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Bernardo P, Scala MR, Rubino A, Spennato P, Mirone G, Russo C, Santangelo P, Covelli E, Grimaldi G, D'Onofrio V, Cinalli G. Low-grade epilepsy-associated tumors: Epilepsy outcome and antiseizure medication discontinuation after lesionectomies as first-line surgical approach in pediatric population. Epileptic Disord 2024; 26:460-470. [PMID: 38700931 DOI: 10.1002/epd2.20234] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 08/17/2024]
Abstract
OBJECTIVE This study aimed to evaluate epilepsy outcome and antiseizure medication (ASM) discontinuation after lesionectomies as first surgical approach in pediatric population diagnosed with low-grade epilepsy-associated neuroepithelial tumors (LEATs). METHODS We conducted a retrospective study. Thirty-six consecutive patients with histological diagnoses of LEATs who underwent surgery between 2018 and 2021 at our institution were included. The clinical and surgical data were retrospectively analyzed. RESULTS Thirty (83.3%) of 36 patients are free of disabling seizures (Engel class I) and 19 (63,4%) of them are classified as Engel Ia. In 17 (47.2%) patients, ASM could be discontinued. The mean age at surgery was 8.6 years (±4.04) and the mean age at onset of epilepsy was 7.2 years (±3.8), whereas the mean duration of epilepsy in months at the time of surgery was 21.3 months (±23.7). The epileptogenic tumor was in the temporal lobe in 20 (55.5%) patients. Because of seizure persistence, a second or a third surgery was necessary for six patients (16.7%) and four of them had residual lesions (three in temporal and one in extratemporal site). No perioperative complications were recorded, including acute seizures, with a median hospitalization time of 7 days. Shorter epilepsy duration at time of surgery as long as a single ASM was significantly correlated with an Engel class I outcome (p-value = .01 and p-value = .016, respectively). Focal seizure semeiology was associated with an increased probability of antiseizure medication discontinuation (p-value = .042). SIGNIFICANCE Our findings confirm that shorter epilepsy disease duration, monotherapy before surgery, and seizure semeiology are determinant factors for a positive seizure outcome and medication discontinuation, also with less invasive surgical approaches such as lesionectomies. However, considering the intrinsic multifactorial epileptogenic nature of LEATs, a tailored surgical approach should be considered to optimize clinical and seizure outcome, especially for lesions located in the temporal lobe.
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Affiliation(s)
- Pia Bernardo
- Department of Neurosciences, Pediatric Psychiatry and Neurology, Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy
| | - Maria Rosaria Scala
- Department of Neurosciences, Pediatric Neurosurgery Unit, Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy
| | - Alfonso Rubino
- Department of Neurosciences, Pediatric Neurology, Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy
| | - Pietro Spennato
- Department of Neurosciences, Pediatric Neurosurgery Unit, Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy
| | - Giuseppe Mirone
- Department of Neurosciences, Pediatric Neurosurgery Unit, Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy
| | - Carmela Russo
- Department of Neurosciences, Pediatric Neuroradiology Unit, Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy
| | - Pia Santangelo
- Department of Neurosciences, Pediatric Psychiatry and Neurology, Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy
| | - Eugenio Covelli
- Department of Neurosciences, Pediatric Neuroradiology Unit, Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy
| | - Giampina Grimaldi
- Department of Neurosciences, Pediatric Psychiatry and Neurology, Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy
| | - Vittoria D'Onofrio
- Department of Pathology, Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy
| | - Giuseppe Cinalli
- Department of Neurosciences, Pediatric Neurosurgery Unit, Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy
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Eriksson MH, Prentice F, Piper RJ, Wagstyl K, Adler S, Chari A, Booth J, Moeller F, Das K, Eltze C, Cooray G, Perez Caballero A, Menzies L, McTague A, Shavel-Jessop S, Tisdall MM, Cross JH, Martin Sanfilippo P, Baldeweg T. Long-term neuropsychological trajectories in children with epilepsy: does surgery halt decline? Brain 2024; 147:2791-2802. [PMID: 38643018 PMCID: PMC11292899 DOI: 10.1093/brain/awae121] [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: 11/11/2023] [Revised: 02/29/2024] [Accepted: 03/16/2024] [Indexed: 04/22/2024] Open
Abstract
Neuropsychological impairments are common in children with drug-resistant epilepsy. It has been proposed that epilepsy surgery might alleviate these impairments by providing seizure freedom; however, findings from prior studies have been inconsistent. We mapped long-term neuropsychological trajectories in children before and after undergoing epilepsy surgery, to measure the impact of disease course and surgery on functioning. We performed a retrospective cohort study of 882 children who had undergone epilepsy surgery at Great Ormond Street Hospital (1990-2018). We extracted patient information and neuropsychological functioning [obtained from IQ tests (domains: full-scale IQ, verbal IQ, performance IQ, working memory and processing speed) and tests of academic attainment (reading, spelling and numeracy)] and investigated changes in functioning using regression analyses. We identified 500 children (248 females) who had undergone epilepsy surgery [median age at surgery = 11.9 years, interquartile range = (7.8, 15.0)] and neuropsychological assessment. These children showed declines in all domains of neuropsychological functioning in the time leading up to surgery (all P-values ≤0.001; e.g. βFSIQ = -1.9, SEFSIQ = 0.3, PFSIQ < 0.001). Children lost on average one to four points per year, depending on the domain considered; 27%-43% declined by ≥10 points from their first to their last preoperative assessment. At the time of presurgical evaluation, most children (46%-60%) scored one or more standard deviations below the mean (<85) on the different neuropsychological domains; 37% of these met the threshold for intellectual disability (full-scale IQ < 70). On a group level, there was no change in performance from pre- to postoperative assessment on any of the domains (all P-values ≥0.128). However, children who became seizure free through surgery showed higher postoperative neuropsychological performance (e.g. rrb-FSIQ = 0.37, P < 0.001). These children continued to demonstrate improvements in neuropsychological functioning over the course of their long-term follow-up (e.g. βFSIQ = 0.9, SEFSIQ = 0.3, PFSIQ = 0.004). Children who had discontinued antiseizure medication treatment at 1-year follow-up showed an 8- to 13-point advantage in postoperative working memory, processing speed and numeracy, and greater improvements in verbal IQ, working memory, reading and spelling (all P-values ≤0.034) over the postoperative period compared with children who were seizure free and still receiving antiseizure medication. In conclusion, by providing seizure freedom and the opportunity for antiseizure medication cessation, epilepsy surgery might not only halt but reverse the downward trajectory that children with drug-resistant epilepsy display in neuropsychological functioning. To halt this decline as soon as possible or, potentially, to prevent it from occurring in the first place, children with focal epilepsy should be considered for epilepsy surgery as early as possible after diagnosis.
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Affiliation(s)
- Maria H Eriksson
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Department of Neuropsychology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
- Department of Neurology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Freya Prentice
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Department of Neuropsychology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Rory J Piper
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Konrad Wagstyl
- Department of Imaging Neuroscience, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Sophie Adler
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
| | - Aswin Chari
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - John Booth
- Data Research, Innovation and Virtual Environments Unit, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Friederike Moeller
- Department of Neurophysiology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Krishna Das
- Department of Neurology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
- Department of Neurophysiology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Christin Eltze
- Department of Neurophysiology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Gerald Cooray
- Department of Neurophysiology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
- Department of Clinical Neuroscience, Karolinska Institutet, Solna 171 77, Sweden
| | - Ana Perez Caballero
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Lara Menzies
- Department of Clinical Genetics, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Amy McTague
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Department of Clinical Genetics, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Sara Shavel-Jessop
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Department of Neuropsychology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Martin M Tisdall
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - J Helen Cross
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Department of Neurology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
- Young Epilepsy, Lingfield, RH7 6PW, UK
| | - Patricia Martin Sanfilippo
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Department of Neuropsychology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Torsten Baldeweg
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Department of Neuropsychology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
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Laguitton V, Boutin M, Brissart H, Breuillard D, Bilger M, Forthoffer N, Guinet V, Hennion S, Kleitz C, Mirabel H, Mosca C, Pradier S, Samson S, Voltzenlogel V, Planton M, Denos M, Bulteau C. Neuropsychological assessment in pediatric epilepsy surgery: A French procedure consensus. Rev Neurol (Paris) 2024; 180:494-506. [PMID: 37949750 DOI: 10.1016/j.neurol.2023.08.019] [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: 02/16/2023] [Revised: 07/11/2023] [Accepted: 08/08/2023] [Indexed: 11/12/2023]
Abstract
Neuropsychological assessment is a mandatory part of the pre- and post-operative evaluation in pediatric epilepsy surgery. The neuropsychology task force of the ILAE - French Chapter aims to define a neuropsychological procedure consensus based on literature review and adapted for French practice. They performed a systematic review of the literature published between 1950 and 2023 on cognitive evaluation of individuals undergoing presurgical work-up and post-surgery follow-up and focused on the pediatric population aged 6-16. They classified publications listed in the PubMed database according to their level of scientific evidence. The systematic literature review revealed no study with high statistical power and only four studies using neuropsychological scales in their French version. Afterwards, the experts defined a neuropsychological consensus strategy in pediatric epilepsy surgery according to the psychometric determinants of cognitive tests, specificity of epilepsy, surgery context, French culture and literature reports. A common French neuropsychological procedure dedicated to pediatric epilepsy surgery is now available. This procedure could serve as a guide for the pre- and post-surgical work-up in French centers with pediatric epilepsy surgery programs. The main goal is to anticipate the functional risks of surgery, to support the postoperative outcome beyond the seizure-related one, while taking into consideration the plasticity and vulnerability of the immature brain and allowing the possibility of collaborative studies.
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Affiliation(s)
- V Laguitton
- Clinical Neurophysiology AP-HM, Timone Hospital, Marseille, France; Department of Pediatric Neurology, APHM, Timone Hospital, Marseille, France.
| | - M Boutin
- GHU-Paris Pôle Neuro-Sainte-Anne - Neurosurgery Unity, 1, rue Cabanis, Paris, France
| | - H Brissart
- Université de Lorraine, CNRS, CRAN, 54000 Nancy, France; Université de Lorraine, CHRU-Nancy, Service de Neurologie, 54000 Nancy, France
| | - D Breuillard
- Reference Center Rare Epilepsies, Hôpital Necker Enfants-Malades, Paris, France
| | - M Bilger
- Neurology Department, Hôpital Hautepierre, CHRU Strasbourg, Strasbourg, France
| | - N Forthoffer
- Université de Lorraine, CNRS, CRAN, 54000 Nancy, France
| | - V Guinet
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Lyon, France
| | - S Hennion
- Reference Center Rare Epilepsies, Epilepsy Unit, University Lille, INSERM, CHU Lille, U1171 Degenerative and vascular cognitive disorders, Lille, France
| | - C Kleitz
- Neurology Department, Hôpital Hautepierre, CHRU Strasbourg, Strasbourg, France
| | - H Mirabel
- Neurology Department, Hôpital Pierre-Paul Riquet, CHU de Toulouse, Toulouse, France
| | - C Mosca
- Epilepsy Unit, CHU Grenoble-Alpes, Grenoble-Alpes, France
| | - S Pradier
- Functional Explorations of the Nervous System, Clinical Neurosciences Center, University Hospital Center Pellegrin, Bordeaux, France
| | - S Samson
- Neurology Department, Rehabilitation Unit, GH Pitié-Salpêtrière, APHP, Paris, France; Équipe Neuropsychologie: Audition, Cognition et Action (EA 4072), UFR de psychologie, Université Lille-Nord de France, Villeneuve d'Ascq, France
| | - V Voltzenlogel
- Centre d'études et de recherches en psychopathologie et psychologie de la santé, université de Toulouse, UT2J, Toulouse, France
| | - M Planton
- Neurology Department, Hôpital Pierre-Paul Riquet, CHU de Toulouse, Toulouse, France; Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - M Denos
- Neurology Department, Rehabilitation Unit, GH Pitié-Salpêtrière, APHP, Paris, France
| | - C Bulteau
- Pediatric Neurosurgery Department, Rothschild Foundation Hospital, EpiCare Member, Paris, France; University of Paris Cité, MC(2)Lab, Institute of Psychology, 92000 Boulogne-Billancourt, France
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4
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Schmidlechner T, Zaddach M, Heinen F, Cornell S, Ramantani G, Rémi J, Vollmar C, Kunz M, Borggraefe I. IQ changes after pediatric epilepsy surgery: a systematic review and meta-analysis. J Neurol 2024; 271:177-187. [PMID: 37770569 PMCID: PMC10770207 DOI: 10.1007/s00415-023-12002-8] [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: 08/17/2023] [Revised: 09/07/2023] [Accepted: 09/10/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVE This systematic review aimed to assess the intellectual outcome of children who underwent surgery for epilepsy. METHODS A systematic review of electronic databases was conducted on December 3, 2021, for PubMed and January 11, 2022, for Web of Science. The review was conducted according to the PRISMA guidelines. The included studies reported on intelligence quotient (IQ) or developmental quotient (DQ) before and after epilepsy surgery in children. Studies were included, if the patients had medically intractable epilepsy and if the study reported mainly on curative surgical procedures. We conducted a random-effects meta-analysis to determine the mean change of IQ/DQ. RESULTS Fifty-seven studies reporting on a total of 2593 patients met the inclusion criteria. The mean age at surgery was 9.2 years (± 3.44; range 2.4 months-19.81 years). Thirty-eight studies showed IQ/DQ improvement on a group level, 8 yielded stable IQ/DQ, and 19 showed deterioration. Pooled analysis revealed a significant mean gain in FSIQ of + 2.52 FSIQ points (95% CI 1.12-3.91). The pooled mean difference in DQ was + 1.47 (95% CI - 6.5 to 9.5). The pooled mean difference in IQ/DQ was 0.73 (95% CI - 4.8 to 6.2). Mean FSIQ gain was significantly higher in patients who reached seizure freedom (+ 5.58 ± 8.27) than in patients who did not (+ 0.23 ± 5.65). It was also significantly higher in patients who stopped ASM after surgery (+ 6.37 ± 3.80) than in patients who did not (+ 2.01 ± 2.41). Controlled studies showed a better outcome in the surgery group compared to the non-surgery group. There was no correlation between FSIQ change and age at surgery, epilepsy duration to surgery, and preoperative FSIQ. SIGNIFICANCE The present review indicates that there is a mean gain in FSIQ and DQ in children with medically intractable epilepsy after surgery. The mean gain of 2.52 FSIQ points reflects more likely sustainability of intellectual function rather than improvement after surgery. Seizure-free and ASM-free patients reach higher FSIQ gains. More research is needed to evaluate individual changes after specific surgery types and their effect on long-term follow-up.
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Affiliation(s)
- Tristan Schmidlechner
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. Von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Lindwurmstreet 4, 80337, Munich, Germany
| | - Malin Zaddach
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. Von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Lindwurmstreet 4, 80337, Munich, Germany
| | - Florian Heinen
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. Von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Lindwurmstreet 4, 80337, Munich, Germany
| | - Sonia Cornell
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. Von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Lindwurmstreet 4, 80337, Munich, Germany
| | - Georgia Ramantani
- Department of Neuropediatrics, University Children's Hospital, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Jan Rémi
- Department of Neurology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- Comprehensive Epilepsy Center, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Christian Vollmar
- Department of Neurology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- Comprehensive Epilepsy Center, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Mathias Kunz
- Department of Neurosurgery, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- Comprehensive Epilepsy Center, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Ingo Borggraefe
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. Von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Lindwurmstreet 4, 80337, Munich, Germany.
- Comprehensive Epilepsy Center, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.
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5
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Yu H, Liu Q, Wang R, Liu C, Sun Y, Wang Y, Ji T, Wang S, Liu X, Jiang Y, Cai L. Long-term seizure and developmental outcomes of epilepsy surgery in children under 3 years old: A single-center study of 113 patients. CNS Neurosci Ther 2024; 30:e14481. [PMID: 37786975 PMCID: PMC10805390 DOI: 10.1111/cns.14481] [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: 06/21/2023] [Revised: 08/30/2023] [Accepted: 09/15/2023] [Indexed: 10/04/2023] Open
Abstract
AIMS To investigate the clinical characteristics, surgical strategy, developmental and seizure outcomes, and predictors of surgical outcome in children with drug-resistant epilepsy (DRE) under 3 years old. METHODS One hundred thirteen consecutive children younger than 3 years of age with DRE underwent curative surgical treatment after multidisciplinary preoperative evaluation using the strategy developed in the pediatric epilepsy center of Peking University First Hospital (PKFHPEC) between 2014 and 2018. These patients were selected for retrospective study. The relevant clinical data were collected and analyzed. The surgical prognoses were classified using the Engel classification, and the developmental assessment results were collected. Statistical analysis of the clinical data was performed to analyze the predictors of seizure outcomes and their correlation with developmental outcomes. RESULTS All the patients were followed up for more than 3 years, and 98 (86.7%) patients had no seizure recurrence. One year after surgery, the seizure-free rate was 86.7%, which was as high as that at the last follow-up. Cortical dysplasia was the most frequent etiology of DRE in this cohort, accounting for 77.0%. According to the Engel classification, acute postoperative seizure (APOS; p < 0.001) was a predictor of seizure recurrence. No deaths occurred. No unpredicted long-term severe complications occurred except for one ventricular peritoneal shunt. The patients' neurodevelopmental statuses were improved after successful surgery, while the scores of the pre- and postoperative developmental assessments were closely correlated. CONCLUSIONS For children who are younger than 3 years old and have DRE and structural abnormalities, early curative treatment can lead to long-term good seizure outcomes and a low complication rate. The development of appropriate strategies for both presurgical evaluation and resection is crucial for the success of surgery.
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Affiliation(s)
- Hao Yu
- Pediatric Epilepsy CenterPeking University First HospitalBeijingChina
| | - Qingzhu Liu
- Pediatric Epilepsy CenterPeking University First HospitalBeijingChina
| | - Ruofan Wang
- Pediatric Epilepsy CenterPeking University First HospitalBeijingChina
| | - Chang Liu
- Pediatric Epilepsy CenterPeking University First HospitalBeijingChina
| | - Yu Sun
- Pediatric Epilepsy CenterPeking University First HospitalBeijingChina
| | - Yao Wang
- Pediatric Epilepsy CenterPeking University First HospitalBeijingChina
| | - Taoyun Ji
- Pediatric Epilepsy CenterPeking University First HospitalBeijingChina
| | - Shuang Wang
- Pediatric Epilepsy CenterPeking University First HospitalBeijingChina
| | - Xiaoyan Liu
- Pediatric Epilepsy CenterPeking University First HospitalBeijingChina
| | - Yuwu Jiang
- Pediatric Epilepsy CenterPeking University First HospitalBeijingChina
| | - Lixin Cai
- Pediatric Epilepsy CenterPeking University First HospitalBeijingChina
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Arfaie S, Amin P, Kwan ATH, Solgi A, Sarabi A, Hakak-Zargar B, Brunette-Clément T, Pushenko D, Mir-Moghtadaei K, Mashayekhi MS, Mofatteh M, Honarvar F, Ren LY, Noiseux-Lush C, Azizi Z, Pearl PL, Baldeweg T, Weil AG, Fallah A. Long-term full-scale intelligent quotient outcomes following pediatric and childhood epilepsy surgery: A systematic review and meta-analysis. Seizure 2023; 106:58-67. [PMID: 36774775 DOI: 10.1016/j.seizure.2023.01.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 12/28/2022] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Cognitive measures are an important primary outcome of pediatric, adolescents, and childhood epilepsy surgery. The purpose of this systematic review and meta-analysis is to assess whether there are long-term alterations (≥ 5 years) in the Full-Scale Intelligence Quotient (FSIQ) of pediatric patients undergoing epilepsy surgery. METHODS Electronic databases (EMBASE, MEDLINE, and Scopus) were searched for English articles from inception to October 2022 that examined intelligence outcomes in pediatric epilepsy surgery patients. Inclusion criteria were defined as the patient sample size of ≥ 5, average follow- up of ≥5 years, and surgeries performed on individuals ≤ 18 years old at the time of surgery. Exclusion criteria consisted of palliative surgery, animal studies, and studies not reporting surgical or FSIQ outcomes. Publication bias was assessed using a funnel plot and the Quality in Prognosis Studies (QUIPS) toolset was used for quality appraisal of the selected articles. A random-effects network meta-analysis was performed to compare FSIQ between surgical patients at baseline and follow-up and Mean Difference (MD) was used to calculate the effect size of each study. Point estimates for effects and 95% confidence intervals for moderation analysis were performed on variables putatively associated with the effect size. RESULTS 21,408 studies were screened for abstract and title. Of these, 797 fit our inclusion and exclusion criteria and proceeded to full-text screening. Overall, seven studies met our requirements and were selected. Quantitative analysis was performed on these studies (N = 330). The mean long-term difference between pre- and post- operative FSIQ scores across all studies was noted at 3.36 [95% CI: (0.14, 6.57), p = 0.04, I2 = 0%] and heterogeneity was low. CONCLUSION To our knowledge, this is the first meta-analysis to measure the long-term impacts of FSIQ in pediatric and adolescent epilepsy patients. Our overall results in this meta-analysis indicate that while most studies do not show long-term FSIQ deterioration in pediatric patients who underwent epilepsy surgery, there was an increase of 3.36 FSIQ points, however, the observed changes were not clinically significant. Moreover, at the individual patient level analysis, while most children did not show long-term FSIQ deterioration, few had significant decline. These findings indicate the importance of surgery as a viable option for pediatric patients with medically refractory epilepsy.
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Affiliation(s)
- Saman Arfaie
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada; Faculty of Medicine, McGill University, Montreal, QC, Canada; Department of Molecular and Cell Biology, University of California Berkeley, Berkeley, CA, United States of America
| | - Pouya Amin
- Department of Molecular and Cell Biology, University of California Berkeley, Berkeley, CA, United States of America
| | - Angela T H Kwan
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Department of Chemical and Physical Sciences, University of Toronto, Toronto, ON, Canada
| | - Arad Solgi
- School of Kinesiology & Health Science, York University, Toronto, ON, Canada
| | - Ali Sarabi
- School of Computing and Augmented Intelligence, Arizona State University, Tempe, AZ, United States of America
| | | | | | - Denys Pushenko
- Department of Chemical and Physical Sciences, University of Toronto, Toronto, ON, Canada; Department of Biology, University of Toronto, Toronto, ON, Canada
| | | | | | - Mohammad Mofatteh
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, United Kingdom.
| | - Faraz Honarvar
- Faculty of Medicine, Queen's University, Kingston, ON, Canada
| | - Lily Yuxi Ren
- Lane Medical Library and Knowledge Management Center, Stanford Medicine, Stanford University, Palo Alto, CA, United States of America
| | | | - Zahra Azizi
- Stanford Medicine, Stanford University, Palo Alto, CA, United States of America; School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, United Kingdom
| | - Phillip Lawrence Pearl
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Torsten Baldeweg
- Department of Developmental Neuroscience, UCL Great Ormond Street Institute for Child Health, London WC1N 1EH, United Kingdom; Great Ormond Street Hospital NHS Foundation Trust, London WC1N 3JH, United Kingdom
| | - Alexander G Weil
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Montreal, QC, Canada
| | - Aria Fallah
- Department of Neurosurgery and Pediatrics, David Geffen School of Medicine at University of California, Los Angeles, CA, United States of America
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7
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Goldstein HE, Poliakov A, Shaw DW, Barry D, Tran K, Novotny EJ, Saneto RP, Marashly A, Warner MH, Wright JN, Hauptman JS, Ojemann JG, Shurtleff HA. Precision medicine in pediatric temporal epilepsy surgery: optimization of outcomes through functional MRI memory tasks and tailored surgeries. J Neurosurg Pediatr 2022; 30:272-283. [PMID: 35901731 DOI: 10.3171/2022.5.peds22148] [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: 04/22/2022] [Accepted: 05/27/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The goal of epilepsy surgery is both seizure cessation and maximal preservation of function. In temporal lobe (TL) cases, the lack of functional MRI (fMRI) tasks that effectively activate mesial temporal structures hampers preoperative memory risk assessment, especially in children. This study evaluated pediatric TL surgery outcome optimization associated with tailored resection informed by an fMRI memory task. METHODS The authors identified focal onset TL epilepsy patients with 1) TL resections; 2) viable fMRI memory scans; and 3) pre- and postoperative neuropsychological (NP) evaluations. They retrospectively evaluated preoperative fMRI memory scans, available Wada tests, pre- and postoperative NP scores, postoperative MRI scans, and postoperative Engel class outcomes. To assess fMRI memory task outcome prediction, the authors 1) overlaid preoperative fMRI activation onto postoperative structural images; 2) classified patients as having "overlap" or "no overlap" of activation and resection cavities; and 3) compared these findings with memory improvement, stability, or decline, based on Reliable Change Index calculations. RESULTS Twenty patients met the inclusion criteria. At a median of 2.1 postoperative years, 16 patients had Engel class IA outcomes and 1 each had Engel class IB, ID, IIA, and IID outcomes. Functional MRI activation was linked to NP memory outcome in 19 of 20 cases (95%). Otherwise, heterogeneity characterized the cohort. CONCLUSIONS Functional MRI memory task activation effectively predicted individual NP outcomes in the context of tailored TL resections. Patients had excellent seizure and overall good NP outcomes. This small study adds to extant literature indicating that pediatric TL epilepsy does not represent a single clinical syndrome. Findings support individualized surgical intervention using fMRI memory activation to help guide this precision medicine approach.
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Affiliation(s)
- Hannah E Goldstein
- 1Neurosciences Center, Seattle Children's Hospital, Seattle
- 2Department of Neurological Surgery, University of Washington School of Medicine, Seattle
- 3Division of Neurosurgery, Seattle Children's Hospital, Seattle
- 9Center for Integrated Brain Research, Seattle Children's Hospital, Seattle, Washington; and
| | - Andrew Poliakov
- 1Neurosciences Center, Seattle Children's Hospital, Seattle
- 3Division of Neurosurgery, Seattle Children's Hospital, Seattle
- 4Department of Radiology, Seattle Children's Hospital, Seattle
| | - Dennis W Shaw
- 4Department of Radiology, Seattle Children's Hospital, Seattle
- 5Department of Radiology, University of Washington School of Medicine, Seattle
| | - Dwight Barry
- 6Clinical Analytics, Seattle Children's Hospital, Seattle
| | - Kieu Tran
- 2Department of Neurological Surgery, University of Washington School of Medicine, Seattle
- 3Division of Neurosurgery, Seattle Children's Hospital, Seattle
| | - Edward J Novotny
- 1Neurosciences Center, Seattle Children's Hospital, Seattle
- 7Division of Pediatric Neurology, Seattle Children's Hospital, Seattle
- 8Department of Neurology, University of Washington School of Medicine, Seattle
- 9Center for Integrated Brain Research, Seattle Children's Hospital, Seattle, Washington; and
| | - Russell P Saneto
- 1Neurosciences Center, Seattle Children's Hospital, Seattle
- 7Division of Pediatric Neurology, Seattle Children's Hospital, Seattle
- 8Department of Neurology, University of Washington School of Medicine, Seattle
- 9Center for Integrated Brain Research, Seattle Children's Hospital, Seattle, Washington; and
| | - Ahmad Marashly
- 10Epilepsy Center, Department of Neurology, The Johns Hopkins University Medical Center, Baltimore, Maryland
| | - Molly H Warner
- 1Neurosciences Center, Seattle Children's Hospital, Seattle
- 7Division of Pediatric Neurology, Seattle Children's Hospital, Seattle
- 9Center for Integrated Brain Research, Seattle Children's Hospital, Seattle, Washington; and
| | - Jason N Wright
- 4Department of Radiology, Seattle Children's Hospital, Seattle
- 5Department of Radiology, University of Washington School of Medicine, Seattle
| | - Jason S Hauptman
- 1Neurosciences Center, Seattle Children's Hospital, Seattle
- 2Department of Neurological Surgery, University of Washington School of Medicine, Seattle
- 3Division of Neurosurgery, Seattle Children's Hospital, Seattle
- 9Center for Integrated Brain Research, Seattle Children's Hospital, Seattle, Washington; and
| | - Jeffrey G Ojemann
- 1Neurosciences Center, Seattle Children's Hospital, Seattle
- 2Department of Neurological Surgery, University of Washington School of Medicine, Seattle
- 3Division of Neurosurgery, Seattle Children's Hospital, Seattle
- 5Department of Radiology, University of Washington School of Medicine, Seattle
- 9Center for Integrated Brain Research, Seattle Children's Hospital, Seattle, Washington; and
| | - Hillary A Shurtleff
- 1Neurosciences Center, Seattle Children's Hospital, Seattle
- 7Division of Pediatric Neurology, Seattle Children's Hospital, Seattle
- 9Center for Integrated Brain Research, Seattle Children's Hospital, Seattle, Washington; and
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8
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Arski ON, Martire DJ, Young JM, Wong SM, Suresh H, Kerr EN, Ochi A, Otsubo H, Sharma R, Widjaja E, Snead OC, Jain P, Donner EJ, Smith ML, Ibrahim GM. Connectomic Profiles and Cognitive Trajectories After Epilepsy Surgery in Children. Neurology 2022; 98:e2233-e2244. [PMID: 35410904 DOI: 10.1212/wnl.0000000000200273] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 02/08/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Neurocognitive outcomes following surgery for temporal lobe epilepsy in childhood are variable. Postoperative changes are not directly predicted by seizure-freedom and associations between epilepsy, neuropsychological function, and developing neural networks are poorly understood. Here, we leveraged whole-brain connectomic profiling in magnetoencephalography (MEG) to retrospectively study associations between brain connectivity and neuropsychological function in children with temporal lobe epilepsy undergoing resective surgery. METHODS Clinical and MEG data were retrospectively analyzed for children who underwent temporal lobe epilepsy surgery at the Hospital for Sick Children from 2000 to 2021. Resting-state connectomes were constructed from neuromagnetic oscillations via the weighted phase lag index. Using a partial least-squares (PLS) approach, multidimensional associations between patient connectomes, neuropsychological scores, and clinical covariates were assessed. Bootstrap resampling statistics were performed to assess statistical significance. RESULTS A total of 133 medical records were reviewed, and 5 PLS analyses were performed. Each PLS analysis probed a particular neuropsychological domain and the associations between its baseline and post-operative scores and the connectomic data. In each PLS analysis, a significant latent variable was identified, representing a specific percentage of the variance in the data, and relating neural networks to clinical covariates, which included changes in rote verbal memory (N=41, p = 0.01, σ2 = 0.38), narrative/verbal memory (N=57, p = 0.00, σ2 = 0.52), visual memory (N=51, p = 0.00, σ2 = 0.43), working memory (N=44, p = 0.00, σ2 = 0.52), and overall intellectual function (N=59, p = 0.00, σ2 = 0.55). Children with more diffuse, bilateral intrinsic connectivity across several frequency bands showed lower scores on all neuropsychological assessments but demonstrated a greater propensity for gains following resective surgery. CONCLUSION Here, we report that connectomes characterized by diffuse connectivity, reminiscent of developmentally immature networks, are associated with lower pre-operative cognition and post-operative cognitive improvement. These findings provide a potential means to understand neurocognitive function in children with temporal lobe epilepsy and expected changes post-operatively.
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Affiliation(s)
- Olivia N Arski
- Program in Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, ON.,Institute of Medical Science, University of Toronto, Toronto, ON
| | - Daniel J Martire
- Program in Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, ON
| | - Julia M Young
- Program in Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, ON.,Department of Psychology, Hospital for Sick Children, University of Toronto, Toronto, ON
| | - Simeon M Wong
- Program in Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, ON.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON
| | - Hrishikesh Suresh
- Division of Neurosurgery, Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, ON
| | - Elizabeth N Kerr
- Department of Psychology, Hospital for Sick Children, University of Toronto, Toronto, ON
| | - Ayako Ochi
- Division of Neurology, Hospital for Sick Children, University of Toronto, Toronto, ON
| | - Hiroshi Otsubo
- Division of Neurology, Hospital for Sick Children, University of Toronto, Toronto, ON
| | - Roy Sharma
- Division of Neurology, Hospital for Sick Children, University of Toronto, Toronto, ON
| | - Elysa Widjaja
- Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, ON
| | - O Carter Snead
- Division of Neurology, Hospital for Sick Children, University of Toronto, Toronto, ON
| | - Puneet Jain
- Division of Neurology, Hospital for Sick Children, University of Toronto, Toronto, ON
| | - Elizabeth J Donner
- Division of Neurology, Hospital for Sick Children, University of Toronto, Toronto, ON
| | - Mary Lou Smith
- Program in Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, ON.,Department of Psychology, Hospital for Sick Children, University of Toronto, Toronto, ON.,Department of Psychology, University of Toronto Mississauga, Mississauga, ON
| | - George M Ibrahim
- Program in Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, ON.,Institute of Medical Science, University of Toronto, Toronto, ON.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON.,Division of Neurosurgery, Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, ON
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9
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Papadelis C, Conrad SE, Song Y, Shandley S, Hansen D, Bosemani M, Malik S, Keator C, Perry MS. Case Report: Laser Ablation Guided by State of the Art Source Imaging Ends an Adolescent's 16-Year Quest for Seizure Freedom. Front Hum Neurosci 2022; 16:826139. [PMID: 35145387 PMCID: PMC8821813 DOI: 10.3389/fnhum.2022.826139] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/03/2022] [Indexed: 01/14/2023] Open
Abstract
Epilepsy surgery is the most effective therapeutic approach for children with drug resistant epilepsy (DRE). Recent advances in neurosurgery, such as the Laser Interstitial Thermal Therapy (LITT), improved the safety and non-invasiveness of this method. Electric and magnetic source imaging (ESI/MSI) plays critical role in the delineation of the epileptogenic focus during the presurgical evaluation of children with DRE. Yet, they are currently underutilized even in tertiary epilepsy centers. Here, we present a case of an adolescent who suffered from DRE for 16 years and underwent surgery at Cook Children's Medical Center (CCMC). The patient was previously evaluated in a level 4 epilepsy center and treated with multiple antiseizure medications for several years. Presurgical evaluation at CCMC included long-term video electroencephalography (EEG), magnetoencephalography (MEG) with simultaneous conventional EEG (19 channels) and high-density EEG (256 channels) in two consecutive sessions, MRI, and fluorodeoxyglucose - positron emission tomography (FDG-PET). Video long-term EEG captured nine focal-onset clinical seizures with a maximal evolution over the right frontal/frontal midline areas. MRI was initially interpreted as non-lesional. FDG-PET revealed a small region of hypometabolism at the anterior right superior temporal gyrus. ESI and MSI performed with dipole clustering showed a tight cluster of dipoles in the right anterior insula. The patient underwent intracranial EEG which indicated the right anterior insular as seizure onset zone. Eventually LITT rendered the patient seizure free (Engel 1; 12 months after surgery). Retrospective analysis of ESI and MSI clustered dipoles found a mean distance of dipoles from the ablated volume ranging from 10 to 25 mm. Our findings highlight the importance of recent technological advances in the presurgical evaluation and surgical treatment of children with DRE, and the underutilization of epilepsy surgery in children with DRE.
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Affiliation(s)
- Christos Papadelis
- Jane and John Justin Neuroscience Center, Cook Children's Health Care System, Fort Worth, TX, United States
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, United States
- School of Medicine, Texas Christian University, University of North Texas Health Science Center, Fort Worth, TX, United States
- *Correspondence: Christos Papadelis orcid.org/0000-0001-6125-9217
| | - Shannon E. Conrad
- Jane and John Justin Neuroscience Center, Cook Children's Health Care System, Fort Worth, TX, United States
| | - Yanlong Song
- Jane and John Justin Neuroscience Center, Cook Children's Health Care System, Fort Worth, TX, United States
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, United States
| | - Sabrina Shandley
- Jane and John Justin Neuroscience Center, Cook Children's Health Care System, Fort Worth, TX, United States
| | - Daniel Hansen
- Jane and John Justin Neuroscience Center, Cook Children's Health Care System, Fort Worth, TX, United States
| | - Madhan Bosemani
- Department of Radiology, Cook Children's Medical Center, Fort Worth, TX, United States
| | - Saleem Malik
- Jane and John Justin Neuroscience Center, Cook Children's Health Care System, Fort Worth, TX, United States
| | - Cynthia Keator
- Jane and John Justin Neuroscience Center, Cook Children's Health Care System, Fort Worth, TX, United States
| | - M. Scott Perry
- Jane and John Justin Neuroscience Center, Cook Children's Health Care System, Fort Worth, TX, United States
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10
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Kaur N, Nowacki AS, Haut JS, Klaas P, Ferguson L, Lachhwani D, Bingaman W, Lineweaver TT, Busch RM. Cognitive outcomes following pediatric epilepsy surgery. Epilepsy Res 2022; 180:106859. [PMID: 35042117 DOI: 10.1016/j.eplepsyres.2022.106859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/10/2021] [Accepted: 01/06/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To characterize outcomes following pediatric epilepsy surgery across a broad range of cognitive domains using empirical methods (i.e., reliable change indices: RCIs), compare these outcomes with those based on traditional methods (i.e., standard deviation: SD), and identify factors associated with postoperative cognitive declines and/or improvements. METHODS This retrospective cohort study included 186 children who underwent surgical resection for treatment of pharmacoresistant epilepsy and who completed pre- and postoperative neuropsychological assessments. Postoperative testing occurred approximately 6.5 months after surgery and included measures of intelligence, attention/working memory, processing speed, language, executive functioning, visuospatial skills, memory, and academic achievement. Change scores for each patient were classified as decline, no change, or improvement using epilepsy-specific RCIs. Chi-square goodness of fit tests were used to compare the distribution of outcomes as classified with RCIs to those obtained using a traditional one SD cutoff. Multinomial regression analyses were conducted to identify factors associated with cognitive decline and/or improvement. RESULTS While 18% of children demonstrated no postoperative declines or improvements in any cognitive domain, the majority demonstrated relatively focal changes (declines and/or improvements in 1-2 cognitive domains). Rates of postoperative decline and improvement across individual cognitive domains were variable and ranged from 4-35% and 2-31%, respectively. Compared to RCIs, SD methodology often overestimated postoperative improvements and varied with respect to declines. Factors associated with RCI decline or improvement included preoperative performance, age at surgery, surgery site, and postoperative seizures. SIGNIFICANCE Results suggest substantial variability in individual cognitive outcomes approximately 6.5 months following pediatric epilepsy surgery. The differences in change distributions obtained using epilepsy-specific RCIs versus SDs highlight the need for studies using empiric methodology to study postoperative cognitive change. Variables associated with postoperative cognitive change may be used to develop multivariable prediction models in future studies to aid clinical decision-making and patient counseling.
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Affiliation(s)
- Navkiranjot Kaur
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Amy S Nowacki
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA; Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jennifer S Haut
- Department of Psychiatry & Psychology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Pediatrics, Psychology Section, Texas Children's Hospital, Houston, TX, USA
| | - Patricia Klaas
- Department of Psychiatry & Psychology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lisa Ferguson
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Deepak Lachhwani
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - William Bingaman
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Robyn M Busch
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA; Department of Psychiatry & Psychology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
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11
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Greuter L, Guzman R, Soleman J. Pediatric and Adult Low-Grade Gliomas: Where Do the Differences Lie? CHILDREN (BASEL, SWITZERLAND) 2021; 8:1075. [PMID: 34828788 PMCID: PMC8624473 DOI: 10.3390/children8111075] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/17/2021] [Accepted: 11/17/2021] [Indexed: 12/21/2022]
Abstract
Two thirds of pediatric gliomas are classified as low-grade (LGG), while in adults only around 20% of gliomas are low-grade. However, these tumors do not only differ in their incidence but also in their location, behavior and, subsequently, treatment. Pediatric LGG constitute 65% of pilocytic astrocytomas, while in adults the most commonly found histology is diffuse low-grade glioma (WHO II), which mostly occurs in eloquent regions of the brain, while its pediatric counterpart is frequently found in the infratentorial compartment. The different tumor locations require different skillsets from neurosurgeons. In adult LGG, a common practice is awake surgery, which is rarely performed on children. On the other hand, pediatric neurosurgeons are more commonly confronted with infratentorial tumors causing hydrocephalus, which more often require endoscopic or shunt procedures to restore the cerebrospinal fluid flow. In adult and pediatric LGG surgery, gross total excision is the primary treatment strategy. Only tumor recurrences or progression warrant adjuvant therapy with either chemo- or radiotherapy. In pediatric LGG, MEK inhibitors have shown promising initial results in treating recurrent LGG and several ongoing trials are investigating their role and safety. Moreover, predisposition syndromes, such as neurofibromatosis or tuberous sclerosis complex, can increase the risk of developing LGG in children, while in adults, usually no tumor growth in these syndromes is observed. In this review, we discuss and compare the differences between pediatric and adult LGG, emphasizing that pediatric LGG should not be approached and managed in the same way as adult LCG.
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Affiliation(s)
- Ladina Greuter
- Department of Neurosurgery, University Hospital of Basel, 4031 Basel, Switzerland; (R.G.); (J.S.)
- Department of Neurosurgery, King’s College Hospital, NHS Foundation Trust, London SE5 9RS, UK
| | - Raphael Guzman
- Department of Neurosurgery, University Hospital of Basel, 4031 Basel, Switzerland; (R.G.); (J.S.)
- Division of Pediatric Neurosurgery, University Children’s Hospital of Basel, 4056 Basel, Switzerland
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland
| | - Jehuda Soleman
- Department of Neurosurgery, University Hospital of Basel, 4031 Basel, Switzerland; (R.G.); (J.S.)
- Division of Pediatric Neurosurgery, University Children’s Hospital of Basel, 4056 Basel, Switzerland
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland
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12
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Beatty CW, Lockrow JP, Gedela S, Gehred A, Ostendorf AP. The Missed Value of Underutilizing Pediatric Epilepsy Surgery: A Systematic Review. Semin Pediatr Neurol 2021; 39:100917. [PMID: 34620465 DOI: 10.1016/j.spen.2021.100917] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
Pediatric epilepsy surgery is underutilized. Only 1%-11% of children with drug resistant epilepsy (DRE) undergo surgical treatment, or less than half of those estimated to benefit. We conducted a systematic review of articles published in PubMed, EMBASE, and Web of Science in order to study the factors related to surgery underutilization as well as the impact on both the individual and the healthcare system. Our review demonstrates multiple factors leading to underutilization, including family misconceptions about epilepsy surgery, lack of provider knowledge, as well as systemic health disparities. While the upfront cost of epilepsy surgery is significant, the long-term financial benefits and reduced health resource utilization tilt the economic advantage in favor of surgery in children with DRE. Additionally, timely interventions improve seizure and cognitive outcomes with low risk of complications. Further interventions are needed at the levels of family, provider, and the healthcare system to increase access to pediatric epilepsy surgery.
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Affiliation(s)
- Christopher W Beatty
- The Ohio State University and Nationwide Children's Hospital, Division of Neurology, Department of Pediatrics, Columbus, OH
| | - Jason P Lockrow
- Department of Neurology, Section of Pediatric Neurology, University of Washington, Seattle, WA
| | - Satyanarayana Gedela
- Emory University and Children's Healthcare of Atlanta, Division of Neurology, Department of Pediatrics, Atlanta, GA
| | - Alison Gehred
- Medical Library Division, Nationwide Children's Hospital, Columbus, OH
| | - Adam P Ostendorf
- The Ohio State University and Nationwide Children's Hospital, Division of Neurology, Department of Pediatrics, Columbus, OH.
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13
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Abstract
There is increasing interest in the assessment of learning and memory in typically developing children as well as in children with neurodevelopmental disorders. However, neuropsychological assessments have been hampered by the dearth of standardised tests that enable direct comparison between distinct memory processes or between types of stimulus materials. We developed a tablet-based paired-associate learning paradigm, the Pair Test, based on neurocognitive models of learning and memory. The aims are to (i) establish the utility of this novel memory tool for use with children across a wide age range, and (ii) examine test validity, reliability and reproducibility of the construct. The convergent validity of the test was found to be adequate, and higher test reliability was shown for the Pair Test compared to standardised measures. Moderate test-retest reproducibility was shown, despite a long time interval between sessions (14 months). Moreover, the Pair Test is able to capture developmental changes in memory, and can therefore chart the developmental trajectory of memory and learning functions across childhood and adolescence. Finally, we used this novel instrument to acquire normative data from 130 typically developing children, aged 8-18 years. Age-stratified normative data are provided for learning, delayed recall and delayed recognition, for measures of verbal and non-verbal memory. The Pair Test thus provides measures of learning and memory accounting for encoding, consolidation and retrieval processes. As such, the standardised test results can be used to determine the status of learning and memory in healthy children, and also to identify deficits in paediatric patients at risk of damage to the neural network underlying mnemonic functions.
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Affiliation(s)
- Sarah Buck
- Cognitive Neuroscience and Neuropsychiatry Section, Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK.
- Great Ormond Street Hospital for Children, National Health Service Trust, London, UK.
| | - Filipa Bastos
- Cognitive Neuroscience and Neuropsychiatry Section, Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children, National Health Service Trust, London, UK
- Unit of Paediatric Neurology and Neurorehabilitation, Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Torsten Baldeweg
- Cognitive Neuroscience and Neuropsychiatry Section, Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children, National Health Service Trust, London, UK
| | - Faraneh Vargha-Khadem
- Cognitive Neuroscience and Neuropsychiatry Section, Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children, National Health Service Trust, London, UK
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14
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Kahana Levy N, Segalovsky J, Benifla M, Elkana O. Quantitative Meta-Analyses: Lateralization of Memory Functions Before and After Surgery in Children with Temporal Lobe Epilepsy. Neuropsychol Rev 2021; 31:535-568. [PMID: 33675457 DOI: 10.1007/s11065-020-09470-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 11/29/2020] [Indexed: 11/26/2022]
Abstract
RATIONALE Memory deficits in children with epilepsy have been reported in some but not all studies assessing the effects of side of seizures and resection from the temporal lobe on cognitive performance. This meta-analysis provides a quantitative systematic review of previous studies on this issue. METHOD A critical review and meta-analysis of the literature on memory performance in children with Temporal Lobe Epilepsy (TLE) was conducted. Search identified 25 studies, 13 of which compared children with TLE to healthy age-matched controls and 12 of which compared children with TLE before and after surgery. RESULTS Heterogeneity of the comparisons of children with TLE to healthy controls impeded drawing definitive conclusions. However, in 55% of the studies, verbal memory in children with left TLE (LTLE) was impaired as compared to healthy controls. Verbal memory performance slightly declines after pediatric LTLE surgery, but nonverbal memory tasks are not affected. By contrast, verbal memory performance is not affected by pediatric right TLE (RTLE) surgery. CONCLUSIONS The findings suggest that side of the epileptogenic zone and resection from the temporal lobe affect verbal memory in children with LTLE. Right resection seems to be safe with respect to verbal memory performance.
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Affiliation(s)
- Naomi Kahana Levy
- Comprehensive Epilepsy Center, Rambam Health Care Campus, Haifa, Israel
| | - Jonathan Segalovsky
- School of Behavioral Sciences, Academic College of Tel Aviv-Jaffa, P.O.B. 8401, 61083, Tel-Aviv-Jaffa, Israel
| | - Mony Benifla
- Comprehensive Epilepsy Center, Rambam Health Care Campus, Haifa, Israel
| | - Odelia Elkana
- School of Behavioral Sciences, Academic College of Tel Aviv-Jaffa, P.O.B. 8401, 61083, Tel-Aviv-Jaffa, Israel.
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15
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Li W, Jiang Y, Qin Y, Zhou B, Lei D, Luo C, Zhang H, Gong Q, Zhou D, An D. Dynamic gray matter and intrinsic activity changes after epilepsy surgery. Acta Neurol Scand 2021; 143:261-270. [PMID: 33058145 DOI: 10.1111/ane.13361] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 09/20/2020] [Accepted: 10/05/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To explore the dynamic changes of gray matter volume and intrinsic brain activity following anterior temporal lobectomy (ATL) in patients with unilateral mesial temporal lobe epilepsy (mTLE) who achieved seizure-free for 2 years. MATERIALS AND METHODS High-resolution T1-weighted MRI and resting-state functional MRI data were obtained in ten mTLE patients at five serial timepoints: before surgery, 3, 6, 12, and 24 months after surgery. The gray matter volume (GMV) and amplitude of low-frequency fluctuations (ALFF) were compared among the five scans to depict the dynamic changes after ATL. RESULTS After successful ATL, GMV decreased in several ipsilateral brain regions: ipsilateral insula, thalamus, and putamen showed gradual gray matter atrophy from 3 to 24 months, while ipsilateral superior temporal gyrus, middle temporal gyrus, inferior temporal gyrus, middle occipital gyrus, inferior occipital gyrus, caudate nucleus, lingual gyrus, and fusiform gyrus showed significant GMV decrease at 3 months follow-up, without further changes. Ipsilateral insula showed gradual ALFF decrease from 3 to 24 months after surgery. Ipsilateral superior temporal gyrus showed ALFF decrease at 3 months follow-up, without further changes. Ipsilateral thalamus and cerebellar vermis showed obvious ALFF increase after surgery. CONCLUSIONS Surgical resection may lead to a short-term reduction of gray matter volume and intrinsic brain activity in neighboring regions, while the progressive gray matter atrophy may be due to possible intrinsic mechanism of mTLE. Dynamic ALFF changes provide evidence that disrupted focal spontaneous activities were reorganized after successful surgery.
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Affiliation(s)
- Wei Li
- Department of Neurology West China Hospital Sichuan University Chengdu China
| | - Yuchao Jiang
- The Clinical Hospital of Chengdu Brain Science Institute MOE Key Lab for Neuroinformation Center for Information in Medicine School of life Science and technology University of Electronic Science and Technology of China Chengdu China
| | - Yingjie Qin
- Department of Neurology West China Hospital Sichuan University Chengdu China
| | - Baiwan Zhou
- Department of Radiology Huaxi MR Research Center West China Hospital Sichuan University Chengdu China
| | - Du Lei
- Department of Radiology Huaxi MR Research Center West China Hospital Sichuan University Chengdu China
| | - Cheng Luo
- The Clinical Hospital of Chengdu Brain Science Institute MOE Key Lab for Neuroinformation Center for Information in Medicine School of life Science and technology University of Electronic Science and Technology of China Chengdu China
- Research Unit of NeuroInformation Chinese Academy of Medical Sciences Chengdu China
| | - Heng Zhang
- Department of Neurosurgery West China Hospital Sichuan University Chengdu China
| | - Qiyong Gong
- Department of Radiology Huaxi MR Research Center West China Hospital Sichuan University Chengdu China
| | - Dong Zhou
- Department of Neurology West China Hospital Sichuan University Chengdu China
| | - Dongmei An
- Department of Neurology West China Hospital Sichuan University Chengdu China
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16
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Morita-Sherman M, Louis S, Vegh D, Busch RM, Ferguson L, Bingaman J, Bulacio J, Najm I, Jones S, Zajichek A, Hogue O, Kattan MW, Blumcke I, Cendes F, Jehi L. Outcomes of resections that spare vs remove an MRI-normal hippocampus. Epilepsia 2020; 61:2545-2557. [PMID: 33063852 DOI: 10.1111/epi.16694] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/24/2020] [Accepted: 08/24/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To characterize seizure and cognitive outcomes of sparing vs removing an magnetic resonance imaging (MRI)-normal hippocampus in patients with temporal lobe epilepsy. METHODS In this retrospective cohort study, we reviewed clinical, imaging, surgical, and histopathological data on 152 individuals with temporal lobe epilepsy and nonlesional hippocampi categorized into hippocampus-spared (n = 74) or hippocampus-resected (n = 78). Extra-hippocampal lesions were allowed. Pre- and postoperative cognitive data were available on 86 patients. Predictors of seizure and cognitive outcomes were identified using Cox-proportional hazard modeling followed by treatment-specific model reduction according to Akaike information criterion, and built into an online risk calculator. RESULTS Seizures recurred in 40% within one postoperative year, and in 63% within six postoperative years. Male gender (P = .03), longer epilepsy duration (P < .01), normal MRI (P = .04), invasive evaluation (P = .02), and acute postoperative seizures (P < .01) were associated with a higher risk of recurrence. We found no significant difference in postoperative seizure freedom rates at 5 years between those whose hippocampus was spared and those whose hippocampus was resected (P = .17). Seizure outcome models built with pre- and postoperative data had bootstrap validated concordance indices of 0.65 and 0.72. The dominant hippocampus-spared group had lower rates of decline in verbal memory (39% vs 70%; P = .03) and naming (41% vs 79%; P = .01) compared to the hippocampus-resected group. Partial hippocampus sparing had the same risk of verbal memory decline as for complete removal. SIGNIFICANCE Sparing or removing an MRI-normal hippocampus yielded similar long-term seizure outcome. A more conservative approach, sparing the hippocampus, only partially shields patients from postoperative cognitive deficits. Risk calculators are provided to facilitate clinical counseling.
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Affiliation(s)
| | - Shreya Louis
- Cleveland Clinic Lerner College of Medicine, Medical School, Cleveland, OH, USA
| | - Deborah Vegh
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Robyn M Busch
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Lisa Ferguson
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Justin Bingaman
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Juan Bulacio
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Imad Najm
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Stephen Jones
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Olivia Hogue
- Quantitative Health Sciences, Cleveland, OH, USA
| | | | - Ingmar Blumcke
- Institute of Neuropathology, University Hospitals Erlangen, Erlangen, Germany
| | - Fernando Cendes
- Department of Neurology, University of Campinas, Campinas, Brazil
| | - Lara Jehi
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
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17
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Abstract
Since the seminal work on the patient HM, who in his adulthood presented an acquired amnesic syndrome following the resection of the bilateral temporal lobe, other research has described several cases of isolated memory dysfunction in children. This chapter presents developmental and long-lasting memory disorders emerging from an organic or neurologic cause at birth or in infancy. More notably, we focus on developmental amnesic syndrome caused by neonatal bihippocampal damage and memory dysfunction caused by medial temporal developmental epilepsy. We describe these two pediatric populations and present the consequences of hippocampal/medial temporal lobe damage in the development of memory systems. We review episodic memory deficits in children with developmental amnesia and temporal lobe epilepsy and highlight their impact on new learning, personal memories, and independent life. Finally, we provide a brief overview of some of the insights and debates emerging from classic work and recent advances in the context of episodic memory dysfunction displayed by children with hippocampal/medial temporal lobe amnesia and propose new perspectives in child neuropsychology of memory, suggesting new avenues for more ecologic memory assessment and rehabilitation.
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18
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de Knegt VE, Hoei-Hansen CE, Knudsen M, Jakobsen AV, Mûller E, Thomsen KM, Jespersen B, Uldall PV, Børresen ML. Increase in cognitive function is seen in many single-operated pediatric patients after epilepsy surgery. Seizure 2020; 81:254-262. [PMID: 32911236 DOI: 10.1016/j.seizure.2020.08.002] [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: 04/03/2020] [Revised: 08/02/2020] [Accepted: 08/04/2020] [Indexed: 02/08/2023] Open
Abstract
PURPOSE The recurrent seizures of pediatric drug-resistant epilepsy (DRE) are known to impair brain development and can lead to a loss in cognitive functioning. Surgery is increasingly being used to treat children with DRE. This study investigates the pre- and postoperative cognitive function in a pediatric epilepsy surgery cohort as well as predictive determinants of change in intelligence quotient (IQ) following surgery. METHODS A consecutive series of 91 Danish children who underwent focal resective epilepsy surgery between January 1996 and December 2016 were included. All underwent preoperative cognitive evaluation and were reevaluated at 1-year and/or 2-year follow-up. Single-operated and multi-operated patients were examined separately. RESULTS 79 of 91 patients were single-operated. Single-operated patients received less anti-epileptic drugs (AED) and experienced a decrease in seizure frequency postoperatively, p < 0.001. IQ increased postoperatively (IQ change ± standard deviation: 3.3 ± 14.0), p < 0.05. High preoperative seizure frequency was a significant predictor for decreased IQ, p < 0.01. Multi-operated patients did not experience a reduction in AED treatment. Surgery and continued AED treatment did, however, result in significantly better seizure control, p < 0.01. IQ remained unchanged in multi-operated patients. CONCLUSION Epilepsy surgery allowed for IQ gains in single-operated patients. Preoperative seizure frequency was a significant predictor of IQ change following surgery. Interactions between other, not included, possible predictors remain to be examined. Single-operated patients had the best cognitive outcome. The inclusion of a non-surgical control group is needed to assess the extent of the beneficial effects of surgery on cognitive ability.
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Affiliation(s)
| | | | - Marianne Knudsen
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Anne Vagner Jakobsen
- Department of Neuropediatrics, The Danish Epilepsy Center, Filadelfia, Dianalund, Denmark
| | - Elisabeth Mûller
- Department of Neuropediatrics, The Danish Epilepsy Center, Filadelfia, Dianalund, Denmark
| | - Katrine Moe Thomsen
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Bo Jespersen
- Department of Neurosurgery, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Peter Vilhelm Uldall
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Neuropediatrics, The Danish Epilepsy Center, Filadelfia, Dianalund, Denmark
| | - Malene Landbo Børresen
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark.
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19
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Ono KE, Bearden DJ, Adams E, Doescher J, Koh S, Eksioglu Y, Gross RE, Drane DL. Cognitive and behavioral outcome of stereotactic laser amydalohippocampotomy in a pediatric setting. Epilepsy Behav Rep 2020; 14:100370. [PMID: 32642637 PMCID: PMC7334373 DOI: 10.1016/j.ebr.2020.100370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/16/2020] [Accepted: 05/18/2020] [Indexed: 11/28/2022] Open
Abstract
We present neuropsychological and functional outcome data in a teenager undergoing stereotactic laser amygdalohippocampotomy (SLAH) who had drug-resistant mesial temporal lobe epilepsy due to left hippocampal sclerosis. Given strong baseline cognitive performance, there was concern for post-operative declines in language and verbal memory were this patient to undergo open resection. She was evaluated pre- and post-ablation with clinical and experimental neuropsychological measures including semantic memory, category-specific object/face recognition and naming, spatial learning, and socio-emotional processing. The patient became seizure-free following SLAH and experienced significant improvements in school performance and social engagement. She experienced improvement in recognition and naming of multiple object categories, memory functions, and verbal fluency. In contrast, the patient declined significantly in her ability to recognize emotional tone from facial expressions, a socio-emotional process that had been normal prior to surgery. We believe this decline was related to surgical disruption of the limbic system, an area highly involved in emotional processing, and suspect such deficits are an under-assessed and unrecognized risk for all surgeries involving the amygdalohippocampal complex and broader limbic system regions. We hope this positive SLAH outcome will serve as impetus for group level research to establish its safety and efficacy in the pediatric setting. Stereotactic laser ablation can be used successfully in pediatric epilepsy. At risk cognitive abilities did not decline after focal ablation in this teenager. Functional improvement was observed that paralleled gains in seizure status and cognition. Deficits still occurred in select areas related to focal structures ablated. Socio-emotional deficits can result from surgeries restricted to the amygdalohippocampal complex.
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Affiliation(s)
- Kim E Ono
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Children's Hospital of Atlanta, Atlanta, GA, USA
| | - Donald J Bearden
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Children's Hospital of Atlanta, Atlanta, GA, USA
| | - Elizabeth Adams
- Department of Neurology, Minnesota Epilepsy Group, Minneapolis, MN, USA
| | - Jason Doescher
- Department of Neurology, Minnesota Epilepsy Group, Minneapolis, MN, USA
| | - Sookyong Koh
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Children's Hospital of Atlanta, Atlanta, GA, USA
| | - Yaman Eksioglu
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Children's Hospital of Atlanta, Atlanta, GA, USA
| | - Robert E Gross
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA.,Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.,Coulter Department of Biomedical Engineering, Emory University, GA, USA
| | - Daniel L Drane
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.,Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA
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20
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Pajkert A, Ploner CJ, Lehmann TN, Witte VA, Oltmanns F, Sommer W, Holtkamp M, Heekeren HR, Finke C. Early volumetric changes of hippocampus and medial prefrontal cortex following medial temporal lobe resection. Eur J Neurosci 2020; 52:4375-4384. [PMID: 32421911 DOI: 10.1111/ejn.14784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/07/2020] [Accepted: 05/09/2020] [Indexed: 12/14/2022]
Abstract
Previous studies have shown that cognitive demands and physical exercise stimulate adult neurogenesis in the dentate gyrus and hippocampus. Recent observations in healthy humans and patients with mild cognitive impairment moreover suggest that training-induced increases in hippocampal volume may be associated with improved memory performance. The corresponding plasticity processes in hippocampal volume may occur on timescales of months to years. For patients with focal lesions in this region, previous functional imaging studies suggest that increased recruitment of the contralateral hippocampus and extratemporal regions may be an important part of the reorganization of episodic memory. However, it is currently unclear whether focal damage to the medial temporal lobe (MTL) induces gray matter (GM) volume changes in the intact contralateral hippocampus and in connected network regions on a shorter timescale. We therefore investigated whether unilateral resection of the MTL, including the hippocampus, induces measurable volumetric changes in the contralateral hippocampus and in the default mode network (DMN). We recruited 31 patients with unilateral left (N = 19) or right (N = 12) hippocampal sclerosis undergoing MTL resection for treatment of drug-resistant epilepsy. Structural MRI was acquired immediately before and 3 months after surgery. Longitudinal voxel-based morphometry (VBM) analysis revealed a significant increase of right hippocampal volume following resection of the left anterior MTL. Furthermore, this patient group showed GM volume increases in the DMN. These results demonstrate significant structural plasticity of the contralateral hippocampus, even in patients with a long-standing unilateral hippocampal dysfunction and structural reorganization processes extending to distant, but functionally connected brain regions.
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Affiliation(s)
- Anna Pajkert
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph J Ploner
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Veronica A Witte
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | | | - Werner Sommer
- Institut für Psychologie, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Martin Holtkamp
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Epilepsy-Center Berlin-Brandenburg, Berlin, Germany
| | - Hauke R Heekeren
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany.,Center for Cognitive Neuroscience Berlin, Freie Universität Berlin, Berlin, Germany
| | - Carsten Finke
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin School of Mind & Brain, Humboldt-Universität zu Berlin, Berlin, Germany
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21
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Rizzi M, Revay M, d'Orio P, Scarpa P, Mariani V, Pelliccia V, Della Costanza M, Zaniboni M, Castana L, Cardinale F, Lo Russo G, Cossu M. Tailored multilobar disconnective epilepsy surgery in the posterior quadrant. J Neurosurg 2020; 132:1345-1357. [PMID: 31026825 DOI: 10.3171/2019.1.jns183103] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 01/18/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Surgical treatment of drug-resistant epilepsy originating from the posterior quadrant (PQ) of the brain often requires large multilobar resections, and disconnective techniques have been advocated to limit the risks associated with extensive tissue removal. Few previous studies have described a tailored temporoparietooccipital (TPO) disconnective approach; only small series with short postoperative follow-ups have been reported. The aim of the present study was to present a tailored approach to multilobar PQ disconnections (MPQDs) for epilepsy and to provide details about selection of patients, presurgical investigations, surgical technique, treatment safety profile, and seizure and cognitive outcome in a large, single-center series of patients with a long-term follow-up. METHODS In this retrospective longitudinal study, the authors searched their prospectively collected database for patients who underwent MPQD for drug-resistant epilepsy in the period of 2005-2017. Tailored MPQDs were a posteriori grouped as follows: type I (classic full TPO disconnection), type II (partial TPO disconnection), type III (full temporooccipital [TO] disconnection), and type IV (partial TO disconnection), according to the disconnection plane in the occipitoparietal area. A bivariate statistical analysis was carried out to identify possible predictors of seizure outcome (Engel class I vs classes II-IV) among several presurgical, surgical, and postsurgical variables. Preoperative and postoperative cognitive profiles were also collected and evaluated. RESULTS Forty-two consecutive patients (29 males, 24 children) met the inclusion criteria. According to the presurgical evaluation (including stereo-electroencephalography in 13 cases), 12 (28.6%), 24 (57.1%), 2 (4.8%), and 4 (9.5%) patients received a type I, II, III, or IV MPQD, respectively. After a mean follow-up of 80.6 months, 76.2% patients were in Engel class I at last contact; at 6 months and 2 and 5 years postoperatively, Engel class I was recorded in 80.9%, 74.5%, and 73.5% of cases, respectively. Factors significantly associated with seizure freedom were the occipital pattern of seizure semiology and the absence of bilateral interictal epileptiform abnormalities at the EEG (p = 0.02). Severe complications occurred in 4.8% of the patients. The available neuropsychological data revealed postsurgical improvement in verbal domains, whereas nonunivocal outcomes were recorded in the other functions. CONCLUSIONS The presented data indicate that the use of careful anatomo-electro-clinical criteria in the presurgical evaluation allows for customizing the extent of surgical disconnections in PQ epilepsies, with excellent results on seizures and an acceptable safety profile.
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Affiliation(s)
- Michele Rizzi
- 1"C. Munari" Center for Epilepsy Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan
| | - Martina Revay
- 1"C. Munari" Center for Epilepsy Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan
- 3Section of Neurosurgery, Department of Neurosciences and of Sense Organs, University of Milan
| | - Piergiorgio d'Orio
- 1"C. Munari" Center for Epilepsy Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan
- 2Institute of Neuroscience, CNR, Parma
| | - Pina Scarpa
- 4Cognitive Neuropsychology Centre, Department of Neuroscience, ASST Grande Ospedale Metropolitano Niguarda, Milan
| | - Valeria Mariani
- 1"C. Munari" Center for Epilepsy Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan
| | - Veronica Pelliccia
- 1"C. Munari" Center for Epilepsy Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan
- 2Institute of Neuroscience, CNR, Parma
| | - Martina Della Costanza
- 1"C. Munari" Center for Epilepsy Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan
- 5Clinic of Neurosurgery, Polytechnic University of Marche, Ancona; and
| | - Matteo Zaniboni
- 6Neurological Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Laura Castana
- 1"C. Munari" Center for Epilepsy Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan
| | - Francesco Cardinale
- 1"C. Munari" Center for Epilepsy Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan
| | - Giorgio Lo Russo
- 1"C. Munari" Center for Epilepsy Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan
| | - Massimo Cossu
- 1"C. Munari" Center for Epilepsy Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan
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22
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Helmstaedter C, Beeres K, Elger C, Kuczaty S, Schramm J, Hoppe C. Cognitive outcome of pediatric epilepsy surgery across ages and different types of surgeries: A monocentric 1-year follow-up study in 306 patients of school age. Seizure 2020; 77:86-92. [DOI: 10.1016/j.seizure.2019.07.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 06/05/2019] [Accepted: 07/25/2019] [Indexed: 01/20/2023] Open
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23
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Buck S, Bastos F, Baldeweg T, Vargha-Khadem F. A Functional MRI Paradigm Suitable for Language and Memory Mapping in Pediatric Temporal Lobe Epilepsy. Front Neurol 2020; 10:1384. [PMID: 31998226 PMCID: PMC6966885 DOI: 10.3389/fneur.2019.01384] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/16/2019] [Indexed: 11/13/2022] Open
Abstract
Functional Magnetic Resonance Imaging (fMRI) is a technique frequently used to determine the territories of eloquent tissue that serve critical functions, such as language. This can be particularly useful as part of the pre-surgical assessment for temporal lobe epilepsy (TLE) in order to predict cognitive outcome and guide surgical decision-making. Whereas language fMRI is widely used, memory fMRI is less frequently employed in adult TLE, and lacking in childhood TLE. We have developed a combined language/memory fMRI paradigm that is suitable for children, to provide clinically useful information for surgical planning in pediatric TLE. We evaluated this paradigm in 28 healthy children, aged 8 to 18 years. The advantages of this paradigm are: (a) it examines the functional mapping of language and memory networks within one scanning session, (b) provides assessment of both memory encoding- and retrieval-related neural networks, (c) examines recall-based retrieval to engage hippocampal involvement compared to recognition-based retrieval, and (d) provides overt verbal responses to monitor in-scanner memory performance. This novel fMRI paradigm was designed for language and memory mapping in pediatric TLE and could provide clinically useful information for surgical planning. Finally, parallel versions of the paradigm allow the comparison of brain activations pre- and post-surgical intervention.
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Affiliation(s)
- Sarah Buck
- Cognitive Neuroscience and Neuropsychiatry Section, Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Great Ormond Street Hospital for Children National Health Service Trust, London, United Kingdom
| | - Filipa Bastos
- Cognitive Neuroscience and Neuropsychiatry Section, Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Great Ormond Street Hospital for Children National Health Service Trust, London, United Kingdom
- Unit of Paediatric Neurology and Neurorehabilitation, Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Torsten Baldeweg
- Cognitive Neuroscience and Neuropsychiatry Section, Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Great Ormond Street Hospital for Children National Health Service Trust, London, United Kingdom
| | - Faraneh Vargha-Khadem
- Cognitive Neuroscience and Neuropsychiatry Section, Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Great Ormond Street Hospital for Children National Health Service Trust, London, United Kingdom
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24
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Buck S, Sidhu MK. A Guide to Designing a Memory fMRI Paradigm for Pre-surgical Evaluation in Temporal Lobe Epilepsy. Front Neurol 2020; 10:1354. [PMID: 31998216 PMCID: PMC6962296 DOI: 10.3389/fneur.2019.01354] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/09/2019] [Indexed: 12/05/2022] Open
Abstract
There has been increasing interest in the clinical and experimental use of memory functional Magnetic Resonance Imaging (fMRI). The 2017 American Academy of Neurology practice guidelines on the use of pre-surgical cognitive fMRI suggests that verbal memory fMRI could be used to lateralize memory functions in people with Temporal Lobe Epilepsy (TLE) and should be used to predict post-operative verbal memory outcome. There are however technical and methodological considerations, to optimize both the sensitivity and specificity of this imaging modality. Below we discuss these constraints and suggest recommendations to consider when designing a memory fMRI paradigm.
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Affiliation(s)
- Sarah Buck
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology of Neurology, London, United Kingdom
- Epilepsy Society MRI Unit, Chalfont Saint Peter, United Kingdom
| | - Meneka K. Sidhu
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology of Neurology, London, United Kingdom
- Epilepsy Society MRI Unit, Chalfont Saint Peter, United Kingdom
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25
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Hoppe C, Porębska I, Beeres K, Sassen R, Kuczaty S, Gleissner U, Lendt M, Elger CE, Helmstaedter C. Parents' view of the cognitive outcome one year after pediatric epilepsy surgery. Epilepsy Behav 2019; 101:106552. [PMID: 31698257 DOI: 10.1016/j.yebeh.2019.106552] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 09/06/2019] [Accepted: 09/08/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The cognitive outcome of pediatric epilepsy surgery has mainly been examined on the basis of standardized tests. Here, we analyzed the outcome in six cognitive domains from the parents' view. METHODS Included were consecutive surgical pediatric patients whose parents filled-in a comprehensive questionnaire on cognitive problems in children and adolescents (Kognitive Probleme bei Kindern und Jugendlichen (KOPKIJ); Gleissner et al. 2006) at the preoperative baseline (T1) as well as twelve months thereafter (T2). All children also underwent standard neuropsychological assessments at T1 and T2. RESULTS Parents of 96 patients provided pre- and postoperative KOPKIJ data. Overall, 80% of the children became seizure-free at the follow-up. Group means indicated a strong positive effect of time on KOPKIJ and neuropsychological performance. We found postoperative improvements in five out of six cognitive domains (language, memory, executive functions, attention, school; unchanged: visuospatial abilities). Individually, improvements were twice as likely as declines. However, 33 patients (35%) experienced significant decline in at least one cognitive domain. Later onset of epilepsy resulted in better performance but had no effect on change scores. Seizure-free status, lower antiseizure drug load, and stronger drug reduction after surgery contributed to postoperative cognitive improvements as perceived by the parents; no other effects of clinical factors were obtained (e.g., localization/lateralization). Despite their similar outcome patterns, change scores as derived from parental ratings and neuropsychological assessment were not correlated. CONCLUSIONS Parents acknowledged the overall positive neurocognitive development after pediatric epilepsy surgery as previously shown by standardized tests. Seizure freedom and lower antiseizure drug load contributed to the beneficial cognitive outcome. Even if cognitive improvements outweighed declines, a risk for cognitive decline with impact on everyday functioning does exist.
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Affiliation(s)
- Christian Hoppe
- Department of Epileptology, University of Bonn Medical Centre, Venusberg-Campus 1, FRG-53127 Bonn, Germany.
| | - Izabela Porębska
- Department of Epileptology, University of Bonn Medical Centre, Venusberg-Campus 1, FRG-53127 Bonn, Germany
| | - Kassandra Beeres
- Department of Epileptology, University of Bonn Medical Centre, Venusberg-Campus 1, FRG-53127 Bonn, Germany
| | - Robert Sassen
- Department of Epileptology, University of Bonn Medical Centre, Venusberg-Campus 1, FRG-53127 Bonn, Germany
| | - Stefan Kuczaty
- Department of Epileptology, University of Bonn Medical Centre, Venusberg-Campus 1, FRG-53127 Bonn, Germany
| | - Ulrike Gleissner
- LVR-Klinik Bonn, Kinderneurologisches Zentrum, Waldenburger Ring 46, FRG-53119 Bonn, Germany
| | - Michael Lendt
- St. Mauritius Therapieklinik, Strümper Str. 111, FRG-40670 Meerbusch, Germany
| | - Christian E Elger
- Department of Epileptology, University of Bonn Medical Centre, Venusberg-Campus 1, FRG-53127 Bonn, Germany
| | - Christoph Helmstaedter
- Department of Epileptology, University of Bonn Medical Centre, Venusberg-Campus 1, FRG-53127 Bonn, Germany; St. Mauritius Therapieklinik, Strümper Str. 111, FRG-40670 Meerbusch, Germany
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26
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Bauman K, Devinsky O, Liu AA. Temporal lobe surgery and memory: Lessons, risks, and opportunities. Epilepsy Behav 2019; 101:106596. [PMID: 31711868 PMCID: PMC6885125 DOI: 10.1016/j.yebeh.2019.106596] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 10/04/2019] [Accepted: 10/04/2019] [Indexed: 11/19/2022]
Abstract
Careful study of the clinical outcomes of temporal lobe epilepsy (TLE) surgery has greatly advanced our knowledge of the neuroanatomy of human memory. After early cases resulted in profound amnesia, the critical role of the hippocampus and associated medial temporal lobe (MTL) structures to declarative memory became evident. Surgical approaches quickly changed to become unilateral and later, to be more precise, potentially reducing cognitive morbidity. Neuropsychological studies following unilateral temporal lobe resection (TLR) have challenged early models, which simplified the lateralization of verbal and visual memory function. Diagnostic tests, including intracarotid sodium amobarbital procedure (WADA), structural magnetic resonance imaging (MRI), and functional neuroimaging (functional MRI (fMRI), positron emission tomography (PET), and single-photon emission computed tomography (SPECT)), can more accurately lateralize and localize epileptogenic cortex and predict memory outcomes from surgery. Longitudinal studies have shown that memory may even improve in seizure-free patients. From 70 years of experience with epilepsy surgery, we now have a richer understanding of the clinical, neuroimaging, and surgical predictors of memory decline-and improvement-after TLR. "Special Issue: Epilepsy & Behavior's 20th Anniversary".
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Affiliation(s)
- Kristie Bauman
- NYU Langone Health, Department of Neurology, 222 East 41st Street 9th Floor, New York, NY 10017, United States of America
| | - Orrin Devinsky
- NYU Langone Health, Department of Neurology, 222 East 41st Street 9th Floor, New York, NY 10017, United States of America; NYU Comprehensive Epilepsy Center, 223 East 34th Street, New York, NY 10016, United States of America
| | - Anli A Liu
- NYU Langone Health, Department of Neurology, 222 East 41st Street 9th Floor, New York, NY 10017, United States of America; NYU Comprehensive Epilepsy Center, 223 East 34th Street, New York, NY 10016, United States of America.
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Danguecan AN, Smith ML. Verbal associative memory outcomes in pediatric surgical temporal lobe epilepsy: Exploring the impact of mesial structures. Epilepsy Behav 2019; 101:106529. [PMID: 31678810 DOI: 10.1016/j.yebeh.2019.106529] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/21/2019] [Accepted: 08/28/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We examined verbal associative memory outcomes in children with left- or right-sided temporal lobe epilepsy (TLE) who received combined lateral and mesial resections versus lateral resections sparing mesial structures. We hypothesized that children who underwent left-sided resections including mesial structures would show the greatest verbal associative memory declines following surgery. METHOD We retrospectively analyzed neuropsychology assessment results from a sample of 65 children with TLE who completed pre- and postoperative evaluation at the Hospital for Sick Children in Toronto, Canada. We examined verbal associative memory score changes between groups by laterality (left versus right) and resection type (lateral only versus lateral and mesial resection). We also explored potential associations between certain epilepsy-related characteristics and verbal associative memory changes. RESULTS Postoperative decline was found in children with left-sided resections, but not those with right-sided resections. In children who received left-sided resections, there was some suggestion of verbal associative memory decline in those who had both lateral and mesial tissues excised, but not in those with lateral resections only. Notably, there was also a language dominance (typical versus atypical) by resection type interaction. Specifically, for the typical language group, children with left lateral plus mesial resections (but not mesial sparing resections) showed postoperative verbal associative memory declines, whereas the opposite was true for the atypical language group. SIGNIFICANCE These data contribute to our growing understanding of verbal memory outcomes following TLE in childhood, with consideration of the extent of resection to mesial structures. Our findings also highlight the importance of language laterality when interpreting neuropsychological assessment findings and making predictions regarding risk of functional loss following surgery.
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Affiliation(s)
- Ashley N Danguecan
- Department of Psychology, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada.
| | - Mary Lou Smith
- Department of Psychology, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada; Department of Psychology, University of Toronto Mississauga, Mississauga, Canada; Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, Canada.
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Stewart E, Smith ML. Visuospatial learning and memory in children pre- and posttemporal lobe resection: Patterns of localization and lateralization. Epilepsy Behav 2019; 94:189-194. [PMID: 30970297 DOI: 10.1016/j.yebeh.2019.03.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/13/2019] [Accepted: 03/16/2019] [Indexed: 10/27/2022]
Abstract
In children with epilepsy, the impact of surgery including or sparing the mesial temporal lobes (TLs) on visuospatial memory has not been thoroughly investigated, and a clear pattern of hemispheric lateralization has not been observed. The primary aim of this study was to examine visuospatial learning and memory outcomes in children with epilepsy prior to and one year after surgical excision, to determine whether outcomes differed as a function of the localization and lateralization of surgical excisions. Forty-six children who underwent unilateral TL surgery with sparing of the mesial structures (TL group, N = 21, 16 left) or including mesial structures (TL + M group, N = 25 children, 12 left) were retrospectively recruited. Outcomes on the Children's Memory Scale (CMS) Dot Locations subtest (learning, immediate, and delayed recall scores) were examined prior to and following epilepsy surgery. Results revealed significantly reduced visuospatial memory (delayed recall) in the TL + M compared with the TL group after surgery. Despite this significant postoperative difference, there was no significant change in learning, immediate, or delayed recall scores in either group. However, inspection of individual change scores showed that fewer children in the TL + M group improved in delayed recall after surgery (7.2%) compared with children in the TL group (30%) whereas a similar proportion of children in the TL + M (30.4%) and TL (23.3%) groups showed a decline. There were no significant differences in learning or memory scores as a function of seizure laterality before or after surgery and no differences in change over time. Seizure outcome, age at surgery, age at seizure onset, and percentage life with epilepsy were not related to visuospatial learning or memory outcomes; however, greater number of antiepileptic drugs (AEDs) following surgery was related to poorer visuospatial memory (delayed recall) in the TL + M group. In summary, the results show that visuospatial learning and memory performance do not seem to show a significant decline following TL resections in childhood, regardless of whether or not surgery includes the mesial TL and involves the left or right hemisphere. However, although mesial TL excisions might not result in a deficit in visuospatial memory, they may hinder progressions made after surgery. Further research is needed to examine how resection of the mesial TL (alone or in combination with lateral TL structures) affects visuospatial memory outcomes in children, as well as to investigate the degree to which other treatment factors, such as medication, may affect visual memory outcomes.
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Affiliation(s)
- Elizabeth Stewart
- School of Psychology, The University of Sydney, Camperdown, NSW 2007, Australia
| | - Mary Lou Smith
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON L5L 1C6, Canada; Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.
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Memory in children with epilepsy: Utility of the WRAML-2 in generalized and focal epilepsy syndromes. Epilepsy Behav 2018; 89:30-36. [PMID: 30384096 DOI: 10.1016/j.yebeh.2018.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/02/2018] [Accepted: 10/03/2018] [Indexed: 11/21/2022]
Abstract
The material-specific model for memory impairment predicts that verbal memory deficits are seen with left temporal seizures, and visual memory deficits are seen with right temporal seizures (Henkin et al., 2005). In pediatric epilepsy, seizure pathology has not always yielded the expected material-specific memory profiles. This study used the Wide Range Assessment of Memory and Learning-Second Edition (WRAML-2) to assess memory functioning among pediatric patients with epilepsy. The WRAML-2 was administered to 180 youth with epilepsy during their neuropsychological evaluations. Memory and recognition scores correlated significantly with epilepsy severity variables. There were no significant differences in verbal and visual memory and recognition index scores among patients with generalized epilepsy or among those with lateralized or localized electroencephalography (EEG) patterns and lesions on imaging. However, clinically meaningful verbal versus visual discrepancy scores were significantly related to lateralized abnormalities on EEG and magnetic resonance imaging (MRI) results. Most patients with right hemisphere pathology showed the expected material-specific visual memory deficits, while fewer than 15% of the left hemisphere cases showed the expected verbal memory deficits. Over one-third of those with identified left-sided pathology showed clinically significant deficits in visual memory. Findings are incongruent with the material-specific memory model and reflect the fact that early developmental neurological insults can lead to functional reorganization/crowding effects in children with left hemisphere epilepsy. On exploratory analyses, there were no significant differences in discrepancy scores among participants with left, right, and bilateral languages on Wada and functional MRI (fMRI). However, those with right and bilateral language dominance were more likely to show discrepancies that were incongruent with the material-specific model.
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Neurosurgical approaches to pediatric epilepsy: Indications, techniques, and outcomes of common surgical procedures. Seizure 2018; 77:76-85. [PMID: 30473268 DOI: 10.1016/j.seizure.2018.11.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/07/2018] [Accepted: 11/14/2018] [Indexed: 01/01/2023] Open
Abstract
Epilepsy is a common pediatric neurological condition, and approximately one-third of children with epilepsy are refractory to medical management. For these children neurosurgery may be indicated, but operative success is dependent on complete delineation of the epileptogenic zone. In this review, surgical techniques for pediatric epilepsy are considered. First, potentially-curative operations are discussed and broadly divided into resections and disconnections. Then, two palliative approaches to seizure control are reviewed. Finally, future neurosurgical approaches to epilepsy are considered.
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Helmstaedter C, Elger C, Vogt V. Cognitive outcomes more than 5 years after temporal lobe epilepsy surgery: Remarkable functional recovery when seizures are controlled. Seizure 2018; 62:116-123. [DOI: 10.1016/j.seizure.2018.09.023] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/25/2018] [Accepted: 09/27/2018] [Indexed: 11/16/2022] Open
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Morrison CE, MacAllister WS, Barr WB. Neuropsychology Within a Tertiary Care Epilepsy Center. Arch Clin Neuropsychol 2018; 33:354-364. [PMID: 29718083 DOI: 10.1093/arclin/acx134] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 12/04/2017] [Indexed: 11/12/2022] Open
Abstract
Epilepsy is a prevalent condition characterized by variations in its clinical presentation, etiology, and amenability to treatment. Through history, neuropsychologists have played a significant role in performing research studies on changes in language, memory, and executive functioning in patients with epilepsy, including those undergoing surgical treatment for medically refractory seizures. These studies provided a foundation for establishing neuropsychologists as critical members of interdisciplinary clinical teams specializing in evaluation and treatment of epilepsy. This article describes a number of elements of specialized neuropsychological practice that have evolved over the years within a tertiary care epilepsy center. Through diagnostic interview and objective testing, the neuropsychologist is able to provide a more complete and objective understanding of a patient's cognitive and behavioral functioning than what is obtained by other clinicians through brief office visits. While assessment of cognition, mood, and behavior is the most commonly provided service to patients with epilepsy from all age groups, there are many instances when neuropsychologists in surgical settings are called to perform more specialized procedures, including the intracarotid amytal (Wada) procedure, electrocortical stimulation mapping of language eloquent brain regions, and functional brain imaging procedures. While working as a neuropsychologist on an interdisciplinary epilepsy care team requires specialized knowledge and clinical training, it is extremely satisfying due to the diversity of the patient population and the particular challenges resulting from the often unique manner that cognition and behavior can be affected in patients with epilepsy across the lifespan.
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Affiliation(s)
- Chris E Morrison
- New York University School of Medicine, Department of Neurology, New York, NY, USA
| | | | - William B Barr
- New York University School of Medicine, Department of Neurology, New York, NY, USA
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Kadish NE, Bast T, Reuner G, Wagner K, Mayer H, Schubert-Bast S, Wiegand G, Strobl K, Brandt A, Korinthenberg R, van Velthoven V, Schulze-Bonhage A, Zentner J, Ramantani G. Epilepsy Surgery in the First 3 Years of Life: Predictors of Seizure Freedom and Cognitive Development. Neurosurgery 2018; 84:E368-E377. [DOI: 10.1093/neuros/nyy376] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 07/18/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Navah Ester 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
| | - Thomas Bast
- Epilepsy Centre Kork, Kehl-Kork, Germany
- Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Gitta Reuner
- Section Neuropediatrics and Inborn Errors of Metabolism, University Children's Hospital, Heidelberg, Germany
| | | | - Hans Mayer
- Epilepsy Centre Kork, Kehl-Kork, Germany
| | - Susanne Schubert-Bast
- Section Neuropediatrics and Inborn Errors of Metabolism, University Children's Hospital, Heidelberg, Germany
- Department of Neuropediatrics, Goethe- University, Frankfurt am Main, Germany
| | - Gert Wiegand
- Department of Neuropediatrics, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | | | - Armin Brandt
- Epilepsy Centre, University Hospital Freiburg, Germany
| | - Rudolf Korinthenberg
- Division of Neuropediatrics and Muscular Disorders, Department of Paediatrics and Adolescent Medicine, University Hospital Freiburg, Germany
| | | | | | - Josef Zentner
- Department of Neurosurgery, University Hospital Freiburg, Germany
| | - Georgia Ramantani
- Medical Faculty, University of Freiburg, Freiburg, Germany
- Epilepsy Centre, University Hospital Freiburg, Germany
- Department of Neuropediatrics, University Children's Hospital Zürich, Switzerland
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Shah MN, Mitra A, Goyal MS, Snyder AZ, Zhang J, Shimony JS, Limbrick DD, Raichle ME, Smyth MD. Resting state signal latency predicts laterality in pediatric medically refractory temporal lobe epilepsy. Childs Nerv Syst 2018; 34:901-910. [PMID: 29511809 PMCID: PMC5897166 DOI: 10.1007/s00381-018-3770-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 02/27/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Temporal lobe epilepsy (TLE) affects resting state brain networks in adults. This study aims to correlate resting state functional MRI (rsMRI) signal latency in pediatric TLE patients with their laterality. METHODS From 2006 to 2016, 26 surgical TLE patients (12 left, 14 right) with a mean age of 10.7 years (range 0.9-18) were prospectively studied. Preoperative rsMRI was obtained in patients with concordant lateralizing structural MRI, EEG, and PET studies. Standard preprocessing techniques and seed-based rsMRI analyses were performed. Additionally, the latency in rsMRI signal between each 6 mm voxel sampled was examined, compared to the global mean signal, and projected onto standard atlas space for individuals and the cohort. RESULTS All but one of the 26 patients improved seizure frequency postoperatively with a mean follow-up of 2.9 years (range 0-7.7), with 21 patients seizure-free. When grouped for epileptogenic laterality, the latency map qualitatively demonstrated that the right TLE patients had a relatively early signal pattern, whereas the left TLE patients had a relatively late signal pattern compared to the global mean signal in the right temporal lobe. Quantitatively, the two groups had significantly different signal latency clusters in the bilateral temporal lobes (p < 0.001). CONCLUSION There are functional MR signal latency changes in medical refractory pediatric TLE patients. Qualitatively, signal latency in the right temporal lobe precedes the mean signal in right TLE patients and is delayed in left TLE patients. With larger confirmatory studies, preoperative rsMRI latency analysis may offer an inexpensive, noninvasive adjunct modality to lateralize pediatric TLE.
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Affiliation(s)
- Manish N Shah
- Departments of Pediatric Surgery and Neurosurgery, McGovern Medical School at UTHealth, 6431 Fannin St, MSB 5.144, Houston, TX, 77030, USA.
| | - Anish Mitra
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Manu S Goyal
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Abraham Z Snyder
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, 63110, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Jing Zhang
- Departments of Pediatric Surgery and Neurosurgery, McGovern Medical School at UTHealth, 6431 Fannin St, MSB 5.144, Houston, TX, 77030, USA
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - David D Limbrick
- Department of Neurological Surgery, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Marcus E Raichle
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, 63110, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, 63110, USA
- Department of Biomedical Engineering, Washington University School of Medicine, St. Louis, MO, 63110, USA
- Department of Anatomy and Neurobiology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Matthew D Smyth
- Department of Neurological Surgery, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO, 63110, USA
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Radhakrishnan A, Menon R, Abraham M, Vilanilam G, Sharma S, Thomas B, Kesavadas C, Cherian A, Varma R, Thomas SV. Predictors of outcome after surgery in 134 children with drug-resistant TLE. Epilepsy Res 2018; 139:150-156. [DOI: 10.1016/j.eplepsyres.2017.11.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 11/23/2017] [Accepted: 11/29/2017] [Indexed: 12/01/2022]
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Sibilia V, Barba C, Metitieri T, Michelini G, Giordano F, Genitori L, Guerrini R. Cognitive outcome after epilepsy surgery in children: A controlled longitudinal study. Epilepsy Behav 2017; 73:23-30. [PMID: 28605630 DOI: 10.1016/j.yebeh.2017.03.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 03/03/2017] [Accepted: 03/04/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To analyze the determinants of cognitive outcome two years after surgery for drug-resistant epilepsy in a cohort of 31 children when compared to a control group of 14 surgical candidates who had yet to undergo surgery two years after the first neuropsychological assessment. METHODS Controlled longitudinal study including three evaluations of IQ (Intelligence Quotient) scores or GDQ (General Developmental Quotient) for each group depending on the patient's age: prior to surgery (T0), one year (T1) and two years (T2) after surgery for the surgical group; baseline (T0) and one year (T1) and 2years (T2) after the first evaluation for the control-group. At follow-up, 25 children (80%) of the surgical group were seizure free, while seizure outcome was unsatisfactory in the remaining six (20%). To analyze language, visuomotor skills, memory, reading, visual attention, and behavior, we selected 11 school age children in the surgical group and nine controls. We reported performance prior to (T0) and one year after surgery (T1). RESULTS There was a significant correlation between earlier age at seizure onset and lower IQ/GDQ at T0 (r=0.39; p=0.03) in the overall cohort. IQ/GDQ scores did not significantly differ between the surgical and control groups when analyzed at T0 and T2. However, they evolved differently with an improved developmental trajectory becoming identifiable only in the surgical group (F1,31=5.33 p=0.028; η2=0.15). There was also a significant increase of forward digit span (Z=2.33; p=0.02) and Rey recall scores (Z=1.97; p=0.049) in the surgical school age subgroup at T1 versus T0. SIGNIFICANCE We identified significantly different developmental trajectories in operated versus non- operated children with improved IQ/GDQ scores in operated children only. We also observed a significant increase of digit span scores and Rey recall scores a year after surgery. Further studies including larger samples with longer follow-ups are needed to confirm these preliminary findings.
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Affiliation(s)
- Valentina Sibilia
- Pediatric Neurology Unit and Laboratories, Children's Hospital A. Meyer-University of Florence, Viale Pieraccini 24, 50139 Florence, Italy
| | - Carmen Barba
- Pediatric Neurology Unit and Laboratories, Children's Hospital A. Meyer-University of Florence, Viale Pieraccini 24, 50139 Florence, Italy
| | - Tiziana Metitieri
- Pediatric Neurology Unit and Laboratories, Children's Hospital A. Meyer-University of Florence, Viale Pieraccini 24, 50139 Florence, Italy
| | - Giovanni Michelini
- Department of Neuroscience -University of Parma, Via Volturno 39, 43125, Parma, Italy
| | - Flavio Giordano
- Pediatric Neurosurgery Unit, Children's Hospital A. Meyer-University of Florence, Viale Pieraccini 24, 50139 Florence, Italy
| | - Lorenzo Genitori
- Pediatric Neurosurgery Unit, Children's Hospital A. Meyer-University of Florence, Viale Pieraccini 24, 50139 Florence, Italy
| | - Renzo Guerrini
- Pediatric Neurology Unit and Laboratories, Children's Hospital A. Meyer-University of Florence, Viale Pieraccini 24, 50139 Florence, Italy; IRCCS Stella Maris, Viale del Tirreno 331, 56128 Calambrone Pisa, Italy.
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Kalilani L, Lu C, Pierre-Louis B, Gold M. Lacosamide and concomitant use of antiepileptic and other medications in a US population - A retrospective cohort study. Epilepsy Behav 2017; 72:51-57. [PMID: 28575767 DOI: 10.1016/j.yebeh.2017.04.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 03/09/2017] [Accepted: 04/08/2017] [Indexed: 01/23/2023]
Abstract
Information on the use of lacosamide and concomitant antiepileptic and non-antiepileptic drugs (non-AEDs) is available from clinical trials and observational studies with small sample sizes. This retrospective cohort study was conducted to gain insight into the use of lacosamide in a large number of patients with epilepsy in real-life clinical practice with less restrictive selection criteria compared with clinical trial participants. The Truven Health MarketScan (Commercial Claims and Medicare Supplemental) database was used to identify patients with a prior diagnosis of epilepsy with at least one prescription claim for lacosamide between June 2009 and September 2013 and continuous health insurance enrolment with medical and pharmacy coverage during the 1-year pre-index baseline period. A total of 8859 eligible patients were identified, of whom, at index (lacosamide initiation), 16.8% received lacosamide as monotherapy and 54.0% as polytherapy. The median prescription duration was 196days (Interquartile range 69-476days). Levetiracetam was the most frequently prescribed concomitant AED across all age groups, followed by phenytoin among older (>65years) and lamotrigine among younger patients. Older patients who had LCM monotherapy at initiation, were prescribed fewer concomitant AEDs, but more non-AEDs. The most common non-AED medications were prescribed for pain, psychiatric conditions, hyperlipidemia and gastrointestinal diseases across all age groups. Overall, results suggest that the lacosamide use is driven predominantly by age and that there is substantial use of lacosamide monotherapy (16.8%), despite lack of indication at the time of the study. Results also reveal substantial use of concomitant non-AEDs; 90.4% among patients >65years of age and 54.3% among those ≤17years, confirming the high prevalence of comorbidities among patients with epilepsy across all ages. Despite the availability of numerous newer AEDs, older AEDs are still being frequently prescribed, especially for elderly patients, notably phenytoin. This warrants careful consideration, given the strong propensity of enzyme-inducing AEDs to interact with other drugs, producing unwanted side effects. These results highlight the value of real-life prescription patterns and the potential in informing treatment decisions to ensure patients receive appropriate treatment.
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Affiliation(s)
- Linda Kalilani
- UCB Pharma, 8010 Arco Corporate Drive, Raleigh, NC, USA.
| | - Chao Lu
- UCB Pharma, 8010 Arco Corporate Drive, Raleigh, NC, USA.
| | | | - Michael Gold
- UCB Pharma, 8010 Arco Corporate Drive, Raleigh, NC, USA.
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Liu TT, Behrmann M. Functional outcomes following lesions in visual cortex: Implications for plasticity of high-level vision. Neuropsychologia 2017; 105:197-214. [PMID: 28668576 DOI: 10.1016/j.neuropsychologia.2017.06.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 06/27/2017] [Accepted: 06/28/2017] [Indexed: 12/13/2022]
Abstract
Understanding the nature and extent of neural plasticity in humans remains a key challenge for neuroscience. Importantly, however, a precise characterization of plasticity and its underlying mechanism has the potential to enable new approaches for enhancing reorganization of cortical function. Investigations of the impairment and subsequent recovery of cognitive and perceptual functions following early-onset cortical lesions in humans provide a unique opportunity to elucidate how the brain changes, adapts, and reorganizes. Specifically, here, we focus on restitution of visual function, and we review the findings on plasticity and re-organization of the ventral occipital temporal cortex (VOTC) in published reports of 46 patients with a lesion to or resection of the visual cortex early in life. Findings reveal that a lesion to the VOTC results in a deficit that affects the visual recognition of more than one category of stimuli (faces, objects and words). In addition, the majority of pediatric patients show limited recovery over time, especially those in whom deficits in low-level vision also persist. Last, given that neither the equipotentiality nor the modularity view on plasticity was clearly supported, we suggest some intermediate possibilities in which some plasticity may be evident but that this might depend on the area that was affected, its maturational trajectory as well as its structural and functional connectivity constraints. Finally, we offer suggestions for future research that can elucidate plasticity further.
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Affiliation(s)
- Tina T Liu
- Department of Psychology, and, Center for the Neural Basis of Cognition, Carnegie Mellon University, Pittsburgh, PA, USA.
| | - Marlene Behrmann
- Department of Psychology, and, Center for the Neural Basis of Cognition, Carnegie Mellon University, Pittsburgh, PA, USA.
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Cano-López I, Vázquez JF, Campos A, Gutiérrez A, Garcés M, Gómez-Ibáñez A, Conde R, González-Bono E, Villanueva V. Age at surgery as a predictor of cognitive improvements in patients with drug-resistant temporal epilepsy. Epilepsy Behav 2017; 70:10-17. [PMID: 28407524 DOI: 10.1016/j.yebeh.2017.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 12/16/2016] [Accepted: 03/04/2017] [Indexed: 10/19/2022]
Abstract
Temporal lobe epilepsy (TLE) surgery is an effective procedure that can produce cognitive changes. However, the prognostic factors related with cognitive outcomes need to be better understood. The aim of the present study is to know if age at surgery is a reliable predictor of verbal memory competence and considering factors such as: hemisphere; type of surgery; pre-surgical seizure frequency; and epilepsy duration. Sixty-one typically dominant patients with drug-resistant TLE (34 with left TLE [L-TLE] and 27 with right TLE [R-TLE]) underwent a neuropsychological assessment before and a year after surgery. Results showed that R-TLE patients had better evolution in short- and long-term verbal memory and naming than L-TLE patients (for all, p >.04). L-TLE patients also more frequently showed a strong and reliable decline in these functions than R-TLE patients. No effects for gender or type of surgery were found. From a multivariate approach, patients with improvements in verbal competence underwent surgery at earlier ages and suffered epilepsy for less time (for all, p <0.4). The relevance of age at surgery was confirmed as a predictor of long-term verbal memory changes, although the frequency of partial seizures also explains, at least partially, these changes. In addition, the frequency of partial seizures explains short-term verbal memory changes. These results emphasize the importance of early intervention, independently of the resected hemisphere, in order to minimize the cognitive side-effects of epilepsy treatment, as well the need to consider cognitive functions as related processes and network dependent.
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Affiliation(s)
- Irene Cano-López
- Department of Psychobiology/IDOCAL, University of Valencia, Spain; Multidisciplinary Epilepsy Unit/Neurology Service, Hospital Universitario y Politécnico La Fe, Spain
| | - Juan Francisco Vázquez
- Multidisciplinary Epilepsy Unit/Neurology Service, Hospital Universitario y Politécnico La Fe, Spain
| | - Anabel Campos
- Multidisciplinary Epilepsy Unit/Neurology Service, Hospital Universitario y Politécnico La Fe, Spain
| | - Antonio Gutiérrez
- Multidisciplinary Epilepsy Unit/Neurology Service, Hospital Universitario y Politécnico La Fe, Spain
| | - Mercedes Garcés
- Multidisciplinary Epilepsy Unit/Neurology Service, Hospital Universitario y Politécnico La Fe, Spain
| | - Asier Gómez-Ibáñez
- Multidisciplinary Epilepsy Unit/Neurology Service, Hospital Universitario y Politécnico La Fe, Spain
| | - Rebeca Conde
- Multidisciplinary Epilepsy Unit/Neurology Service, Hospital Universitario y Politécnico La Fe, Spain
| | | | - Vicente Villanueva
- Multidisciplinary Epilepsy Unit/Neurology Service, Hospital Universitario y Politécnico La Fe, Spain.
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Rubinger L, Hazrati LN, Ahmed R, Rutka J, Snead C, Widjaja E. Microscopic and macroscopic infarct complicating pediatric epilepsy surgery. Epilepsia 2017; 58:393-401. [PMID: 28111751 DOI: 10.1111/epi.13667] [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: 12/20/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE There is some suggestion that microscopic infarct could be associated with invasive monitoring, but it is unclear if the microscopic infarct is also visible on imaging and associated with neurologic deficits. The aims of this study were to assess the rates of microscopic and macroscopic infarct and other major complications of pediatric epilepsy surgery, and to determine if these complications were higher following invasive monitoring. METHODS We reviewed the epilepsy surgery data from a tertiary pediatric center, and collected data on microscopic infarct on histology and macroscopic infarct on postoperative computed tomography (CT) or magnetic resonance imaging (MRI) done one day after surgery and major complications. RESULTS Three hundred fifty-two patients underwent surgical resection and there was one death. Forty-two percent had invasive monitoring. Thirty patients (9%) had microscopic infarct. Univariable analyses showed that microscopic infarct was higher among patients with invasive monitoring relative to no invasive monitoring (20% vs. 0.5%, respectively, p < 0.001). Eighteen patients (5%) had macroscopic infarct on CT or MRI. Univariable analysis showed no significant difference in macroscopic infarct between invasive monitoring and no invasive monitoring (8% vs. 3%, respectively, p = 0.085). One patient with microscopic infarct had transient right hemiparesis, and two with both macroscopic and microscopic infarct had unexpected persistent neurologic deficits. Thirty-two major complications (9.1%) were reported, with no difference in major complications between invasive monitoring and no invasive monitoring (10% vs. 7%, p = 0.446). In the multivariable analysis, invasive monitoring increased the odds of microscopic infarct (odds ratio [OR] 15.87, p = 0.009), but not macroscopic infarct (OR 2.6, p = 0.173) or major complications (OR 1.4, p = 0.500), after adjusting for age at surgery, sex, age at seizure onset, operative type, and operative location. SIGNIFICANCE Microscopic infarct was associated with invasive monitoring, and none of the patients had permanent neurologic deficits. Macroscopic infarct was not associated with invasive monitoring, and two patients with macroscopic infarct had persistent neurologic deficits.
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Affiliation(s)
- Luc Rubinger
- Neuroscience and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lili-Naz Hazrati
- Department of Pathology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Raheel Ahmed
- Department of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - James Rutka
- Department of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Carter Snead
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elysa Widjaja
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada.,Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada
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Law N, Benifla M, Rutka J, Smith ML. Verbal memory after temporal lobe epilepsy surgery in children: Do only mesial structures matter? Epilepsia 2016; 58:291-299. [PMID: 28012164 DOI: 10.1111/epi.13635] [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] [Accepted: 11/08/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Previous findings have been mixed regarding verbal memory outcome after left temporal lobectomy in children, and there are few studies comparing verbal memory change after lateral versus mesial temporal lobe resections. We compared verbal memory outcome associated with sparing or including the mesial structures in children who underwent left or right temporal lobe resection. We also investigated predictors of postsurgical verbal memory change. METHODS We retrospectively assessed verbal memory change approximately 1 year after unilateral temporal lobe epilepsy surgery using a list learning task. Participants included 23 children who underwent temporal lobe surgery with sparing of the mesial structures (13 left), and 40 children who had a temporal lobectomy that included resection of mesial structures (22 left). RESULTS Children who underwent resection from the left lateral and mesial temporal lobe were the only group to show decline in verbal memory. Furthermore, when we considered language representation in the left temporal resection group, patients with left language representation and spared mesial structures showed essentially no change in verbal memory from preoperative to follow-up, whereas those with left language representation and excised mesial structures showed a decline. Postoperative seizure status had no effect on verbal memory change in children after left temporal lobe surgery. Finally, we found that patients with intact preoperative verbal memory experienced a significant decline compared to those with below average preoperative verbal memory. SIGNIFICANCE Our findings provide evidence of significant risk factors for verbal memory decline in children, specific to left mesial temporal lobe epilepsy. Children who undergo left temporal lobe surgery that includes mesial structures may be most vulnerable for verbal memory decline, especially when language representation is localized to the left hemisphere and when preoperative verbal memory is intact.
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Affiliation(s)
- Nicole Law
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada.,Department of Psychology, Hospital for Sick Children, Toronto, Ontario, Canada.,Program in Neurosciences and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mony Benifla
- Department of Neurosurgery, Hadassah Medical Center, Jerusalem, Israel
| | - James Rutka
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Mary Lou Smith
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada.,Department of Psychology, Hospital for Sick Children, Toronto, Ontario, Canada.,Program in Neurosciences and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada
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Abstract
First-line treatment for epilepsy is antiepileptic drug and requires an interdisciplinary approach and enduring commitment and adherence from the patient and family for successful outcome. Despite adherence to antiepileptic drugs, refractory epilepsy occurs in approximately 30% of children with epilepsy, and surgical treatment is an important intervention to consider. Surgical management of pediatric epilepsy is highly effective in selected patients with refractory epilepsy; however, an evidence-based protocol, including best methods of presurgical imaging assessments, and neurodevelopmental and/or behavioral health assessments, is not currently available for clinicians. Surgical treatment of epilepsy can be critical to avoid negative outcomes in functional, cognitive, and behavioral health status. Furthermore, it is often the only method to achieve seizure freedom in refractory epilepsy. Although a large literature base can be found for adults with refractory epilepsy undergoing surgical treatment, less is known about how surgical management affects outcomes in children with epilepsy. The purpose of the review was fourfold: (1) to evaluate the available literature regarding presurgical assessment and postsurgical outcomes in children with medically refractory epilepsy, (2) to identify gaps in our knowledge of surgical treatment and its outcomes in children with epilepsy, (3) to pose questions for further research, and (4) to advocate for a more unified presurgical evaluation protocol including earlier referral for surgical candidacy of pediatric patients with refractory epilepsy. Despite its effectiveness, epilepsy surgery remains an underutilized but evidence-based approach that could lead to positive short- and long-term outcomes for children with refractory epilepsy.
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Vecchi M, Barba C, De Carlo D, Stivala M, Guerrini R, Albamonte E, Ranalli D, Battaglia D, Lunardi G, Boniver C, Piccolo B, Pisani F, Cantalupo G, Nieddu G, Casellato S, Cappanera S, Cesaroni E, Zamponi N, Serino D, Fusco L, Iodice A, Palestra F, Giordano L, Freri E, De Giorgi I, Ragona F, Granata T, Fiocchi I, Bova SM, Mastrangelo M, Verrotti A, Matricardi S, Fontana E, Caputo D, Darra F, Dalla Bernardina B, Beccaria F, Capovilla G, Baglietto MP, Gagliardi A, Vignoli A, Canevini MP, Perissinotto E, Francione S. Symptomatic and presumed symptomatic focal epilepsies in childhood: An observational, prospective multicentre study. Epilepsia 2016; 57:1808-1816. [DOI: 10.1111/epi.13574] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2016] [Indexed: 10/20/2022]
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Helmstaedter C, Witt JA. How neuropsychology can improve the care of individual patients with epilepsy. Looking back and into the future. Seizure 2016; 44:113-120. [PMID: 27789166 DOI: 10.1016/j.seizure.2016.09.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 09/23/2016] [Accepted: 09/23/2016] [Indexed: 02/06/2023] Open
Abstract
Some of the roots of current clinical neuropsychology go back to the early days of epilepsy surgery. Looking back a huge number of publications have dealt with cognition in epilepsy. The major factors driving this work were questions relating to surgery, antiepileptic drugs and, more recently, also to underlying pathology. However, most factors affecting cognition in epilepsy have been discerned many years ago. The body of neuropsychological literature in this field has accumulated much knowledge, raising the question why, apart from epilepsy surgery settings, neuropsychology has still not been fully integrated in the routine care of patients with epilepsy. This review on the occasion of Seizure's 25th anniversary attempts to summarize clinically relevant diagnostic advances following a question guided, modular, and evidence-based approach. In doing so, we hope to attract the interest of readers to an exciting mode of assessment which does not only have theoretical but also practical relevance. The comorbidities of epilepsy are becoming an increasingly relevant topic. It is now widely accepted that, while epilepsy may be defined by the occurrence of epileptic seizures, these seizures represent only one of several possible sources of cognitive impairment. It is well-established that there are complex interactions between epilepsy, cognition and behavior, and that both seizures and problems with cognition or behavior may result from a common underlying pathology requiring treatment. With this review we aim to demonstrate that neuropsychology can make a highly valuable contribution to the care of individual patients by contributing to the diagnostic process and by serving as a tool for the monitoring of disease and treatment, thereby improving the quality and safety of patient care. On a national, European, and international level, first efforts are being made to homogenize diagnostics across epilepsy centers and countries in order to achieve a common language and core standards. This should improve communication within and outside the speciality, and help to generate the data required to allow the field to make further progress.
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Puka K, Smith ML. Remembrance and time passed: Memory outcomes 4-11 years after pediatric epilepsy surgery. Epilepsia 2016; 57:1798-1807. [DOI: 10.1111/epi.13571] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Klajdi Puka
- Department of Psychology; The Hospital for Sick Children; Toronto Ontario Canada
| | - Mary Lou Smith
- Department of Psychology; The Hospital for Sick Children; Toronto Ontario Canada
- Department of Psychology; University of Toronto Mississauga; Mississauga Ontario Canada
- Neurosciences and Mental Health Program; The Hospital for Sick Children; Toronto Ontario Canada
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Functional Connectome before and following Temporal Lobectomy in Mesial Temporal Lobe Epilepsy. Sci Rep 2016; 6:23153. [PMID: 27001417 PMCID: PMC4802388 DOI: 10.1038/srep23153] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 02/29/2016] [Indexed: 01/05/2023] Open
Abstract
As mesial temporal lobe epilepsy (mTLE) has been recognized as a network disorder, a longitudinal connectome investigation may shed new light on the understanding of the underlying pathophysiology related to distinct surgical outcomes. Resting-state functional MRI data was acquired from mTLE patients before (n = 37) and after (n = 24) anterior temporal lobectomy. According to surgical outcome, patients were classified as seizure-free (SF, n = 14) or non-seizure-free (NSF, n = 10). First, we found higher network resilience to targeted attack on topologically central nodes in the SF group compared to the NSF group, preoperatively. Next, a two-way mixed analysis of variance with between-subject factor ‘outcome’ (SF vs. NSF) and within-subject factor ‘treatment’ (pre-operation vs. post-operation) revealed divergent dynamic reorganization in nodal topological characteristics between groups, in the temporoparietal junction and its connection with the ventral prefrontal cortex. We also correlated the network damage score (caused by surgical resection) with postsurgical brain function, and found that the damage score negatively correlated with postoperative global and local parallel information processing. Taken together, dynamic connectomic architecture provides vital information for selecting surgical candidates and for understanding brain recovery mechanisms following epilepsy surgery.
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Preece D, Allan A, Becerra R. A case study of the neuropsychological outcomes following microsurgery, conventional radiotherapy and stereotactic radiotherapy for an adult's recurrent craniopharyngioma. Brain Inj 2016; 30:104-11. [PMID: 26736032 DOI: 10.3109/02699052.2015.1104552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To examine the neuropsychological outcomes for an adult patient, 2 years after receiving microsurgery and conventional radiotherapy for a recurrent craniopharyngioma; and the impact of a further intervention, stereotactic radiotherapy, on this level of neuropsychological functioning. PARTICIPANT JD, a 30 year old male whose recurrent craniopharyngioma had 2 years earlier been treated with two operations and conventional radiotherapy. DESIGN JD was assessed (using standardized clinical tests) before and after a course of stereotactic radiotherapy. RESULTS Prior to stereotactic radiotherapy (and 2 years after microsurgery and conventional radiotherapy) JD's IQ was intact, but considerable impairments were present in executive functioning, memory, theory of mind and processing speed. Fifteen months after stereotactic radiotherapy, all neuropsychological domains remained largely static or improved, supporting the utility of this treatment option in the neuropsychological domain. However, deficits in executive functioning, memory and processing speed remained. CONCLUSION These findings suggest that, even after multiple treatments, substantial cognitive impairments can be present in an adult patient with a recurrent craniopharyngioma. This profile of deficits underlines the inadequacy of relying purely on IQ as a marker for cognitive health in this population and emphasizes the need to include neuropsychological impairments as a focus of rehabilitation with these patients.
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Affiliation(s)
- David Preece
- a School of Psychology and Social Science, Edith Cowan University , Perth WA , Australia
| | - Alfred Allan
- a School of Psychology and Social Science, Edith Cowan University , Perth WA , Australia
| | - Rodrigo Becerra
- a School of Psychology and Social Science, Edith Cowan University , Perth WA , Australia
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Wessling C, Bartels S, Sassen R, Schoene-Bake JC, von Lehe M. Brain tumors in children with refractory seizures—a long-term follow-up study after epilepsy surgery. Childs Nerv Syst 2015. [PMID: 26201552 DOI: 10.1007/s00381-015-2825-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Epilepsy surgery is an established treatment option for medically refractory epilepsy. Brain tumors, besides dysplasias, vascular malformations, and other lesions, can cause refractory epilepsy. Long-term epilepsy-associated brain tumors, even though mostly benign, are neoplastic lesions and thus have to be considered as both epileptic and oncological lesions. METHODS We retrospectively analyzed epileptological and oncological long-term follow-up (FU) in pediatric patients who underwent brain surgery for refractory epilepsy and whose histology showed a tumor as underlying cause (n = 107, mean FU 119 months). RESULTS At last available outcome, 82.2% of patients were seizure free (International League Against Epilepsy (ILAE) class 1) and seizure outcome was stable over more than 14 years. Fifty-four percent of the patients were without anti-epileptic drugs (AEDs) at last available outcome; 96.2% of the tumors were classified WHO grade I and II and 3.7% were malignant (WHO grade III). Adjuvant treatment was administered in 5.7%; 2.9% had relapse and one patient died (tumor-related mortality = 1.4%). After surgery, 91% of the patients attended regular school/university and/or professional training. CONCLUSIONS This study shows that epileptological outcome within this group is promising and stable and oncological outcome has a very good prognosis. However, oncological FU must not be dismissed as a small percentage of patients who suffer from malignant tumors and adjuvant treatment, relapse, and mortality have to be considered.
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Affiliation(s)
- Caroline Wessling
- Department of Neurosurgery, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany,
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Reinholdson J, Olsson I, Edelvik A, Hallböök T, Lundgren J, Rydenhag B, Malmgren K. Long-term follow-up after epilepsy surgery in infancy and early childhood – A prospective population based observational study. Seizure 2015. [DOI: 10.1016/j.seizure.2015.05.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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