1
|
Kimura N, Takahashi Y, Usui N, Matsuda K, Otani H, Kasai Y, Kondo A, Imai K, Takita J. Neuropsychological outcome after frontal surgery for pediatric-onset epilepsy with focal cortical dysplasia in adolescent and young adult. Epilepsy Behav 2024; 153:109687. [PMID: 38368791 DOI: 10.1016/j.yebeh.2024.109687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/03/2024] [Accepted: 02/05/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVE We investigated neuropsychological outcome in patients with pharmacoresistant pediatric-onset epilepsy caused by focal cortical dysplasia (FCD), who underwent frontal lobe resection during adolescence and young adulthood. METHODS Twenty-seven patients were studied, comprising 15 patients who underwent language-dominant side resection (LDR) and 12 patients who had languagenondominant side resection (n-LDR). We evaluated intelligence (language function, arithmetic ability, working memory, processing speed, visuo-spatial reasoning), executive function, and memory in these patients before and two years after resection surgery. We analyzed the relationship between neuropsychological outcome and resected regions (side of language dominance and location). RESULTS Although 75% of the patients showed improvement or no change in individual neuropsychological tests after surgical intervention, 25% showed decline. The cognitive tests that showed improvement or decline varied between LDR and n-LDR. In patients who had LDR, decline was observed in Vocabulary and Phonemic Fluency (both 5/15 patients), especially after resection of ventrolateral frontal cortex, and improvement was observed in WCST-Category (7/14 patients), Block Design (6/15 patients), Digit Symbol (4/15 patients), and Delayed Recall (3/9 patients). In patients who underwent n-LDR, improvement was observed in Vocabulary (3/12 patients), but decline was observed in Block Design (2/9 patients), and WCST-Category (2/9 patients) after resection of dorsolateral frontal cortex; and Arithmetic (3/10 patients) declined after resection of dorsolateral frontal cortex or ventrolateral frontal cortex. General Memory (3/8 patients), Visual Memory (3/8 patients), Delayed Recall (3/8 patients), Verbal Memory (2/9 patients), and Digit Symbol (3/12 patients) also declined after n-LDR. CONCLUSION Postoperative changes in cognitive function varied depending on the location and side of the resection. For precise presurgical prediction of neuropsychological outcome after surgery, further prospective studies are needed to accumulate data of cognitive changes in relation to the resection site.
Collapse
Affiliation(s)
- Nobusuke Kimura
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorder, Urushiyama 886, Aoi-ku, Shizuoka 420-8688, Japan; Naniwa Ikuno Hospital, Daikoku 1-10-3, Naniwa-ku, Oosaka 556-0014, Japan.
| | - Yukitoshi Takahashi
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorder, Urushiyama 886, Aoi-ku, Shizuoka 420-8688, Japan; Department of Pediatrics, Gifu University School of Medicine, Japan; School of Pharmaceutical Sciences, University of Shizuoka, Japan.
| | - Naotaka Usui
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorder, Urushiyama 886, Aoi-ku, Shizuoka 420-8688, Japan.
| | - Kazumi Matsuda
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorder, Urushiyama 886, Aoi-ku, Shizuoka 420-8688, Japan.
| | - Hideyuki Otani
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorder, Urushiyama 886, Aoi-ku, Shizuoka 420-8688, Japan.
| | - Yoshinobu Kasai
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorder, Urushiyama 886, Aoi-ku, Shizuoka 420-8688, Japan.
| | - Akihiko Kondo
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorder, Urushiyama 886, Aoi-ku, Shizuoka 420-8688, Japan.
| | - Katsumi Imai
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorder, Urushiyama 886, Aoi-ku, Shizuoka 420-8688, Japan.
| | - Junko Takita
- Kyoto University, Shogoin Kawahara-cho 53, Sakyo-ku, Kyoto 606-8507, Japan.
| |
Collapse
|
2
|
Doll A, Wegrzyn M, Woermann FG, Labudda K, Bien CG, Kissler J. MRI evidence for material-specific encoding deficits and mesial-temporal alterations in presurgical frontal lobe epilepsy patients. Epilepsia Open 2024; 9:355-367. [PMID: 38093701 PMCID: PMC10839294 DOI: 10.1002/epi4.12881] [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: 07/13/2023] [Revised: 11/27/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE Neuroimaging studies reveal frontal lobe (FL) contributions to memory encoding. Accordingly, memory impairments are documented in frontal lobe epilepsy (FLE). Still, little is known about the structural or functional correlates of such impairments. Particularly, material specificity of functional changes in cerebral activity during memory encoding in FLE is unclear. METHODS We compared 24 FLE patients (15 right-sided) undergoing presurgical evaluation with 30 healthy controls on a memory fMRI-paradigm of learning scenes, faces, and words followed by an out-of-scanner recognition task as well as regarding their mesial temporal lobe (mTL) volumes. We also addressed effects of FLE lateralization and performance level (normal vs. low). RESULTS FLE patients had poorer memory performance and larger left hippocampal volumes than controls. Volume increase seemed, however, irrelevant or even dysfunctional for memory performance. Further, functional changes in FLE patients were right-sided for scenes and faces and bilateral for words. In detail, during face encoding, FLE patients had, regardless of their performance level, decreased mTL activation, while during scene and word encoding only low performing FLE patients had decreased mTL along with decreased FL activation. Intact verbal memory performance was associated with higher right frontal activation in FLE patients but not in controls. SIGNIFICANCE Pharmacoresistant FLE has a distinct functional and structural impact on the mTL. Effects vary with the encoded material and patients' performance levels. Thus, in addition to the direct effect of the FL, memory impairment in FLE is presumably to a large part due to functional mTL changes triggered by disrupted FL networks. PLAIN LANGUAGE SUMMARY Frontal lobe epilepsy (FLE) patients may suffer from memory impairment. Therefore, we asked patients to perform a memory task while their brain was scanned by MRI in order to investigate possible changes in brain activation during learning. FLE patients showed changes in brain activation during learning and also structural changes in the mesial temporal lobe, which is a brain region especially relevant for learning but not the origin of the seizures in FLE. We conclude that FLE leads to widespread changes that contribute to FLE patients' memory impairment.
Collapse
Affiliation(s)
- Anna Doll
- Department of Epileptology (Krankenhaus Mara)Medical School, Bielefeld UniversityBielefeldGermany
- Department of PsychologyBielefeld UniversityBielefeldGermany
| | - Martin Wegrzyn
- Department of PsychologyBielefeld UniversityBielefeldGermany
| | - Friedrich G. Woermann
- Department of Epileptology (Krankenhaus Mara)Medical School, Bielefeld UniversityBielefeldGermany
| | - Kirsten Labudda
- Department of Epileptology (Krankenhaus Mara)Medical School, Bielefeld UniversityBielefeldGermany
- Department of PsychologyBielefeld UniversityBielefeldGermany
| | - Christian G. Bien
- Department of Epileptology (Krankenhaus Mara)Medical School, Bielefeld UniversityBielefeldGermany
| | - Johanna Kissler
- Department of PsychologyBielefeld UniversityBielefeldGermany
- Center for Cognitive Interaction Technology (CITEC)Bielefeld UniversityBielefeldGermany
| |
Collapse
|
3
|
Otomo M, Osawa SI, Suzuki K, Kakinuma K, Ukishiro K, Suzuki H, Niizuma K, Narita N, Nakasato N, Tominaga T. Bilateral and asymmetrical localization of language function identified by the superselective infusion of propofol in an epilepsy patient with a mild malformation of cortical development: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 6:CASE23451. [PMID: 38145562 PMCID: PMC10751223 DOI: 10.3171/case23451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 11/16/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Atypical localization of language function can result in unexpected postsurgical deficits after cortical resection, but it is difficult to predict the risk in the presurgical evaluation. The authors experienced a rare case of the bilateral and independent existence of different components of language function identified by segmented evaluation of anatomical anterior and posterior language areas using the superselective infusion of propofol. OBSERVATIONS A 32-year-old right-handed female presented with drug-resistant epilepsy. Comprehensive epilepsy evaluation suggested that the epileptic foci involved the whole left frontal lobe but provided less evidence of structural abnormality. To estimate the extent of functional deterioration likely to be caused by an extended left frontal lobectomy, the authors evaluated segmented cortical function in the ipsi- and contralateral hemispheres by the superselective infusion of propofol into the branches of the intracranial artery. The results revealed bilateral and asymmetrical localization of language function because the patient presented with different components of aphasia in each hemisphere. Based on the authors' assessment of her functional tolerance, an extended left frontal lobectomy was performed and resulted in neurological deficits within the anticipated range. LESSONS An accurate understanding of the correlations between vascular and functional anatomy and the highly specific evaluation of language function provides more advanced presurgical assessment, allowing more tailored planning of cortical resection.
Collapse
Affiliation(s)
| | | | | | | | | | - Hiroyoshi Suzuki
- Department of Pathology, Sendai Medical Center, Sendai, Miyagi, Japan
| | - Kuniyasu Niizuma
- Departments of Neurosurgery
- Neurosurgical Engineering and Translational Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Department of Neurosurgical Engineering and Translational Neuroscience, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Miyagi, Japan; and
| | - Norio Narita
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | | | | |
Collapse
|
4
|
Giampiccolo D, Binding LP, Caciagli L, Rodionov R, Foulon C, de Tisi J, Granados A, Finn R, Dasgupta D, Xiao F, Diehl B, Torzillo E, Van Dijk J, Taylor PN, Koepp M, McEvoy AW, Baxendale S, Chowdhury F, Duncan JS, Miserocchi A. Thalamostriatal disconnection underpins long-term seizure freedom in frontal lobe epilepsy surgery. Brain 2023; 146:2377-2388. [PMID: 37062539 PMCID: PMC10232243 DOI: 10.1093/brain/awad085] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 02/08/2023] [Accepted: 03/02/2023] [Indexed: 04/18/2023] Open
Abstract
Around 50% of patients undergoing frontal lobe surgery for focal drug-resistant epilepsy become seizure free post-operatively; however, only about 30% of patients remain seizure free in the long-term. Early seizure recurrence is likely to be caused by partial resection of the epileptogenic lesion, whilst delayed seizure recurrence can occur even if the epileptogenic lesion has been completely excised. This suggests a coexistent epileptogenic network facilitating ictogenesis in close or distant dormant epileptic foci. As thalamic and striatal dysregulation can support epileptogenesis and disconnection of cortico-thalamostriatal pathways through hemispherotomy or neuromodulation can improve seizure outcome regardless of focality, we hypothesize that projections from the striatum and the thalamus to the cortex may contribute to this common epileptogenic network. To this end, we retrospectively reviewed a series of 47 consecutive individuals who underwent surgery for drug-resistant frontal lobe epilepsy. We performed voxel-based and tractography disconnectome analyses to investigate shared patterns of disconnection associated with long-term seizure freedom. Seizure freedom after 3 and 5 years was independently associated with disconnection of the anterior thalamic radiation and anterior cortico-striatal projections. This was also confirmed in a subgroup of 29 patients with complete resections, suggesting these pathways may play a critical role in supporting the development of novel epileptic networks. Our study indicates that network dysfunction in frontal lobe epilepsy may extend beyond the resection and putative epileptogenic zone. This may be critical in the pathogenesis of delayed seizure recurrence as thalamic and striatal networks may promote epileptogenesis and disconnection may underpin long-term seizure freedom.
Collapse
Affiliation(s)
- Davide Giampiccolo
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
- Institute of Neuroscience, Cleveland Clinic London, London SW1X 7HY, UK
| | - Lawrence P Binding
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
- Department of Computer Science, Centre for Medical Image Computing, University College London, London WC1V 6LJ, UK
| | - Lorenzo Caciagli
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Roman Rodionov
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
| | - Chris Foulon
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
| | - Jane de Tisi
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
| | - Alejandro Granados
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Roisin Finn
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Debayan Dasgupta
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Fenglai Xiao
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
| | - Beate Diehl
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
| | - Emma Torzillo
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
| | - Jan Van Dijk
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
| | - Peter N Taylor
- Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle upon Tyne NE4 5TG, UK
| | - Matthias Koepp
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
| | - Andrew W McEvoy
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
- Institute of Neuroscience, Cleveland Clinic London, London SW1X 7HY, UK
| | - Sallie Baxendale
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
| | - Fahmida Chowdhury
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
| | - Anna Miserocchi
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
- Institute of Neuroscience, Cleveland Clinic London, London SW1X 7HY, UK
| |
Collapse
|
5
|
Ljunggren S, Winblad S, Samuelsson H, Malmgren K. Decision-making under ambiguity after frontal lobe resection for epilepsy. Epilepsy Behav 2023; 142:109215. [PMID: 37075512 DOI: 10.1016/j.yebeh.2023.109215] [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: 11/28/2022] [Revised: 04/02/2023] [Accepted: 04/04/2023] [Indexed: 04/21/2023]
Abstract
PURPOSE Decision-making is crucial to daily life and can impact our society as well as economic conditions. Although the frontal lobes have been identified as important for decision-making, this capacity has only been studied to a limited extent in frontal lobe epilepsy and not at all after frontal lobe resection (FLR) for epilepsy. This study aimed to explore decision-making under ambiguity after FLR for epilepsy. METHODS Fourteen patients having undergone FLR for epilepsy completed the Iowa Gambling Task (IGT) which is a widely used tool to measure decision-making under ambiguity. Iowa Gambling Task scores included in the analysis were: total net score, separate scores from five blocks across the test, and a change score (last block of IGT minus first block). A group of healthy controls (n = 30) was used as a comparison. Associations between IGT and standardized neuropsychological methods for assessment of executive functions, self-rating questionnaires of mental health, fatigue, and behavior linked to frontal lobe dysfunction were also investigated. RESULTS The patient group performed inferior to controls at the final block of the IGT (p =.001).A group difference in IGT change scores was found (p =.005), reflectingthe absence of a positive change in performance over time for the FLR group compared to the control group. Correlations with tests of executive functions as well as self-rating scales were mainly statistically nonsignificant. CONCLUSIONS This study shows that patients having undergone FLR for epilepsy have difficulties with decision-making under ambiguity. The performance illustrated a failure to learn throughout the task. Executive as well as emotional deficits may impact decision-making processes in this patient group and need to be considered in further studies. Prospective studies with larger cohorts are needed.
Collapse
Affiliation(s)
- Sofia Ljunggren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Blå Stråket 7, SE-413 45 Gothenburg, Sweden; Department of Neurology, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden.
| | - Stefan Winblad
- Department of Psychology, Gothenburg University, Box 500, SE-405 30 Gothenburg, Sweden.
| | - Hans Samuelsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Blå Stråket 7, SE-413 45 Gothenburg, Sweden; Department of Psychology, Gothenburg University, Box 500, SE-405 30 Gothenburg, Sweden.
| | - Kristina Malmgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Blå Stråket 7, SE-413 45 Gothenburg, Sweden; Department of Neurology, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden.
| |
Collapse
|
6
|
Quality of life after epilepsy surgery: How domain-specific cognitive changes impact QOL within the context of seizure outcome. Epilepsy Behav 2022; 137:108948. [PMID: 36283290 DOI: 10.1016/j.yebeh.2022.108948] [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: 08/02/2022] [Revised: 09/27/2022] [Accepted: 10/06/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Neurosurgery is an effective treatment option for pharmacoresistant epilepsy. Although post-surgical seizure freedom is considered the primary goal of epilepsy surgery, other factors that impact Quality of Life (QOL) are also important to consider, including post-surgical cognitive changes. This study aimed to examine the impact of post-surgical cognitive changes on QOL in the context of seizure outcomes. METHODS Participants were 196 adults with focal epilepsy who underwent either frontal (n = 27) or temporal (n = 169) lobe resection. Each participant completed pre- and post-surgical neuropsychological evaluations, and cognitive composites were constructed for the following domains: language, attention/processing speed, memory, executive function, and visuospatial skill. The Quality of Life in Epilepsy (QOLIE-10) questionnaire was used to assess QOL. Seizure outcome was determined by seizure status six months post-surgery. RESULTS Eighty-one percent of patients were seizure-free post-surgery and generally reported improved QOL. While a significant portion of patient's demonstrated declines in language and verbal memory following surgery, only a decline in verbal memory was associated with worse QOL; however, this relationship was no longer significant after controlling for seizure outcome. Instead, reduced post-surgical QOL was primarily observed in those who experienced both seizure recurrence and a decline in executive function. Notably, depression was a significant covariate in all of the models. CONCLUSIONS The findings from this study improve our ability to counsel patients about the trade-off between cognitive decline and seizure remittance in the greater context of overall QOL. Reassuringly, it appears that QOL is improved regardless of cognitive changes when patients have good seizure outcomes. However, for those that experience a "double hit" (i.e., cognitive decline without seizure remission), post-surgical QOL may be reduced. Changes in depression also appear to play a crucial role in QOL outcomes.
Collapse
|
7
|
Nitta N, Usui N, Kondo A, Tottori T, Terada K, Kasai Y, Takahashi Y, Nozaki K, Inoue Y. Neuropsychological outcomes after frontal lobectomy to treat intractable epilepsy. Epilepsy Behav 2021; 123:108240. [PMID: 34375803 DOI: 10.1016/j.yebeh.2021.108240] [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: 05/20/2021] [Revised: 07/14/2021] [Accepted: 07/24/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Frontal lobectomy is often used as a surgical treatment for frontal lobe epilepsy, especially when a large epileptogenic zone in the frontal lobe is inferred from preoperative evaluation. The frontal lobe is important for cognitive functions such as executive functions and verbal fluency, but the neuropsychological outcome after a frontal or prefrontal lobectomy that includes both the dorsolateral prefrontal cortex and ventral prefrontal cortex has not been studied thoroughly. In the present study, we evaluated neuropsychological outcomes after patients with frontal lobe epilepsy received a frontal or prefrontal lobectomy. METHODS We retrospectively reviewed the data of patients with frontal lobe epilepsy who underwent a frontal or prefrontal lobectomy that includes both the dorsolateral prefrontal cortex and ventral prefrontal cortex at 16 years or older from October 2004 to December 2014, with a minimum postoperative follow-up of 24 months. We analyzed and compared neuropsychological outcomes, including executive functions, verbal fluency, intelligence, and memory, before and after the operation. RESULTS Eighteen patients were 16 years or older and underwent pre- and postoperative (2 years after the operation) neuropsychological evaluations. Patients showed significant deterioration only on the Benton Visual Retention Test. Performance on tests of frontal lobe functions, such as executive function and verbal fluency, showed no significant deterioration. CONCLUSIONS Overall cognitive performance, including functions widely thought to depend on the frontal lobe, is stable after a frontal or prefrontal lobectomy to treat frontal lobe epilepsy.
Collapse
Affiliation(s)
- Naoki Nitta
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Urushiyama 886, Aoi-ku, Shizuoka 420-8688, Japan; Department of Neurosurgery, Shiga University of Medical Science, Seta-Tsukinowa-Cho, Otsu, Shiga 520-2192, Japan.
| | - Naotaka Usui
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Urushiyama 886, Aoi-ku, Shizuoka 420-8688, Japan.
| | - Akihiko Kondo
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Urushiyama 886, Aoi-ku, Shizuoka 420-8688, Japan
| | - Takayasu Tottori
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Urushiyama 886, Aoi-ku, Shizuoka 420-8688, Japan.
| | - Kiyohito Terada
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Urushiyama 886, Aoi-ku, Shizuoka 420-8688, Japan.
| | - Yoshinobu Kasai
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Urushiyama 886, Aoi-ku, Shizuoka 420-8688, Japan.
| | - Yukitoshi Takahashi
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Urushiyama 886, Aoi-ku, Shizuoka 420-8688, Japan.
| | - Kazuhiko Nozaki
- Department of Neurosurgery, Shiga University of Medical Science, Seta-Tsukinowa-Cho, Otsu, Shiga 520-2192, Japan.
| | - Yushi Inoue
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Urushiyama 886, Aoi-ku, Shizuoka 420-8688, Japan.
| |
Collapse
|
8
|
Ferguson L, Miller M, Whiting A, Haut J, Klaas P, Bingaman W, Lachhwani D, Lineweaver TT, Floden D, Busch RM. Cognitive outcomes following frontal lobe resection for treatment of epilepsy in children and adolescents. Epilepsy Behav 2021; 124:108265. [PMID: 34509884 DOI: 10.1016/j.yebeh.2021.108265] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/06/2021] [Accepted: 08/08/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To use reliable change indices (RCIs) developed specifically for pediatric patients with epilepsy to examine cognitive outcomes after frontal lobe resection for pharmacoresistant epilepsy. METHODS Forty-one pediatric patients (25 male, Mage = 10 years) completed comprehensive neuropsychological evaluations before and an average of 6.5 months after frontal lobe resections for treatment of epilepsy. Evaluations included tests of intelligence, attention/working memory, processing speed, language, visuospatial skills, executive function, and episodic memory. Practice effect-adjusted RCIs were used to determine clinically significant postoperative cognitive change. Demographic, disease, and surgical variables were examined to identify factors associated with postoperative cognitive decline or improvement. RESULTS Within each cognitive domain, there was a large proportion of patients (51-84%) who did not exhibit significant cognitive change. In terms of overall cognitive profile, 44% demonstrated improvement in at least one domain and 69% declined in at least one domain. Postoperative cognitive improvement occurred most commonly in the domain of processing speed, whereas postoperative cognitive decline occurred most frequently in the domain of visuospatial skills. Younger age at surgery was associated with cognitive improvement. Older age at seizure onset and higher baseline cognitive performance were associated with cognitive decline. SIGNIFICANCE Approximately 6.5 months after frontal lobe resection, only 15% of our sample showed stable performance across all cognitive domains. Seventeen percent of patients showed improvements without declines, 42% showed declines without improvements, and 27% showed a mix of improvements and declines across different cognitive domains. Age and baseline abilities were associated with postoperative cognitive change on multiple measures. With 1 in 8 children demonstrating postoperative decline across three or more domains, further research is needed to identify factors associated with cognitive decline in order to inform clinical decision-making and patient/family counseling.
Collapse
Affiliation(s)
- Lisa Ferguson
- Epilepsy Center, Neurological Institute Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Margaret Miller
- Department of Neurology, Neurological Institute Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Alexander Whiting
- Department of Neurosurgery, Neurological Institute Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Jennifer Haut
- Department of Pediatrics, Psychology Section, Texas Children's Hospital, 6701 Fannin Street, Suite 1630, Houston, TX 77003, USA.
| | - Patricia Klaas
- Department of Neurology, Neurological Institute Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - William Bingaman
- Epilepsy Center, Neurological Institute Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Department of Neurosurgery, Neurological Institute Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Deepak Lachhwani
- Epilepsy Center, Neurological Institute Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Department of Neurology, Neurological Institute Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Tara T Lineweaver
- Department of Psychology, Butler University, 4600 Sunset Avenue, Indianapolis, IN 46208, USA.
| | - Darlene Floden
- Department of Neurology, Neurological Institute Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Center for Neurological Restoration, Neurological Institute Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Robyn M Busch
- Epilepsy Center, Neurological Institute Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Department of Neurology, Neurological Institute Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| |
Collapse
|
9
|
Ljunggren S, Winblad S, Hällgren Graneheim U, Malmgren K, Ozanne A. Experiences of emotional and psychosocial functioning after frontal lobe resection for epilepsy. Epilepsy Behav 2021; 121:108077. [PMID: 34087680 DOI: 10.1016/j.yebeh.2021.108077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/11/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Frontal lobe resection (FLR) is the second most common epilepsy surgery procedure in adults. Few studies address neuropsychological consequences after FLR. The aim of this study was to explore patients' and relatives' experiences of cognitive, emotional and social cognitive functioning after frontal lobe epilepsy surgery. METHODS Semi-structured interviews were held with 14 patients having gone through FLR as adults during the years 2000-2016 and 12 of their relatives. Interviews were audio-recorded, transcribed and analyzed with inductive qualitative content analysis. RESULTS Positive as well as negative consequences were described both by patients and relatives. Feelings of relief and an increased capacity to experience emotions of well-being were mainly experienced as related to seizure freedom. A newfound autonomy and a more grown-up identity as opposed to a self-image based on epilepsy was also highlighted. However, results also showed that even for seizure free patients, FLR could give rise to negative experiences, the most prominent of which were mental fatigue, lowered mood and social withdrawal. Coping strategies included planning ahead to avoid mental exhaustion. Over all, respondents considered that the epilepsy surgery had been a risk well worth taking and that positive consequences outweighed the negative ones. CONCLUSIONS This study shows a range of positive as well as negative outcomes after FLR for epilepsy. The findings indicate that lowered mood and mental fatigue could affect the life situation in a negative way, regardless of seizure outcome. This is important to consider in the preoperative counselling of patients and their families, as well as in the postsurgical follow-up. It is also crucial that the epilepsy surgery team has the possibility to offer rehabilitation and support to families regarding these aspects after surgery.
Collapse
Affiliation(s)
- Sofia Ljunggren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Blå Stråket 7, SE-413 45 Göteborg, Sweden; Department of Neurology, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden.
| | - Stefan Winblad
- Department of Psychology, Gothenburg University, Box 500, SE-405 30 Göteborg, Sweden.
| | - Ulla Hällgren Graneheim
- Department of Health Care Sciences, University West, SE-461 32 Trollhättan, Sweden; Department of Nursing, Umeå University, SE-901 87 Umeå, Sweden.
| | - Kristina Malmgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Blå Stråket 7, SE-413 45 Göteborg, Sweden; Department of Neurology, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden.
| | - Anneli Ozanne
- Department of Neurology, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, SE-413 45 Göteborg, Sweden.
| |
Collapse
|
10
|
Jehi L, Braun K. Does etiology really matter for epilepsy surgery outcome? Brain Pathol 2021; 31:e12965. [PMID: 34196987 PMCID: PMC8412085 DOI: 10.1111/bpa.12965] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 04/01/2021] [Indexed: 12/17/2022] Open
Abstract
Multiple factors influence the outcomes of epilepsy surgery. Prognostic indicators varying from clinical characteristics, imaging findings, ictal, and interictal electrophysiological activity have been linked to surgical outcomes. In this review, we focus on the relatively under‐studied role of the underlying epilepsy histopathology in driving post‐surgical outcomes, specifically focusing on the broad categories of seizure outcomes and cognitive outcomes. For each of these two outcomes of interest, we answer two questions: 1)‐ does etiology matter? and 2)‐ how could it matter? The goal is to review the existing literature on the relationship between etiology and surgical outcomes to provide the best possible judgment as to whether a causal relationship exists between histopathology and the ultimate surgical outcome as an initial step. Then, we delve into the possible mechanisms via which such relationships can be explained. We conclude with a call to action to the epilepsy surgery and histopathology research community to push the mechanistic understanding of the pathology‐outcome interaction and identify actionable knowledge and biomarkers that could inform patient care in a timely fashion. In this review, we focus on the relatively under‐studied role of the underlying epilepsy histopathology in driving post‐surgical outcomes, specifically focusing on the broad categories of seizure outcomes and cognitive outcomes. For each of these two outcomes of interest, we answer two questions: (1) does etiology matter? and (2) how could it matter? We then delve into the mechanisms of these answers.
Collapse
Affiliation(s)
- Lara Jehi
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | - Kees Braun
- Dept. of Neurology & Neurosurgery, University Medical Center Utrecht, Utrecht University, the Netherlands
| |
Collapse
|
11
|
Whiting AC, Morita-Sherman M, Li M, Vegh D, Machado de Campos B, Cendes F, Wang X, Bingaman W, Jehi LE. Automated analysis of cortical volume loss predicts seizure outcomes after frontal lobectomy. Epilepsia 2021; 62:1074-1084. [PMID: 33756031 DOI: 10.1111/epi.16877] [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: 11/18/2020] [Revised: 03/03/2021] [Accepted: 03/03/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Patients undergoing frontal lobectomy demonstrate lower seizure-freedom rates than patients undergoing temporal lobectomy and several other resective interventions. We attempted to utilize automated preoperative quantitative analysis of focal and global cortical volume loss to develop predictive volumetric indicators of seizure outcome after frontal lobectomy. METHODS Ninety patients who underwent frontal lobectomy were stratified based on seizure freedom at a mean follow-up time of 3.5 (standard deviation [SD] 2.5) years. Automated quantitative analysis of cortical volume loss organized by distinct brain region and laterality was performed on preoperative T1-weighted magnetic resonance imaging (MRI) studies. Univariate statistical analysis was used to select potential predictors of seizure freedom. Backward variable selection and multivariate logistical regression were used to develop models to predict seizure freedom. RESULTS Forty-eight of 90 (53.3%) patients were seizure-free at the last follow-up. Several frontal and extrafrontal brain regions demonstrated statistically significant differences in both volumetric cortical volume loss and volumetric asymmetry between the left and right sides in the seizure-free and non-seizure-free cohorts. A final multivariate logistic model utilizing only preoperative quantitative MRI data to predict seizure outcome was developed with a c-statistic of 0.846. Using both preoperative quantitative MRI data and previously validated clinical predictors of seizure outcomes, we developed a model with a c-statistic of 0.897. SIGNIFICANCE This study demonstrates that preoperative cortical volume loss in both frontal and extrafrontal regions can be predictive of seizure outcome after frontal lobectomy, and models can be developed with excellent predictive capabilities using preoperative MRI data. Automated quantitative MRI analysis can be quickly and reliably performed in patients with frontal lobe epilepsy, and further studies may be developed for integration into preoperative risk stratification.
Collapse
Affiliation(s)
- Alexander C Whiting
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Manshi Li
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Deborah Vegh
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Fernando Cendes
- Department of Neurology, University of Campinas UNICAMP, Campinas, Brazil
| | - Xiaofeng Wang
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - William Bingaman
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Lara E Jehi
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| |
Collapse
|
12
|
Abstract
Nearly 30% of epilepsy patients are refractory to medical therapy. Surgical management of epilepsy is an increasingly viable option for these patients. Although surgery has historically been used as a palliative option, improvements in technology and outcomes show its potential in certain subsets of patients. This article reviews the two main categories of surgical epilepsy treatment-resective surgery and neuromodulation. Resective surgery includes temporal lobe resections, extratemporal resections, laser interstitial thermal therapy, and disconnection procedures. We discuss the three main types of neuromodulation-vagal nerve stimulation, responsive neurostimulation, and deep brain stimulation for epilepsy. The history and indications are explored for each type of treatment. Given the myriad types of resection and neuromodulation techniques, patient selection is reviewed in detail, with a discussion on which patients are most likely to benefit from different treatment strategies. We also discuss outcomes with examples of the pertinent landmark trials and their results. Finally, complications and surgical technique are reviewed. As new indications emerge and patient selection is refined, surgical management will continue to evolve as an adjuvant therapy for epileptic patients.
Collapse
Affiliation(s)
- Shahjehan Ahmad
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Ryan Khanna
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Sepehr Sani
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| |
Collapse
|
13
|
Hirata S, Morino M, Nakae S, Matsumoto T. Surgical Technique and Outcome of Extensive Frontal Lobectomy for Treatment of Intracable Non-lesional Frontal Lobe Epilepsy. Neurol Med Chir (Tokyo) 2020; 60:17-25. [PMID: 31801933 PMCID: PMC6970070 DOI: 10.2176/nmc.oa.2018-0286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Although extensive frontal lobectomy (eFL) is a common surgical procedure for intractable frontal lobe epilepsy (FLE), there have been very few reports regarding surgical techniques for eFL. This article provides step-by-step descriptions of our surgical technique for non-lesional FLE. Sixteen patients undergoing eFL were included in this study. The goals were to maximize gray matter removal, including the orbital gyrus and subcallosal area, and to spare the primary motor and premotor cortexes and anterior perforated substance. The eFL consists of three steps: (1) positioning, craniotomy, and exposure; (2) lateral frontal lobe resection; and (3), resection of the rectus gyrus and orbital gyrus. Resection ahead of bregma allows preservation of motor and premotor area function. To remove the orbital gyrus preserving anterior perforated substance, it is essential to visualize the olfactory trigone beneath the pia. It is important to observe the surface of the contralateral medial frontal lobe for complete removal of the subcallosal area of the frontal lobe. Thirteen patients (81.25%) became seizure-free and three patients (18.75%) continued to have seizures. None of the patients showed any complications. The eFL is a good surgical technique for the treatment of intractable non-lesional FLE. For treatment of epilepsy by eFL, it is important to resect the non-eloquent area of the frontal lobe as much as possible with preservation of the eloquent cortex.
Collapse
|
14
|
Figueroa J, Morell A, Bowory V, Shah AH, Eichberg D, Buttrick SS, Richardson A, Sarkiss C, Ivan ME, Komotar RJ. Minimally invasive keyhole temporal lobectomy approach for supramaximal glioma resection: A safety and feasibility study. J Clin Neurosci 2020; 72:57-62. [PMID: 31948883 DOI: 10.1016/j.jocn.2020.01.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 01/05/2020] [Indexed: 10/25/2022]
Abstract
With a recent trend towards supra-maximal resection for gliomas and minimally invasive techniques, keyhole temporal lobectomies may serve an important role in neurosurgical oncology. Due to their location and proximity to eloquent brain, temporal lobe gliomas offer unique challenges that may limit the extent of resection. Here we describe a modified technique using mini-craniotomies through a keyhole approach for temporal lobectomies in glioma patients. We retrospectively reviewed data from consecutive patients who underwent temporal lobectomies for resection of gliomas from 2012 to 2018. Demographic data, extent of tumor resection, pre and post-op KPS, short term and long term complications, as well as other relevant data were collected. We identified 57 patients who underwent keyhole-mini craniotomy for temporal lobectomies for glioma. Surgical procedures were performed in 12 patients for low-grade glioma (LGG) and 45 patients for high-grade glioma (HGG). Awake craniotomies were performed in 15 of the cases, and 13 cases were for tumor recurrence. Supra-maximal resection (SMR) was achieved in 15 patients, while gross total resection (GTR) and near total resection (NTR) achieved in 32 patients and 10 patients, respectively. Average pre- and post-op KPS were equivalent, and post-operative complications requiring surgical intervention were experienced in 4 patients. Here we show that our modified keyhole craniotomy is both safe and effective in achieving SMR or GTR in glioma patients, with minimal morbidity. This minimally-invasive temporal lobectomy may be an instrumental tool for neurosurgical oncologists transitioning to less invasive techniques.
Collapse
Affiliation(s)
- Javier Figueroa
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States.
| | - Alexis Morell
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
| | - Veronica Bowory
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
| | - Ashish H Shah
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
| | - Daniel Eichberg
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
| | - Simon S Buttrick
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
| | - Angela Richardson
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
| | - Christopher Sarkiss
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
| | - Ricardo J Komotar
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
| |
Collapse
|
15
|
Balasubramani PP, Moreno-Bote R, Hayden BY. Using a Simple Neural Network to Delineate Some Principles of Distributed Economic Choice. Front Comput Neurosci 2018; 12:22. [PMID: 29643773 PMCID: PMC5882864 DOI: 10.3389/fncom.2018.00022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 03/12/2018] [Indexed: 01/03/2023] Open
Abstract
The brain uses a mixture of distributed and modular organization to perform computations and generate appropriate actions. While the principles under which the brain might perform computations using modular systems have been more amenable to modeling, the principles by which the brain might make choices using distributed principles have not been explored. Our goal in this perspective is to delineate some of those distributed principles using a neural network method and use its results as a lens through which to reconsider some previously published neurophysiological data. To allow for direct comparison with our own data, we trained the neural network to perform binary risky choices. We find that value correlates are ubiquitous and are always accompanied by non-value information, including spatial information (i.e., no pure value signals). Evaluation, comparison, and selection were not distinct processes; indeed, value signals even in the earliest stages contributed directly, albeit weakly, to action selection. There was no place, other than at the level of action selection, at which dimensions were fully integrated. No units were specialized for specific offers; rather, all units encoded the values of both offers in an anti-correlated format, thus contributing to comparison. Individual network layers corresponded to stages in a continuous rotation from input to output space rather than to functionally distinct modules. While our network is likely to not be a direct reflection of brain processes, we propose that these principles should serve as hypotheses to be tested and evaluated for future studies.
Collapse
Affiliation(s)
- Pragathi P. Balasubramani
- Brain and Cognitive Sciences, Center for Visual Science, Center for the Origins of Cognition, University of Rochester, Rochester, NY, United States
| | - Rubén Moreno-Bote
- Department of Information and Communications Technologies, Center for Brain and Cognition, University Pompeu Fabra, Barcelona, Spain
- Serra Húnter Fellow Programme, University Pompeu Fabra, Barcelona, Spain
| | - Benjamin Y. Hayden
- Neuroscience and Center for Magnetic Resonance Research, University of Minnesota, Minnesota, MN, United States
| |
Collapse
|