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Aljishi A, Sherman BE, Huberdeau DM, Obaid S, Khan K, Lamsam L, Zibly Z, Sivaraju A, Turk-Browne NB, Damisah EC. Statistical learning in epilepsy: Behavioral and anatomical mechanisms in the human brain. Epilepsia 2024; 65:753-765. [PMID: 38116686 PMCID: PMC10948305 DOI: 10.1111/epi.17871] [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: 10/15/2023] [Revised: 12/18/2023] [Accepted: 12/18/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVE Statistical learning, the fundamental cognitive ability of humans to extract regularities across experiences over time, engages the medial temporal lobe (MTL) in the healthy brain. This leads to the hypothesis that statistical learning (SL) may be impaired in patients with epilepsy (PWE) involving the temporal lobe, and that this impairment could contribute to their varied memory deficits. In turn, studies done in collaboration with PWE, that evaluate the necessity of MTL circuitry through disease and causal perturbations, provide an opportunity to advance basic understanding of SL. METHODS We implemented behavioral testing, volumetric analysis of the MTL substructures, and direct electrical brain stimulation to examine SL across a cohort of 61 PWE and 28 healthy controls. RESULTS We found that behavioral performance in an SL task was negatively associated with seizure frequency irrespective of seizure origin. The volume of hippocampal subfields CA1 and CA2/3 correlated with SL performance, suggesting a more specific role of the hippocampus. Transient direct electrical stimulation of the hippocampus disrupted SL. Furthermore, the relationship between SL and seizure frequency was selective, as behavioral performance in an episodic memory task was not impacted by seizure frequency. SIGNIFICANCE Overall, these results suggest that SL may be hippocampally dependent and that the SL task could serve as a clinically useful behavioral assay of seizure frequency that may complement existing approaches such as seizure diaries. Simple and short SL tasks may thus provide patient-centered endpoints for evaluating the efficacy of novel treatments in epilepsy.
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Affiliation(s)
- Ayman Aljishi
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
- Department of Psychology, Vanderbilt University, Nashville, TN, 37240, USA
| | - Brynn E. Sherman
- Department of Psychology, Yale University, New Haven, CT 06520, USA
| | | | - Sami Obaid
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Kamren Khan
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Layton Lamsam
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Zion Zibly
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Adithya Sivaraju
- Department of Neurology, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Nicholas B. Turk-Browne
- Department of Psychology, Yale University, New Haven, CT 06520, USA
- Wu Tsai Institute, Yale University, New Haven, CT, 06510, USA
| | - Eyiyemisi C. Damisah
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
- Wu Tsai Institute, Yale University, New Haven, CT, 06510, USA
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT 06510, USA
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2
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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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Aljishi A, Sherman BE, Huberdeau DM, Obaid S, Sivaraju A, Turk-Browne NB, Damisah EC. Statistical learning in epilepsy: Behavioral, anatomical, and causal mechanisms in the human brain. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.04.25.538321. [PMID: 37162937 PMCID: PMC10168289 DOI: 10.1101/2023.04.25.538321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Statistical learning, the fundamental cognitive ability of humans to extract regularities across experiences over time, engages the medial temporal lobe in the healthy brain. This leads to the hypothesis that statistical learning may be impaired in epilepsy patients, and that this impairment could contribute to their varied memory deficits. In turn, epilepsy patients provide a platform to advance basic understanding of statistical learning by helping to evaluate the necessity of medial temporal lobe circuitry through disease and causal perturbations. We implemented behavioral testing, volumetric analysis of the medial temporal lobe substructures, and direct electrical brain stimulation to examine statistical learning across a cohort of 61 epilepsy patients and 28 healthy controls. Behavioral performance in a statistical learning task was negatively associated with seizure frequency, irrespective of where seizures originated in the brain. The volume of hippocampal subfields CA1 and CA2/3 correlated with statistical learning performance, suggesting a more specific role of the hippocampus. Indeed, transient direct electrical stimulation of the hippocampus disrupted statistical learning. Furthermore, the relationship between statistical learning and seizure frequency was selective: behavioral performance in an episodic memory task was impacted by structural lesions in the medial temporal lobe and by antiseizure medications, but not by seizure frequency. Overall, these results suggest that statistical learning may be hippocampally dependent and that this task could serve as a clinically useful behavioral assay of seizure frequency distinct from existing neuropsychological tests. Simple and short statistical learning tasks may thus provide patient-centered endpoints for evaluating the efficacy of novel treatments in epilepsy.
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Affiliation(s)
- Ayman Aljishi
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Brynn E. Sherman
- Department of Psychology, Yale University, New Haven, CT 06520, USA
| | | | - Sami Obaid
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Adithya Sivaraju
- Department of Neurology, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Nicholas B. Turk-Browne
- Department of Psychology, Yale University, New Haven, CT 06520, USA
- Wu Tsai Institute, Yale University, New Haven, CT, 06510, USA
| | - Eyiyemisi C. Damisah
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
- Wu Tsai Institute, Yale University, New Haven, CT, 06510, USA
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT 06510, USA
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4
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Ryan JJ, Kreiner DS, Gontkovsky ST, Teichner G. Wechsler memory scale-fourth edition (WMS-IV) in the neuropsychological evaluation of patients diagnosed with probable Alzheimer's disease. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-8. [PMID: 36635988 DOI: 10.1080/23279095.2023.2164858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
There is a scarcity of research concerning Wechsler Memory Scale-Fourth Edition (WMS-IV) findings in Alzheimer's disease (AD). We provide information, beyond that in the test manual, concerning the power of the scale to detect AD-associated memory deficits. Participants were 87 individuals with diagnoses made according to criteria specified in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5): 31 probable neurocognitive disorders due to AD and 33 patients with depression. Twenty-three elderly controls were also studied. The depressed and control participants had similar demographics as well as test scores and therefore were blended into a single control group (n = 56). AD patients were significantly impaired on the four WMS-IV indexes relative to controls, and the index pattern of performance differed across groups. Delayed Memory Index was a significant weakness in AD, whereas the Visual Memory Index was the lowest mean for controls. Sensitivity, specificity, hit rate, positive predictive value, and negative predictive value were strong to excellent for each index when a cutoff of 1.5 SDs below the normative mean was used to separate ADs and controls. Receiver operating characteristics curve analyses yielded excellent area under the curve statistics that ranged from .970 for the Visual Memory Index to .999 for the Delayed Memory Index. A supplementary analysis yielded similar results when the AD group was divided into mild (n = 10) and major (n = 21) subgroups.
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Affiliation(s)
- Joseph J Ryan
- University of Central Missouri, Warrensburg, MO, USA
| | | | - Samuel T Gontkovsky
- Adena Health System, Chillicothe, OH, USA
- Wexner Medical Center, College of Medicine, Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
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Diaz-Orueta U, Rogers BM, Blanco-Campal A, Burke T. The challenge of neuropsychological assessment of visual/visuo-spatial memory: A critical, historical review, and lessons for the present and future. Front Psychol 2022; 13:962025. [PMID: 36081731 PMCID: PMC9447442 DOI: 10.3389/fpsyg.2022.962025] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 07/15/2022] [Indexed: 11/26/2022] Open
Abstract
A proliferation of tests exists for the assessment of auditory-verbal memory processes. However, from a clinical practice perspective, the situation is less clear when it comes to the ready availability of reliable and valid tests for the evaluation of visual/visuo-spatial memory processes. While, at face value, there appear to be a wide range of available tests of visual/visuo-spatial memory, utilizing different types of materials and assessment strategies, a number of criticisms have been, and arguably should be, leveled at the majority of these tests. The criticisms that have been directed toward what are typically considered to be visual/visuo-spatial memory tests, such as (1) the potential for verbal mediation, (2) over-abstraction of stimuli, (3) the requirement of a drawing response, and (4) the lack of sensitivity to unilateral brain lesions, mean that, in reality, the number of readily available valid tests of visual/visuo-spatial memory is, at best, limited. This article offers a critical, historical review on the existing measures and resources for the neuropsychological assessment of visual/visuo-spatial memory, and it showcases some examples of newer tests that have aimed to overcome the challenges of assessing these important aspects of memory. The article also identifies new trends and examples of how technological advances such as virtual reality may add value to overcome previous obstacles to assessment, thereby offering professionals more reliable, accurate means to evaluate visual/visuo-spatial memory in clinical practice.
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Affiliation(s)
- Unai Diaz-Orueta
- Department of Psychology, Maynooth University, Maynooth, Ireland
| | - Bronagh M. Rogers
- Department of Psychology, Faculty of Arts, Humanities and Social Sciences, University of Limerick, Limerick, Ireland
| | - Alberto Blanco-Campal
- Department of Psychiatry for the Older Person and Memory Clinic Services, Health Service Executive, Ardee and Navan, Ireland
| | - Teresa Burke
- Faculty of Science and Health, School of Psychology, Dublin City University, Dublin, Ireland
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6
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Furey RT, Petrauskas V, Bowden SC, Simpson LC, Meade CE, Davis BM, D'Souza WJ. Latent Semantic Structure of the WMS-III Verbal Paired-Associates. Arch Clin Neuropsychol 2021; 37:970-980. [PMID: 34929041 DOI: 10.1093/arclin/acab093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To investigate the factor structure of the verbal paired-associates (VPA) subtest in the WMS-III using a theoretically driven model of semantic processing previously found to be well-fitting for the WMS-IV version of the test. METHOD Archival data were used from 267 heterogeneous neurosciences patients and 223 seizure disorder patients who completed the WMS-III as part of a standard neuropsychological evaluation. Confirmatory factor analysis was used to test theoretically driven models for VPA based on principles of semantic processing. Four nested models of different complexities were examined and compared for goodness-of-fit using chi-squared difference testing. Measurement invariance testing was conducted across heterogeneous neuroscience and seizure disorder samples to test generality of the factor model. RESULTS After removing items with limited variability (very easy or very hard; 12 of 40 items), a four-factor model was found to be best-fitting in the present patient samples. The four factors were "recreational", "functional", "material", and "symbolic", each representing semantic knowledge associated with the function of the target word referent. This model subsequently met the criteria for the strict measurement invariance, showing good overall fit when factor loadings, thresholds, and residuals were held to equality across samples. CONCLUSIONS The results of this study provide further evidence that "arbitrary" associations between word pairs in VPA items have an underlying semantic structure, challenging the idea that unrelated hard-pairs are semantic-free. These results suggest that a semantic-structure model may be implemented as an alternative scoring in future editions of the WMS to facilitate interpretation.
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Affiliation(s)
- Rachel T Furey
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Vilija Petrauskas
- Department of Psychology, Neuropsychology Service, British Columbia Children's Hospital, British Columbia, Vancouver, Canada
| | - Stephen C Bowden
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia.,Department of Medicine, St. Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Leonie C Simpson
- Neuropsychology, Department of Allied Health, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Catherine E Meade
- Department of Medicine, St. Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Brooke M Davis
- Private Practice, Launch Psychology, Melbourne, VIC, Australia
| | - Wendyl J D'Souza
- Department of Medicine, St. Vincent's Hospital Melbourne, Melbourne, VIC, Australia
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Hoogland G, Hendriksen RGF, Slegers RJ, Hendriks MPH, Schijns OEMG, Aalbers MW, Vles JSH. The expression of the distal dystrophin isoforms Dp140 and Dp71 in the human epileptic hippocampus in relation to cognitive functioning. Hippocampus 2018; 29:102-110. [PMID: 30069964 DOI: 10.1002/hipo.23015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 07/11/2018] [Accepted: 07/12/2018] [Indexed: 01/06/2023]
Abstract
Dystrophin is an important protein within the central nervous system. The absence of dystrophin, characterizing Duchenne muscular dystrophy (DMD), is associated with brain related comorbidities such as neurodevelopmental (e.g., cognitive and behavioural) deficits and epilepsy. Especially mutations in the downstream part of the DMD gene affecting the dystrophin isoforms Dp140 and Dp71 are found to be associated with cognitive deficits. However, the function of Dp140 is currently not well understood and its expression pattern has previously been implicated to be developmentally regulated. Therefore, we evaluated Dp140 and Dp71 expression in human hippocampi in relation to cognitive functioning in patients with drug-resistant temporal lobe epilepsy (TLE) and post-mortem controls. Hippocampal samples obtained as part of epilepsy surgery were quantitatively analyzed by Western blot and correlations with neuropsychological test results (i.e., memory and intelligence) were examined. First, we demonstrated that the expression of Dp140 does not appear to differ across different ages throughout adulthood. Second, we identified an inverse correlation between memory loss (i.e., verbal and visual memory), but not intelligence (i.e., neither verbal nor performance), and hippocampal Dp140 expression. Finally, patients with TLE appeared to have similar Dp140 expression levels compared to post-mortem controls without neurological disease. Dp140 may thus have a function in normal cognitive (i.e., episodic memory) processes.
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Affiliation(s)
- Govert Hoogland
- School for Mental Health & Neuroscience, Maastricht University, Maastricht, The Netherlands.,Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ruben G F Hendriksen
- School for Mental Health & Neuroscience, Maastricht University, Maastricht, The Netherlands.,Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Rutger J Slegers
- School for Mental Health & Neuroscience, Maastricht University, Maastricht, The Netherlands.,Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marc P H Hendriks
- Kempenhaeghe Epilepsy Centre, Heeze, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Olaf E M G Schijns
- Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marlien W Aalbers
- Department of Neurosurgery, Groningen University Medical Centre, Groningen, The Netherlands
| | - Johan S H Vles
- School for Mental Health & Neuroscience, Maastricht University, Maastricht, The Netherlands.,Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
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Rzezak P, Lima EM, Gargaro AC, Coimbra E, de Vincentiis S, Velasco TR, Leite JP, Busatto GF, Valente KD. Everyday memory impairment in patients with temporal lobe epilepsy caused by hippocampal sclerosis. Epilepsy Behav 2017; 69:31-36. [PMID: 28222339 DOI: 10.1016/j.yebeh.2017.01.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 12/25/2016] [Accepted: 01/08/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Patients with temporal lobe epilepsy caused by hippocampal sclerosis (TLE-HS) have episodic memory impairment. Memory has rarely been evaluated using an ecologic measure, even though performance on these tests is more related to patients' memory complaints. We aimed to measure everyday memory of patients with TLE-HS to age- and gender-matched controls. METHODS We evaluated 31 patients with TLE-HS and 34 healthy controls, without epilepsy and psychiatric disorders, using the Rivermead Behavioral Memory Test (RBMT), Visual Reproduction (WMS-III) and Logical Memory (WMS-III). We evaluated the impact of clinical variables such as the age of onset, epilepsy duration, AED use, history of status epilepticus, and seizure frequency on everyday memory. Statistical analyses were performed using MANCOVA with years of education as a confounding factor. RESULTS Patients showed worse performance than controls on traditional memory tests and in the overall score of RBMT. Patients had more difficulties to recall names, a hidden belonging, to deliver a message, object recognition, to remember a story full of details, a previously presented short route, and in time and space orientation. Clinical epilepsy variables were not associated with RBMT performance. Memory span and working memory were correlated with worse performance on RBMT. SIGNIFICANCE Patients with TLE-HS demonstrated deficits in everyday memory functions. A standard neuropsychological battery, designed to assess episodic memory, would not evaluate these impairments. Impairment in recalling names, routes, stories, messages, and space/time disorientation can adversely impact social adaptation, and we must consider these ecologic measures with greater attention in the neuropsychological evaluation of patients with memory complaints.
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Affiliation(s)
- Patrícia Rzezak
- Laboratory of Clinical Neurophysiology, Psychiatry Department, University of São Paulo (USP) School of Medicine, São Paulo, SP, Brazil; Laboratory of Neuroimaging in Neuroscience (LIM 21), University of São Paulo (USP) School of Medicine, São Paulo, SP, Brazil; Group for the Study of Cognitive and Psychiatric Disorders in Epilepsy, Clinics Hospital, University of Sao Paulo (USP), Brazil; Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of Sao Paulo (USP), Brazil.
| | - Ellen Marise Lima
- Laboratory of Clinical Neurophysiology, Psychiatry Department, University of São Paulo (USP) School of Medicine, São Paulo, SP, Brazil; Group for the Study of Cognitive and Psychiatric Disorders in Epilepsy, Clinics Hospital, University of Sao Paulo (USP), Brazil
| | - Ana Carolina Gargaro
- Ribeirao Preto School of Medicine, Department of Neurosciences and Behavior, University of Sao Paulo (USP), Brazil
| | - Erica Coimbra
- Ribeirao Preto School of Medicine, Department of Neurosciences and Behavior, University of Sao Paulo (USP), Brazil
| | - Silvia de Vincentiis
- Laboratory of Clinical Neurophysiology, Psychiatry Department, University of São Paulo (USP) School of Medicine, São Paulo, SP, Brazil; Group for the Study of Cognitive and Psychiatric Disorders in Epilepsy, Clinics Hospital, University of Sao Paulo (USP), Brazil
| | - Tonicarlo Rodrigues Velasco
- Ribeirao Preto School of Medicine, Department of Neurosciences and Behavior, University of Sao Paulo (USP), Brazil
| | - João Pereira Leite
- Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of Sao Paulo (USP), Brazil; Ribeirao Preto School of Medicine, Department of Neurosciences and Behavior, University of Sao Paulo (USP), Brazil
| | - Geraldo F Busatto
- Laboratory of Neuroimaging in Neuroscience (LIM 21), University of São Paulo (USP) School of Medicine, São Paulo, SP, Brazil; Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of Sao Paulo (USP), Brazil
| | - Kette D Valente
- Laboratory of Clinical Neurophysiology, Psychiatry Department, University of São Paulo (USP) School of Medicine, São Paulo, SP, Brazil; Laboratory of Neuroimaging in Neuroscience (LIM 21), University of São Paulo (USP) School of Medicine, São Paulo, SP, Brazil; Group for the Study of Cognitive and Psychiatric Disorders in Epilepsy, Clinics Hospital, University of Sao Paulo (USP), Brazil; Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of Sao Paulo (USP), Brazil
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9
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Jermakowicz WJ, Kanner AM, Sur S, Bermudez C, D'Haese PF, Kolcun JPG, Cajigas I, Li R, Millan C, Ribot R, Serrano EA, Velez N, Lowe MR, Rey GJ, Jagid JR. Laser thermal ablation for mesiotemporal epilepsy: Analysis of ablation volumes and trajectories. Epilepsia 2017; 58:801-810. [PMID: 28244590 DOI: 10.1111/epi.13715] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To identify features of ablations and trajectories that correlate with optimal seizure control and minimize the risk of neurocognitive deficits in patients undergoing laser interstitial thermal therapy (LiTT) for mesiotemporal epilepsy (mTLE). METHODS Clinical and radiographic data were reviewed from a prospectively maintained database of all patients undergoing LiTT for the treatment of mTLE at the University of Miami Hospital. Standard preoperative and postoperative evaluations, including contrast-enhanced magnetic resonance imaging (MRI) and neuropsychological testing, were performed in all patients. Laser trajectory and ablation volumes were computed both by manual tracing of mesiotemporal structures and by nonrigid registration of ablation cavities to a common reference system based on 7T MRI data. RESULTS Among 23 patients with at least 1-year follow-up, 15 (65%) were free of disabling seizures since the time of their surgery. Sparing of the mesial hippocampal head was significantly correlated with persistent disabling seizures (p = 0.01). A lateral trajectory through the hippocampus showed a trend for poor seizure outcome (p = 0.08). A comparison of baseline and postoperative neurocognitive testing revealed areas of both improvement and worsening, which were not associated with ablation volume or trajectory. SIGNIFICANCE At 1-year follow-up, LiTT appears to be a safe and effective tool for the treatment of mTLE, although a longer follow-up period is necessary to confirm these observations. Better understanding of the impact of ablation volume and location could potentially fine-tune this technique to improve seizure-freedom rates and associated neurologic and cognitive changes.
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Affiliation(s)
- Walter J Jermakowicz
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A
| | - Andres M Kanner
- Epilepsy Division, Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A
| | - Samir Sur
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A
| | - Christina Bermudez
- Division of Neuropsychology, Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A
| | - Pierre-Francois D'Haese
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee, U.S.A
| | - John Paul G Kolcun
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A
| | - Iahn Cajigas
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A
| | - Rui Li
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee, U.S.A
| | - Carlos Millan
- Epilepsy Division, Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A
| | - Ramses Ribot
- Epilepsy Division, Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A
| | - Enrique A Serrano
- Epilepsy Division, Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A
| | - Naymee Velez
- Epilepsy Division, Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A
| | - Merredith R Lowe
- Epilepsy Division, Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A
| | - Gustavo J Rey
- Division of Neuropsychology, Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A
| | - Jonathan R Jagid
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A
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