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Ailion A, Duong P, Maiman M, Tsuboyama M, Smith ML. Clinical recommendations for conducting pediatric functional language and memory mapping during the phase I epilepsy presurgical workup. Clin Neuropsychol 2024; 38:1060-1084. [PMID: 37985747 DOI: 10.1080/13854046.2023.2281708] [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: 08/31/2023] [Accepted: 11/02/2023] [Indexed: 11/22/2023]
Abstract
Objective: Pediatric epilepsy surgery effectively controls seizures but may risk cognitive, language, or memory decline. Historically, the intra-carotid anesthetic procedure (IAP or Wada Test) was pivotal for language and memory function. However, advancements in noninvasive mapping, notably functional magnetic resonance imaging (fMRI), have transformed clinical practice, reducing IAP's role in presurgical evaluations. Method: We conducted a critical narrative review on mapping technologies, including factors to consider for discordance. Results: Neuropsychological findings suggest that if pre-surgery function remains intact and the surgery targets the eloquent cortex, there is a high chance for decline. Memory and language decline are particularly pronounced post-left anterior temporal lobe resection (ATL), making presurgical cognitive assessment crucial for predicting postoperative outcomes. However, the risk of functional decline is not always clear - particularly with higher rates of atypical organization in pediatric epilepsy patients and discordant findings from cognitive mapping. We found little research to date on the use of IAP and other newer technologies for lateralization/localization in pediatric epilepsy. Based on this review, we introduce an IAP decision tree to systematically navigate discordance in IAP decisions for epilepsy presurgical workup. Conclusions: Future research should be aimed at pediatric populations to improve the precision of functional mapping, determine which methods predict post-surgical deficits and then create evidence-based practice guidelines to standardize mapping procedures. Explicit directives are needed for resolving conflicts between developing mapping procedures and established clinical measures. The proposed decision tree is the first step to standardize when to consider IAP or invasive mapping, in coordination with the multidisciplinary epilepsy surgical team.
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Affiliation(s)
- Alyssa Ailion
- Department of Psychiatry, Boston Children's Hospital, Harvard Medical School
- Department of Neurology, Boston Children's Hospital, Harvard Medical School
| | - Priscilla Duong
- Department of Psychiatry, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University School of Medicine
| | - Moshe Maiman
- Department of Psychiatry, Boston Children's Hospital, Harvard Medical School
| | - Melissa Tsuboyama
- Department of Neurology, Boston Children's Hospital, Harvard Medical School
| | - Mary Lou Smith
- Department of Psychology, The Hospital for Sick Children, University of Toronto Mississauga
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Koizumi K, Kunii N, Ueda K, Takabatake K, Nagata K, Fujitani S, Shimada S, Nakao M. Intracranial Neurofeedback Modulating Neural Activity in the Mesial Temporal Lobe During Memory Encoding: A Pilot Study. Appl Psychophysiol Biofeedback 2023; 48:439-451. [PMID: 37405548 PMCID: PMC10581957 DOI: 10.1007/s10484-023-09595-1] [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] [Accepted: 06/24/2023] [Indexed: 07/06/2023]
Abstract
Removal of the mesial temporal lobe (MTL) is an established surgical procedure that leads to seizure freedom in patients with intractable MTL epilepsy; however, it carries the potential risk of memory damage. Neurofeedback (NF), which regulates brain function by converting brain activity into perceptible information and providing feedback, has attracted considerable attention in recent years for its potential as a novel complementary treatment for many neurological disorders. However, no research has attempted to artificially reorganize memory functions by applying NF before resective surgery to preserve memory functions. Thus, this study aimed (1) to construct a memory NF system that used intracranial electrodes to feedback neural activity on the language-dominant side of the MTL during memory encoding and (2) to verify whether neural activity and memory function in the MTL change with NF training. Two intractable epilepsy patients with implanted intracranial electrodes underwent at least five sessions of memory NF training to increase the theta power in the MTL. There was an increase in theta power and a decrease in fast beta and gamma powers in one of the patients in the late stage of memory NF sessions. NF signals were not correlated with memory function. Despite its limitations as a pilot study, to our best knowledge, this study is the first to report that intracranial NF may modulate neural activity in the MTL, which is involved in memory encoding. The findings provide important insights into the future development of NF systems for the artificial reorganization of memory functions.
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Affiliation(s)
- Koji Koizumi
- Department of Mechanical Engineering, Graduate School of Engineering, The University of Tokyo, Tokyo, Japan.
| | - Naoto Kunii
- Department of Neurosurgery, The University of Tokyo, Tokyo, Japan
| | - Kazutaka Ueda
- Department of Mechanical Engineering, Graduate School of Engineering, The University of Tokyo, Tokyo, Japan
| | | | - Keisuke Nagata
- Department of Neurosurgery, The University of Tokyo, Tokyo, Japan
| | - Shigeta Fujitani
- Department of Neurosurgery, The University of Tokyo, Tokyo, Japan
| | - Seijiro Shimada
- Department of Neurosurgery, The University of Tokyo, Tokyo, Japan
| | - Masayuki Nakao
- Department of Mechanical Engineering, Graduate School of Engineering, The University of Tokyo, Tokyo, Japan
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Castro‐Lima H, Passarelli V, Ribeiro ES, Adda CC, Preturlon‐Santos APP, Jorge CL, Valério R, Tzu WH, Boa‐Sorte N, Pipek LZ, Castro LHM. Bilateral ictal EEG is associated with better memory outcome after hippocampal sclerosis surgery. Epilepsia Open 2023; 8:1532-1540. [PMID: 37750472 PMCID: PMC10690677 DOI: 10.1002/epi4.12834] [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: 01/18/2023] [Accepted: 09/17/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVE To compare memory outcomes after surgery for unilateral hippocampal sclerosis (HS)-associated epilepsy in patients with unilateral and bilateral ictal electrographic involvement. METHODS We prospectively evaluated HS patients, aged 18-55 years and IQ ≥70. Left (L) and right (R) surgical groups underwent noninvasive video-EEG monitoring and Wada test. We classified patients as Ipsilateral if ictal EEG was restricted to the HS side, or Bilateral, if at least one seizure onset occurred contralaterally to the HS, or if ictal discharge evolved to the opposite temporal region. Patients who declined surgery served as controls. Memory was evaluated on two occasions with Rey Auditory-Verbal Learning Test and Rey Visual-Design Learning Test. Baseline neuropsychological test scores were compared between groups. Pre- and postoperative scores were compared within each group. Reliable change index Z-scores (RCI) were obtained using controls as references, and compared between surgical groups. RESULTS We evaluated 64 patients. Patients were classified as: L-Ipsilateral (9), L-Bilateral (15), L-Control (9), R-Ipsilateral (10), R-Bilateral (9), and R-Control (12). On preoperative evaluation, memory performance did not differ among surgical groups. Right HS patients did not present postoperative memory decline. L-Ipsilateral group presented postoperative decline on immediate (P = 0.036) and delayed verbal recall (P = 0.011), while L-Bilateral did not decline. L-Ipsilateral had lower RCI Z-scores, indicating delayed verbal memory decline compared to L-Bilateral (P = 0.012). SIGNIFICANCE Dominant HS patients with bilateral ictal involvement presented less pronounced postoperative verbal memory decline compared to patients with exclusive ipsilateral ictal activity. Surgery was indicated in these patients regardless of memory impairment on neuropsychological testing, since resection of the left sclerotic hippocampus could result in cessation of contralateral epileptiform activity, and, therefore, improved memory function.
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Affiliation(s)
| | - Valmir Passarelli
- Department of Neurology, Hospital das Clínicas HCFMUSP, Faculdade de MedicinaUniversity of Sao PauloSão PauloBrazil
| | - Elyse S Ribeiro
- Division of Psychology, Hospital das Clínicas HCFMUSP, Faculdade de MedicinaUniversity of Sao PauloSão PauloBrazil
| | - Carla C Adda
- Division of Psychology, Hospital das Clínicas HCFMUSP, Faculdade de MedicinaUniversity of Sao PauloSão PauloBrazil
| | - Ana Paula P Preturlon‐Santos
- Department of Neurology, Hospital das Clínicas HCFMUSP, Faculdade de MedicinaUniversity of Sao PauloSão PauloBrazil
| | - Carmen L Jorge
- Department of Neurology, Hospital das Clínicas HCFMUSP, Faculdade de MedicinaUniversity of Sao PauloSão PauloBrazil
| | - Rosa Valério
- Department of Neurology, Hospital das Clínicas HCFMUSP, Faculdade de MedicinaUniversity of Sao PauloSão PauloBrazil
| | - Wen Hung Tzu
- Department of Neurosurgery, Hospital das Clínicas HCFMUSP, Faculdade de MedicinaUniversity of Sao PauloSão PauloBrazil
| | - Ney Boa‐Sorte
- Bahiana School of Medicine and Public HealthSalvadorBrazil
| | - Leonardo Zumerkorn Pipek
- Department of Neurology, Hospital das Clínicas HCFMUSP, Faculdade de MedicinaUniversity of Sao PauloSão PauloBrazil
| | - Luiz Henrique M Castro
- Department of Neurology, Hospital das Clínicas HCFMUSP, Faculdade de MedicinaUniversity of Sao PauloSão PauloBrazil
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Kochi R, Osawa SI, Jin K, Ishida M, Kanno A, Iwasaki M, Suzuki K, Kawashima R, Tominaga T, Nakasato N. Language MEG predicts postoperative verbal memory change in left mesial temporal lobe epilepsy. Clin Neurophysiol 2023; 156:69-75. [PMID: 37890232 DOI: 10.1016/j.clinph.2023.09.010] [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: 08/28/2023] [Accepted: 09/05/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVE To clarify whether preoperative language magnetoencephalography (MEG) predicts postoperative verbal memory (VM) changes in left mesial temporal lobe epilepsy (LMTLE). METHODS We reviewed 18 right-handed patients with LMTLE who underwent anterior temporal lobectomy or selective amygdala hippocampectomy, 12 with (HS+) and 6 without hippocampal sclerosis (HS-). Patients underwent neuropsychological assessment before and after surgery. MEG was measured with an auditory verbal learning task in patients preoperatively and in 15 right-handed controls. Dynamic statistical parametric mapping (dSPM) was used for source imaging of task-related activity. Language laterality index (LI) was calculated by z-score of dSPM in language-related regions. LI in the region of HS+ and HS- was compared to controls. The correlation between LI and postoperative VM change was assessed in HS+ and HS-. RESULTS Preoperative LI in supramarginal gyrus showed greater right-shifted lateralization in both HS+ and HS- than in controls. Right-shifted LI in supramarginal gyrus was correlated with postoperative VM increase in HS+ (p = 0.019), but not in HS-. CONCLUSIONS Right-shifted language lateralization in dSPM of MEG signals may predict favorable VM outcome in HS+ of LMTLE. SIGNIFICANCE Findings warrant further investigation of the relation between regional language laterality index and postoperative verbal memory changes.
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Affiliation(s)
- Ryuzaburo Kochi
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Shin-Ichiro Osawa
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kazutaka Jin
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
| | - Makoto Ishida
- Department of Advanced Spintronics Medical Engineering, Tohoku University Graduate School of Engineering, Sendai, Miyagi, Japan
| | - Akitake Kanno
- Department of Advanced Spintronics Medical Engineering, Tohoku University Graduate School of Engineering, Sendai, Miyagi, Japan
| | - Masaki Iwasaki
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Kyoko Suzuki
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Ryuta Kawashima
- Department of Functional Brain Imaging, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Nobukazu Nakasato
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; Department of Advanced Spintronics Medical Engineering, Tohoku University Graduate School of Engineering, Sendai, Miyagi, Japan
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O’Donnell CM, Anderson CT, Oleksy AJ, Swanson SJ. A Comparison of Neuropsychological Outcomes following Responsive Neurostimulation and Anterior Temporal Lobectomy in Drug-Resistant Epilepsy. Brain Sci 2023; 13:1628. [PMID: 38137076 PMCID: PMC10741568 DOI: 10.3390/brainsci13121628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 11/20/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
Neuropsychological outcomes following temporal lobe resection for drug-resistant epilepsy (DRE) are well established. For instance, left anterior temporal lobectomy (LATL) is associated with a greater risk for cognitive morbidity compared to right (RATL). However, the impact of neuromodulatory devices, specifically responsive neurostimulation (RNS), remains an area of active interest. There are currently no head-to-head comparisons of neuropsychological outcomes after surgical resection and neuromodulation. This study reports on a cohort of 21 DRE patients with the RNS System who received comprehensive pre- and post-implantation neuropsychological testing. We compared both cognitive and seizure outcomes in the RNS group to those of 307 DRE patients who underwent LATL (n = 138) or RATL (n = 169). RNS patients had higher seizure rates pre-intervention. While fewer in the RNS group achieved Class I Engel outcomes compared to the ATL cohorts, RNS patients also showed seizure frequency declines from pre- to post-intervention that were similar to those who underwent resective surgery. Moreover, the RNS and RATL groups were similar in their neuropsychological outcomes, showing no significant cognitive decline post-intervention. In contrast, the LATL group notably declined in object naming and verbal list learning. Direct comparisons like this study may be used to guide clinicians in shared decision making to tailor management plans for patients' overall treatment goals.
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Affiliation(s)
- Carly M. O’Donnell
- Department of Neurology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
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Mock N, Balzer C, Gutbrod K, Jäncke L, Wandel J, Bonati L, Trost W. Nonverbal memory tests revisited: Neuroanatomical correlates and differential influence of biasing cognitive functions. Cortex 2023; 164:63-76. [PMID: 37201378 DOI: 10.1016/j.cortex.2023.03.012] [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: 09/14/2022] [Revised: 02/01/2023] [Accepted: 03/31/2023] [Indexed: 05/20/2023]
Abstract
The detection of right temporal lobe dysfunction with nonverbal memory tests has remained difficult in the past. Reasons for this might be the potential influence of other biasing cognitive functions such as executive functions or the verbalisability of nonverbal material. The aim of this study was to investigate three classic nonverbal memory tests by identifying their neuroanatomical correlates with lesion-symptom mapping (LSM) and by probing their independence from verbal encoding abilities and executive functions. In a cohort of 119 patients with first-time cerebrovascular accident, memory performance was assessed in the Nonverbal Learning and Memory Test for Routes (NLMTR), the Rey Complex Figure Test (RCFT), and the Visual Design Learning Test (VDLT). Calculating multivariate LSM, we identified crucial brain structures for these three nonverbal memory tests. Behavioural analyses were performed to assess the impact of executive functions and verbal encoding abilities with regression analyses and likelihood-ratio tests. LSM revealed for the RCFT mainly right-hemispheric frontal, insular, subcortical, and white matter structures and for the NLMTR right-hemispheric temporal (hippocampus), insular, subcortical, and white matter structures. The VDLT did not reach significance in LSM analyses. Behavioural results showed that amongst the three nonverbal memory tests the impact of executive functions was most pronounced for RCFT, and the impact of verbal encoding abilities was most important in VDLT. Likelihood-ratio tests confirmed that only for NLMTR did the goodness of fit not significantly improve by adding executive functions or verbal encoding abilities. These results suggest that amongst the three nonverbal memory tests the NLMTR, as a spatial navigation test, could serve as the most suitable marker of right-hemispheric temporal lobe functioning, with the right hippocampus being involved only in this test. In addition, the behavioural results propose that only NLMTR seems mostly unaffected by executive functions and verbal encoding abilities.
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Affiliation(s)
- Nadia Mock
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland; Department of Psychology, University of Zurich, Zurich, Switzerland; Department of Neurology, Zurich University Hospital, Zurich, Switzerland.
| | | | - Klemens Gutbrod
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Neurozentrum Bern, Switzerland
| | - Lutz Jäncke
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Jasmin Wandel
- Institute for Optimisation and Data Analysis, Bern University of Applied Sciences, Switzerland
| | - Leo Bonati
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland; Department of Neurology, Department of Clinical Research, Basel University Hospital, Switzerland
| | - Wiebke Trost
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland
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Mock N, Balzer C, Gutbrod K, De Haan B, Jäncke L, Ettlin T, Trost W. Lesion-symptom mapping corroborates lateralization of verbal and nonverbal memory processes and identifies distributed brain networks responsible for memory dysfunction. Cortex 2022; 153:178-193. [DOI: 10.1016/j.cortex.2022.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 12/10/2021] [Accepted: 04/28/2022] [Indexed: 11/25/2022]
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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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The Impact of Right Temporal Lobe Epilepsy On Nonverbal Memory: Meta-regression of Stimulus- and Task-related Moderators. Neuropsychol Rev 2021; 32:537-557. [PMID: 34559363 DOI: 10.1007/s11065-021-09514-3] [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: 06/01/2020] [Accepted: 05/24/2021] [Indexed: 11/08/2022]
Abstract
Nonverbal memory tests have great potential value for detecting the impact of lateralized pathology and predicting the risk of memory loss following right temporal lobe resection (TLR) for temporal lobe epilepsy (TLE) patients, but this potential has not been realized. Previous reviews suggest that stimulus type moderates the capacity of nonverbal memory tests to detect right-lateralized pathology (i.e., faces > designs), but the roles of other task-related factors have not been systematically explored. We address these limitations using mixed model meta-regression (k = 158) of right-lateralization effects (right worse than left TLE) testing the moderating effects of: 1) stimulus type (designs, faces, spatial), 2) learning format (single trial, repeated trials), 3) testing delay (immediate or long delay), and 4) testing format (recall, recognition) for three patient scenarios: 1) presurgical, 2) postsurgical, and 3) postsurgical change. Stimulus type significantly moderated the size of the right-lateralization effect (faces > designs) for postsurgical patients, test format moderated the size of the right-lateralization effect for presurgical-postsurgical change (recognition > recall) but learning format and test delay had no right-lateralization effect for either sample. For presurgical patients, none of the task-related factors significantly increased right-lateralization effects. This comprehensive review reveals the value of recognition testing in gauging the risk of nonverbal memory decline.
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Alexandratou I, Patrikelis P, Messinis L, Alexoudi A, Verentzioti A, Stefanatou M, Nasios G, Panagiotopoulos V, Gatzonis S. Long-Term Neuropsychological Outcomes Following Temporal Lobe Epilepsy Surgery: An Update of the Literature. Healthcare (Basel) 2021; 9:healthcare9091156. [PMID: 34574930 PMCID: PMC8466433 DOI: 10.3390/healthcare9091156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 11/22/2022] Open
Abstract
We present an update of the literature concerning long-term neuropsychological outcomes following surgery for refractory temporal lobe epilepsy (TLE). A thorough search was conducted through the PubMed and Medline electronic databases for studies investigating neuropsychological function in adult patients undergoing resective TLE surgery and followed for a mean/median > five years period. Two independent reviewers screened citations for eligibility and assessed relevant studies for the risk of bias. We found eleven studies fulfilling the above requirements. Cognitive function remained stable through long-term follow up despite immediate post-surgery decline; a negative relation between seizure control and memory impairment has emerged and a possible role of more selective surgery procedures is highlighted.
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Affiliation(s)
- Ioanna Alexandratou
- Department of Neurology, Evangelismos Hospital, Ipsilantou 45-47, 10676 Athens, Greece
- Correspondence:
| | - Panayiotis Patrikelis
- First Department of Neurosurgery, School of Medicine, National and Kapodistrian University of Athens, 10676 Athens, Greece; (P.P.); (A.A.); (A.V.); (M.S.); (S.G.)
| | - Lambros Messinis
- Lab of Cognitive Neuroscience, Department of Psychology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
- Department of Psychiatry, University of Patras Medical School, 26504 Patras, Greece
| | - Athanasia Alexoudi
- First Department of Neurosurgery, School of Medicine, National and Kapodistrian University of Athens, 10676 Athens, Greece; (P.P.); (A.A.); (A.V.); (M.S.); (S.G.)
| | - Anastasia Verentzioti
- First Department of Neurosurgery, School of Medicine, National and Kapodistrian University of Athens, 10676 Athens, Greece; (P.P.); (A.A.); (A.V.); (M.S.); (S.G.)
| | - Maria Stefanatou
- First Department of Neurosurgery, School of Medicine, National and Kapodistrian University of Athens, 10676 Athens, Greece; (P.P.); (A.A.); (A.V.); (M.S.); (S.G.)
| | - Grigorios Nasios
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, 45500 Ioannina, Greece;
| | | | - Stylianos Gatzonis
- First Department of Neurosurgery, School of Medicine, National and Kapodistrian University of Athens, 10676 Athens, Greece; (P.P.); (A.A.); (A.V.); (M.S.); (S.G.)
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Busch RM, Hogue O, Miller M, Ferguson L, McAndrews MP, Hamberger M, Kim M, McDonald CR, Reyes A, Drane DL, Hermann BP, Bingaman W, Najm IM, Kattan MW, Jehi L. Nomograms to Predict Verbal Memory Decline After Temporal Lobe Resection in Adults With Epilepsy. Neurology 2021; 97:e263-e274. [PMID: 34011574 PMCID: PMC8302146 DOI: 10.1212/wnl.0000000000012221] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 04/14/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To develop and externally validate models to predict the probability of postoperative verbal memory decline in adults after temporal lobe resection (TLR) for epilepsy using easily accessible preoperative clinical predictors. METHODS Multivariable models were developed to predict delayed verbal memory outcome on 3 commonly used measures: Rey Auditory Verbal Learning Test (RAVLT) and Logical Memory (LM) and Verbal Paired Associates (VPA) subtests from Wechsler Memory Scale-Third Edition. With the use of the Harrell step-down procedure for variable selection, models were developed in 359 adults who underwent TLR at the Cleveland Clinic and validated in 290 adults at 1 of 5 epilepsy surgery centers in the United States or Canada. RESULTS Twenty-nine percent of the development cohort and 26% of the validation cohort demonstrated significant decline on at least 1 verbal memory measure. Initial models had good to excellent predictive accuracy (calibration [c] statistic range 0.77-0.80) in identifying patients with memory decline; however, models slightly underestimated decline in the validation cohort. Model coefficients were updated with data from both cohorts to improve stability. The model for RAVLT included surgery side, baseline memory score, and hippocampal resection. The models for LM and VPA included surgery side, baseline score, and education. Updated model performance was good to excellent (RAVLT c = 0.81, LM c = 0.76, VPA c = 0.78). Model calibration was very good, indicating no systematic overestimation or underestimation of risk. CONCLUSIONS Nomograms are provided in 2 easy-to-use formats to assist clinicians in estimating the probability of verbal memory decline in adults considering TLR for treatment of epilepsy. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that multivariable prediction models accurately predict verbal memory decline after TLR for epilepsy in adults.
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Affiliation(s)
- Robyn M Busch
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison.
| | - Olivia Hogue
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Margaret Miller
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Lisa Ferguson
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Mary Pat McAndrews
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Marla Hamberger
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Michelle Kim
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Carrie R McDonald
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Anny Reyes
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Daniel L Drane
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Bruce P Hermann
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - William Bingaman
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Imad M Najm
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Michael W Kattan
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Lara Jehi
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
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12
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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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13
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Miller M, Hogue O, Hogan T, Busch RM. Naming decline after epilepsy surgery is associated with subjective language complaints. Epilepsy Behav 2019; 99:106484. [PMID: 31477537 DOI: 10.1016/j.yebeh.2019.106484] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/05/2019] [Accepted: 08/05/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This retrospective, observational study investigated the relationship between objective naming decline and patient report of subjective decline in language functioning following epilepsy surgery. The role of depression in this relationship was also examined. METHODS A total of 429 adults with pharmacoresistant epilepsy completed the Boston Naming Test (BNT) and Memory Assessment Clinics Self-Rating Scale (MAC-S) before and after resective surgery. Multiple regression analyses were used to examine the relationship between objective naming decline and subjective language functioning, while controlling for the confounding effect of depression. RESULTS Individuals who experienced moderate to severe naming decline (≥11 raw points on BNT) following surgery reported a decline in subjective language functioning (p < .001) and endorsed problems with word-retrieval as well as more general semantic abilities. Those who experienced mild naming decline (5-10 raw points) also reported an increase in subjective language problems (p = .006). Complaints in this group were less severe than in those with more marked naming declines and were primarily related to word-retrieval. Both of these relationships remained significant after controlling for the confounding effect of depression (p < .005-.014). CONCLUSIONS Individuals with epilepsy who experience naming decline following surgery perceive these declines in their daily life, regardless of whether or not they are depressed. Findings support the utilization of risk models to predict naming outcome and the importance of counseling patients regarding the risk for naming decline following surgery.
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Affiliation(s)
- Margaret Miller
- Epilepsy Center, Neurological Institute Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Olivia Hogue
- Department of Quantitative Health Sciences, Lerner Research Institute Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Thomas Hogan
- Department of Neurology, Neurological Institute Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Robyn M Busch
- Epilepsy Center, Neurological Institute Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States; Department of Neurology, Neurological Institute Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States.
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14
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Sveikata L, Kavan N, Pegna AJ, Seeck M, Assal F, Momjian S, Schaller K, Vulliemoz S. Postoperative memory prognosis in temporal lobe epilepsy surgery: The contribution of postictal memory. Epilepsia 2019; 60:1639-1649. [PMID: 31329286 DOI: 10.1111/epi.16281] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/13/2019] [Accepted: 06/18/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The prediction of verbal memory decline after temporal lobe epilepsy (TLE) surgery remains difficult at an individual level. We evaluated the prognostic value of postictal memory testing in predicting the postoperative verbal memory function. METHODS Sixty-three consecutive patients were included in the analysis who underwent TLE surgery at our center with preoperative interictal/postictal and postoperative memory testing. Verbal memory was evaluated using the Rey Auditory Verbal Learning Test (RAVLT). We used reliable change indices with 90% confidence interval (90% RCIs) to evaluate a significant postoperative memory decline. The sensitivity (Sn), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), area under the curve (AUC), and accuracy (ACC) were calculated. The analysis was performed for all TLE patients and for the subgroup with hippocampal sclerosis (HS). RESULTS Left-TLE patients (n = 31) had lower verbal memory scores on RAVLT than right-TLE at 3 months (57% vs 78%) and 12 months (53% vs 78%) after surgery. The 90% RCI was estimated to be a loss of 4 out of 15 items. The predictive value was Sn = 42%, Sp = 84%, PPV = 39%, NPV = 86%, AUC = 0.630, and ACC = 76% to predict a verbal memory decline in the whole group (n = 63). In HS patients (n = 41), the postictal verbal memory test had Sn = 50%, Sp = 88%, PPV = 50%, NPV = 88%, AUC = 0.689, and ACC = 81% to predict a significant postoperative decline. SIGNIFICANCE Postictal memory is a noninvasive bedside memory test that can help predict the postoperative verbal memory decline in patients with HS with an overall accuracy of 81%.
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Affiliation(s)
- Lukas Sveikata
- Division of Neurology, Department of Clinical Neurosciences, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Nicole Kavan
- Neuropsychology Unit, Department of Clinical Neurosciences, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Alan J Pegna
- Neuropsychology Unit, Department of Clinical Neurosciences, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.,School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| | - Margitta Seeck
- Division of Neurology, Department of Clinical Neurosciences, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Frederic Assal
- Division of Neurology, Department of Clinical Neurosciences, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Shahan Momjian
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Karl Schaller
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Serge Vulliemoz
- Division of Neurology, Department of Clinical Neurosciences, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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15
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Elverman KH, Resch ZJ, Quasney EE, Sabsevitz DS, Binder JR, Swanson SJ. Temporal lobe epilepsy is associated with distinct cognitive phenotypes. Epilepsy Behav 2019; 96:61-68. [PMID: 31077942 DOI: 10.1016/j.yebeh.2019.04.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/09/2019] [Accepted: 04/10/2019] [Indexed: 10/26/2022]
Abstract
Neuropsychological assessment is critical for understanding the impact of seizures on cognition and informing treatment decisions. While focus is often placed on examining groups based on seizure type/epilepsy syndrome, an alternate approach emphasizes empirically derived groups based solely on cognitive performance. This approach has been used to identify cognitive phenotypes in temporal lobe epilepsy (TLE). The current study sought to replicate prior work by Hermann and colleagues (2007) and identify cognitive phenotypes in a separate, larger cohort of 185 patients with TLE (92 left TLE, 93 right TLE). Cluster analysis revealed 3- and 4-cluster solutions, with clusters differentiated primarily by overall level of performance in the 3-cluster solution (Low, Middle, and High performance) and by more varying cognitive phenotypes in the 4-cluster solution (Globally Low, Low Executive Functioning/Speed, Low Language/Memory, and Globally High). Differences in cognitive performance as well as demographic and clinical seizure variables are presented. A greater proportion of the patients with left TLE were captured by Cluster 3 (Low Language/Memory) than by the other 3 clusters, though this cluster captured only approximately one-third of the overall group with left TLE. Consistent with prior findings, executive functioning and speed emerged as additional domains of interest in this sample of patients with TLE. The current results extend prior work examining cognitive phenotypes in TLE and highlight the importance of identifying the comprehensive range of potential cognitive profiles in TLE.
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Affiliation(s)
- Kathleen H Elverman
- Medical College of Wisconsin, Department of Neurology, United States of America
| | - Zachary J Resch
- Rosalind Franklin University of Medicine and Science, United States of America
| | - Erin E Quasney
- Medical College of Wisconsin, Department of Neurology, United States of America
| | - David S Sabsevitz
- Medical College of Wisconsin, Department of Neurology, United States of America
| | - Jeffrey R Binder
- Medical College of Wisconsin, Department of Neurology, United States of America
| | - Sara J Swanson
- Medical College of Wisconsin, Department of Neurology, United States of America.
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16
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Abstract
Epilepsy affects 65 million people worldwide, and is a leading neurologic cause of loss of quality-adjusted life years. The diagnosis of seizures and epilepsy often depends on a careful history, and is supported with electroencephalogram and imaging. First-line treatment of epilepsy includes medical management. Antiepileptic drugs must be chosen with the patient's particular comorbidities in mind. Drug-resistant epilepsy cases should be referred to an epilepsy specialist and may be evaluated for additional medications, epilepsy surgery, neurostimulation, or dietary therapy. When caring for women, providers must take into account needs for contraception or pregnancy safety where applicable.
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Affiliation(s)
- Emily L Johnson
- Department of Neurology, Johns Hopkins School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA.
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17
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Busch RM, Hogue O, Kattan MW, Hamberger M, Drane DL, Hermann B, Kim M, Ferguson L, Bingaman W, Gonzalez-Martinez J, Najm IM, Jehi L. Nomograms to predict naming decline after temporal lobe surgery in adults with epilepsy. Neurology 2018; 91:e2144-e2152. [PMID: 30404781 DOI: 10.1212/wnl.0000000000006629] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 08/17/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To develop and externally validate models to predict the probability of postoperative naming decline in adults following temporal lobe epilepsy surgery using easily accessible preoperative clinical predictors. METHODS In this retrospective, prediction model development study, multivariable models were developed in a cohort of 719 patients who underwent temporal lobe epilepsy surgery at Cleveland Clinic and externally validated in a cohort of 138 patients who underwent temporal lobe surgery at one of 3 epilepsy surgery centers in the United States (Columbia University Medical Center, Emory University School of Medicine, University of Washington School of Medicine). RESULTS The development cohort was 54% female with an average age at surgery of 36 years (SD 12). Twenty-six percent of this cohort experienced clinically relevant postoperative naming decline. The model included 5 variables: side of surgery, age at epilepsy onset, age at surgery, sex, and education. When applied to the external validation cohort, the model performed very well, with excellent calibration and a c statistic (reflecting discriminatory ability) of 0.81. A second model predicting moderate to severe postoperative naming decline included 3 variables: side of surgery, age at epilepsy onset, and preoperative naming score. This model generated a c statistic of 0.84 in the external validation cohort and showed good calibration. CONCLUSION Externally validated nomograms are provided in 2 easy-to-use formats (paper version and online calculator) clinicians can use to estimate the probability of naming decline in patients considering epilepsy surgery for treatment of pharmacoresistant temporal lobe epilepsy.
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Affiliation(s)
- Robyn M Busch
- From the Epilepsy Center (R.M.B., L.F., W.B., J.G.-M., I.M.N., L.J.), Department of Psychiatry & Psychology (R.M.B., L.F.), Department of Neurology (R.M.B., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Cleveland Clinic, OH; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (B.H.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.L.D., M.K.), University of Washington School of Medicine, Seattle.
| | - Olivia Hogue
- From the Epilepsy Center (R.M.B., L.F., W.B., J.G.-M., I.M.N., L.J.), Department of Psychiatry & Psychology (R.M.B., L.F.), Department of Neurology (R.M.B., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Cleveland Clinic, OH; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (B.H.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.L.D., M.K.), University of Washington School of Medicine, Seattle
| | - Michael W Kattan
- From the Epilepsy Center (R.M.B., L.F., W.B., J.G.-M., I.M.N., L.J.), Department of Psychiatry & Psychology (R.M.B., L.F.), Department of Neurology (R.M.B., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Cleveland Clinic, OH; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (B.H.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.L.D., M.K.), University of Washington School of Medicine, Seattle
| | - Marla Hamberger
- From the Epilepsy Center (R.M.B., L.F., W.B., J.G.-M., I.M.N., L.J.), Department of Psychiatry & Psychology (R.M.B., L.F.), Department of Neurology (R.M.B., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Cleveland Clinic, OH; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (B.H.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.L.D., M.K.), University of Washington School of Medicine, Seattle
| | - Daniel L Drane
- From the Epilepsy Center (R.M.B., L.F., W.B., J.G.-M., I.M.N., L.J.), Department of Psychiatry & Psychology (R.M.B., L.F.), Department of Neurology (R.M.B., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Cleveland Clinic, OH; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (B.H.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.L.D., M.K.), University of Washington School of Medicine, Seattle
| | - Bruce Hermann
- From the Epilepsy Center (R.M.B., L.F., W.B., J.G.-M., I.M.N., L.J.), Department of Psychiatry & Psychology (R.M.B., L.F.), Department of Neurology (R.M.B., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Cleveland Clinic, OH; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (B.H.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.L.D., M.K.), University of Washington School of Medicine, Seattle
| | - Michelle Kim
- From the Epilepsy Center (R.M.B., L.F., W.B., J.G.-M., I.M.N., L.J.), Department of Psychiatry & Psychology (R.M.B., L.F.), Department of Neurology (R.M.B., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Cleveland Clinic, OH; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (B.H.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.L.D., M.K.), University of Washington School of Medicine, Seattle
| | - Lisa Ferguson
- From the Epilepsy Center (R.M.B., L.F., W.B., J.G.-M., I.M.N., L.J.), Department of Psychiatry & Psychology (R.M.B., L.F.), Department of Neurology (R.M.B., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Cleveland Clinic, OH; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (B.H.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.L.D., M.K.), University of Washington School of Medicine, Seattle
| | - William Bingaman
- From the Epilepsy Center (R.M.B., L.F., W.B., J.G.-M., I.M.N., L.J.), Department of Psychiatry & Psychology (R.M.B., L.F.), Department of Neurology (R.M.B., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Cleveland Clinic, OH; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (B.H.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.L.D., M.K.), University of Washington School of Medicine, Seattle
| | - Jorge Gonzalez-Martinez
- From the Epilepsy Center (R.M.B., L.F., W.B., J.G.-M., I.M.N., L.J.), Department of Psychiatry & Psychology (R.M.B., L.F.), Department of Neurology (R.M.B., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Cleveland Clinic, OH; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (B.H.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.L.D., M.K.), University of Washington School of Medicine, Seattle
| | - Imad M Najm
- From the Epilepsy Center (R.M.B., L.F., W.B., J.G.-M., I.M.N., L.J.), Department of Psychiatry & Psychology (R.M.B., L.F.), Department of Neurology (R.M.B., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Cleveland Clinic, OH; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (B.H.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.L.D., M.K.), University of Washington School of Medicine, Seattle
| | - Lara Jehi
- From the Epilepsy Center (R.M.B., L.F., W.B., J.G.-M., I.M.N., L.J.), Department of Psychiatry & Psychology (R.M.B., L.F.), Department of Neurology (R.M.B., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Cleveland Clinic, OH; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (B.H.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.L.D., M.K.), University of Washington School of Medicine, Seattle
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18
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Donos C, Breier J, Friedman E, Rollo P, Johnson J, Moss L, Thompson S, Thomas M, Hope O, Slater J, Tandon N. Laser ablation for mesial temporal lobe epilepsy: Surgical and cognitive outcomes with and without mesial temporal sclerosis. Epilepsia 2018; 59:1421-1432. [DOI: 10.1111/epi.14443] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Cristian Donos
- Vivian L. Smith Department of Neurosurgery; McGovern Medical School; Houston TX USA
| | - Joshua Breier
- Children's Learning Institute; University of Texas Health Science Center at Houston; Houston TX USA
| | - Elliott Friedman
- Department of Radiology; McGovern Medical School; Houston TX USA
| | - Patrick Rollo
- Vivian L. Smith Department of Neurosurgery; McGovern Medical School; Houston TX USA
| | - Jessica Johnson
- Vivian L. Smith Department of Neurosurgery; McGovern Medical School; Houston TX USA
| | - Lauren Moss
- Children's Learning Institute; University of Texas Health Science Center at Houston; Houston TX USA
| | - Stephen Thompson
- Department of Neurology; McGovern Medical School; Houston TX USA
| | - Melissa Thomas
- Department of Neurology; McGovern Medical School; Houston TX USA
| | - Omotola Hope
- Department of Neurology; McGovern Medical School; Houston TX USA
| | - Jeremy Slater
- Department of Neurology; McGovern Medical School; Houston TX USA
| | - Nitin Tandon
- Vivian L. Smith Department of Neurosurgery; McGovern Medical School; Houston TX USA
- Mischer Neuroscience Institute; Memorial Hermann Hospital Texas Medical Center; Houston TX USA
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19
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Krámská L, Vojtěch Z, Lukavský J, Stará M, Malíková H. Five-Year Neuropsychological Outcome after Stereotactic Radiofrequency Amygdalohippocampectomy for Mesial Temporal Lobe Epilepsy: Longitudinal Study. Stereotact Funct Neurosurg 2017; 95:149-157. [DOI: 10.1159/000468527] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 03/02/2017] [Indexed: 11/19/2022]
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20
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Girgis F, Greil ME, Fastenau PS, Sweet J, Lüders H, Miller JP. Resection of Temporal Neocortex During Multiple Hippocampal Transections for Mesial Temporal Lobe Epilepsy Does not Affect Seizure or Memory Outcome. Oper Neurosurg (Hagerstown) 2017; 13:711-717. [DOI: 10.1093/ons/opx031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 01/31/2017] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Multiple hippocampal transection (MHT) is a surgical treatment for mesial temporal lobe epilepsy associated with improved postoperative neuropsychological outcomes compared with lobectomy.
OBJECTIVE
To determine whether resection of the amygdala and anterior temporal neocortex during MHT affects postoperative seizure/memory outcome.
METHODS
Seventeen patients with normal magnetic resonance imaging and stereo-electroencephalogram-proven drug-resistant dominant mesial temporal lobe epilepsy were treated with MHT. Nine patients underwent MHT alone (MHT–) and 8 patients underwent MHT plus removal of the amygdala and anterior 4.5 cm of temporal neocortex lateral to the fusiform gyrus (MHT+). Verbal and visual-spatial memory were assessed in all patients preoperatively and in 14 patients postoperatively using the Wechsler Memory Scale. Postoperative seizure control was assessed at 12 months for all patients.
RESULTS
Overall, 11 of 17 patients (64.7%) were Engel class 1 at 1 year (6/9 MHT–, 5/8 MHT+, P = .38), and 10 of 14 patients (71.4%) had no significant postoperative decline in either verbal or visual memory (6/8 MHT–, 4/6 MHT+, P = .42). Verbal memory declined in 2 of 8 MHT– and 1 of 6 MHT+ patients, and visual memory declined in 1 of 8 MHT– and 2 of 6 MHT+ patients. Two patients had improved visual memory postoperatively, both in the MHT+ group.
CONCLUSION
MHT on the dominant side is associated with high rates of seizure freedom and favorable memory preservation outcomes regardless of the extent of neocortical resection. Preservation of the temporal neocortex and amygdala during MHT does not appear to decrease the risk of postoperative memory decline, nor does it alter seizure outcome.
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Affiliation(s)
- Fady Girgis
- Department of Neurosurgery, University Hospital Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Madeline E Greil
- Department of Neurosurgery, University Hospital Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Philip S Fastenau
- Department of Neurology, University Hospital Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jennifer Sweet
- Department of Neurosurgery, University Hospital Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Hans Lüders
- Department of Neurology, University Hospital Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jonathan P Miller
- Department of Neurosurgery, University Hospital Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
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21
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Strandberg M, Mannfolk P, Stenberg L, Ljung H, Rorsman I, Larsson EM, van Westen D, Källén K. A Functional MRI-Based Model for Individual Memory Assessment in Patients Eligible for Anterior Temporal Lobe Resection. Open Neuroimag J 2017; 11:1-16. [PMID: 28567171 PMCID: PMC5420180 DOI: 10.2174/1874440001711010001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/21/2017] [Accepted: 02/27/2017] [Indexed: 11/22/2022] Open
Abstract
Title: A functional (f) MRI-based model for individual memory assessment in patients eligible for temporal lobe resection. Aim: To investigate if pre-operative fMRI memory paradigms, add predictive information with regard to post-surgical memory deficits. Methods: Fourteen pharmacoresistant Temporal Lobe Epilepsy (TLE) patients accepted for Anterior Temporal Lobe Resection (ATLR) were included. A clinical risk assessment score (RAS 0-3) was constructed from structural MRI, neuropsychological testing and hemisphere dominance. fMRI lateralization indices (LIs) over frontal language and medial temporal regions were calculated. Predictive value from clinical risk scoring and added value from fMRI LIs were correlated to post-surgical memory change scores (significant decline -1 SD). Verbal memory outcome was classified either as expected (RAS 2-3 and post-operative decline; RAS 0-1 and intact post-operative verbal memory) or as unexpected (RAS 2-3 and intact post-operative verbal memory post-surgery; RAS 0-1 and post-operative decline). Results: RAS for verbal memory decline exhibited a specificity of 67% and a sensitivity of 75%. Significant correlations were found between frontal language LIs and post-operative verbal memory (r = -0.802; p = 0.017) for left (L) TLE and between medial temporal lobe LIs and visuospatial memory (r = 0.829; p = 0.021), as well as verbal memory (r = 0.714; p = 0.055) for right (R) TLE. Ten patients had expected outcome and four patients had an unexpected outcome. In two MRI-negative RTLE patients that suffered significant verbal memory decline post-operatively, fMRI identified bilateral language and right lateralized medial temporal verbal encoding. In two LTLE patients with MRI pathology and verbal memory dysfunction, neither RAS nor fMRI identified the risk for aggravated verbal memory decline following ATLR. Conclusion: fMRI visualization of temporal-frontal network activation may add value to the pre-surgical work-up in epilepsy patients eligible for ATLR. Frontal language patterns are important for prediction in both L and RTLE. Strong left lateralized language in LTLE, as well as bilateral language combined with right lateralized encoding in RTLE, seems to indicate an increased risk for post-operative verbal memory decline.
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Affiliation(s)
- Maria Strandberg
- Department of Neurology and Clinical Sciences, Lund University Hospital, SE-221 85 Lund, Sweden
| | - Peter Mannfolk
- Diagnostic Radiology, Department of Clinical Sciences, Lund University Hospital, SE-221 85 Lund, Sweden
| | - Lars Stenberg
- Diagnostic Radiology, Department of Clinical Sciences, Lund University Hospital, SE-221 85 Lund, Sweden
| | - Hanna Ljung
- Department of Neurology and Clinical Sciences, Lund University Hospital, SE-221 85 Lund, Sweden
| | - Ia Rorsman
- Department of Neurology and Clinical Sciences, Lund University Hospital, SE-221 85 Lund, Sweden
| | - Elna-Marie Larsson
- Department of Radiology, Uppsala University Hospital, SE-75185, Uppsala, Sweden
| | - Danielle van Westen
- Diagnostic Radiology, Department of Clinical Sciences, Lund University Hospital, SE-221 85 Lund, Sweden
| | - Kristina Källén
- Department of Neurology and Clinical Sciences, Lund University Hospital, SE-221 85 Lund, Sweden
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22
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Klamer S, Milian M, Erb M, Rona S, Lerche H, Ethofer T. Face-name association task reveals memory networks in patients with left and right hippocampal sclerosis. NEUROIMAGE-CLINICAL 2017; 14:174-182. [PMID: 28180076 PMCID: PMC5279692 DOI: 10.1016/j.nicl.2017.01.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 01/17/2017] [Accepted: 01/20/2017] [Indexed: 11/23/2022]
Abstract
We aimed to identify reorganization processes of episodic memory networks in patients with left and right temporal lobe epilepsy (TLE) due to hippocampal sclerosis as well as their relations to neuropsychological memory performance. We investigated 28 healthy subjects, 12 patients with left TLE (LTLE) and 9 patients with right TLE (RTLE) with hippocampal sclerosis by means of functional magnetic resonance imaging (fMRI) using a face-name association task, which combines verbal and non-verbal memory functions. Regions-of-interest (ROIs) were defined based on the group results of the healthy subjects. In each ROI, fMRI activations were compared across groups and correlated with verbal and non-verbal memory scores. The face-name association task yielded activations in bilateral hippocampus (HC), left inferior frontal gyrus (IFG), left superior frontal gyrus (SFG), left superior temporal gyrus, bilateral angular gyrus (AG), bilateral medial prefrontal cortex and right anterior temporal lobe (ATL). LTLE patients demonstrated significantly less activation in the left HC and left SFG, whereas RTLE patients showed significantly less activation in the HC bilaterally, the left SFG and right AG. Verbal memory scores correlated with activations in the left and right HC, left SFG and right ATL and non-verbal memory scores with fMRI activations in the left and right HC and left SFG. The face-name association task can be employed to examine functional alterations of hippocampal activation during encoding of both verbal and non-verbal material in one fMRI paradigm. Further, the left SFG seems to be a convergence region for encoding of verbal and non-verbal material. Memory networks in patients with hippocampal sclerosis were compared to controls. Verbal and nonverbal memory correlated with activations in both HC and left SFG Patients with left hippocampal sclerosis activated less in the left HC and left SFG. Patients with right-sided lesion activated less in both HC, left SFG and right AG. Left SFG seems to be convergence region for encoding of verbal + nonverbal material.
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Affiliation(s)
- Silke Klamer
- Department of Neurology and Epileptology, University Hospital Tübingen and Hertie Institute of Clinical Brain Research, Tübingen, Germany
| | - Monika Milian
- Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany
| | - Michael Erb
- Department of Biomedical Magnetic Resonance, University of Tübingen, Tübingen, Germany
| | - Sabine Rona
- Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany
| | - Holger Lerche
- Department of Neurology and Epileptology, University Hospital Tübingen and Hertie Institute of Clinical Brain Research, Tübingen, Germany; Werner Reichardt Centre for Integrative Neuroscience, University of Tübingen, Tübingen, Germany
| | - Thomas Ethofer
- Department of Biomedical Magnetic Resonance, University of Tübingen, Tübingen, Germany; Werner Reichardt Centre for Integrative Neuroscience, University of Tübingen, Tübingen, Germany; Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
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23
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Vogt VL, Äikiä M, Del Barrio A, Boon P, Borbély C, Bran E, Braun K, Carette E, Clark M, Cross JH, Dimova P, Fabo D, Foroglou N, Francione S, Gersamia A, Gil-Nagel A, Guekht A, Harrison S, Hecimovic H, Heminghyt E, Hirsch E, Javurkova A, Kälviäinen R, Kavan N, Kelemen A, Kimiskidis VK, Kirschner M, Kleitz C, Kobulashvili T, Kosmidis MH, Kurtish SY, Lesourd M, Ljunggren S, Lossius MI, Malmgren K, Mameniskiené R, Martin-Sanfilippo P, Marusic P, Miatton M, Özkara Ç, Pelle F, Rubboli G, Rudebeck S, Ryvlin P, van Schooneveld M, Schmid E, Schmidt PM, Seeck M, Steinhoff BJ, Shavel-Jessop S, Tarta-Arsene O, Trinka E, Viggedal G, Wendling AS, Witt JA, Helmstaedter C. Current standards of neuropsychological assessment in epilepsy surgery centers across Europe. Epilepsia 2017; 58:343-355. [PMID: 28067423 DOI: 10.1111/epi.13646] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2016] [Indexed: 11/29/2022]
Abstract
We explored the current practice with respect to the neuropsychological assessment of surgical epilepsy patients in European epilepsy centers, with the aim of harmonizing and establishing common standards. Twenty-six epilepsy centers and members of "E-PILEPSY" (a European pilot network of reference centers in refractory epilepsy and epilepsy surgery), were asked to report the status of neuropsychological assessment in adults and children via two different surveys. There was a consensus among these centers regarding the role of neuropsychology in the presurgical workup. Strong agreement was found on indications (localization, epileptic dysfunctions, adverse drugs effects, and postoperative monitoring) and the domains to be evaluated (memory, attention, executive functions, language, visuospatial skills, intelligence, depression, anxiety, and quality of life). Although 186 different tests are in use throughout these European centers, a core group of tests reflecting a moderate level of agreement could be discerned. Variability exists with regard to indications, protocols, and paradigms for the assessment of hemispheric language dominance. For the tests in use, little published evidence of clinical validity in epilepsy was provided. Participants in the survey reported a need for improvement concerning the validity of the tests, tools for the assessment of everyday functioning and accelerated forgetting, national norms, and test co-normalization. Based on the present survey, we documented a consensus regarding the indications and principles of neuropsychological testing. Despite the variety of tests in use, the survey indicated that there may be a core set of tests chosen based on experience, as well as on published evidence. By combining these findings with the results of an ongoing systematic literature review, we aim for a battery that can be recommended for the use across epilepsy surgical centers in Europe.
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Affiliation(s)
- Viola Lara Vogt
- Department of Epileptology, Medical Center, University of Bonn, Bonn, Germany
| | - Marja Äikiä
- Epilepsy Center/Neurocenter, Kuopio University Hospital, Kuopio, Finland.,School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Antonio Del Barrio
- Department of Neurology, Epilepsy Program, Hospital Ruber International, Madrid, Spain
| | - Paul Boon
- Department of Neurology, Center for Refractory Epilepsy, University Hospital Ghent, Ghent, Belgium
| | - Csaba Borbély
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Ema Bran
- Department of Clinical Neurosciences, Pediatric Neurology Clinic, Carol Davila University of Medicine, Bucharest, Romania.,Alexandu Obregia Clinical Psychiatric Hospital, Pediatric Neurology Clinic, Bucharest, Romania
| | - Kees Braun
- Department of Child Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Evelien Carette
- Department of Neurology, Center for Refractory Epilepsy, University Hospital Ghent, Ghent, Belgium
| | - Maria Clark
- University College London Institute of Child Health & Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | - Judith Helen Cross
- University College London Institute of Child Health & Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | - Petia Dimova
- Clinic of Child Neurology, St Naum University Hospital of Neurology and Psychiatry, Sofia, Bulgaria
| | - Daniel Fabo
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | | | - Stefano Francione
- Claudio Munari Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Anna Gersamia
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia.,Department of Neurology and Neurosurgery of the Russian National Research Medical University, Moscow, Russia
| | - Antonio Gil-Nagel
- Department of Neurology, Epilepsy Program, Hospital Ruber International, Madrid, Spain
| | - Alla Guekht
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia.,Department of Neurology and Neurosurgery of the Russian National Research Medical University, Moscow, Russia
| | - Sue Harrison
- University College London Institute of Child Health & Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | - Hrvoje Hecimovic
- Department of Neurology, Zagreb Epilepsy Center, University Hospital, Zagreb, Croatia
| | - Einar Heminghyt
- National Center for Epilepsy (SSE), Oslo University Hospital, Oslo, Norway
| | | | - Alena Javurkova
- 2nd Faculty of Medicine, Motol University Hospital, Charles University in Prague, Prague, Czech Republic
| | | | - Nicole Kavan
- EEG & Epilepsy Unit, Hospital of Geneva & Functional Neurology and Neurosurgery Program, University Hospitals of Geneva and Lausanne, Geneva, Switzerland
| | - Anna Kelemen
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | | | - Margarita Kirschner
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | - Teia Kobulashvili
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | - Selin Yagci Kurtish
- Division of Clinical Electro-Neurophysiology, Department of Neurology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Mathieu Lesourd
- Department of Clinical Neurosciences, CHUV, Lausanne, Switzerland
| | - Sofia Ljunggren
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | | | - Kristina Malmgren
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Ruta Mameniskiené
- Faculty of Medicine, Clinic of Neurology and Neurosurgery, Vilnius University, Vilnius, Lithuania.,Department of Neurology, Vilnius University Hospital Santariškių klinikos, Vilnius, Lithuania
| | - Patricia Martin-Sanfilippo
- University College London Institute of Child Health & Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | - Petr Marusic
- 2nd Faculty of Medicine, Motol University Hospital, Charles University in Prague, Prague, Czech Republic
| | - Marijke Miatton
- Department of Neurology, Center for Refractory Epilepsy, University Hospital Ghent, Ghent, Belgium
| | - Çiğdem Özkara
- Division of Clinical Electro-Neurophysiology, Department of Neurology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Federica Pelle
- Claudio Munari Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Guido Rubboli
- Danish Epilepsy Center, Filadelfia/University of Copenhagen, EEMA (European Epilepsy Monitoring Unit Association), Dianalund, Denmark.,Epilepsy Institute, IDEE, Lyon, France
| | - Sarah Rudebeck
- University College London Institute of Child Health & Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | - Philippe Ryvlin
- Department of Clinical Neurosciences, CHUV, Lausanne, Switzerland.,Epilepsy Institute, IDEE, Lyon, France
| | - Monique van Schooneveld
- Department of Pediatric Psychology, Sector of Neuropsychology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Elisabeth Schmid
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | - Margitta Seeck
- EEG & Epilepsy Unit, Hospital of Geneva & Functional Neurology and Neurosurgery Program, University Hospitals of Geneva and Lausanne, Geneva, Switzerland
| | | | - Sara Shavel-Jessop
- University College London Institute of Child Health & Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | - Oana Tarta-Arsene
- Department of Clinical Neurosciences, Pediatric Neurology Clinic, Carol Davila University of Medicine, Bucharest, Romania.,Alexandu Obregia Clinical Psychiatric Hospital, Pediatric Neurology Clinic, Bucharest, Romania
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Gerd Viggedal
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Juri-Alexander Witt
- Department of Epileptology, Medical Center, University of Bonn, Bonn, Germany
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24
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Bostock ECS, Kirkby KC, Garry MI, Taylor BVM. Systematic Review of Cognitive Function in Euthymic Bipolar Disorder and Pre-Surgical Temporal Lobe Epilepsy. Front Psychiatry 2017; 8:133. [PMID: 28848456 PMCID: PMC5552675 DOI: 10.3389/fpsyt.2017.00133] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 07/10/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Bipolar disorder (BD) and temporal lobe epilepsy (TLE) overlap in domains including epidemiology, treatment response, shared neurotransmitter involvement and temporal lobe pathology. Comparison of cognitive function in both disorders may indicate temporal lobe mediated processes relevant to BD. This systematic review examines neuropsychological test profiles in euthymic bipolar disorder type I (BD-I) and pre-surgical TLE and compares experimental designs used. METHODS A search of PubMed, PsychINFO, and Scopus using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. Inclusion criteria were comparison group or pre- to post-surgical patients; reported neuropsychological tests; participants aged 18-60 years. Fifty six studies met criteria: 27 BD-I; 29 TLE. RESULTS Deficits in BD-I compared to healthy controls (HC) were in executive function, attention span and verbal memory. Deficits in TLE compared to HC were in executive function and memory. In the pre- to post-surgical comparisons, verbal memory in left temporal lobe (LTL) and, less consistently, visuospatial memory in right temporal lobe (RTL) epilepsy declined following surgery. BD-I studies used comprehensive test batteries in well-defined euthymic patients compared to matched HC groups. TLE studies used convenience samples pre- to post-surgery, comparing LTL and RTL subgroups, few included comparisons to HC (5 studies). TLE studies typically examined a narrow range of known temporal lobe-mediated neuropsychological functions, particularly verbal and visuospatial memory. CONCLUSION Both disorders exhibit deficits in executive function and verbal memory suggestive of both frontal and temporal lobe involvement. However, deficits in TLE are measured pre- to post-surgery and not controlled at baseline pre-surgery. Further research involving a head-to-head comparison of the two disorders on a broad range of neuropsychological tests is needed to clarify the nature and extent of cognitive deficits and potential overlaps.
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Affiliation(s)
| | - Kenneth C Kirkby
- Psychiatry, School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Michael I Garry
- Psychology, School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Bruce V M Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
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Shah U, Desai A, Ravat S, Muzumdar D, Godge Y, Sawant N, Jain M, Jain N. Memory outcomes in mesial temporal lobe epilepsy surgery. Int J Surg 2016; 36:448-453. [DOI: 10.1016/j.ijsu.2015.11.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 11/16/2015] [Accepted: 11/20/2015] [Indexed: 11/25/2022]
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Johnson EL, Krauss GL. Evaluating and Treating Epilepsy Based on Clinical Subgroups. Neurol Clin 2016; 34:595-610. [DOI: 10.1016/j.ncl.2016.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Noll KR, Weinberg JS, Ziu M, Benveniste RJ, Suki D, Wefel JS. Neurocognitive Changes Associated With Surgical Resection of Left and Right Temporal Lobe Glioma. Neurosurgery 2016; 77:777-85. [PMID: 26317672 DOI: 10.1227/neu.0000000000000987] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Little is known regarding the neurocognitive impact of temporal lobe tumor resection. OBJECTIVE To clarify subacute surgery-related changes in neurocognitive functioning (NCF) in patients with left (LTL) and right (RTL) temporal lobe glioma. METHODS Patients with glioma in the LTL (n = 45) or RTL (n = 19) completed comprehensive pre- and postsurgical neuropsychological assessments. NCF was analyzed with 2-way mixed design repeated-measures analysis of variance, with hemisphere (LTL or RTL) as an independent between-subjects factor and pre- and postoperative NCF as a within-subjects factor. RESULTS About 60% of patients with LTL glioma and 40% with RTL lesions exhibited significant worsening on at least 1 NCF test. Domains most commonly impacted included verbal memory and executive functioning. Patients with LTL tumor showed greater decline than patients with RTL tumor on verbal memory and confrontation naming tests. Nonetheless, over one-third of patients with RTL lesions also showed verbal memory decline. CONCLUSION In patients with temporal lobe glioma, NCF decline in the subacute postoperative period is common. As expected, patients with LTL tumor show more frequent and severe decline than patients with RTL tumor, particularly on verbally mediated measures. However, a considerable proportion of patients with RTL tumor also exhibit decline across various domains, even those typically associated with left hemisphere structures, such as verbal memory. While patients with RTL lesions may show even greater decline in visuospatial memory, this domain was not assessed. Nonetheless, neuropsychological assessment can identify acquired deficits and help facilitate early intervention in patients with temporal lobe glioma.
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Affiliation(s)
- Kyle R Noll
- Departments of *Neuro-Oncology and ‡Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas; §Brain and Spine Institute, Seton Hospital, Austin, Texas; ¶Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
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Stylianou P, Kimchi G, Hoffmann C, Blat I, Harnof S. Neuroimaging for patient selection for medial temporal lobe epilepsy surgery: Part 2 functional neuroimaging. J Clin Neurosci 2016; 23:23-33. [DOI: 10.1016/j.jocn.2015.04.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 04/11/2015] [Accepted: 04/18/2015] [Indexed: 11/17/2022]
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Baciu M, Perrone-Bertolotti M. What do patients with epilepsy tell us about language dynamics? A review of fMRI studies. Rev Neurosci 2015; 26:323-41. [PMID: 25741734 DOI: 10.1515/revneuro-2014-0074] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 11/20/2014] [Indexed: 11/15/2022]
Abstract
The objective of this review is to resume major neuroimaging findings on language organization and plasticity in patients with focal and refractory epilepsy, to discuss the effect of modulatory variables that should be considered alongside patterns of reorganization, and to propose possible models of language reorganization. The focal and refractory epilepsy provides a real opportunity to investigate various types of language reorganization in different conditions. The 'chronic' condition (induced by the epileptogenic zone or EZ) is associated with either recruitment of homologous regions of the opposite hemisphere or recruitment of intrahemispheric, nonlinguistic regions. In the 'acute' condition (neurosurgery and EZ resection), the initial interhemispheric shift (induced by the chronic EZ) could follow a reverse direction, back to the initial hemisphere. These different patterns depend on several modulatory factors and are associated with various levels of language performance. As a neuroimaging tool, functional magnetic resonance imaging enables the detailed investigation of both hemispheres simultaneously and allows for comparison with healthy controls, potentially creating a more comprehensive and more realistic picture of brain-language relations. Importantly, functional neuroimaging approaches demonstrate a good degree of concordance on a theoretical level, but also a considerable degree of individual variability, attesting to the clinical importance with these methods to establish, empirically, language localization in individual patients. Overall, the unique features of epilepsy, combined with ongoing advances in technology, promise further improvement in understanding of language substrate.
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Surgical outcomes with non-invasive presurgical evaluation in MRI determined bilateral mesial temporal sclerosis: A retrospective cohort study. Int J Surg 2015; 36:429-435. [PMID: 26407830 DOI: 10.1016/j.ijsu.2015.09.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 08/25/2015] [Accepted: 09/06/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND & OBJECTIVE Epilepsy surgery for bilateral hippocampal sclerosis continues to pose a challenge and outcomes even with invasive evaluations have not been very promising. Very few studies have analyzed surgery outcomes for patients with MRI determined, bilateral mesial temporal sclerosis (MTS) after non-invasive pre-surgical evaluation. MATERIAL AND METHODS We studied 35 patients with bilateral MTS who underwent anterior temporal lobectomy (ATL) after non-invasive pre-surgical evaluation. Clinical history, EEG, neuropsychology profile and symmetry of MTS on MRI were reviewed in the groups of 'seizure free' and 'not seizure free' patients. RESULTS At an average follow up of 44 months (range 12-110 months), 26 out of 35 patients (74%) were seizure free. Unilateral interictal discharges were seen in 57% patients. 94% patients had unilateral ictal EEG onset. Bilateral interictal discharges were significantly associated with 'not seizure free' outcome (p = 0.02). Pre-operatively, 24 (71%) patients had bilateral (verbal and visual) memory impairment while 10 (28%) patients had unilateral (verbal or visual) memory impairment and 1 patient had a normal memory profile. Overall, no significant decline in memory was seen in left or right surgery groups post-operatively. There was significant improvement in Quality of Life scores in all patients (p = <0.0005). CONCLUSION Patients with bilateral MTS on MRI can be unilateral on electro physiology and neuropsychology, and can have a very good surgical outcome. In a setting of limited resources, a noninvasive pre-surgical protocol can be used. With proper patient selection, the outcomes may be comparable to those reported with invasive pre-surgical protocols. Patients with unilateral interictal and ictal EEG have the best outcome. Up to 50% patients with bilateral interictal discharges can have a seizure free outcome. Patients with bilateral independent seizure onset have a less favourable prognosis. Patients who are not seizure free can still attain worthwhile improvement in seizure frequency without significant decline in memory and some improvement in quality of life.
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Littleton AC, Schmidt JD, Register-Mihalik JK, Gioia GA, Waicus KM, Mihalik JP, Guskiewicz KM. Effects of Attention Deficit Hyperactivity Disorder and Stimulant Medication on Concussion Symptom Reporting and Computerized Neurocognitive Test Performance. Arch Clin Neuropsychol 2015; 30:683-93. [DOI: 10.1093/arclin/acv043] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2015] [Indexed: 01/09/2023] Open
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Barnett AJ, Park MTM, Pipitone J, Chakravarty MM, McAndrews MP. Functional and structural correlates of memory in patients with mesial temporal lobe epilepsy. Front Neurol 2015; 6:103. [PMID: 26029159 PMCID: PMC4429573 DOI: 10.3389/fneur.2015.00103] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 04/25/2015] [Indexed: 11/13/2022] Open
Abstract
Individuals with medial temporal lobe epilepsy (mTLE) often show material-specific memory impairment (verbal for left, visuospatial for right hemisphere), which can be exacerbated following surgery aimed at the epileptogenic regions of medial and anterolateral temporal cortex. There is a growing body of evidence suggesting that characterization of structural and functional integrity of these regions using MRI can aid in prediction of post-surgical risk of further memory decline. We investigated the nature of the relationship between structural and functional indices of hippocampal integrity with pre-operative memory performance in a group of 26 patients with unilateral mTLE. Structural integrity was assessed using hippocampal volumes, while functional integrity was assessed using hippocampal activation during the encoding of novel scenes. We quantified structural and functional integrity in terms of asymmetry, calculated as (L - R)/(L + R). Factor scores for verbal and visual memory were calculated from a clinical database and an asymmetry score (verbal - visual) was used to characterize memory performance. We found, as expected, a significant difference between left and right mTLE (RTLE) groups for hippocampal volume asymmetry, with each group showing an asymmetry favoring the unaffected temporal lobe. Encoding activation asymmetry showed a similar pattern, with left mTLE patients showing activation preferential to the right hemisphere and RTLE patients showing the reverse. Finally, we demonstrated that functional integrity mediated the relationship between structural integrity and memory performance for memory asymmetry, suggesting that even if structural changes are evident, ultimately it is the functional integrity of the tissue that most closely explains behavioral performance.
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Affiliation(s)
| | - Min Tae M Park
- Schulich School of Medicine and Dentistry, Western University , London, ON , Canada ; Douglas Mental Health University Institute , Montreal, QC , Canada
| | - Jon Pipitone
- Research Imaging Centre, Centre for Addiction and Mental Health , Toronto, ON , Canada
| | - M Mallar Chakravarty
- Douglas Mental Health University Institute , Montreal, QC , Canada ; Department of Psychiatry and Biomedical Engineering, McGill University , Montreal, QC , Canada
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Sidhu MK, Stretton J, Winston GP, Symms M, Thompson PJ, Koepp MJ, Duncan JS. Memory fMRI predicts verbal memory decline after anterior temporal lobe resection. Neurology 2015; 84:1512-9. [PMID: 25770199 PMCID: PMC4408284 DOI: 10.1212/wnl.0000000000001461] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 12/08/2014] [Indexed: 11/15/2022] Open
Abstract
Objective: To develop a clinically applicable memory functional MRI (fMRI) method of predicting postsurgical memory outcome in individual patients. Methods: In this prospective cohort study, 50 patients with temporal lobe epilepsy (23 left) and 26 controls underwent an fMRI memory encoding paradigm of words with a subsequent out-of-scanner recognition assessment. Neuropsychological assessment was performed preoperatively and 4 months after anterior temporal lobe resection, and at equal time intervals in controls. An event-related analysis was used to explore brain activations for words remembered and change in verbal memory scores 4 months after surgery was correlated with preoperative activations. Individual lateralization indices were calculated within a medial temporal and frontal region and compared with other clinical parameters (hippocampal volume, preoperative verbal memory, age at onset of epilepsy, and language lateralization) as a predictor of verbal memory outcome. Results: In left temporal lobe epilepsy patients, left frontal and anterior medial temporal activations correlated significantly with greater verbal memory decline, while bilateral posterior hippocampal activation correlated with less verbal memory decline postoperatively. In a multivariate regression model, left lateralized memory lateralization index (≥0.5) within a medial temporal and frontal mask was the best predictor of verbal memory outcome after surgery in the dominant hemisphere in individual patients. Neither clinical nor functional MRI parameters predicted verbal memory decline after nondominant temporal lobe resection. Conclusion: We propose a clinically applicable memory fMRI paradigm to predict postoperative verbal memory decline after surgery in the language-dominant hemisphere in individual patients.
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Affiliation(s)
- Meneka K Sidhu
- From the Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London; and the Epilepsy Society MRI Unit, Chalfont St. Peter, UK
| | - Jason Stretton
- From the Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London; and the Epilepsy Society MRI Unit, Chalfont St. Peter, UK
| | - Gavin P Winston
- From the Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London; and the Epilepsy Society MRI Unit, Chalfont St. Peter, UK
| | - Mark Symms
- From the Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London; and the Epilepsy Society MRI Unit, Chalfont St. Peter, UK
| | - Pamela J Thompson
- From the Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London; and the Epilepsy Society MRI Unit, Chalfont St. Peter, UK
| | - Matthias J Koepp
- From the Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London; and the Epilepsy Society MRI Unit, Chalfont St. Peter, UK
| | - John S Duncan
- From the Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London; and the Epilepsy Society MRI Unit, Chalfont St. Peter, UK.
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Kovanda TJ, Tubbs RS, Cohen-Gadol AA. Transsylvian selective amygdalohippocampectomy for treatment of medial temporal lobe epilepsy: Surgical technique and operative nuances to avoid complications. Surg Neurol Int 2014; 5:133. [PMID: 25298915 PMCID: PMC4174670 DOI: 10.4103/2152-7806.140651] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 07/03/2014] [Indexed: 11/08/2022] Open
Abstract
Background: A number of different surgical techniques are effective for treatment of drug-resistant medial temporal lobe epilepsy. Of these, transsylvian selective amygdalohippocampectomy (SA), which was originally developed to maximize temporal lobe preservation, is arguably the most technically demanding to perform. Recent studies have suggested that SA may result in better neuropsychological outcomes with similar postoperative seizure control as standard anterior temporal lobectomy, which involves removal of the lateral temporal neocortex. Methods: In this article, the authors describe technical nuances to improve the safety of SA. Results: Wide sylvian fissure opening and use of neuronavigation allows an adequate exposure of the amygdala and hippocampus through a corticotomy within the inferior insular sulcus. Avoidance of rigid retractors and careful manipulation and mobilization of middle cerebral vessels will minimize ischemic complications. Identification of important landmarks during amygdalohippocampectomy, such as the medial edge of the tentorium and the third nerve within the intact arachnoid membranes covering the brainstem, further avoids operator disorientation. Conclusion: SA is a safe technique for resection of medial temporal lobe epileptogenic foci leading to drug-resistant medial temporal lobe epilepsy.
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Affiliation(s)
- Timothy J Kovanda
- Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - R Shane Tubbs
- Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama, USA
| | - Aaron A Cohen-Gadol
- Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Miozzo M, Hamberger MJ. Preserved meaning in the context of impaired naming in temporal lobe epilepsy. Neuropsychology 2014; 29:274-281. [PMID: 24933490 DOI: 10.1037/neu0000097] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Word-finding difficulties are a common complaint among individuals with left (domain) temporal lobe epilepsy (TLE). We tested the hypothesis that these difficulties stem from a deficit in semantic processing. METHOD We tested and compared semantic processing in left and right TLE patients and healthy controls. To avoid the confound of word retrieval, we used two semantic tasks (semantic priming and picture-matching) that did not require spoken word production. In addition to accuracy, we recorded response time in an effort to achieve a sensitive assessment of semantic processing. RESULTS Semantic priming was in all respects comparable between left TLE patients with documented word-finding difficulty and right TLE patients without word-finding difficulty. Likewise, performances were comparable between groups on picture matching, which demanded knowledge of detailed semantic features for decisions regarding subtle differences in semantic relatedness. CONCLUSIONS Overall, these results, which demonstrate a relative preservation of semantic processing in left TLE, suggest that the probable cause of word-finding difficulty in this group relates to processes that follow semantic retrieval in word production, involving the retrieval of lexical/phonological information. In addition to clinical implications for remediation, these results refine our understanding of the neurocognitive organization of temporal mechanisms supporting spoken word production.
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Duchowny M, Bhatia S. Epilepsy: preserving memory in temporal lobectomy-are networks the key? Nat Rev Neurol 2014; 10:245-6. [PMID: 24752125 DOI: 10.1038/nrneurol.2014.67] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Michael Duchowny
- Department of Neurology, Miami Children's Hospital, 3200 SW 60th Court, Miami, FL 33155, USA
| | - Sanjiv Bhatia
- Department of Neurosurgery, Miami Children's Hospital, 3200 SW 60th Court, Miami, FL 33155, USA
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Chapin JS, Busch RM, Silveira DC, Wehner T, Naugle RI, Ferguson L, Najm IM. Memory performance in older adults before and after temporal lobectomy for pharmacoresistant epilepsy. Clin Neuropsychol 2013; 27:1316-27. [PMID: 24159928 DOI: 10.1080/13854046.2013.850535] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Little is known about the effects of epilepsy surgery on memory in older adults. The purpose of this study was to determine if older adults exhibit greater memory decline than younger adults after anterior temporal lobectomy (ATL). Patients 55 years and older at time of surgery (23 left, 14 right ATL, range 55-66 years) were compared to patients age 25-35 years (44 left, 33 right ATL) to assess differences in preoperative to postoperative change in WMS-III index scores. Repeated-measures ANOVAs and ANCOVAs revealed that older patients did not demonstrate greater decline than younger patients across any of the memory indices. Rather, in the left ATL group, older patients showed less decline than younger patients on the Auditory Delayed Memory Index. Similarly, in the right ATL group, older patients showed less decline than younger patients on the Visual Delayed Memory Index. These patterns were also apparent in frequency of individual change. Results provide preliminary evidence that older adults who are good candidates for ATL are not at greater risk for memory decline when measured at 7 months postoperatively.
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Willment KC, Golby A. Hemispheric lateralization interrupted: material-specific memory deficits in temporal lobe epilepsy. Front Hum Neurosci 2013; 7:546. [PMID: 24032014 PMCID: PMC3759288 DOI: 10.3389/fnhum.2013.00546] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 08/19/2013] [Indexed: 02/01/2023] Open
Abstract
The hemispheric lateralization of memory has largely been informed through the study of patients with temporal lobe epilepsy originating from medial temporal sources (mTLE). The material-specific model of memory relies on the basic framework that the left temporal lobe mediates verbal memories, while the right temporal lobe mediates non-verbal memories. Over the years, this model has been refined, and even challenged, as our understanding of the material-specific memory deficits in mTLE has been further elaborated in the neuropsychological and neuroimaging literature. The first goal of this mini-review is to highlight the major findings in the mTLE literature that have advanced and expanded our understanding of material-specific memory deficits in mTLE. Second, we will review how functional neuroimaging patterns of material-specific hemispheric lateralization in mTLE are being translated into the innovative clinical application of preoperative fMRI memory mapping.
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Affiliation(s)
- Kim Celone Willment
- Department of Neurology, Brigham and Women's Hospital , Boston, MA , USA ; Department of Psychiatry, Brigham and Women's Hospital , Boston, MA , USA ; Golby Lab, A Surgical Brain Mapping Laboratory, Department of Neurosurgery, Brigham and Women's Hospital , Boston, MA , USA
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Carone DA, Green P, Drane DL. Word Memory Test Profiles in Two Cases with Surgical Removal of the Left Anterior Hippocampus and Parahippocampal Gyrus. APPLIED NEUROPSYCHOLOGY-ADULT 2013; 21:155-60. [DOI: 10.1080/09084282.2012.755533] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Dominic A. Carone
- a Physical Medicine and Rehabilitation, SUNY Upstate Medical University , Syracuse , New York
| | - Paul Green
- b Private Practice , Edmonton , Alberta , Canada
| | - Daniel L. Drane
- c Department of Neurology , Emory University School of Medicine , Atlanta , Georgia
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Bonelli SB, Thompson PJ, Yogarajah M, Powell RHW, Samson RS, McEvoy AW, Symms MR, Koepp MJ, Duncan JS. Memory reorganization following anterior temporal lobe resection: a longitudinal functional MRI study. ACTA ACUST UNITED AC 2013; 136:1889-900. [PMID: 23715092 PMCID: PMC3673465 DOI: 10.1093/brain/awt105] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Anterior temporal lobe resection controls seizures in 50-60% of patients with intractable temporal lobe epilepsy but may impair memory function, typically verbal memory following left, and visual memory following right anterior temporal lobe resection. Functional reorganization can occur within the ipsilateral and contralateral hemispheres. We investigated the reorganization of memory function in patients with temporal lobe epilepsy before and after left or right anterior temporal lobe resection and the efficiency of postoperative memory networks. We studied 46 patients with unilateral medial temporal lobe epilepsy (25/26 left hippocampal sclerosis, 16/20 right hippocampal sclerosis) before and after anterior temporal lobe resection on a 3 T General Electric magnetic resonance imaging scanner. All subjects had neuropsychological testing and performed a functional magnetic resonance imaging memory encoding paradigm for words, pictures and faces, testing verbal and visual memory in a single scanning session, preoperatively and again 4 months after surgery. Event-related analysis revealed that patients with left temporal lobe epilepsy had greater activation in the left posterior medial temporal lobe when successfully encoding words postoperatively than preoperatively. Greater pre- than postoperative activation in the ipsilateral posterior medial temporal lobe for encoding words correlated with better verbal memory outcome after left anterior temporal lobe resection. In contrast, greater postoperative than preoperative activation in the ipsilateral posterior medial temporal lobe correlated with worse postoperative verbal memory performance. These postoperative effects were not observed for visual memory function after right anterior temporal lobe resection. Our findings provide evidence for effective preoperative reorganization of verbal memory function to the ipsilateral posterior medial temporal lobe due to the underlying disease, suggesting that it is the capacity of the posterior remnant of the ipsilateral hippocampus rather than the functional reserve of the contralateral hippocampus that is important for maintaining verbal memory function after anterior temporal lobe resection. Early postoperative reorganization to ipsilateral posterior or contralateral medial temporal lobe structures does not underpin better performance. Additionally our results suggest that visual memory function in right temporal lobe epilepsy is affected differently by right anterior temporal lobe resection than verbal memory in left temporal lobe epilepsy.
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Affiliation(s)
- Silvia B Bonelli
- Epilepsy Society MRI Unit, Epilepsy Society, Chalfont St Peter, SL9 0RJ, UK
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Janecek JK, Swanson SJ, Sabsevitz DS, Hammeke TA, Raghavan M, Mueller W, Binder JR. Naming outcome prediction in patients with discordant Wada and fMRI language lateralization. Epilepsy Behav 2013; 27:399-403. [PMID: 23541860 PMCID: PMC3644871 DOI: 10.1016/j.yebeh.2013.02.030] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 02/25/2013] [Accepted: 02/27/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Investigations of the validity of fMRI as an alternative to Wada language testing have yielded Wada/fMRI discordance rates of approximately 15%, but almost nothing is known regarding the relative accuracy of Wada and fMRI in discordant cases. The objective of this study was to determine which of the two (the Wada test or the language fMRI) is more predictive of postoperative naming outcome following left anterior temporal lobectomy in discordant cases. METHODS Among 229 patients with epilepsy who prospectively underwent Wada and fMRI language testing, ten had discordant language lateralization results, underwent left anterior temporal lobectomy, and returned for postoperative language testing. The relative accuracy of Wada and fMRI for predicting language outcome was examined in these cases. RESULTS Functional magnetic resonance imaging provided a more accurate prediction of language outcome in seven patients, Wada was more accurate in two patients, and the two tests were equally accurate in one patient. CONCLUSIONS In cases of discordance, fMRI predicted postsurgical naming outcome with relatively better accuracy compared to the Wada test.
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Affiliation(s)
- Julie K Janecek
- Department of Neurology and the Comprehensive Epilepsy Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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Working memory and intelligence are associated with victoria symptom validity test hard item performance in patients with intractable epilepsy. J Int Neuropsychol Soc 2013; 19:314-23. [PMID: 23331934 DOI: 10.1017/s1355617712001397] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Loring et al. (Journal of clinical and experimental neuropsychology, 2005:27;610–617) observed relationships between VSVT hard item performance and IQ and memory indices in epilepsy surgical candidates, with a potential confound of low FSIQ on VSVT performance. The present study replicated the Loring et al. study in a larger sample and extended their findings by examining the relationships among VSVT performance, FSIQ, and working memory. A total of 404 patients with medically intractable epilepsy completed a comprehensive neuropsychological assessment. Differences in WAIS-III and WMS-III performance were examined as a function of VSVT hard score categories as determined by Grote et al. (2000)--that is, valid, > 20/24; questionable, 18–20; or invalid, < 18. Quantile regression models were constructed to compare the strength of the relationship between FSIQ and VSVT at various points of the FSIQ distribution. Linear regression analyses examined working memory as a potential mediator between FSIQ and VSVT performance. The invalid group performed more poorly than the valid and questionable groups on multiple measures of intelligence and memory. The strength of the relationship between FSIQ and VSVT hard item performance decreased as FSIQ increased, and working memory mediated this relationship. Results suggest VSVT hard item scores may be impacted by working memory difficulties and/or low intellectual functioning.
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Abstract
Forty-four patients with temporal lobe epilepsy (TLE) (25 left) and 40 healthy control participants performed a complex visual scene-encoding fMRI task in a 4-T Varian scanner. Healthy controls and left temporal lobe epilepsy (LTLE) patients demonstrated symmetric activation during scene encoding. In contrast, right temporal lobe (RTLE) patients demonstrated left lateralization of scene encoding which differed significantly from healthy controls and LTLE patients (all p≤.05). Lateralization of scene encoding to the right hemisphere among LTLE patients was associated with inferior verbal memory performance as measured by neuropsychological testing (WMS-III Logical Memory Immediate, p = 0.049; WMS-III Paired Associates Immediate, p = 0.036; WMS-III Paired Associates Delayed, p = 0.047). In RTLE patients, left lateralization of scene encoding was associated with lower visuospatial memory performance (BVRT, p = 0.043) but improved verbal memory performance (WMS-III Word List, p = 0.049). These findings indicate that, despite the negative effects of epilepsy, memory functioning is better supported by the affected hemisphere than the hemisphere contralateral to the seizure focus.
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Affiliation(s)
- Cristina Bigras
- Department of Psychology, University of Cincinnati Academic Health Center, Cincinnati, OH, USA.
| | - Paula K. Shear
- Department of Psychology, University of Cincinnati Academic Health Center, Cincinnati, OH, USA.
,Center for Imaging Research, University of Cincinnati Academic Health Center, Cincinnati, OH, USA.
| | - Jennifer Vannest
- Division of Pediatric Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
,Pediatric Neuroimaging Research Consortium, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Jane B. Allendorfer
- Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, OH, USA.
| | - Jerzy P. Szaflarski
- Department of Psychology, University of Cincinnati Academic Health Center, Cincinnati, OH, USA.
,Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, OH, USA.
,Center for Imaging Research, University of Cincinnati Academic Health Center, Cincinnati, OH, USA.
,Pediatric Neuroimaging Research Consortium, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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Malikova H, Kramska L, Liscak R, Vojtech Z, Prochazka T, Mareckova I, Lukavsky J, Druga R. Stereotactic radiofrequency amygdalohippocampectomy for the treatment of temporal lobe epilepsy: Do good neuropsychological and seizure outcomes correlate with hippocampal volume reduction? Epilepsy Res 2012; 102:34-44. [DOI: 10.1016/j.eplepsyres.2012.04.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 03/28/2012] [Accepted: 04/21/2012] [Indexed: 11/26/2022]
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Bell BD. Route learning impairment in temporal lobe epilepsy. Epilepsy Behav 2012; 25:256-62. [PMID: 23041173 PMCID: PMC3481014 DOI: 10.1016/j.yebeh.2012.07.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 07/21/2012] [Accepted: 07/25/2012] [Indexed: 10/27/2022]
Abstract
Memory impairment on neuropsychological tests is relatively common in temporal lobe epilepsy (TLE) patients. However, memory has been rarely evaluated in more naturalistic settings. This study assessed TLE (n=19) and control (n=32) groups on a real-world route learning (RL) test. Compared to the controls, the TLE group committed significantly more total errors across the three RL test trials. Route learning errors correlated significantly with standardized auditory and visual memory and visual-perceptual test scores in the TLE group. In the TLE subset for whom hippocampal data were available (n=14), RL errors also correlated significantly with left hippocampal volume. This is one of the first studies to demonstrate real-world memory impairment in TLE patients and its association with both mesial temporal lobe integrity and standardized memory test performance. The results support the ecological validity of clinical neuropsychological assessment.
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Affiliation(s)
- Brian D. Bell
- Department of Neurology/Neuropsychology section, University of Wisconsin School of Medicine and Public Health, Madison, WI,Mental Health Service, W.S. Middleton Memorial VA Hospital, Madison, WI
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Role of functional MRI in presurgical evaluation of memory function in temporal lobe epilepsy. EPILEPSY RESEARCH AND TREATMENT 2012; 2012:687219. [PMID: 22957237 PMCID: PMC3420704 DOI: 10.1155/2012/687219] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 03/07/2012] [Accepted: 03/11/2012] [Indexed: 11/18/2022]
Abstract
Many diagnostic tools have been employed to predict the likelihood of a postoperative memory decline after a standard temporal lobectomy, including the intracarotid amobarbital testing (IAT) or Wada, regarded as the gold standard test for over the past half a century. Functional MRI (fMRI) is also a promising tool in that regard. Its routine use to predict the postoperative memory decline has been limited because of the varied study paradigms, discrepancies in analysis, and interpretation of the results. Based on the existing literatures, fMRI cannot replace IAT for the routine presurgical evaluation of the patients with temporal lobe epilepsy (TLE) yet. Large multicentre studies with a panel of memory test are required to determine the full potential of fMRI and use it reliably to replace IAT in the routine clinical practice. In this paper, we review various aspects of memory fMRI, including the experimental designs, data analysis, and findings.
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Dulay MF, Busch RM. Prediction of neuropsychological outcome after resection of temporal and extratemporal seizure foci. Neurosurg Focus 2012; 32:E4. [DOI: 10.3171/2012.1.focus11340] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Resection of seizure foci is an effective treatment for the control of medically intractable epilepsy. However, cognitive morbidity can occur as a result of surgical intervention. This morbidity is dependent on several factors, including location and extent of resection, disease characteristics, patient demographic characteristics, and functional status of the tissue to be resected. In this review article, the authors provide a summary of the neurocognitive outcomes of epilepsy surgery with an emphasis on presurgical predictors of postsurgical cognitive decline.
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Affiliation(s)
- Mario F. Dulay
- 1Comprehensive Epilepsy Program and Department of Neurosurgery, The Methodist Hospital Neurological Institute, Houston, Texas; and
| | - Robyn M. Busch
- 2Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
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Mansouri A, Fallah A, Valiante TA. Determining surgical candidacy in temporal lobe epilepsy. EPILEPSY RESEARCH AND TREATMENT 2012; 2012:706917. [PMID: 22957238 PMCID: PMC3420473 DOI: 10.1155/2012/706917] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 10/26/2011] [Accepted: 12/03/2011] [Indexed: 11/22/2022]
Abstract
Temporal lobe epilepsy (TLE) is the most common form of adult epilepsy that is amenable to surgical treatment. In the carefully selected patient, excellent seizure outcome can be achieved with minimal or no side effects from surgery. This may result in improved psychosocial functioning, achieving higher education, and maintaining or gaining employment. The objective of this paper is to discuss the surgical selection process of a patient with TLE. We define what constitutes a patient that has medically refractory TLE, describe the typical history and physical examination, and distinguish between mesial TLE and neocortical TLE. We then review the role of routine (ambulatory/sleep-deprived electroencephalography (EEG), video EEG, magnetic resonance imaging (MRI), neuropsychological testing, and Wada testing) and ancillary preoperative testing (positron emission tomography, single-photon emission computed tomography (SPECT), subtraction ictal SPECT correlated to MRI (SISCOM), magnetoencephalography, magnetic resonance spectroscopy, and functional MRI) in selecting surgical candidates. We describe the surgical options for resective epilepsy surgery in TLE and its commonly associated risks while highlighting some of the controversies. Lastly, we present teaching cases to illustrate the presurgical workup of patients with medically refractory TLE.
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Affiliation(s)
- Alireza Mansouri
- Department of Neurosurgery, Toronto Western Hospital, Toronto, ON, Canada M5G 1L5
| | - Aria Fallah
- Department of Neurosurgery, Toronto Western Hospital, Toronto, ON, Canada M5G 1L5
| | - Taufik A. Valiante
- Department of Neurosurgery, Toronto Western Hospital, Toronto, ON, Canada M5G 1L5
- University Health Network, Toronto, ON, Canada M5G 1L5
- Division of Fundamental Neurobiology, Toronto Western Research Institute, Toronto Western Hospital, 4W-436, 399 Bathurst Street, Toronto, ON, Canada M5T 2S8
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Noachtar S, Rémi J. [Epilepsy surgery]. DER NERVENARZT 2012; 83:209-12. [PMID: 22237649 DOI: 10.1007/s00115-011-3341-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Epilepsy surgery is an important therapeutic option for patients with epilepsy since one third of all epilepsy patients will still not be become seizure free despite newly developed antiepileptic drugs. Anterior temporal lobe resection is the most common procedure. Extratemporal resections require more complex diagnostics and often invasive evaluation which is not the case in most temporal epilepsy patients due to improved imaging (MRI, PET, SPECT). Electrical stimulation of the anterior thalamus has been available as a treatment option since last year.
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Affiliation(s)
- S Noachtar
- Neurologische Klinik und Poliklinik, Klinikum der Universität München-Großhadern, Marchioninistr. 15, 81377, München, Deutschland.
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The cognitive effects of amygdalohippocampal deep brain stimulation in patients with temporal lobe epilepsy. Epilepsy Behav 2011; 22:759-64. [PMID: 22030536 DOI: 10.1016/j.yebeh.2011.09.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 08/22/2011] [Accepted: 09/10/2011] [Indexed: 11/24/2022]
Abstract
The aim of this study was to examine the effects of amygdalohippocampal deep brain stimulation (AH-DBS) on cognitive functioning in patients with refractory temporal lobe epilepsy. The population consisted of 10 patients (7 men) who underwent ipsilateral (n=8) or bilateral (n=2) AH-DBS. Intellectual and neuropsychological evaluation was performed before and 6 months after initiation of AH-DBS. Group analyses revealed no overall pattern of change in cognitive measures, but improvement was seen in emotional well-being. Individual results varied over a broad spectrum ranging from no cognitive effects to negative effects on intelligence capacities, divided attention, and concept formation, to positive effects on speed of information processing and speed of finger movements. AH-DBS is a valuable treatment alternative for patients with refractory epilepsy that appears to have no major adverse neuropsychological consequences and enhances emotional well-being on the group level. Individual results are too diverse at this moment to allow viable interpretation. Additional studies are needed to confirm these preliminary results.
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