department of Neurology, University of Virginia, Charlottesville, VA, USA.
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Jain K, Ramesh R, Krishnan S, Kesavapisharady K, Divya KP, Sarma SP, Kishore A. Cognitive outcome following bilateral subthalamic nucleus deep brain stimulation for Parkinson's disease-a comparative observational study in Indian patients. Acta Neurol Belg 2022; 122:447-456. [PMID: 34448152 DOI: 10.1007/s13760-021-01778-z] [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: 05/18/2021] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) of the subthalamic nucleus (STN) improves motor symptoms and motor complications of Parkinson's disease (PD). The intervention is expected to result in some cognitive changes, the nature of which is not uniform across the studies which have reported them. PD itself is associated with progressive cognitive decline and hence longitudinal follow-up studies with medically managed control group of patients are needed to explore the cognitive deficits attributable to DBS. METHODS We conducted a prospective comparative observational study to assess the effects of bilateral STN DBS on cognition. Cognitive functions were assessed at baseline and after a minimum of two years after surgery, and compared with baseline and follow-up assessments in patients on medical management alone. RESULTS Thirty-four patients with PD who underwent bilateral STN DBS and thirty-four medically managed patients participated in the study. At a mean follow-up of around 33 months, we found a significant decline in verbal fluency scores in the DBS group compared to those on medical management alone (1.15 ± 1.23 vs 0.59 ± 0.93, p = 0.034) and a trend for decline was noted in digit span test. There was no difference in the performance in tests addressing other cognitive domains, or tests of global cognitive function. No patient developed dementia. Motor functions and activities of daily living (ADL) were significantly better in the surgical group. CONCLUSION STN DBS results in minor deficits in executive functions, particularly verbal fluency. These may be inconsequential, considering the marked improvement in motor functions and ADL.
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Doll A, Wegrzyn M, Benzait A, Mertens M, Woermann FG, Labudda K, Bien CG, Kissler J. Whole-brain functional correlates of memory formation in mesial temporal lobe epilepsy. NEUROIMAGE-CLINICAL 2021; 31:102723. [PMID: 34147817 PMCID: PMC8220377 DOI: 10.1016/j.nicl.2021.102723] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 06/06/2021] [Accepted: 06/07/2021] [Indexed: 11/29/2022]
Abstract
Large study of encoding and subsequent memory for words, faces, and scenes. Less ipsilateral mesial temporal activity in mesial temporal lobe epilepsy (mTLE). Extra-mTL activity in mTLE only partly relevant for memory formation. Across materials contralateral mTL decisive to maintain intact memory in mTLE. Left frontal activation correlates with better verbal memory only in left mTLE.
The mesial temporal lobe is a key region for episodic memory. Accordingly, memory impairment is frequent in patients with mesial temporal lobe epilepsy. However, the functional relevance of potentially epilepsy-induced reorganisation for memory formation is still not entirely clear. Therefore, we investigated whole-brain functional correlates of verbal and non-verbal memory encoding and subsequent memory formation in 56 (25 right sided) mesial temporal lobe epilepsy patients and 21 controls. We applied an fMRI task of learning scenes, faces, and words followed by an out-of-scanner recognition test. During encoding of faces and scenes left and right mesial temporal lobe epilepsy patients had consistently reduced activation in the epileptogenic mesial temporal lobe compared with controls. Activation increases in patients were apparent in extra-temporal regions, partly associated with subsequent memory formation (left frontal regions and basal ganglia), and patients had less deactivation in regions often linked to the default mode and auditory networks. The more specific subsequent memory contrast indicated only marginal group differences. Correlating patients’ encoding activation with memory performance both within the paradigm and with independent clinical measures demonstrated predominantly increased contralateral mesio-temporal activation supporting intact memory performance. In left temporal lobe epilepsy patients, left frontal activation was also correlated with better verbal memory performance. Taken together, our findings hint towards minor extra-temporal plasticity in mesial temporal lobe epilepsy patients, which is in line with pre-surgical impairment and post-surgical memory decline in many patients. Further, data underscore the importance of particularly the contralateral mesial temporal lobe itself, to maintain intact memory performance.
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Affiliation(s)
- Anna Doll
- Bielefeld University, Medical School, Department of Epileptology (Krankenhaus Mara), Maraweg 21, Bielefeld 33617, Germany; Bielefeld University, Department of Psychology, Universitätsstraße 25, Bielefeld 33615, Germany.
| | - Martin Wegrzyn
- Bielefeld University, Department of Psychology, Universitätsstraße 25, Bielefeld 33615, Germany
| | - Anissa Benzait
- Bielefeld University, Medical School, Department of Epileptology (Krankenhaus Mara), Maraweg 21, Bielefeld 33617, Germany; Bielefeld University, Department of Psychology, Universitätsstraße 25, Bielefeld 33615, Germany
| | - Markus Mertens
- Bielefeld University, Medical School, Department of Epileptology (Krankenhaus Mara), Maraweg 21, Bielefeld 33617, Germany
| | - Friedrich G Woermann
- Bielefeld University, Medical School, Department of Epileptology (Krankenhaus Mara), Maraweg 21, Bielefeld 33617, Germany
| | - Kirsten Labudda
- Bielefeld University, Department of Psychology, Universitätsstraße 25, Bielefeld 33615, Germany
| | - Christian G Bien
- Bielefeld University, Medical School, Department of Epileptology (Krankenhaus Mara), Maraweg 21, Bielefeld 33617, Germany
| | - Johanna Kissler
- Bielefeld University, Department of Psychology, Universitätsstraße 25, Bielefeld 33615, Germany; Center for Cognitive Interaction Technology (CITEC), University of Bielefeld, Inspiration 1, Bielefeld 33619, Germany
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Facial memory ability and self-awareness in patients with temporal lobe epilepsy after anterior temporal lobectomy. PLoS One 2021; 16:e0248785. [PMID: 33793593 PMCID: PMC8016293 DOI: 10.1371/journal.pone.0248785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 03/05/2021] [Indexed: 11/19/2022] Open
Abstract
Anterior temporal lobectomy (ATL) is the most common surgical treatment for drug-resistant temporal lobe epilepsy (TLE). Right ATL has been reported to reduce facial memory ability in patients with TLE, as indicated by poor performance on the Warrington Recognition Memory Test for Faces (RMF), which is commonly used to evaluate visual memory in these patients. However, little is known about whether patients with TLE exhibit difficulties in identifying faces in daily life after ATL. The aim of this study was to investigate facial memory ability and self-awareness of face identification difficulties in patients with TLE after ATL. Sixteen patients with TLE after right ATL, 14 patients with TLE after left ATL, and 29 healthy controls were enrolled in this study. We developed the multiview face recognition test (MFRT), which comprises a learning phase (one or three frontal face images without external facial feature information) and a recognition phase (frontal, oblique, or noise-masked face images). Facial memory abilities were examined in all participants using the MFRT and RMF, and self-awareness of difficulties in face identification was evaluated using the 20-item prosopagnosia index (PI20), which has been widely used to assess developmental prosopagnosia. The MFRT performance in patients with TLE after ATL was significantly worse than that in healthy controls regardless of the resected side, whereas the RMF scores in patients with TLE were significantly worse than those in healthy controls only after right ATL. The MFRT performance in patients with TLE after both left and right ATL was more influenced by working memory load than that in healthy controls. The PI20 scores revealed that patients with TLE after left ATL were aware of their difficulties in identifying faces. These findings suggest that patients with TLE not only after right ATL but also after left ATL might have difficulties in face identification.
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Wagner K, Gau K, Metternich B, Geiger MJ, Wendling AS, Kadish NE, Reuner G, Mayer H, Mader I, Beck J, Zentner J, Urbach H, Schulze-Bonhage A, Kaller CP, Foit NA. Effects of hippocampus-sparing resections in the temporal lobe: Hippocampal atrophy is associated with a decline in memory performance. Epilepsia 2020; 61:725-734. [PMID: 32162320 DOI: 10.1111/epi.16473] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 02/18/2020] [Accepted: 02/18/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE In patients with temporal lobe epilepsy (TLE) with a nonlesional and nonepileptogenic hippocampus (HC), in order to preserve functionally intact brain tissue, the HC is not resected. However, some patients experience postoperative memory decline, possibly due to disruption of the extrahippocampal memory network and secondary hippocampal volume (HV) loss. The purpose of this study was to determine the extent of hippocampal atrophy ipsilateral and contralateral to the side of the surgery and its relation to memory outcomes. METHODS Hippocampal volume and verbal as well as visual memory performance were retrospectively examined in 55 patients (mean age ± standard deviation [SD] 30 ± 15 years, 25 female, 31 left) before and 5 months after surgery within the temporal lobe that spared the entire HC. HV was extracted based on prespecified templates, and resection volumes were also determined. RESULTS HV loss was found both ipsilateral and contralateral to the side of surgery (P < .001). Postoperative left HV loss was a significant predictor of postoperative verbal memory deterioration after left-sided surgery (P < .01). Together with the preoperative verbal memory performance, postoperative left HV explained almost 60% of the variance (P < .0001). However, right HV was not a clear predictor of visual memory performance. Larger resection volumes were associated with smaller postoperative HV, irrespective of side of surgery (left: P < .05, right: P < .01). SIGNIFICANCE A disruption of the memory network by any resection within the TL, especially within the language-dominant hemisphere, may lead to HC atrophy and memory decline. These findings may further improve the counseling of patients concerning their postoperative memory outcome before TL resections sparing the entire HC.
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Affiliation(s)
- Kathrin Wagner
- Epilepsy Centre, Medical Center - University of Freiburg, Freiburg, Germany.,Freiburg Brain Imaging, Medical Center - University of Freiburg, Freiburg, Germany
| | - Karin Gau
- Epilepsy Centre, Medical Center - University of Freiburg, Freiburg, Germany.,Freiburg Brain Imaging, Medical Center - University of Freiburg, Freiburg, Germany
| | - Birgitta Metternich
- Epilepsy Centre, Medical Center - University of Freiburg, Freiburg, Germany.,Freiburg Brain Imaging, Medical Center - University of Freiburg, Freiburg, Germany
| | - Maximilian J Geiger
- Epilepsy Centre, Medical Center - University of Freiburg, Freiburg, Germany.,Freiburg Brain Imaging, Medical Center - University of Freiburg, Freiburg, Germany
| | | | - Navah E Kadish
- Department of Neuropediatrics, University Medical Centre Schleswig-Holstein, Kiel, Germany.,Department of Medical Psychology and Medical Sociology, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - Gitta Reuner
- Institute for Education Studies, Heidelberg University, Heidelberg, Germany.,Division of Neuropediatrics and Metabolic Medicine, Clinic I, Centre for Pediatric and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Hans Mayer
- Epilepsy Centre Kork, Kehl-Kork, Germany
| | - Irina Mader
- Freiburg Brain Imaging, Medical Center - University of Freiburg, Freiburg, Germany.,Department of Neuroradiology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Jürgen Beck
- Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany
| | - Josef Zentner
- Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany
| | - Horst Urbach
- Freiburg Brain Imaging, Medical Center - University of Freiburg, Freiburg, Germany.,Department of Neuroradiology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Andreas Schulze-Bonhage
- Epilepsy Centre, Medical Center - University of Freiburg, Freiburg, Germany.,Freiburg Brain Imaging, Medical Center - University of Freiburg, Freiburg, Germany
| | - Christoph P Kaller
- Freiburg Brain Imaging, Medical Center - University of Freiburg, Freiburg, Germany.,Department of Neuroradiology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Niels A Foit
- Freiburg Brain Imaging, Medical Center - University of Freiburg, Freiburg, Germany.,Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany
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Morishita Y, Mugikura S, Mori N, Tamura H, Sato S, Akashi T, Jin K, Nakasato N, Takase K. Atrophy of the ipsilateral mammillary body in unilateral hippocampal sclerosis shown by thin-slice-reconstructed volumetric analysis. Neuroradiology 2019; 61:515-523. [PMID: 30637459 DOI: 10.1007/s00234-019-02158-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 01/03/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Conventional volumetric analysis could not detect ipsilateral atrophy of the mammillary body in patients with unilateral hippocampal sclerosis. By using thin-slice-reconstructed volumetric analysis, we investigated whether the mammillary body volume is smaller on the hippocampal sclerosis side than in healthy subjects or the non-hippocampal sclerosis side. METHODS This retrospective study included 45 patients with unilateral hippocampal sclerosis and 30 healthy subjects. Three-dimensional T1WI of 1 mm thicknesses were oversampled to a thickness of 0.2 mm (thin-slice-reconstructed images), and the mammillary bodies were segmented manually to determine mammillary body volume on each side. Mammillary body volumes on the hippocampal sclerosis side were compared with those in healthy subjects or the non-hippocampal sclerosis side. RESULTS In patients with right hippocampal sclerosis, right mammillary body volume was both significantly smaller than that in healthy subjects (30.3 ± 10.3 vs. 43.3 ± 8.07 mm3, P < 0.001) and significantly smaller than the left mammillary body volume in each patient (30.3 ± 10.3 vs. 41.4 ± 10.1 mm3, P < 0.001). Similarly, in patients with left hippocampal sclerosis, left mammillary body volume was both significantly smaller than that in healthy subjects (37.7 ± 11.2 vs. 47.0 ± 8.65 mm3, P < 0.001) and significantly smaller than right mammillary body volume in each patient (37.7 ± 11.2 vs. 42.5 ± 7.78 mm3, P = 0.044). CONCLUSIONS In this study, thin-slice-reconstructed volumetric analysis showed that, in patients with unilateral hippocampal sclerosis, mammillary body volume on the hippocampal sclerosis side is smaller than that in healthy subjects and the non-hippocampal sclerosis side.
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Affiliation(s)
- Yohei Morishita
- Department of Diagnostic Radiology, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Shunji Mugikura
- Department of Diagnostic Radiology, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
| | - Naoko Mori
- Department of Diagnostic Radiology, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Hajime Tamura
- Department of Diagnostic Radiology, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Shiho Sato
- Department of Diagnostic Radiology, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Toshiaki Akashi
- Department of Diagnostic Radiology, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Kazutaka Jin
- Department of Epileptology, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, Japan
| | - Nobukazu Nakasato
- Department of Epileptology, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
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Rajesh P, Thomas B, Pammi VC, Kesavadas C, Alexander A, Radhakrishnan A, Thomas S, Menon R. Hippocampal activations in mesial temporal lobe epilepsy due to hippocampal sclerosis- an observational study on intramural encoding-delayed recall paradigms using task-based memory fMRI. Epilepsy Res 2018; 145:31-39. [DOI: 10.1016/j.eplepsyres.2018.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/13/2018] [Accepted: 05/25/2018] [Indexed: 10/16/2022]
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11
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Memory Rehabilitation in Patients with Epilepsy: a Systematic Review. Neuropsychol Rev 2018; 28:88-110. [PMID: 29450813 DOI: 10.1007/s11065-018-9367-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 01/21/2018] [Indexed: 10/18/2022]
Abstract
Memory failure is a common clinical concern of patients with epilepsy and is associated with significant functional impairments. Thus, memory rehabilitation is of critical clinical importance. In this article, we aimed to systematically evaluate the efficacy of memory rehabilitation in patients with epilepsy. The Preferred Items for Systematic Reviews and Meta-Analyses (PRISMA) was used to guide searches, extraction and reporting of data in this review. PsycINFO, Medline and PsychBITE searches yielded 95 studies. Twelve papers met inclusion criteria, reporting outcomes of cognitive or behavioural interventions that specifically targeted the rehabilitation of memory in patients with epilepsy. Methodological rigour was rated using the Single-Case Experimental Design (SCED) scale for single-case studies and a modified version of the Downs and Black checklist for group studies. Twelve prospective studies, nine group (six pre-post design, one waitlist crossover, two randomised controlled trials) and three single-case studies were identified. Eleven of the studies included adults, eight of which involved adults with temporal lobe epilepsy (TLE). One paediatric study was identified. The quality of group studies ranged from 36% (poor) to 72% (good), using the modified Downs and Black checklist. Single-case studies were assessed using the SCED scale and assessed to range in quality from four to seven out to 11. Overall, memory rehabilitation was associated with improved memory function in all studies. Verbal memory outcomes were most commonly examined and associated with improvements. This review found that the level of evidence available to support rehabilitation of memory in patients with epilepsy was generally weak and inconsistent. Nevertheless, studies conducted to date, albeit of limited methodological quality, offer preliminary evidence that memory rehabilitation is associated with improvements in verbal memory in patients with temporal lobe epilepsy. Little is known about the efficacy of memory rehabilitation in patients with non-TLE, children, and other aspects of memory difficulties. Guidelines for future research are proposed.
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Volumetric Changes in Hippocampal Subregions and Memory Performance in Mesial Temporal Lobe Epilepsy with Hippocampal Sclerosis. Neurosci Bull 2017; 34:389-396. [PMID: 29094314 DOI: 10.1007/s12264-017-0186-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/03/2017] [Indexed: 10/18/2022] Open
Abstract
In the present study we explored the different patterns of volumetric atrophy in hippocampal subregions of patients with left and right mesial temporal lobe epilepsy with hippocampal sclerosis (TLE-HS). Meanwhile, the memory impairment patterns in Chinese-speaking TLE-HS patients and potential influencing factors were also determined. TLE-HS patients (21 left and 17 right) and 21 healthy controls were recruited to complete T2-weighted imaging and verbal/nonverbal memory assessment. The results showed that both left and right TLE-HS patients had overall reduced hippocampal subregion volumes on the sclerotic side, and cornu ammonis sectors (CA1) exhibited maximum atrophy. The verbal memory of left TLE-HS patients was significantly impaired (P < 0.001) and was not associated with the volumes of the left hippocampal subregions. Verbal or nonverbal memory impairment was not found in the patients with right TLE-HS. These results suggested that the atrophy of hippocampal subregion volumes cannot account for the verbal memory impairment, which might be related to the functional network.
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Doyle KL, Woods SP, McDonald CR, Leyden KM, Holden HM, E Morgan E, Gilbert PE, Corey-Bloom J. Verbal episodic memory profiles in HIV-Associated Neurocognitive Disorders (HAND): A comparison with Huntington's disease and mesial temporal lobe epilepsy. APPLIED NEUROPSYCHOLOGY-ADULT 2017; 26:17-27. [PMID: 28850256 DOI: 10.1080/23279095.2017.1353993] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
HIV-associated neurocognitive disorders (HAND) commonly feature verbal episodic memory impairment historically characterized by a retrieval deficit, consistent with a classic "subcortical" presentation; however, there are hints of a subtle shift toward a more "cortical" memory profile characterized by a primary encoding deficit. The current study evaluated this possibility by comparing the pattern of HAND-associated verbal episodic memory deficits to those of traditional "subcortical" (i.e., Huntington's disease; HD) versus "cortical" (i.e., left temporal lobe epilepsy with mesial temporal sclerosis; L-MTLE) profiles. Seventy-seven individuals with HAND, 47 individuals with HD, 21 individuals with L-MTLE, and 45 healthy participants were administered the California Verbal Learning Test - 2nd Edition (CVLT-II). CVLT-II profiles were classified as reflecting a primary encoding deficit, retrieval deficit, or a normal profile. Among participants with a deficit profile, the HAND group showed the highest rates of retrieval versus encoding profiles (71% vs. 29%), followed by HD (59% vs. 41%), L-MTLE (46% vs. 54%), and healthy (50% vs. 50%) groups. While significant profile heterogeneity was observed across clinical groups, findings suggest that HIV-associated verbal episodic memory impairments are most consistent with a traditional "subcortical," retrieval deficit profile, consistent with the primary frontostriatal neuropathogenesis of HIV disease.
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Affiliation(s)
- Katie L Doyle
- a Department of Psychiatry , University of California San Diego , La Jolla , California.,c Departments of Psychology and Psychiatry , San Diego State University-University of California Joint Doctoral Program in Clinical Psychology , San Diego , California
| | - Steven Paul Woods
- b Department of Psychology , University of Houston , Houston , Texas
| | - Carrie R McDonald
- a Department of Psychiatry , University of California San Diego , La Jolla , California
| | - Kelly M Leyden
- a Department of Psychiatry , University of California San Diego , La Jolla , California
| | - Heather M Holden
- c Departments of Psychology and Psychiatry , San Diego State University-University of California Joint Doctoral Program in Clinical Psychology , San Diego , California
| | - Erin E Morgan
- a Department of Psychiatry , University of California San Diego , La Jolla , California
| | - Paul E Gilbert
- d Department of Psychology , San Diego State University , San Diego , California
| | - Jody Corey-Bloom
- a Department of Psychiatry , University of California San Diego , La Jolla , California
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Whitman L, Scharaga EA, Blackmon K, Wiener J, Bender HA, Weiner HL, MacAllister WS. Material specificity of memory deficits in children with temporal tumors and seizures: A case series. APPLIED NEUROPSYCHOLOGY-CHILD 2016; 6:335-344. [PMID: 27366934 DOI: 10.1080/21622965.2016.1197126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In adults, left temporal lobe pathology is typically associated with verbal memory deficits, whereas right temporal lobe pathology is thought to produce visual memory deficits in right-handed individuals. However, in children and adolescents with temporal lobe pathology, conclusions regarding material specificity of memory deficits remain unclear. The goal of the present case series is to examine the profile of verbal and visual memory impairment in children with temporal lobe tumors. Three patients with identified right temporal tumors and three patients with left temporal tumors are included. The Wide Range Assessment of Memory and Learning-Second Edition (WRAML-2) was administered as part of a larger neuropsychological battery. As anticipated, participants with right temporal lesions showed impaired visual memory relative to intact verbal memory. Interestingly, although the discrepancies between verbal and visual indices were less extreme, those with left temporal lesions showed a similar memory profile. These seemingly counterintuitive findings among left temporal tumor patients likely reflect less hemispheric specialization in children in comparison to adults and the fact that early developmental lesions in the left hemisphere may lead to functional reorganization of language-based skills.
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Affiliation(s)
| | - Elyssa A Scharaga
- b Ferkauf Graduate School of Psychology at Yeshiva University , New York , New York
| | - Karen Blackmon
- c Department of Neurology , New York University School of Medicine , New York , New York
| | - Jennifer Wiener
- c Department of Neurology , New York University School of Medicine , New York , New York
| | - Heidi Allison Bender
- d Mount Sinai Center for Cognitive Health, Icahn School of Medicine at Mount Sinai , New York , New York
| | - Howard L Weiner
- e Department of Neurosurgery , Baylor College of Medicine , Houston , Texas
| | - William S MacAllister
- f NYU Comprehensive Epilepsy Center, New York University School of Medicine , New York , New York
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Khalil AF, Iwasaki M, Nishio Y, Jin K, Nakasato N, Tominaga T. Verbal Dominant Memory Impairment and Low Risk for Post-operative Memory Worsening in Both Left and Right Temporal Lobe Epilepsy Associated with Hippocampal Sclerosis. Neurol Med Chir (Tokyo) 2016; 56:716-723. [PMID: 27250575 PMCID: PMC5221783 DOI: 10.2176/nmc.oa.2016-0004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Post-operative memory changes after temporal lobe surgery have been established mainly by group analysis of cognitive outcome. This study investigated individual patient-based memory outcome in surgically-treated patients with mesial temporal lobe epilepsy (TLE). This study included 84 consecutive patients with intractable TLE caused by unilateral hippocampal sclerosis (HS) who underwent epilepsy surgery (47 females, 41 left [Lt] TLE). Memory functions were evaluated with the Wechsler Memory Scale-Revised before and at 1 year after surgery. Pre-operative memory function was classified into three patterns: verbal dominant memory impairment (Verb-D), visual dominant impairment (Vis-D), and no material-specific impairment. Post-operative changes in verbal and visual memory indices were classified into meaningful improvement, worsening, or no significant changes. Pre-operative patterns and post-operative changes in verbal and visual memory function were compared between the Lt and right (Rt) TLE groups. Pre-operatively, Verb-D was the most common type of impairment in both the Lt and Rt TLE groups (65.9 and 48.8%), and verbal memory indices were lower than visual memory indices, especially in the Lt compared with Rt TLE group. Vis-D was observed only in 11.6% of Rt and 7.3% of Lt TLE patients. Post-operatively, meaningful improvement of memory indices was observed in 23.3–36.6% of the patients, and the memory improvement was equivalent between Lt and Rt TLE groups and between verbal and visual materials. In conclusion, Verb-D is most commonly observed in patients with both the Lt and Rt TLE associated with HS. Hippocampectomy can improve memory indices in such patients regardless of the side of surgery and the function impaired.
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Affiliation(s)
- Amr Farid Khalil
- Department of Neurosurgery, Tohoku University Graduate School of Medicine
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Vanli Yavuz EN, Bilgiç B, Matur Z, Bebek N, Gürses C, Gökyiğit A, Öktem Ö, Baykan B. Comparison of Cognitive Parameters Between Bilateral and Unilateral Hippocampal Sclerosis. Noro Psikiyatr Ars 2016; 53:199-204. [PMID: 28373795 DOI: 10.5152/npa.2016.14862] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 02/03/2016] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Recent studies showed that hippocampal sclerosis (HS) patients with unilateral involvement had more diffuse cognitive impairment than expected. Therefore, we aimed to compare the cognitive profiles of bilateral HS (BHS) patients with unilateral HS (UHS) patients. METHODS Consecutive patients, diagnosed with epilepsy, who fulfilled two major magnetic resonance imaging (MRI) criteria (T1 atrophy and T2-FLAIR hyperintensity) for HS were included. Standard neuro-psychological test (NPT) battery consisted of the Turkish version of 15-word verbal memory processes test, Wechsler memory scale visual reproduction subtest, forward and backward digit span, phonemic and semantic fluency, and Stroop test were applied; and the groups with right HS, left HS, and bilateral HS were compared statistically. RESULTS Ninety-one patients, completing the NPT (34 males, 57 females)-16 with BHS, 36 with right HS, and 39 with left HS-were included. Six out of 43 operated patients had BHS. There were no significant differences in education and handedness of the groups. Even though NPT performances of the BHS group were found to be poor compared to UHS subgroups, this was beyond statistical significance. Comparison of BHS with the right HS group showed a significant difference in the learning score of the Verbal Memory Processes Test, but recognition scores were found to be similar in all groups. Compared to the BHS group, both right and left HS groups revealed a significant difference in delayed recall score of the Verbal Memory Processes Test. Although there were no significant differences in the postoperative parameters of the BHS group, UHS subgroups had deficits in many postoperative parameters. CONCLUSION Our study revealed that bilateral involvement of the hippocampi was correlated with a poor cognitive performance. Retrieval failure, rather than a total recall problem, in the memory of the patients resembles a more diffuse involvement not only limited to limbic structures.
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Affiliation(s)
- Ebru Nur Vanli Yavuz
- Department of Neurology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Başar Bilgiç
- Department of Neurology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Zeliha Matur
- Department of Neurology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Nerses Bebek
- Department of Neurology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Candan Gürses
- Department of Neurology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Ayşen Gökyiğit
- Department of Neurology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Öget Öktem
- Department of Neurology, Laboratory of Neuropsychology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Betül Baykan
- Department of Neurology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
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Esfahani-Bayerl N, Finke C, Braun M, Düzel E, Heekeren HR, Holtkamp M, Hasper D, Storm C, Ploner CJ. Visuo-spatial memory deficits following medial temporal lobe damage: A comparison of three patient groups. Neuropsychologia 2016; 81:168-179. [PMID: 26765639 DOI: 10.1016/j.neuropsychologia.2015.12.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 12/01/2015] [Accepted: 12/22/2015] [Indexed: 10/22/2022]
Abstract
The contributions of the hippocampal formation and adjacent regions of the medial temporal lobe (MTL) to memory are still a matter of debate. It is currently unclear, to what extent discrepancies between previous human lesion studies may have been caused by the choice of distinct patient models of MTL dysfunction, as disorders affecting this region differ in selectivity, laterality and mechanisms of post-lesional compensation. Here, we investigated the performance of three distinct patient groups with lesions to the MTL with a battery of visuo-spatial short-term memory tasks. Thirty-one subjects with either unilateral damage to the MTL (postsurgical lesions following resection of a benign brain tumor, 6 right-sided lesions, 5 left) or bilateral damage (10 post-encephalitic lesions, 10 post-anoxic lesions) performed a series of tasks requiring short-term memory of colors, locations or color-location associations. We have shown previously that performance in the association task critically depends on hippocampal integrity. Patients with postsurgical damage of the MTL showed deficient performance in the association task, but performed normally in color and location tasks. Patients with left-sided lesions were almost as impaired as patients with right-sided lesions. Patients with bilateral post-encephalitic lesions showed comparable damage to MTL sub-regions and performed similarly to patients with postsurgical lesions in the association task. However, post-encephalitic patients showed additional impairments in the non-associative color and location tasks. A strikingly similar pattern of deficits was observed in post-anoxic patients. These results suggest a distinct cerebral organization of associative and non-associative short-term memory that was differentially affected in the three patient groups. Thus, while all patient groups may provide appropriate models of medial temporal lobe dysfunction in associative visuo-spatial short-term memory, additional deficits in non-associative memory tasks likely reflect damage of regions outside the MTL. Importantly, the choice of a patient model in human lesion studies of the MTL significantly influences overall performance patterns in visuo-spatial memory tasks.
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Affiliation(s)
| | - Carsten Finke
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Berlin School of Mind and Brain, Humboldt-Universität, Berlin, Germany
| | - Mischa Braun
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Emrah Düzel
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University Magdeburg, Magdeburg, Germany; German Center for Neurodegenerative Diseases (DZNE) Site, Magdeburg, Germany; Institute of Cognitive Neuroscience, University College London, London, United Kingdom
| | - Hauke R Heekeren
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany; Cluster of Excellence "Languages of Emotion", Freie Universität Berlin, Berlin, Germany
| | - Martin Holtkamp
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Epilepsy-Center Berlin-Brandenburg, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Dietrich Hasper
- Department of Nephrology and Medical Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Storm
- Department of Nephrology and Medical Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph J Ploner
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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Passarelli V, Castro-Lima Filho H, Adda CC, Preturlon-Santos AP, Valerio RM, Jorge CL, Puglia-Jr P, Lyra K, Otaduy MG, Wen HT, Castro LH. Contralateral ictal electrographic involvement is associated with decreased memory performance in unilateral mesial temporal sclerosis. J Neurol Sci 2015; 359:241-6. [DOI: 10.1016/j.jns.2015.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 10/08/2015] [Accepted: 11/04/2015] [Indexed: 10/22/2022]
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Rathore C, Alexander A, Sarma PS, Radhakrishnan K. Memory outcome following left anterior temporal lobectomy in patients with a failed Wada test. Epilepsy Behav 2015; 44:207-12. [PMID: 25768711 DOI: 10.1016/j.yebeh.2015.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 02/09/2015] [Accepted: 02/09/2015] [Indexed: 11/15/2022]
Abstract
PURPOSE This study aimed to compare the memory outcome following left anterior temporal lobectomy (ATL) between patients with a failed Wada test and patients who passed the Wada test. METHODS From 1996 to 2002, we performed the Wada test on all patients with unilateral left mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) and concordant electroclinical data before ATL. We used a 12-item recognition paradigm for memory testing and awarded a score of +1 for each correct response and -0.5 for each incorrect response. No patient was denied surgery on the basis of Wada scores. We assessed cognitive and memory functions using the Wechsler Adult Intelligence Scale and the Wechsler Memory Scale preoperatively and at one year after ATL. We compared the number of patients who showed decline in memory scores, as per the published reliable change indices, between the patients with a failed Wada test and the patients who passed the Wada test. RESULTS Out of the 116 eligible patients with left MTLE-HS, 88 underwent bilateral Wada test, while 28 underwent ipsilateral Wada test. None of them developed postoperative amnesia. Approximately, one-third of patients with a failed Wada memory test when the failure was defined as a contralateral score of <4, as an ipsilateral score of >8, and as an asymmetry score of <0. The patients with Wada memory failure had a longer pre-ATL duration of epilepsy (p<0.003). The memory and quality-of-life outcomes did not differ between the group with a failed Wada memory test and the group who passed the Wada memory test. The results remained the same when analyses were repeated at various other cutoff points. CONCLUSION The patients with left MTLE-HS with concordant electroclinical, MRI, and neuropsychological data should not be denied ATL solely on the basis of Wada memory test results.
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Affiliation(s)
- Chaturbhuj Rathore
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Aley Alexander
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - P Sankara Sarma
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Kurupath Radhakrishnan
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
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Menon R, Lekha V, Justus S, Sarma PS, Mathuranath P. A pilot study on utility of Malayalam version of Addenbrooke's Cognitive Examination in detection of amnestic mild cognitive impairment: A critical insight into utility of learning and recall measures. Ann Indian Acad Neurol 2014; 17:420-5. [PMID: 25506164 PMCID: PMC4251016 DOI: 10.4103/0972-2327.144018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 05/25/2014] [Accepted: 06/16/2014] [Indexed: 11/04/2022] Open
Abstract
AIMS This pilot study sought to determine whether the Malayalam adaptation of Addenbrooke's Cognitive Examination (M-ACE) can effectively identify patients with amnestic mild cognitive impairment (a-MCI) and the impact of measures of learning and free recall. MATERIALS AND METHODS A cohort of 23 patients with a-MCI aged between 55-80 years diagnosed as per current criteria and 23 group matched cognitively normal healthy controls (CNHC) were studied. The measures of acquisition and delayed recall were the Rey Auditory Verbal Learning Test (RAVLT) and Wechsler Memory Scale (WMS)-III (verbal and visual subsets) and Delayed Matching-to-sample Test (DMS)-48. Test scores of M-ACE registration and recall scores were included. To examine the differences in test performances between the groups, we compared the number of subjects with test scores less than 1.5 standard deviation (SD) of the control scores. Comparisons between a-MCI and controls were drawn using Fisher's exact test and Mann-Whitney U tests. RESULTS M-ACE registration component ascertained on a 24-point scale failed to demonstrate any differences between a-MCI and controls (P = 0.665) as opposed to recall judged on a cumulative 10-point scale (P = 0.001). Significant differences were noted in RAVLT list learning (P < 0.001) and list recall (P = 0.003), WMS-III paragraph learning (P <0.001) and recall (P = 0.007), visual learning (P = 0.004) and recall (P = 0.001). CONCLUSIONS M-ACE recall scores are an effective screening tool to identify patients with suspected a-MCI. Both word list and paragraph learning and recall components have been found to be sensitive to concretely identify a-MCI and impairment on at least 2 tests should be considered in the diagnostic criteria of MCI rather than rely on a single screening battery.
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Affiliation(s)
- Ramshekhar Menon
- Department of Neurology, Cognition and Behavioural Neurology Section, Trivandrum, Kerala, India
| | - Vs Lekha
- Department of Neurology, Cognition and Behavioural Neurology Section, Trivandrum, Kerala, India
| | - Sunitha Justus
- Department of Neurology, Cognition and Behavioural Neurology Section, Trivandrum, Kerala, India
| | - P Sankara Sarma
- Department of Biostatistics, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Ps Mathuranath
- Department of Neurology, Cognitive and Behavioural Neurology Section, National Institute for Mental Health and Neuro Sciences, Bangalore, Karnataka, India
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Radhakrishnan K. Compassion, commitment, and dedication: Epilepsy & behavior on its 15th anniversary. Epilepsy Behav 2014; 40:104. [PMID: 25278317 DOI: 10.1016/j.yebeh.2014.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 09/01/2014] [Indexed: 10/24/2022]
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