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Aljishi A, Sherman BE, Huberdeau DM, Obaid S, Khan K, Lamsam L, Zibly Z, Sivaraju A, Turk-Browne NB, Damisah EC. Statistical learning in epilepsy: Behavioral and anatomical mechanisms in the human brain. Epilepsia 2024; 65:753-765. [PMID: 38116686 PMCID: PMC10948305 DOI: 10.1111/epi.17871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/18/2023] [Accepted: 12/18/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVE Statistical learning, the fundamental cognitive ability of humans to extract regularities across experiences over time, engages the medial temporal lobe (MTL) in the healthy brain. This leads to the hypothesis that statistical learning (SL) may be impaired in patients with epilepsy (PWE) involving the temporal lobe, and that this impairment could contribute to their varied memory deficits. In turn, studies done in collaboration with PWE, that evaluate the necessity of MTL circuitry through disease and causal perturbations, provide an opportunity to advance basic understanding of SL. METHODS We implemented behavioral testing, volumetric analysis of the MTL substructures, and direct electrical brain stimulation to examine SL across a cohort of 61 PWE and 28 healthy controls. RESULTS We found that behavioral performance in an SL task was negatively associated with seizure frequency irrespective of seizure origin. The volume of hippocampal subfields CA1 and CA2/3 correlated with SL performance, suggesting a more specific role of the hippocampus. Transient direct electrical stimulation of the hippocampus disrupted SL. Furthermore, the relationship between SL and seizure frequency was selective, as behavioral performance in an episodic memory task was not impacted by seizure frequency. SIGNIFICANCE Overall, these results suggest that SL may be hippocampally dependent and that the SL task could serve as a clinically useful behavioral assay of seizure frequency that may complement existing approaches such as seizure diaries. Simple and short SL tasks may thus provide patient-centered endpoints for evaluating the efficacy of novel treatments in epilepsy.
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Affiliation(s)
- Ayman Aljishi
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
- Department of Psychology, Vanderbilt University, Nashville, TN, 37240, USA
| | - Brynn E. Sherman
- Department of Psychology, Yale University, New Haven, CT 06520, USA
| | | | - Sami Obaid
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Kamren Khan
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Layton Lamsam
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Zion Zibly
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Adithya Sivaraju
- Department of Neurology, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Nicholas B. Turk-Browne
- Department of Psychology, Yale University, New Haven, CT 06520, USA
- Wu Tsai Institute, Yale University, New Haven, CT, 06510, USA
| | - Eyiyemisi C. Damisah
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
- Wu Tsai Institute, Yale University, New Haven, CT, 06510, USA
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT 06510, USA
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Sarkis RA, Lam AD, Pavlova M, Locascio JJ, Putta S, Puri N, Pham J, Yih A, Marshall GA, Stickgold R. Epilepsy and sleep characteristics are associated with diminished 24-h memory retention in older adults with epilepsy. Epilepsia 2023; 64:2771-2780. [PMID: 37392445 PMCID: PMC10592425 DOI: 10.1111/epi.17707] [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: 05/16/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVE Individuals with epilepsy often have memory difficulties, and older adults with epilepsy are especially vulnerable, due to the additive effect of aging. The goal of this study was to assess factors that are associated with 24-h memory retention in older adults with epilepsy. METHODS Fifty-five adults with epilepsy, all aged >50 years, performed a declarative memory task involving the recall of the positions of 15 card pairs on a computer screen prior to a 24-h ambulatory electroencephalogram (EEG). We assessed the percentage of encoded card pairs that were correctly recalled after 24 h (24-h retention rate). EEGs were evaluated for the presence and frequency of scalp interictal epileptiform activity (IEA) and scored for total sleep. Global slow wave activity (SWA) power during non-rapid eye movement sleep was also calculated. RESULTS Forty-four participants successfully completed the memory task. Two were subsequently excluded due to seizures on EEG. The final cohort (n = 42) had a mean age of 64.3 ± 7.5 years, was 52% female, and had an average 24-h retention rate of 70.9% ± 30.2%. Predictors of 24-h retention based on multivariate regression analysis when controlling for age, sex, and education included number of antiseizure medications (β = -.20, p = .013), IEA frequency (β = -.08, p = .0094), and SWA power (β = +.002, p = .02). SIGNIFICANCE In older adults with epilepsy, greater frequency of IEA, reduced SWA power, and higher burden of antiseizure medications correlated with worse 24-h memory retention. These factors represent potential treatment targets to improve memory in older adults with epilepsy.
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Affiliation(s)
- Rani A Sarkis
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Alice D Lam
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Milena Pavlova
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Joseph J Locascio
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Swapna Putta
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Nirajan Puri
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jonathan Pham
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Alison Yih
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Gad A Marshall
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Robert Stickgold
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Wang G, Liu X, Zhang M, Wang K, Liu C, Chen Y, Wu W, Zhao H, Xiao B, Wan L, Long L. Structural and functional changes of the cerebellum in temporal lobe epilepsy. Front Neurol 2023; 14:1213224. [PMID: 37602268 PMCID: PMC10435757 DOI: 10.3389/fneur.2023.1213224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
Aims This study aimed to comprehensively explore the cerebellar structural and functional changes in temporal lobe epilepsy (TLE) and its association with clinical information. Methods The SUIT toolbox was utilized to perform cerebellar volume and diffusion analysis. In addition, we extracted the average diffusion values of cerebellar peduncle tracts to investigate microstructure alterations. Seed-based whole-brain analysis was used to investigate cerebellar-cerebral functional connectivity (FC). Subgroup analyses were performed to identify the cerebellar participation in TLE with/without hippocampal sclerosis (HS)/focal-to-bilateral tonic-clonic seizure (FBTCS) and TLE with different lateralization. Results TLE showed widespread gray matter atrophy in bilateral crusII, VIIb, VIIIb, left crusI, and left VIIIa. Both voxel and tract analysis observed diffusion abnormalities in cerebellar afferent peduncles. Reduced FC between the right crus II and the left parahippocampal cortex was found in TLE. Additionally, TLE showed increased FCs between left lobules VI-VIII and cortical nodes of the dorsal attention and visual networks. Across all patients, decreased FC was associated with poorer cognitive function, while increased FCs appeared to reflect compensatory effects. The cerebellar structural changes were mainly observed in HS and FBTCS subgroups and were regardless of seizure lateralization, while cerebellar-cerebral FC alterations were similar in all subgroups. Conclusion TLE exhibited microstructural changes in the cerebellum, mainly related to HS and FBTCS. In addition, altered cerebellar-cerebral functional connectivity is associated with common cognitive alterations in TLE.
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Affiliation(s)
- Ge Wang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Epileptic Disease of Hunan Province, Central South University, Changsha, China
| | - Xianghe Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Epileptic Disease of Hunan Province, Central South University, Changsha, China
| | - Min Zhang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Epileptic Disease of Hunan Province, Central South University, Changsha, China
| | - Kangrun Wang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Epileptic Disease of Hunan Province, Central South University, Changsha, China
| | - Chaorong Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Epileptic Disease of Hunan Province, Central South University, Changsha, China
| | - Yayu Chen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, China
| | - Wenyue Wu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Haiting Zhao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Epileptic Disease of Hunan Province, Central South University, Changsha, China
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Epileptic Disease of Hunan Province, Central South University, Changsha, China
| | - Lily Wan
- Department of Anatomy and Neurobiology, Central South University Xiangya Medical School, Changsha, Hunan, China
| | - Lili Long
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Epileptic Disease of Hunan Province, Central South University, Changsha, China
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Gouilly D, Salabert AS, Bertrand E, Goubeaud M, Catala H, Germain J, Ainaoui N, Rafiq M, Benaiteau M, Carlier J, Nogueira L, Planton M, Hitzel A, Méligne D, Sarton B, Silva S, Lemesle B, Payoux P, Thalamas C, Péran P, Pariente J. Clinical heterogeneity of neuro-inflammatory PET profiles in early Alzheimer's disease. Front Neurol 2023; 14:1189278. [PMID: 37588670 PMCID: PMC10425281 DOI: 10.3389/fneur.2023.1189278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 07/17/2023] [Indexed: 08/18/2023] Open
Abstract
The relationship between neuroinflammation and cognition remains uncertain in early Alzheimer's disease (AD). We performed a cross-sectional study to assess how neuroinflammation is related to cognition using TSPO PET imaging and a multi-domain neuropsychological assessment. A standard uptake value ratio (SUVR) analysis was performed to measure [18F]-DPA-714 binding using the cerebellar cortex or the whole brain as a (pseudo)reference region. Among 29 patients with early AD, the pattern of neuroinflammation was heterogeneous and exhibited no correlation with cognition at voxel-wise, regional or whole-brain level. The distribution of the SUVR values was independent of sex, APOE phenotype, early and late onset of symptoms and the presence of cerebral amyloid angiopathy. However, we were able to demonstrate a complex dissociation as some patients with similar PET pattern had opposed neuropsychological profiles while other patients with opposite PET profiles had similar neuropsychological presentation. Further studies are needed to explore how this heterogeneity impacts disease progression.
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Affiliation(s)
- Dominique Gouilly
- Toulouse Neuroimaging Center, UMR 1214, Inserm/UPS, Toulouse, France
| | - Anne-Sophie Salabert
- Toulouse Neuroimaging Center, UMR 1214, Inserm/UPS, Toulouse, France
- Department of Nuclear Medicine, Toulouse Purpan University Hospital Center, Toulouse, France
| | - Elsa Bertrand
- Center of Clinical Investigation (CIC 1436), Toulouse Purpan University Hospital Center, Toulouse, France
| | - Marie Goubeaud
- Center of Clinical Investigation (CIC 1436), Toulouse Purpan University Hospital Center, Toulouse, France
| | - Hélène Catala
- Center of Clinical Investigation (CIC 1436), Toulouse Purpan University Hospital Center, Toulouse, France
| | - Johanne Germain
- Center of Clinical Investigation (CIC 1436), Toulouse Purpan University Hospital Center, Toulouse, France
| | - Nadéra Ainaoui
- Center of Clinical Investigation (CIC 1436), Toulouse Purpan University Hospital Center, Toulouse, France
| | - Marie Rafiq
- Toulouse Neuroimaging Center, UMR 1214, Inserm/UPS, Toulouse, France
- Department of Cognitive Neurology, Epilepsy and Movement Disorders, Toulouse Purpan University Hospital Center, Toulouse, France
| | - Marie Benaiteau
- Department of Cognitive Neurology, Epilepsy and Movement Disorders, Toulouse Purpan University Hospital Center, Toulouse, France
| | - Jasmine Carlier
- Department of Cognitive Neurology, Epilepsy and Movement Disorders, Toulouse Purpan University Hospital Center, Toulouse, France
| | - Leonor Nogueira
- Laboratory of Cell Biology and Cytology, Toulouse Purpan University Hospital Center, Toulouse, France
| | - Mélanie Planton
- Toulouse Neuroimaging Center, UMR 1214, Inserm/UPS, Toulouse, France
- Department of Cognitive Neurology, Epilepsy and Movement Disorders, Toulouse Purpan University Hospital Center, Toulouse, France
| | - Anne Hitzel
- Department of Nuclear Medicine, Toulouse Purpan University Hospital Center, Toulouse, France
| | - Déborah Méligne
- Toulouse Neuroimaging Center, UMR 1214, Inserm/UPS, Toulouse, France
| | - Benjamine Sarton
- Toulouse Neuroimaging Center, UMR 1214, Inserm/UPS, Toulouse, France
- Critical Care Unit, Toulouse Purpan University Hospital Center, Toulouse, France
| | - Stein Silva
- Toulouse Neuroimaging Center, UMR 1214, Inserm/UPS, Toulouse, France
- Critical Care Unit, Toulouse Purpan University Hospital Center, Toulouse, France
| | - Béatrice Lemesle
- Department of Cognitive Neurology, Epilepsy and Movement Disorders, Toulouse Purpan University Hospital Center, Toulouse, France
| | - Pierre Payoux
- Toulouse Neuroimaging Center, UMR 1214, Inserm/UPS, Toulouse, France
- Department of Nuclear Medicine, Toulouse Purpan University Hospital Center, Toulouse, France
| | - Claire Thalamas
- Center of Clinical Investigation (CIC 1436), Toulouse Purpan University Hospital Center, Toulouse, France
| | - Patrice Péran
- Toulouse Neuroimaging Center, UMR 1214, Inserm/UPS, Toulouse, France
| | - Jérémie Pariente
- Toulouse Neuroimaging Center, UMR 1214, Inserm/UPS, Toulouse, France
- Center of Clinical Investigation (CIC 1436), Toulouse Purpan University Hospital Center, Toulouse, France
- Department of Cognitive Neurology, Epilepsy and Movement Disorders, Toulouse Purpan University Hospital Center, Toulouse, France
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Aljishi A, Sherman BE, Huberdeau DM, Obaid S, Sivaraju A, Turk-Browne NB, Damisah EC. Statistical learning in epilepsy: Behavioral, anatomical, and causal mechanisms in the human brain. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.04.25.538321. [PMID: 37162937 PMCID: PMC10168289 DOI: 10.1101/2023.04.25.538321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Statistical learning, the fundamental cognitive ability of humans to extract regularities across experiences over time, engages the medial temporal lobe in the healthy brain. This leads to the hypothesis that statistical learning may be impaired in epilepsy patients, and that this impairment could contribute to their varied memory deficits. In turn, epilepsy patients provide a platform to advance basic understanding of statistical learning by helping to evaluate the necessity of medial temporal lobe circuitry through disease and causal perturbations. We implemented behavioral testing, volumetric analysis of the medial temporal lobe substructures, and direct electrical brain stimulation to examine statistical learning across a cohort of 61 epilepsy patients and 28 healthy controls. Behavioral performance in a statistical learning task was negatively associated with seizure frequency, irrespective of where seizures originated in the brain. The volume of hippocampal subfields CA1 and CA2/3 correlated with statistical learning performance, suggesting a more specific role of the hippocampus. Indeed, transient direct electrical stimulation of the hippocampus disrupted statistical learning. Furthermore, the relationship between statistical learning and seizure frequency was selective: behavioral performance in an episodic memory task was impacted by structural lesions in the medial temporal lobe and by antiseizure medications, but not by seizure frequency. Overall, these results suggest that statistical learning may be hippocampally dependent and that this task could serve as a clinically useful behavioral assay of seizure frequency distinct from existing neuropsychological tests. Simple and short statistical learning tasks may thus provide patient-centered endpoints for evaluating the efficacy of novel treatments in epilepsy.
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Affiliation(s)
- Ayman Aljishi
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Brynn E. Sherman
- Department of Psychology, Yale University, New Haven, CT 06520, USA
| | | | - Sami Obaid
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Adithya Sivaraju
- Department of Neurology, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Nicholas B. Turk-Browne
- Department of Psychology, Yale University, New Haven, CT 06520, USA
- Wu Tsai Institute, Yale University, New Haven, CT, 06510, USA
| | - Eyiyemisi C. Damisah
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
- Wu Tsai Institute, Yale University, New Haven, CT, 06510, USA
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT 06510, USA
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6
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Steimel SA, Meisenhelter S, Quon RJ, Camp EJ, Tom R, Bujarski KA, Testorf ME, Song Y, Roth RM, Jobst BC. Accelerated long-term forgetting of recall and recognition memory in people with epilepsy. Epilepsy Behav 2023; 141:109152. [PMID: 36893721 DOI: 10.1016/j.yebeh.2023.109152] [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: 09/18/2022] [Revised: 02/17/2023] [Accepted: 02/19/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE Persons with epilepsy (PWE) report memory deficits as one of the most distressing aspects of their disorder. Recently, a long-term memory deficit known as Accelerated Long-Term Forgetting (ALF) has been described in PWE. ALF is characterized by the initial retention of learned information, followed by an accelerated rate of memory decay. However, the rate of ALF varies widely across literature and it is unclear how it impacts different memory retrieval types. The current study aimed to capture the time course of ALF on both free recall and recognition memory using a movie-based task in PWE. METHODS A sample of 30 PWE and 30 healthy comparison (HC) subjects watched a nature documentary and were tested on their recall and recognition of the film's content immediately after viewing and at delays of 24 hours, 48 hours, and 72 hours. Participants also rated the confidence they had in their recognition memory trial responses. RESULTS For recall, PWE exhibit ALF at 72 hours (β = -19.840, SE = 3.743, z(226) = -5.301, p < 0.001). For recognition, PWE had decreased performance compared to controls at the 24-hour (β = -10.165, SE = 4.174, z(224) = -3.166, p = 0.004), 48-hour (β = -8.113, SE = 3.701, z(224) = -2.195, p = 0.044), and 72-hour (β = -10.794, SE = 3.017, z(224) = -3.295, p = 0.003) delays. The PWE group showed positive correlations (tau = 0.165, p < 0.001) between confidence ratings and accuracy, with higher confidence reflecting successful recognition. PWE were 49% less likely to answer either retrieval type correctly at 72 hours (OR 0.51, 95% CI [0.35, 0.74], p < 0.001). Left hemispheric seizure onset decreased the odds of successful retrieval by 88% (OR 0.12, 95% CI [0.01, 0.42], p = 0.019). CONCLUSIONS These findings provide evidence of ALF in PWE, with a differential impact on recall and recognition memory. This further supports the call to include ALF assessments in standard memory evaluations in PWE. Additionally, identifying the neural correlates of ALF in the future will be important in developing targeted therapies to alleviate the burden of memory impairment for PWE.
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Affiliation(s)
- Sarah A Steimel
- Dartmouth College Geisel School of Medicine, 1 Rope Ferry Rd, Hanover, NH 03755, USA.
| | - Stephen Meisenhelter
- Department of Neurology, Dartmouth Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH 03766, USA.
| | - Robert J Quon
- Dartmouth College Geisel School of Medicine, 1 Rope Ferry Rd, Hanover, NH 03755, USA
| | - Edward J Camp
- Department of Neurology, Dartmouth Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH 03766, USA
| | - Rebecca Tom
- Dartmouth College Geisel School of Medicine, 1 Rope Ferry Rd, Hanover, NH 03755, USA
| | - Krzysztof A Bujarski
- Dartmouth College Geisel School of Medicine, 1 Rope Ferry Rd, Hanover, NH 03755, USA; Department of Neurology, Dartmouth Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH 03766, USA.
| | - Markus E Testorf
- Thayer School of Engineering at Dartmouth College, 15 Thayer Dr, Hanover, NH 03755, USA.
| | - Yinchen Song
- Dartmouth College Geisel School of Medicine, 1 Rope Ferry Rd, Hanover, NH 03755, USA; Department of Neurology, Dartmouth Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH 03766, USA.
| | - Robert M Roth
- Dartmouth College Geisel School of Medicine, 1 Rope Ferry Rd, Hanover, NH 03755, USA; Neuropsychology Program, Department of Psychiatry, Dartmouth Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH 03766, USA.
| | - Barbara C Jobst
- Dartmouth College Geisel School of Medicine, 1 Rope Ferry Rd, Hanover, NH 03755, USA; Department of Neurology, Dartmouth Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH 03766, USA.
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Sarkis R. Memories in Persons with Epilepsy: They Are More Fragile Than You Think. Epilepsy Curr 2022; 22:282-284. [PMID: 36285204 PMCID: PMC9549231 DOI: 10.1177/15357597221108026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
“Hidden Objective Memory Deficits Behind Subjective Memory Complaints in
Patients with Temporal Lobe Epilepsy” Lemesle B, Barbeau EJ, Milongo Rigal E, Denuelle M, Valton L, Pariente J, Curot J.
Neurology. 2022 Feb 22;98(8):e818-e828. doi: 10.1212/WNL.0000000000013212. Epub 2021 Dec 14. PMID: 34906979. “Background and objectives: The aim of this work was to test the hypothesis that patients with temporal lobe
epilepsy (TLE) with subjective initial memory complaints (not confirmed by an
objective standard assessment) and various phenotypes also show objective very
long-term memory deficit with accelerated long-term forgetting. We tested patients
with TLE with 2 surprise memory tests after 3 weeks: the standard Free and Cued
Selective Reminding Test (FCSRT) and Epireal, a new test specifically designed to
capture more ecologic aspects of autobiographical memory. Methods: Forty-seven patients with TLE (12 with hippocampal sclerosis, 12 with amygdala
enlargement, 11 with extensive lesions, 12 with normal MRI) who complained about
their memory, but for whom the standard neuropsychological assessment did not reveal
any memory impairment after a standard delay of 20 minutes, underwent 2 surprise
memory tests after 3 weeks. They were compared to 35 healthy controls. Results: After 3 weeks, FCSRT and Epireal recall scores were significantly lower in patients
than in controls (P < .001). There was no significant
correlation between FCSRT and Epireal scores (P = .99). Seventy-six
percent of patients with TLE had objective impairment on at least 1 of these very
long-term memory tests, regardless of the existence and type of lesion or response
to antiseizure medication. Easily applicable, Epireal had a higher effect size,
detected deficits in 28% more patients, and is a useful addition to the standard
workup. Discussion: Assessing long-term memory should be broadened to a wide spectrum of patients with
TLE with a memory complaint, regardless of the epileptic syndrome, regardless of
whether it is associated with a lesion. This could lead to rethinking TLE nosology
associated with memory.”
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Affiliation(s)
- Rani Sarkis
- Brigham and Women's Hospital, Boston, MA, USA
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