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Lorkiewicz SA, Modiano YA, Miller BI, Van Cott AC, Haneef Z, Sullivan-Baca E. The neuropsychological presentation of women with epilepsy: clinical considerations and future directions. Clin Neuropsychol 2023:1-27. [PMID: 37993977 DOI: 10.1080/13854046.2023.2283937] [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: 07/07/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023]
Abstract
Objective: Cognitive, mood, and behavioral changes are common among persons with epilepsy (PWE), resulting in a complex neuropsychological presentation. Women with epilepsy (WWE) represent a distinct cohort within the broader epilepsy population due to sex and gender-specific factors impacting epilepsy semiology and treatment. However, unique neuropsychological profiles among WWE have not been established. This narrative review aims to further define neuropsychological correlates in WWE and promote meaningful discussion related to enhancing the provision of neuropsychological care within this clinical population. Method: Current literature in PWE examining differences in cognitive function, mental health, and quality of life (QoL) between women and men was critically reviewed, emphasizing considerations for neuropsychological practice. Results: WWE demonstrate a preservation of verbal learning and memory compared to men both pre- and post-surgically, with sex-based, neurobiological mechanisms likely contributing to this association. WWE also have elevated risk for affective disorder psychopathology, suicidality, and traumatic experiences. Epidemiology related to psychotic and bipolar spectrum disorders is less clear, and findings are mixed regarding sex-specific behavioral side effects of antiseizure and psychotropic medication. Finally, hormonal and obstetric factors are highlighted as important contributors to neuropsychological symptoms in WWE, with elevated risk for low QoL and increased stigma associated with greater medical and psychiatric comorbidities compared to men. Conclusions: While emerging literature has begun to characterize the neuropsychological presentation of WWE, future research is needed to define sex and gender differences in neuropsychological sequalae among PWE to ensure consistency and quality of care for WWE.
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Affiliation(s)
| | - Yosefa A Modiano
- Neurosciences, McGovern Medical School at UT Health Houston, Houston, TX, USA
| | - Brian I Miller
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Anne C Van Cott
- Neurology Division, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Zulfi Haneef
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
- Epilepsy Centers of Excellence, Veteran's Health Administration, USA
| | - Erin Sullivan-Baca
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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2
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Smith ML, Risse G, Sziklas V, Banks S, Small D, Frasnelli J, Klein D. Neurophysiology, Neuropsychology, Epilepsy, 2022: Hills We Have Climbed and the Hills Ahead. Cognition and Sensory Systems in Healthy and Diseased Subjects. Epilepsy Behav 2023; 140:109119. [PMID: 36804713 DOI: 10.1016/j.yebeh.2023.109119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/22/2023] [Accepted: 01/29/2023] [Indexed: 02/18/2023]
Abstract
This article summarizes selected presentations from a session titled "Cognition and Sensory Systems in Healthy and Diseased Subjects", held to highlight and honor the work of Dr. Marilyn Jones-Gotman. The session was part of a two-day symposium, "Neurophysiology, Neuropsychology, Epilepsy, 2022: Hills We Have Climbed and the Hills Ahead". The session presented research on epilepsy and sensory systems by colleagues and former trainees of Dr. Jones-Gotman. The extended summaries provide an overview of historical and current work in the neuropsychology of epilepsy, neuropsychological and neuroimaging approaches to understanding brain organization, sex differences in brain mechanisms underlying neurological disorders, dietary influences on brain function and cognition, and expertise in olfactory training and language experiences and their implications for brain organization and structure.
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Affiliation(s)
- Mary Lou Smith
- Department of Psychology, University of Toronto Mississauga; Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, ON, Canada.
| | - Gail Risse
- Minnesota Epilepsy Group, Roseville, MN, USA; Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - Viviane Sziklas
- Department of Neurology and Neurosurgery; Department of Psychology, McGill University, Montreal, QC, Canada
| | - Sarah Banks
- Departments of Neuroscience and Psychiatry, University of California, San Diego, CA, USA
| | - Dana Small
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Johannes Frasnelli
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Denise Klein
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
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3
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Stasenko A, Kaestner E, Reyes A, Lalani SJ, Paul B, Hegde M, Helm JL, Ben-Haim S, McDonald CR. Association Between Microstructural Asymmetry of Temporal Lobe White Matter and Memory Decline After Anterior Temporal Lobectomy. Neurology 2022; 98:e1151-e1162. [PMID: 35058338 PMCID: PMC8935440 DOI: 10.1212/wnl.0000000000200047] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 01/03/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Risk for memory decline is a substantial concern in patients with temporal lobe epilepsy (TLE) undergoing anterior temporal lobectomy (ATL). Although prior studies have identified associations between memory and integrity of white matter (WM) networks within the medial temporal lobe (MTL) preoperatively, we contribute a study examining whether microstructural asymmetry of deep and superficial WM networks within the MTL predicts postoperative memory decline. METHODS Patients with drug-resistant TLE were recruited from 2 epilepsy centers in a prospective longitudinal study. All patients completed preoperative T1 and diffusion-weighted MRI (DWI) as well as preoperative and postoperative neuropsychological testing. Preoperative fractional anisotropy (FA) of the WM directly beneath the neocortex (i.e., superficial WM [SWM]) and of deep WM tracts associated with memory were calculated. Asymmetry was calculated for hippocampal volume and FA of each WM tract or region and examined in linear and logistic regressions with preoperative to postoperative memory change as the primary outcome. RESULTS Data were analyzed from 42 patients with TLE (19 left TLE [LTLE], 23 right TLE [RTLE]) who underwent ATL. Leftward FA asymmetry of the entorhinal SWM was associated with decline on prose and associative recall in LTLE, whereas leftward FA asymmetry of the uncinate fasciculus (UNC) was associated with decline on prose recall only. After controlling for preoperative memory score and hippocampal volume, leftward FA asymmetry of the entorhinal SWM uniquely contributed to decline in both prose and associative recall (β = -0.46; SE 0.14 and β = -0.68; SE 0.22, respectively) and leftward FA asymmetry of the UNC uniquely contributed to decline in prose recall (β = -0.31; SE 0.14). A model combining asymmetry of hippocampal volume and entorhinal FA correctly classified memory outcomes in 79% of patients with LTLE for prose (area under the curve [AUC] 0.89; sensitivity 82%; specificity 75%) and 81% of patients for associative (AUC 0.79; sensitivity 83%; specificity 80%) recall. Entorhinal SWM asymmetry was the strongest predictor in both models. DISCUSSION Preoperative asymmetry of deep WM and SWM integrity within the MTL is a strong predictor of postoperative memory decline in TLE, suggesting that surgical decision-making may benefit from considering each patient's WM network adequacy and reserve in addition to hippocampal integrity. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that preoperative asymmetry of deep WM and SWM integrity within the MTL is a predictor of postoperative memory decline.
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Affiliation(s)
- Alena Stasenko
- From the Center for Multimodal Imaging and Genetics (A.S., E.K., A.R., C.R.M.) and Departments of Psychiatry (A.S., E.K., A.R., S.J.L., C.R.M.) and Neurosurgery (S.B.-H.), University of California, San Diego; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (A.R., C.R.M.); Department of Neurology (B.P., M.H.), University of California, San Francisco; and Department of Psychology (J.L.H.), San Diego State University, CA
| | - Erik Kaestner
- From the Center for Multimodal Imaging and Genetics (A.S., E.K., A.R., C.R.M.) and Departments of Psychiatry (A.S., E.K., A.R., S.J.L., C.R.M.) and Neurosurgery (S.B.-H.), University of California, San Diego; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (A.R., C.R.M.); Department of Neurology (B.P., M.H.), University of California, San Francisco; and Department of Psychology (J.L.H.), San Diego State University, CA
| | - Anny Reyes
- From the Center for Multimodal Imaging and Genetics (A.S., E.K., A.R., C.R.M.) and Departments of Psychiatry (A.S., E.K., A.R., S.J.L., C.R.M.) and Neurosurgery (S.B.-H.), University of California, San Diego; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (A.R., C.R.M.); Department of Neurology (B.P., M.H.), University of California, San Francisco; and Department of Psychology (J.L.H.), San Diego State University, CA
| | - Sanam J Lalani
- From the Center for Multimodal Imaging and Genetics (A.S., E.K., A.R., C.R.M.) and Departments of Psychiatry (A.S., E.K., A.R., S.J.L., C.R.M.) and Neurosurgery (S.B.-H.), University of California, San Diego; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (A.R., C.R.M.); Department of Neurology (B.P., M.H.), University of California, San Francisco; and Department of Psychology (J.L.H.), San Diego State University, CA
| | - Brianna Paul
- From the Center for Multimodal Imaging and Genetics (A.S., E.K., A.R., C.R.M.) and Departments of Psychiatry (A.S., E.K., A.R., S.J.L., C.R.M.) and Neurosurgery (S.B.-H.), University of California, San Diego; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (A.R., C.R.M.); Department of Neurology (B.P., M.H.), University of California, San Francisco; and Department of Psychology (J.L.H.), San Diego State University, CA
| | - Manu Hegde
- From the Center for Multimodal Imaging and Genetics (A.S., E.K., A.R., C.R.M.) and Departments of Psychiatry (A.S., E.K., A.R., S.J.L., C.R.M.) and Neurosurgery (S.B.-H.), University of California, San Diego; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (A.R., C.R.M.); Department of Neurology (B.P., M.H.), University of California, San Francisco; and Department of Psychology (J.L.H.), San Diego State University, CA
| | - Jonathan L Helm
- From the Center for Multimodal Imaging and Genetics (A.S., E.K., A.R., C.R.M.) and Departments of Psychiatry (A.S., E.K., A.R., S.J.L., C.R.M.) and Neurosurgery (S.B.-H.), University of California, San Diego; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (A.R., C.R.M.); Department of Neurology (B.P., M.H.), University of California, San Francisco; and Department of Psychology (J.L.H.), San Diego State University, CA
| | - Sharona Ben-Haim
- From the Center for Multimodal Imaging and Genetics (A.S., E.K., A.R., C.R.M.) and Departments of Psychiatry (A.S., E.K., A.R., S.J.L., C.R.M.) and Neurosurgery (S.B.-H.), University of California, San Diego; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (A.R., C.R.M.); Department of Neurology (B.P., M.H.), University of California, San Francisco; and Department of Psychology (J.L.H.), San Diego State University, CA
| | - Carrie R McDonald
- From the Center for Multimodal Imaging and Genetics (A.S., E.K., A.R., C.R.M.) and Departments of Psychiatry (A.S., E.K., A.R., S.J.L., C.R.M.) and Neurosurgery (S.B.-H.), University of California, San Diego; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (A.R., C.R.M.); Department of Neurology (B.P., M.H.), University of California, San Francisco; and Department of Psychology (J.L.H.), San Diego State University, CA.
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Christian CA, Reddy DS, Maguire J, Forcelli PA. Sex Differences in the Epilepsies and Associated Comorbidities: Implications for Use and Development of Pharmacotherapies. Pharmacol Rev 2021; 72:767-800. [PMID: 32817274 DOI: 10.1124/pr.119.017392] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The epilepsies are common neurologic disorders characterized by spontaneous recurrent seizures. Boys, girls, men, and women of all ages are affected by epilepsy and, in many cases, by associated comorbidities as well. The primary courses of treatment are pharmacological, dietary, and/or surgical, depending on several factors, including the areas of the brain affected and the severity of the epilepsy. There is a growing appreciation that sex differences in underlying brain function and in the neurobiology of epilepsy are important factors that should be accounted for in the design and development of new therapies. In this review, we discuss the current knowledge on sex differences in epilepsy and associated comorbidities, with emphasis on those aspects most informative for the development of new pharmacotherapies. Particular focus is placed on sex differences in the prevalence and presentation of various focal and generalized epilepsies; psychiatric, cognitive, and physiologic comorbidities; catamenial epilepsy in women; sex differences in brain development; the neural actions of sex and stress hormones and their metabolites; and cellular mechanisms, including brain-derived neurotrophic factor signaling and neuronal-glial interactions. Further attention placed on potential sex differences in epilepsies, comorbidities, and drug effects will enhance therapeutic options and efficacy for all patients with epilepsy. SIGNIFICANCE STATEMENT: Epilepsy is a common neurological disorder that often presents together with various comorbidities. The features of epilepsy and seizure activity as well as comorbid afflictions can vary between men and women. In this review, we discuss sex differences in types of epilepsies, associated comorbidities, pathophysiological mechanisms, and antiepileptic drug efficacy in both clinical patient populations and preclinical animal models.
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Affiliation(s)
- Catherine A Christian
- Department of Molecular and Integrative Physiology, Neuroscience Program, and Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois (C.A.C.); Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, Texas (D.S.R.); Neuroscience Department, Tufts University School of Medicine, Boston, Massachusetts (J.M.); and Departments of Pharmacology and Physiology and Neuroscience, Georgetown University, Washington, D.C. (P.A.F.)
| | - Doodipala Samba Reddy
- Department of Molecular and Integrative Physiology, Neuroscience Program, and Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois (C.A.C.); Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, Texas (D.S.R.); Neuroscience Department, Tufts University School of Medicine, Boston, Massachusetts (J.M.); and Departments of Pharmacology and Physiology and Neuroscience, Georgetown University, Washington, D.C. (P.A.F.)
| | - Jamie Maguire
- Department of Molecular and Integrative Physiology, Neuroscience Program, and Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois (C.A.C.); Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, Texas (D.S.R.); Neuroscience Department, Tufts University School of Medicine, Boston, Massachusetts (J.M.); and Departments of Pharmacology and Physiology and Neuroscience, Georgetown University, Washington, D.C. (P.A.F.)
| | - Patrick A Forcelli
- Department of Molecular and Integrative Physiology, Neuroscience Program, and Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois (C.A.C.); Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, Texas (D.S.R.); Neuroscience Department, Tufts University School of Medicine, Boston, Massachusetts (J.M.); and Departments of Pharmacology and Physiology and Neuroscience, Georgetown University, Washington, D.C. (P.A.F.)
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5
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Adeli E, Zhao Q, Zahr NM, Goldstone A, Pfefferbaum A, Sullivan EV, Pohl KM. Deep learning identifies morphological determinants of sex differences in the pre-adolescent brain. Neuroimage 2020; 223:117293. [PMID: 32841716 PMCID: PMC7780846 DOI: 10.1016/j.neuroimage.2020.117293] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/06/2020] [Accepted: 08/17/2020] [Indexed: 12/11/2022] Open
Abstract
The application of data-driven deep learning to identify sex differences in developing brain structures of pre-adolescents has heretofore not been accomplished. Here, the approach identifies sex differences by analyzing the minimally processed MRIs of the first 8144 participants (age 9 and 10 years) recruited by the Adolescent Brain Cognitive Development (ABCD) study. The identified pattern accounted for confounding factors (i.e., head size, age, puberty development, socioeconomic status) and comprised cerebellar (corpus medullare, lobules III, IV/V, and VI) and subcortical (pallidum, amygdala, hippocampus, parahippocampus, insula, putamen) structures. While these have been individually linked to expressing sex differences, a novel discovery was that their grouping accurately predicted the sex in individual pre-adolescents. Another novelty was relating differences specific to the cerebellum to pubertal development. Finally, we found that reducing the pattern to a single score not only accurately predicted sex but also correlated with cognitive behavior linked to working memory. The predictive power of this score and the constellation of identified brain structures provide evidence for sex differences in pre-adolescent neurodevelopment and may augment understanding of sex-specific vulnerability or resilience to psychiatric disorders and presage sex-linked learning disabilities.
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Affiliation(s)
- Ehsan Adeli
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA 94305, USA
| | - Qingyu Zhao
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA 94305, USA
| | - Natalie M Zahr
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA 94305, USA; Center for Biomedical Sciences, SRI International, Menlo Park, CA 94025, USA
| | - Aimee Goldstone
- Center for Biomedical Sciences, SRI International, Menlo Park, CA 94025, USA
| | - Adolf Pfefferbaum
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA 94305, USA; Center for Biomedical Sciences, SRI International, Menlo Park, CA 94025, USA
| | - Edith V Sullivan
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA 94305, USA
| | - Kilian M Pohl
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA 94305, USA; Center for Biomedical Sciences, SRI International, Menlo Park, CA 94025, USA.
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6
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Loprinzi PD, Frith E. The Role of Sex in Memory Function: Considerations and Recommendations in the Context of Exercise. J Clin Med 2018; 7:jcm7060132. [PMID: 29857518 PMCID: PMC6028920 DOI: 10.3390/jcm7060132] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 05/31/2018] [Accepted: 05/31/2018] [Indexed: 01/16/2023] Open
Abstract
There is evidence to suggest that biological sex plays a critical role in memory function, with sex differentially influencing memory type. In this review, we detail the current evidence evaluating sex-specific effects on various memory types. We also discuss potential mechanisms that explain these sex-specific effects, which include sex differences in neuroanatomy, neurochemical differences, biological differences, and cognitive and affect-related differences. Central to this review, we also highlight that, despite the established sex differences in memory, there is little work directly comparing whether males and females have a differential exercise-induced effect on memory function. As discussed herein, such a differential effect is plausible given the clear sex-specific effects on memory, exercise response, and molecular mediators of memory. We emphasize that future work should be carefully powered to detect sex differences. Future research should also examine these potential exercise-related sex-specific effects for various memory types and exercise intensities and modalities. This will help enhance our understanding of whether sex indeed moderates the effects of exercise and memory function, and as such, will improve our understanding of whether sex-specific, memory-enhancing interventions should be developed, implemented, and evaluated.
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Affiliation(s)
- Paul D Loprinzi
- Exercise Psychology Laboratory, Physical Activity Epidemiology Laboratory, School of Applied Sciences, Department of Health, Exercise Science and Recreation Management, The University of Mississippi, MS 38677, USA.
| | - Emily Frith
- Exercise Psychology Laboratory, Physical Activity Epidemiology Laboratory, School of Applied Sciences, Department of Health, Exercise Science and Recreation Management, The University of Mississippi, MS 38677, USA.
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7
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Berger J, Oltmanns F, Holtkamp M, Bengner T. Sex differences in verbal and nonverbal learning before and after temporal lobe epilepsy surgery. Epilepsy Behav 2017; 66:57-63. [PMID: 28033547 DOI: 10.1016/j.yebeh.2016.11.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/05/2016] [Accepted: 11/28/2016] [Indexed: 11/26/2022]
Abstract
Women outperform men in a host of episodic memory tasks, yet the neuroanatomical basis for this effect is unclear. It has been suggested that the anterior temporal lobe might be especially relevant for sex differences in memory. In the current study, we investigated whether temporal lobe epilepsy (TLE) has an influence on sex effects in learning and memory and whether women and men with TLE differ in their risk for memory deficits after epilepsy surgery. 177 patients (53 women and 41 men with left TLE, 42 women and 41 men with right TLE) were neuropsychologically tested before and one year after temporal lobe resection. We found that women with TLE had better verbal, but not figural, memory than men with TLE. The female advantage in verbal memory was not affected by temporal lobe resection. The same pattern of results was found in a more homogeneous subsample of 84 patients with only hippocampal sclerosis who were seizure-free after surgery. Our findings challenge the concept that the anterior temporal lobe plays a central role in the verbal memory advantage for women.
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Affiliation(s)
- Justus Berger
- Epilepsy-Center Berlin-Brandenburg, Berlin, Germany.
| | | | - Martin Holtkamp
- Epilepsy-Center Berlin-Brandenburg, Berlin, Germany; Department of Neurology, Charité - Universitätsmedizin, Berlin, Germany.
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8
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Long-term memory performance after surgical treatment of unilateral temporal lobe epilepsy (TLE). Epilepsy Res 2014; 108:1228-37. [DOI: 10.1016/j.eplepsyres.2014.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 04/23/2014] [Accepted: 05/03/2014] [Indexed: 11/20/2022]
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9
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10
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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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11
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Banks SJ, Jones-Gotman M, Ladowski D, Sziklas V. Sex differences in the medial temporal lobe during encoding and recognition of pseudowords and abstract designs. Neuroimage 2011; 59:1888-95. [PMID: 21914483 DOI: 10.1016/j.neuroimage.2011.08.087] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 08/23/2011] [Accepted: 08/28/2011] [Indexed: 11/19/2022] Open
Abstract
Sex differences in various cognitive abilities have been demonstrated in terms of performance differentials and, more recently, in differences in activation patterns during fMRI. Hemispheric lateralization is sometimes accentuated in sex differences; e.g., women demonstrating greater activation of the left hemisphere than men during verbal tasks. We were interested in whether this phenomenon applies to memory for words and designs (i.e., material specific memory). Using analogous verbal (pseudowords) and nonverbal (abstract designs) encoding and recognition tasks completed back-to-back in a 3T scanner, we found that women tend to show exaggerated left hippocampal activation during certain stages of encoding and recognition of verbal information, compared with men. Likewise (although to a lesser extent), men showed more right hippocampal activation than women did during the abstract design learning task. These results have important implications for the generalization of fMRI memory study results, for example to clinical populations such as patients undergoing epilepsy surgery.
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Affiliation(s)
- S J Banks
- McGill University, Montreal Neurological Institute, 3801 University Street, Montreal, Quebec, Canada H3A 2B4.
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12
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McDonald CR, Taylor J, Hamberger M, Helmstaedter C, Hermann BP, Schefft B. Future directions in the neuropsychology of epilepsy. Epilepsy Behav 2011; 22:69-76. [PMID: 21795122 DOI: 10.1016/j.yebeh.2011.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 06/05/2011] [Indexed: 11/17/2022]
Abstract
Two important themes for future clinical research in the neuropsychology of epilepsy are proposed: (1) the neurobiological abnormalities that underlie neuropsychological impairment in people with epilepsy, and (2) neuropsychological status of persons with new-onset epilepsy.
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Affiliation(s)
- Carrie R McDonald
- Multimodal Imaging Laboratory, Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
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13
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Hermann BP, Lin JJ, Jones JE, Seidenberg M. The emerging architecture of neuropsychological impairment in epilepsy. Neurol Clin 2009; 27:881-907. [PMID: 19853214 PMCID: PMC2811050 DOI: 10.1016/j.ncl.2009.08.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A new literature is now under way, one linking cognitive abnormalities directly to indices of structural, functional, metabolic, and other neurobiologic markers of cerebral integrity, independent of their association with clinical epilepsy characteristics. These trends are reviewed in this article. The focus is on temporal lobe epilepsy (TLE) as a model with which to address the core points because this form of localization-related epilepsy has been very carefully studied from both a cognitive and imaging standpoint. Some pertinent historical issues are touched on first, followed by more detailed reviews of the cognitive and neuroimaging abnormalities that have been found in TLE, followed by an overview of studies examining direct structure-function relationships in TLE and other epilepsies.
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Affiliation(s)
- Bruce P Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, 600 North Highland Avenue, Madison, WI 53792, USA.
| | - Jack J Lin
- Department of Neurology, University of California-Irvine, Irvine, CA 92697, USA
| | - Jana E Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, 600 North Highland Avenue, Madison, WI 53792, USA
| | - Michael Seidenberg
- Department of Psychology, Rosalind Franklin School of Medicine and Science, 3333 N. Green Bay Road, North Chicago, IL 60064, USA
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Baumann O, Chan E, Mattingley JB. Dissociable neural circuits for encoding and retrieval of object locations during active navigation in humans. Neuroimage 2009; 49:2816-25. [PMID: 19837178 DOI: 10.1016/j.neuroimage.2009.10.021] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Revised: 09/03/2009] [Accepted: 10/08/2009] [Indexed: 10/20/2022] Open
Abstract
Several cortical and subcortical circuits have been implicated in object location memory and navigation. Uncertainty remains, however, about which neural circuits are involved in the distinct processes of encoding and retrieval during active navigation through three-dimensional space. We used functional magnetic resonance imaging (fMRI) to measure neural responses as participants learned the location of a single target object relative to a small set of landmarks. Following a delay, the target was removed and participants were required to navigate back to its original position. The relative and absolute locations of landmarks and the target object were changed on every trial, so that participants had to learn a novel arrangement for each spatial scene. At encoding, greater activity within the right hippocampus and the parahippocampal gyrus bilaterally predicted more accurate navigation to the hidden target object in the retrieval phase. By contrast, during the retrieval phase, more accurate performance was associated with increased activity in the left hippocampus and the striatum bilaterally. Dividing participants into good and poor navigators, based upon behavioural performance, revealed greater striatal activity in good navigators during retrieval, perhaps reflecting superior procedural learning in these individuals. By contrast, the poor navigators showed stronger left hippocampal activity, suggesting reliance on a less effective verbal or symbolic code by this group. Our findings suggest separate neural substrates for the encoding and retrieval stages of object location memory during active navigation, which are further modulated by participants' overall navigational ability.
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Affiliation(s)
- Oliver Baumann
- The University of Queensland, Queensland Brain Institute & School of Psychology, St Lucia, Queensland, 4072, Australia.
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15
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Abstract
In essentially every domain of neuroscience, the generally implicit assumption that few, if any, meaningful differences exist between male and female brain function is being challenged. Here we address how this development is influencing studies of the neurobiology of learning and memory. While it has been commonly held that males show an advantage on spatial tasks, and females on verbal tasks, there is increasing evidence that sex differences are more widespread than previously supposed. Differing performance between the sexes have been observed on a number of common learning tasks in both the human and animal literature, many neither purely spatial nor verbal. We review sex differences reported in various areas to date, while attempting to identify common features of sexually dimorphic tasks, and to place these differences in a neurobiological context. This discussion focuses on studies of four classes of memory tasks for which sex differences have been frequently reported: spatial, verbal, autobiographical, and emotional memory. We conclude that the female verbal advantage extends into numerous tasks, including tests of spatial and autobiographical abilities, but that a small but significant advantage may exist for general episodic memory. We further suggest that for some tasks, stress evokes sex differences, which are not normally observed, and that these differences are mediated largely by interactions between stress and sex hormones.
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Affiliation(s)
- Joseph M Andreano
- Center for the Neurobiology of Learning and Memory, Department of Neurobiology and Behavior, University of California, Irvine, CA 92697-3800, USA
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16
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The selective amobarbital test in the anterior choroidal artery: perfusion pattern assessed by intraarterial SPECT and prediction of postoperative verbal memory. Epilepsy Behav 2008; 12:445-55. [PMID: 18248852 DOI: 10.1016/j.yebeh.2007.11.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2007] [Revised: 11/22/2007] [Accepted: 11/26/2007] [Indexed: 10/22/2022]
Abstract
To screen for patients at risk for memory decline after temporal lobe epilepsy (TLE) surgery, selective amobarbital procedures, such as injection into the anterior choroidal artery (ACA-IAT), are sometimes used. We investigated the extent of the territory affected during ACA-IAT and its predictive value with respect to postoperative memory. Seventeen patients with TLE underwent ACA-IAT. In 9 of 17 patients, intraarterial SPECT co-registrated to MRI allowed delineation of amobarbital-perfused structures. Another subgroup of 9 of 17 patients underwent anterior temporal lobectomy. Verbal memory was tested pre- and postoperatively and during ACA-IAT. Major variations in the ACA-IAT perfusion pattern occurred and were not correlated with the verbal memory scores during ACA-IAT. Postoperatively, no patient experienced a severe verbal memory decline, but individual postoperative performance was not correlated with results during ACA-IAT. Our study suggests that ACA-IAT can be used to screen for severe postoperative amnesia in inconclusive cases, but cannot predict individual outcome, even when the perfusion pattern is taken into account.
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Yucus CJ, Tranel D. Preserved proper naming following left anterior temporal lobectomy is associated with early age of seizure onset. Epilepsia 2007; 48:2241-52. [PMID: 17645534 PMCID: PMC2244800 DOI: 10.1111/j.1528-1167.2007.01211.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Anterior temporal lobectomy (ATL) is an effective surgical option for managing pharmacoresistant temporal lobe epilepsy. Many patients with left ATL develop postsurgical difficulties with proper name retrieval, although curiously, some patients have entirely intact proper naming following left ATL. Here, we tested the hypothesis that early age of seizure onset would be a reliable factor "protecting" patients from developing proper naming defects following left ATL. METHODS Proper naming of unique persons (Famous Faces Test, 155 items) and places (Landmark Test, 65 items) was measured in 23 patients who had undergone left ATL for pharmacoresistant epilepsy. Data were collected for a number of variables, including age of seizure onset, age at surgery, handedness, IQ, and seizure outcome. The patients were sorted into two groups based on proper naming performance: (1) Unimpaired: 7 patients performed normally on both the Faces and Landmark tests; (2) Impaired: 16 patients performed abnormally on one or both of the tests. RESULTS In support of our hypothesis, the Unimpaired group had a significantly earlier age of seizure onset (M = 2.1 years) than the Impaired group (M = 15.1 years). Moreover, a correlation analysis indicated a strong association between age of seizure onset and naming outcome (R =-0.569). The groups were comparable (and statistically indistinguishable) on nearly all other variables. CONCLUSIONS These findings document the importance of age of seizure onset in predicting proper naming outcome following left ATL (with earlier being better), and extend understanding of brain reorganization and plasticity.
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Affiliation(s)
- Chad J Yucus
- Department of Neurology, Division of Behavioral Neurology and Cognitive Neuroscience, University of Iowa College of Medicine, Iowa City, Iowa, USA
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18
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Bengner T, Fortmeier C, Malina T, Lindenau M, Voges B, Goebell E, Stodieck S. Sex differences in face recognition memory in patients with temporal lobe epilepsy, patients with generalized epilepsy, and healthy controls. Epilepsy Behav 2006; 9:593-600. [PMID: 17088107 DOI: 10.1016/j.yebeh.2006.08.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2006] [Revised: 08/18/2006] [Accepted: 08/20/2006] [Indexed: 11/30/2022]
Abstract
The influence of sex on face recognition memory was studied in 49 patients with temporal lobe epilepsy, 20 patients with generalized epilepsy, and 32 healthy controls. After learning 20 faces, serially presented for 5 seconds each, subjects had to recognize the 20 among 40 faces (including 20 new faces) immediately and 24 hours later. Women had better face recognition than men, with no significant differences between groups. Women's advantage was due mainly to superior delayed recognition. Taken together, the results suggest that sex has a similar impact on face recognition in patients with epilepsy and healthy controls, and that testing delayed face recognition raises sensitivity for sex differences. The influence of sex on face recognition in patients with epilepsy should be acknowledged when evaluating individuals or comparing groups.
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Affiliation(s)
- T Bengner
- Epilepsy Center Hamburg, Protestant Hospital Alsterdorf, Hamburg, Germany.
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Spasojević G, Stojanović Z, Suscević D, Malobabić S. Sexual dimorphism of the human corpus callosum: Digital morphometric study. VOJNOSANIT PREGL 2006; 63:933-8. [PMID: 17144427 DOI: 10.2298/vsp0611933s] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background/Aim. Changes in the morphology and the size of the corpus callosum, are related to various pathological conditions. An analysis of these changes requires data about sexual dimorphism of the corpus callosum, which we tried to obtain in our study. We also investigated the method of digital morphometry and compared the obtained results with the results of other authors obtained by magnetic resonance imaging or by planimetry. Methods. A morphological research included 34 human brains (cadavers of both sexes ? 19 female and 15 male aged 26?72 years). By digital morphometry using an AutoCAD software we performed measurements in the corpus callosum: the length (L), width in the half of its length (WW?), length of its cortical margin (LCM), area and perimeter of the anterior and posterior callosal segments, as well as the area and perimeter of the corpus callosum section area. The investigated parameters were analyzed and compared between the females and males. Results. There was not a statistically significant difference between the males and females in the investigated parameters of the corpus callosum (t test; p > 0.05), including the mean values of the two most important parameters, the surface of its midsagittal section area (males 654.11 mm2; females 677.40 mm2) and of its perimeter (males 19.61 cm; females 19.72 cm). The results obtained by digital morphometry were in the range of the results of other authors obtained by magnetic resonance and by planimetry. However, the value of Pearson coefficient of linear correlation between the section surface area and perimeter of the corpus callosum in the males was highly significant (rxy = 0.6943, p < 0.01), while in the females this value was statistically insignificant. Conclusion. Digital morphometry is accurate method in encephalometric investigations. Our results suggest that the problem of sexual dimorphism of the corpus callosum is very complex, because the identical variables (section surface area or its perimeter) do not exhibit the same behavior in males and in females, implicating that these variables even cannot be simply compared between the sexes.
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Affiliation(s)
- Goran Spasojević
- Medicinski fakultet, Zavod za anatomiju, Banja Luka, Republika Srpska, Bosna i Hercegovina
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20
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Kallai J, Csathó A, Kövér F, Makány T, Nemes J, Horváth K, Kovács N, Manning JT, Nadel L, Nagy F. MRI-assessed volume of left and right hippocampi in females correlates with the relative length of the second and fourth fingers (the 2D:4D ratio). Psychiatry Res 2005; 140:199-210. [PMID: 16257514 DOI: 10.1016/j.pscychresns.2004.05.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2003] [Revised: 02/14/2004] [Accepted: 05/21/2004] [Indexed: 11/21/2022]
Abstract
Atrophy of the left or right side of the hippocampus has been related to cognitive deficits and psychiatric disease. In this study, we examined the correlation between the hippocampal volume laterality index and the relative lengths of the second (index finger) and fourth (ring finger) digits (2D:4D) in healthy female subjects. The 2D:4D ratio is fixed in utero, and the ratio is higher in women than in men. There is evidence that this ratio is an indicator of the intrauterine concentration of testosterone, which influences the development of different regions of the brain. Assessing the volume of different parts of the brain of 40 healthy adult female students by magnetic resonance imaging (MRI), we found that the 2D:4D ratio was associated with an asymmetry in the hippocampal sub-regions. Smaller volume on the left side was found in the posterior part of the hippocampus in females with a low (masculine type) 2D:4D ratio. On the other hand, smaller volume on the left side was found in the middle part of the hippocampus in females with a high (female type) 2D:4D ratio. Thus, the development of the middle and posterior regions of the hippocampal formation may respond in opposite ways to prenatal levels of testosterone. Other brain regions such as the amygdala, the cerebral cortex, the total volume hippocampus, and the head of the hippocampus did not show such a difference.
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Affiliation(s)
- Janos Kallai
- Institute of Psychology, University of Pécs, Szigeti u12, H-7624 Pécs, Hungary.
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Bell BD, Fine J, Dow C, Seidenberg M, Hermann BP. Temporal lobe epilepsy and the selective reminding test: the conventional 30-minute delay suffices. Psychol Assess 2005; 17:103-9. [PMID: 15769231 PMCID: PMC1226458 DOI: 10.1037/1040-3590.17.1.103] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Conventional memory assessment may fail to identify memory dysfunction characterized by intact recall for a relatively brief period but rapid forgetting thereafter. This study assessed learning and retention after 30-min and 24-hr delays on auditory and visual selective reminding tests (SRTs) in right (n=20) and left (n=22) temporal lobe epilepsy (TLE) patients and controls (n=49). The left TLE group performed significantly worse than controls on all 3 trials of both tests. The right TLE group differed from the controls on all 3 visual SRT trials and on learning for the auditory SRT. There were no between-groups differences in rate of information lost at the 30-min versus the 24-hr delay. At the individual level, there was no difference in the percentage of patients versus controls who demonstrated isolated memory impairment at the 24-hr delay. Accelerated forgetting over 24 hr is uncommon in TLE patients.
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Affiliation(s)
- Brian D Bell
- Department of Neurology, University of Wisconsin-Madison, Madison, WI 53792, USA.
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22
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Helmstaedter C, Kurthen M, Elger CE. Sex differences in material-specific cognitive functions related to language dominance: an intracarotid amobarbital study in left temporal lobe epilepsy. Laterality 2005; 4:51-63. [PMID: 15513104 DOI: 10.1080/713754322] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Population-based studies of material-specific cognitive functions yield evidence of sex differences: women are superior on verbal tasks whereas men are superior on figural and visuo-spatial tasks. Although there is still no direct evidence, these sex differences have been assumed to be related to a different cerebral organisation of language and nonlanguage functions, i.e. language in women is suggested to be more bilaterally organised than in men. We investigated this issue with respect to verbal/nonverbal memory functions in 42 men and 43 women with left temporal lobe epilepsies who all underwent intracarotid amobarbital testing for language dominance. The results indicate that atypical language dominance is not significantly more frequent in women than in men (44% vs 33%). Atypical dominance was related to an onset of epilepsy before puberty and appeared to be a consequence of the left hemisphere pathology rather than being naturally predisposed. Furthermore, women indeed showed the expected advantage with respect to verbal memory, and men showed an advantage in figural memory. With consideration of language dominance, however, the sex difference in verbal memory was observed particularly with atypical dominance, whereas the sex difference in figural memory was observed with left dominance.
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Bjørnaes H, Stabell KE, Røste GK, Bakke SJ. Changes in verbal and nonverbal memory following anterior temporal lobe surgery for refractory seizures: effects of sex and laterality. Epilepsy Behav 2005; 6:71-84. [PMID: 15652737 DOI: 10.1016/j.yebeh.2004.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2004] [Revised: 10/23/2004] [Accepted: 10/23/2004] [Indexed: 11/18/2022]
Abstract
We studied the effects on verbal and nonverbal memory of anterior temporal lobe (ATL) surgery for epilepsy in 91 patients (46 men, 45 women), all of whom had left-hemisphere dominance for speech. Patients were divided into four groups according to sex and laterality of the excision. The memory tasks were administered shortly before surgery, 6 months postoperatively, and at a 2-year follow-up. Test scores were submitted to repeated-measures analyses of variance. We found that men treated with left temporal resection declined significantly in long-delay verbal memory after surgery, whereas no clear pre- to postoperative sex differences were found with respect to other verbal memory scores. Only the results on long-delay verbal memory confirm previous findings, showing a greater vulnerability of verbal memory to left ATL surgery in men than in women. Women with left temporal excisions obtained particularly poor scores on a long-delay nonverbal memory test preoperatively, but improved their performance on this test significantly after surgery. The seemingly gradual improvement during the 2-year follow-up suggests a plastic process.
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24
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Bilateral hippocampal volume predicts verbal memory function in temporal lobe epilepsy. Epilepsy Behav 2004; 5:687-95. [PMID: 15380120 DOI: 10.1016/j.yebeh.2004.06.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2004] [Revised: 06/17/2004] [Accepted: 06/17/2004] [Indexed: 10/26/2022]
Abstract
The present study used quantitative volume estimates of the hippocampus based on structural magnetic resonance imaging (MRI) to predict memory performance of individuals with epilepsy of temporal lobe origin (TLE). Twenty individuals with TLE completed standardized neuropsychological tests and a quality of life inventory, and participated in a brain MRI protocol designed to obtain high-resolution images of the hippocampus. The combined volume of the left and right hippocampi was found to be the best predictor of objective verbal memory performance. This finding is consistent with the functional adequacy model of hippocampal function. In contrast, the asymmetry between right and left hippocampal volume was the best predictor of subjective ratings of cognitive functioning, which is consistent with the functional reserve model. The collective and complementary functions of the left and right hippocampi merit further exploration in prospective studies of memory function and TLE.
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25
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Lespinet-Najib V, N'Kaoua B, Sauzéon H, Bresson C, Rougier A, Claverie B. Levels of processing with free and cued recall and unilateral temporal lobe epilepsy. BRAIN AND LANGUAGE 2004; 89:83-90. [PMID: 15010240 DOI: 10.1016/s0093-934x(03)00303-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/28/2003] [Indexed: 05/24/2023]
Abstract
This study investigates the role of the temporal lobes in levels-of-processing tasks (phonetic and semantic encoding) according to the nature of recall tasks (free and cued recall). These tasks were administered to 48 patients with unilateral temporal epilepsy (right "RTLE"=24; left "LTLE"=24) and a normal group (n=24). The results indicated that LTLE patients were impaired for semantic processing (free and cued recall) and for phonetic processing (free and cued recall), while for RTLE patients deficits appeared in free recall with semantic processing. It is suggested that the left temporal lobe is involved in all aspects of verbal memory, and that the right temporal lobe is specialized in semantic processing. Moreover, our data seem to indicate that RTLE patients present a retrieval processing impairment (semantic condition), whereas the LTLE group is characterized by encoding difficulties in the phonetic and semantic condition.
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Affiliation(s)
- Véronique Lespinet-Najib
- Laboratoire de Neuropsychologie Expérimentale, Université Victor Segalen Bordeaux 2, Bordeaux, France.
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26
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27
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Scarlatelli-Lima AV, Magalhães LHM, Doretto MC, Moraes MFD. Assessment of the seizure susceptibility of Wistar Audiogenic rat to electroshock, pentyleneterazole and pilocarpine. Brain Res 2003; 960:184-9. [PMID: 12505671 DOI: 10.1016/s0006-8993(02)03831-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This work evaluates the seizure susceptibility of nai;ve female Wistar Audiogenic rats (WARs), a genetic model of reflex epilepsy in which seizures are induced by high-intensity sound stimulation (120 dB SPL), to other pro-convulsive stimuli: transauricular electroshock (ES), pentylenetetrazole (PTZ) and pilocarpine (PILO). Normal Wistar rats from the main breeding stock of the Institute of Biological Sciences, UFMG were taken as controls. Electroshock seizures were induced through a pair of ear-clip electrodes (10 mA, at a frequency of 60 Hz, applied for 1 s). In order to test WAR susceptibility to chemically induced seizures, animals were treated either with PTZ (37.5 mg/kg i.p.) or PILO (200, 270 and 300 mg/kg i.p.). Seizure severity was evaluated by appropriate behavioral severity index scales (SI) specific to each epilepsy model and tested for statistical significance using the non-parametric Mann-Whitney Rank Sum test. Results show a significantly greater susceptibility of WARs for ES (SI(WAR)=3+/-3/3, SI(Wistar)=1+/-1/1; median+/-interquartile range 25%/75%, P<0.01) and PTZ (SI(WAR)=4+/-4/4, SI(Wistar)=1+/-1/4; median+/-interquartile range 25%/75%, P<0.02), as indicated by significantly higher SI scores and shorter latencies for seizure onset (T(WAR)=71+/-7 s, T(Wistar)=94+/-8 s; P<0.05 Student t-test, mean+/-S.E.M.). Although PILO also caused higher SI scores in WARs (WAR(200 mg)=1+/-1/1, Wistar(200 mg)=1+/-1/1; WAR(270 mg)=1.5+/-1/2, Wistar(270 mg)=1+/-1/1.25; WAR(300 mg)=9+/-1/9, Wistar(300 mg)=4+/-1.5/7.5; median+/-interquartile range 25%/75%), statistically significant differences were not observed. In conclusion, our results show that WARs have an inherited broader predisposition for seizures.
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Affiliation(s)
- A V Scarlatelli-Lima
- Department of Physiology and Biophysics, Institute of Biological Sciences, Federal University of Minas Gerais, Av Antonio Carlos 6627, Campus Pampulha, CEP 31270-901, Belo Horizonte, MG, Brazil
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28
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Abstract
The impact of advanced brain imaging procedures in the field of human memory disorder is reviewed, with particular emphasis on current and potential applications that may impact upon the diagnosis and management of memory-disordered patients. While both advanced structural, resting physiological and functional physiological brain imaging procedures have been applied to conditions where memory disorder is a major feature, the specific implications of research findings for diagnosis and treatment in routine clinical practice remain tentative and promising, but not yet substantive enough to inform clinical decisions to a significant degree. In terms of diagnostic applications, several promising areas include dementia, epilepsy, and transient amnesic states. In the case of applications in treatment settings, advanced brain imaging procedures may help to monitor neural correlates of spontaneous recovery or progression of memory function, and may also help in the planning and monitoring of therapeutic intervention.
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Affiliation(s)
- Narinder Kapur
- Wessex Neurological Centre, Department of Psychology, University of Southampton, UK.
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White JR, Matchinsky D, Beniak TE, Arndt RC, Walczak T, Leppik IE, Rarick J, Roman DD, Gumnit RJ. Predictors of postoperative memory function after left anterior temporal lobectomy. Epilepsy Behav 2002; 3:383-389. [PMID: 12609337 DOI: 10.1016/s1525-5050(02)00051-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Patients who undergo left anterior temporal lobectomy (ATL) for intractable epilepsy are at risk of postoperative memory decline. This study attempts to identify the best predictors of memory after ATL using preoperative tests. Thirty-two consecutive patients who underwent left ATL with preoperative and postoperative neuropsychological testing were retrospectively identified. The following independent variables were analyzed by multiple regression: age of onset of seizures, age of temporal lobe damage, gender, MRI results, preoperative memory testing, and intracarotid amytal procedure (IAP) results. Neuropsychological measures of verbal and nonverbal memory served as dependent variables. Male gender (P<0.005), failing the IAP with both left and right hemispheres (P<0.001), and higher logical memory (LM) scores preoperatively (P<0.001) were associated with greater declines in LM after surgery. Our data demonstrate that the IAP predicts postoperative memory independent of other factors known to affect memory after left ATL.
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Affiliation(s)
- James R. White
- MINCEP Epilepsy Care, Suite 200, 5775 Wayzata Boulevard, 55416, Minneapolis, MN, USA
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30
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Abstract
In patients with pharmacologically intractable, complex-partial seizures, surgical excision of the involved temporal lobe may have significant therapeutic benefit. Resection of mesial structures of the temporal lobes, however, entails a significant risk of decreased memory function. Recent advances in the assessment of memory changes following temporal lobectomy surgery emphasize the complexity of subjective ratings of memory functioning in this population. Neuroimaging tools useful in the diagnostic evaluation of epilepsy surgical candidates have now been shown to be useful in predicting memory change in the post-surgical period. Functional magnetic resonance imaging appears to provide significant information regarding hemispheric representation of language in the temporal lobe epilepsy patient, and the use of this technique to predict memory status following surgery appears promising. Clinical studies involving patients who had temporal lobectomy surgeries have also revealed changes in emotional learning related to the degree of amygdala involvement. Moreover, there is increasing evidence to suggest that differential changes in emotional learning occur among patients with right versus left temporal lobe resections.
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Affiliation(s)
- Rebecca Rausch
- Department of Neurology and Psychiatry, UCLA School of Medicine, Los Angeles, California 90095-1769, USA.
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Lee TMC, Yip JTH, Jones-Gotman M. Memory deficits after resection from left or right anterior temporal lobe in humans: a meta-analytic review. Epilepsia 2002; 43:283-91. [PMID: 11906514 DOI: 10.1046/j.1528-1157.2002.09901.x] [Citation(s) in RCA: 211] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Memory deficits in epileptic patients have been found in some, but not all studies assessing the effects of side of seizures and resection from a temporal lobe on cognitive performance. The purpose of this study was to provide a quantitative review of previous studies on this issue. METHODS Based on conventional meta-analytic procedures, we identified 33 studies that assessed verbal and nonverbal memory performance before and after anterior temporal lobectomy. The Logical Memory and Visual Reproduction subtests from the Wechsler Memory Scale were used. These studies were then subjected to two levels of analyses: (a) vote-counting procedure, and (b) effect-size calculations and comparisons. RESULTS Overall, the data confirmed previous findings that verbal memory tasks are sensitive to left hemisphere dysfunction. The efficacy of a "nonverbal" task for tapping function in the nondominant (right) hemisphere was not confirmed, although a trend supporting this speculation was observed. With regard to the comparison of changes in verbal and nonverbal memory before and after resection from a temporal lobe, a clear trend was observed for decline in verbal memory function after resection from the left, especially significant for immediate verbal recall. A trend for contralateral improvement on nonverbal memory also was observed. The pattern of memory change after resection from the right temporal lobe was less clear. CONCLUSIONS The findings of this study suggest that side of epileptic seizure and surgical resection from a temporal lobe affect verbal memory functions. The relations between the laterality of epileptic seizure, surgical resection from the temporal lobe, and nonverbal memory are to be verified by further research.
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Affiliation(s)
- Tatia M C Lee
- Department of Psychology, The University of Hong Kong, Hong Kong.
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32
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Gleissner U, Helmstaedter C, Schramm J, Elger CE. Memory outcome after selective amygdalohippocampectomy: a study in 140 patients with temporal lobe epilepsy. Epilepsia 2002; 43:87-95. [PMID: 11879392 DOI: 10.1046/j.1528-1157.2002.24101.x] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE The technique of selective amygdalohippocampectomy (SAH) was originally developed in epilepsy surgery to spare unaffected brain tissue from surgery, thus minimizing the cognitive consequences of temporal lobe surgery. The results of previous studies, however, are equivocal in this regard. This study evaluated memory after SAH in a large sample of patients with mesial temporal lobe epilepsy. METHODS The 140 patients received material-specific memory tests before and 3 months after unilateral SAH. RESULTS Significant declines in all aspects of verbal learning and memory were found particularly for the left resected group. With reliability-of-change indices, a high number of patients showed postoperative verbal memory declines, < or = 51% in left SAH and < or = 32% in right SAH. For left SAH, a higher preoperative verbal memory performance, a lower preoperative nonverbal memory score, an older age at surgery, and a later onset of epilepsy predicted a stronger decline in verbal memory. After right SAH, the risk for a verbal memory decline was slightly increased when patients had surgical complications or a presurgical evaluation with bilateral intrahippocampal depth electrodes. Results concerning nonverbal memory were less clear. CONCLUSIONS The results clearly indicate, that particularly left SAH can lead to a significant decline in memory functions. Predictors of postoperative verbal memory were similar to those reported for temporal lobectomy. Postoperative deteriorations were broader and stronger in our study than in previous studies. We discuss methodologic differences (sample size, retest interval, extent of resection) and other factors as possible reasons.
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Affiliation(s)
- Ulrike Gleissner
- University Hospital of Epileptology, Bonn, Germany. ,uni-bonn.de
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Wendel JD, Trenerry MR, Xu YC, Sencakova D, Cascino GD, Britton JW, Lagerlund TD, Shin C, So EL, Sharbrough FW, Jack CR. The relationship between quantitative T2 relaxometry and memory in nonlesional temporal lobe epilepsy. Epilepsia 2001; 42:863-8. [PMID: 11488885 DOI: 10.1046/j.1528-1157.2001.042007863.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE We investigated the relationship between preoperative quantitative magnetic resonance imaging (MRI) T2 relaxometry and volumetry of the hippocampi and pre- and postoperative verbal memory in temporal lobectomy patients who had nonlesional temporal lobe epilepsy. METHODS Pre- and postoperative memory data based on the Logical Memory (LM) subtest of the Wechsler Memory Scale-Revised (WMS-R) and the 30-min delayed recall trial of the Rey Auditory Verbal Learning Test (AVLT) were obtained from 26 left and 15 right temporal lobectomy patients. Coronal MRI T2 maps were generated for these 41 temporal lobectomy patients as well as 61 control patients. Hippocampal T2 relaxation times and hippocampal volumes, converted to z scores using control group data, were correlated with neuropsychological performance in the patients. RESULTS In left temporal lobe-onset patients, high T2 in the left hippocampal body predicted higher LM performance after surgery. Asymmetrically high T2 in the left hippocampal body (i.e., the right-minus-left difference), compared with the right hippocampal body, also predicted higher LM performance after surgery. In right temporal lobe-onset patients, high T2 in the left hippocampal body predicted relatively lower AVLT performance after surgery. Multiple regression analysis in left temporal-onset patients revealed that high T2 in the left hippocampal body together with higher preoperative LM performance predict higher postoperative LM performance. CONCLUSIONS Our findings suggest that elevated (i.e., abnormal) hippocampal T2 signal is associated with memory ability (or hippocampal functional capacity) independent of MRI-determined hippocampal atrophy. Therefore, our findings support the use of quantitative T2 relaxometry as an independent predictor of verbal memory outcome in both left and right TLE patients who are candidates for temporal lobectomy.
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Affiliation(s)
- J D Wendel
- Department of Diagnostic Radiology, and Mayo Medical School, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA
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Affiliation(s)
- R Martin
- UAB Epilepsy Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, 35294-0021
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Trenerry MR. Re: gender, memory, and hippocampal volumes: relationships in temporal lobe epilepsy to the editor. Epilepsy Behav 2000; 1:195-6. [PMID: 12609156 DOI: 10.1006/ebeh.2000.0067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- M R Trenerry
- Mayo Clinic, Mayo Foundation, Rochester, Minnesota
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Stuss DT, Levine B, Alexander MP, Hong J, Palumbo C, Hamer L, Murphy KJ, Izukawa D. Wisconsin Card Sorting Test performance in patients with focal frontal and posterior brain damage: effects of lesion location and test structure on separable cognitive processes. Neuropsychologia 2000; 38:388-402. [PMID: 10683390 DOI: 10.1016/s0028-3932(99)00093-7] [Citation(s) in RCA: 364] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Forty-six patients with single focal lesions (35 frontal, 11 nonfrontal) were administered the Wisconsin Card Sorting Test (WCST) under three conditions of test administration. The three conditions varied in the amount of external support provided via specificity of instructions. The WCST, while a multifactorial test, is specifically sensitive to the effects of frontal lobe damage if deficits in language comprehension and visual-spatial search are controlled. There is also specificity of functioning within the frontal lobes: patients with inferior medial frontal lesions, unilateral or bilateral, were not impaired on the standard measures although they had increased loss of set when informed of the sorting categories. Verbal instructions may provide a probe to improve diagnosis and prognosis, assessment of the potential efficacy of treatment, and the time frame of plasticity of specific cognitive operations.
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Affiliation(s)
- D T Stuss
- Rotman Research Institute, Baycrest Centre for Geriatric Care, University of Toronto 3560 Bathurst Street, Toronto, Canada.
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Bengtson M, Martin R, Sawrie S, Gilliam F, Faught E, Morawetz R, Kuzniecky R. Gender, Memory, and Hippocampal Volumes: Relationships in Temporal Lobe Epilepsy. Epilepsy Behav 2000; 1:112-119. [PMID: 12609140 DOI: 10.1006/ebeh.2000.0051] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Previous research has suggested bilateral hippocampal support for verbal memory in women with early left-hemisphere injury and that women experience better verbal memory outcome following anterior temporal lobectomy (ATL). The present study investigated two issues: (1) Do women have better verbal memory outcome following ATL compared with men? (2) Are verbal memory abilities differentially supported by the right and left hippocampus in males and females? Verbal memory performance [Wechsler Memory Scale: Logical Memory (LM) savings score] was assessed in 70 patients who underwent ATL. MRI volumetric measurements of the left and right hippocampus were performed. No LM savings score difference was found between groups preoperatively although a statistically significant gender effect (P < 0.04) was found for postoperative LM savings scores. Females displayed better postoperative memory performance, regardless of side of surgery. Preoperative verbal memory performance was not associated with right or left hippocampal volumes in either left or right ATL females, although the right hippocampus was positively associated with memory performance for left ATL males. Hippocampal volumes were not associated with postoperative LM savings scores for any group. Results suggest that prose recall was only modestly influenced by gender and that bilateral hippocampal support for prose recall was not present in our female patients.
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Guerreiro C, Cendes F, Li LM, Jones-Gotman M, Andermann F, Dubeau F, Piazzini A, Feindel W. Clinical patterns of patients with temporal lobe epilepsy and pure amygdalar atrophy. Epilepsia 1999; 40:453-61. [PMID: 10219271 DOI: 10.1111/j.1528-1157.1999.tb00740.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE MRI volumetric measurements (MRIvol) have been proven reliable in determining mesial temporal atrophy in patients with TLE. We attempted to correlate the clinical features with different patterns of hippocampal formation (HF) and amygdala (AM) atrophy in patients with TLE without foreign tissue lesion. METHODS We studied 65 patients with refractory TLE. They were divided into five groups according to MRIvol results: pure AM atrophy (n = 11, 10 unilateral and one bilateral), unilateral HF atrophy (n = 16), bilateral HF atrophy (n = 12), unilateral AM + HF atrophy (n = 13), and patients with normal volumes of AM and HF (n = 13). MRIvol of AM and HF were performed by using a protocol previously described by Watson et al. (Neurology 1992;42:1743-50). RESULTS Patients with AM atrophy had later onset of seizures compared with those with unilateral HF atrophy (p < 0.01). History of febrile convulsions (p < 0.0001) and frequent secondarily generalized tonic-clonic seizures (GTCSs) were more often found in patients with HF atrophy compared with those with pure AM atrophy and those with normal volumes (p = 0.04). Prolonged postictal confusion was more often found with AM atrophy (p = 0.05). Memory impairment was more severe in patients with HF atrophy than in those with AM atrophy only or in those with normal volumes (p = 0.03). There were no significant differences among the five groups in the following parameters: age, duration of epilepsy, seizure frequency, and presence and type of aura. CONCLUSIONS Prolonged postictal confusion appeared to be related to AM atrophy, in keeping with previous clinical observations. These patients also had a lower incidence of early febrile convulsions, older age at epilepsy onset, lower frequency of secondary GTCS, and lesser memory dysfunction compared with patients with hippocampal atrophy.
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Affiliation(s)
- C Guerreiro
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
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Martin RC, Sawrie SM, Roth DL, Gilliam FG, Faught E, Morawetz RB, Kuzniecky R. Individual memory change after anterior temporal lobectomy: a base rate analysis using regression-based outcome methodology. Epilepsia 1998; 39:1075-82. [PMID: 9776328 DOI: 10.1111/j.1528-1157.1998.tb01293.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To characterize patterns of base rate change on measures of verbal and visual memory after anterior temporal lobectomy (ATL) using a newly developed regression-based outcome methodology that accounts for effects of practice and regression towards the mean, and to comment on the predictive utility of baseline memory measures on postoperative memory outcome. METHODS Memory change was operationalized using regression-based change norms in a group of left (n = 53) and right (n = 48) ATL patients. All patients were administered tests of episodic verbal (prose recall, list learning) and visual (figure reproduction) memory, and semantic memory before and after ATL. RESULTS ATL patients displayed a wide range of memory outcome across verbal and visual memory domains. Significant performance declines were noted for 25-50% of left ATL patients on verbal semantic and episodic memory tasks, while one-third of right ATL patients displayed significant declines in immediate and delayed episodic prose recall. Significant performance improvement was noted in an additional one-third of right ATL patients on delayed prose recall. Base rate change was similar between the two ATL groups across immediate and delayed visual memory. Approximately one-fourth of all patients displayed clinically meaningful losses on the visual memory task following surgery. Robust relationships between preoperative memory measures and nonstandardized change scores were attenuated or reversed using standardized memory outcome techniques. CONCLUSIONS Our results demonstrated substantial group variability in memory outcome for ATL patients. These results extend previous research by incorporating known effects of practice and regression to the mean when addressing meaningful neuropsychological change following epilepsy surgery. Our findings also suggest that future neuropsychological outcome studies should take steps towards controlling for regression-to-the-mean before drawing predictive conclusions.
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Affiliation(s)
- R C Martin
- University of Alabama at Birmingham, School of Medicine, Department of Neurology, Epilepsy Center, 35294-0021, USA
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Davies KG, Bell BD, Bush AJ, Wyler AR. Prediction of verbal memory loss in individuals after anterior temporal lobectomy. Epilepsia 1998; 39:820-8. [PMID: 9701371 DOI: 10.1111/j.1528-1157.1998.tb01175.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Decreased memory function represents the area of greatest neuropsychological morbidity after anterior temporal lobectomy (ATL), particularly for left ATL candidates. We wished to identify easily derived demographic and neuropsychological predictors of risk of pre- to postoperative memory decline using only information available preoperatively. METHODS We assessed decline in memory as measured by the California Verbal Learning Test (CVLT) by deriving multiple regression equations using the following measures as independent variables: age at onset, chronological age at time of surgery, sex, Full Scale IQ (FSIQ), level of education, and preoperative memory scores. In all, 203 patients (93 males, 110 females), undergoing ATL (107 left, 96 right) with preoperative and 6-month postoperative testing, were examined. RESULTS The combination of age, FSIQ, sex, side of surgery and preoperative score was highly predictive (p-values < 0.0001) of postoperative memory scores. Higher postoperative scores were associated with higher preoperative score, younger chronological age, higher FSIQ, female sex, and right side of resection. Reliable change index (RCI) values were used to estimate meaningful decline on the total score across five trials. Logistic regression analysis showed preoperative score and age to be predictors of RCI decline for left-sided resections. Sensitivity of decline (> or =90th centile RCI) prediction was 56%, and specificity was 95%. Validation in 30 patients from a separate population of patients undergoing left ATL produced similar figures. CONCLUSIONS The derived regression equations can accurately predict verbal memory decline on a list-learning task in approximately 50% of individual patients undergoing ATL, and false-positive prediction errors are very rare.
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Affiliation(s)
- K G Davies
- Epi-Care Center, Baptist Memorial Hospital, Department of Neurosurgery, University of Tennessee, Memphis 38103, USA
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Paulson PE, Minoshima S, Morrow TJ, Casey KL. Gender differences in pain perception and patterns of cerebral activation during noxious heat stimulation in humans. Pain 1998; 76:223-9. [PMID: 9696477 PMCID: PMC1828033 DOI: 10.1016/s0304-3959(98)00048-7] [Citation(s) in RCA: 247] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception. Accordingly, positron emission tomography (PET) with intravenous injection of H2(15)O was used to detect increases in regional cerebral blood flow (rCBF) in normal right-handed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm. Each subject was instructed in magnitude estimation based on a scale for which 0 indicated 'no heat sensation'; 7, 'just barely painful' and 10, 'just barely tolerable'. Thermal stimuli were 40 degrees C or 50 degrees C heat, applied with a thermode as repetitive 5-s contacts to the volar forearm. Both male and female subjects rated the 40 degrees C stimuli as warm but not painful and the 50 degrees C stimuli as painful but females rated the 50 degrees C stimuli as significantly more intense than did the males (P=0.0052). Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures, including the posterior insula, anterior cingulate cortex and the cerebellar vermis, during heat pain. However, females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction. Volume of interest comparison (t-statistic) also suggested greater activation of the contralateral insula and thalamus in the females (P < 0.05). These pain-related differences in brain activation may be attributed to gender, perceived pain intensity, or to both factors.
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Affiliation(s)
- P E Paulson
- Neurology Research Laboratories, University of Michigan, VA Medical Center, Ann Arbor 48105, USA
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Davies KG, Bell BD, Bush AJ, Hermann BP, Dohan FC, Jaap AS. Naming decline after left anterior temporal lobectomy correlates with pathological status of resected hippocampus. Epilepsia 1998; 39:407-19. [PMID: 9578031 DOI: 10.1111/j.1528-1157.1998.tb01393.x] [Citation(s) in RCA: 130] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the determinants of postoperative change in visual confrontation naming ability and the differential sensitivity of two common tests of confrontation naming. METHODS In a group of 99 patients undergoing lobectomy of the left, language-dominant anterior temporal lobe, we examined naming ability using two measures: the 60 item Boston Naming Test (BNT), and the Visual Naming (VN) subtest of the Multilingual Aphasia Examination (MAE). ATL entailed resection of lateral temporal lobe followed by microsurgical complete removal of hippocampus. Language mapping was not performed. The status of the resected hippocampus was graded on a scale 0-4 of hippocampal sclerosis (HS). A dichotomous grouping HS- (grades 0 and 1, n = 34) and HS+ (grades 3 and 4, n = 61) was effected. Age at surgery, age of epilepsy onset, sex, extent of lateral temporal resection, Full-Scale IQ (FSIQ), and preoperative naming scores were also examined as potential predictors of pre- versus postoperative naming change. RESULTS Preoperative BNT and VN scores were significantly worse for HS+ than for HS- (BNT, p < 0.05; VN, p = 0.001). Postoperatively, BNT and VN scores significantly declined for HS- as compared with HS+ patients (p < 0.001). For individual risk, the 90th centile of reliable change index (RCI) was used. By this criterion, of the total sample, 39% evidenced decline on the BNT and 17% evidenced decline on the VN. Logistic regression analysis with backward elimination showed HS to be the only predictor of decline in BNT and HS and sex to be the only predictors of VN decline. Males were more at risk than females. Age, age at onset, extent of lateral resection, preoperative scores, and FSIQ were not predictors. Using age at onset as a proxy for HS+/HS- we calculated probabilities for naming decline for given onset age. CONCLUSIONS Both preoperative and postoperative change in naming ability are associated with the pathological status of the hippocampus. The potential interpretations and implications of these findings are discussed.
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Affiliation(s)
- K G Davies
- Epi-Care Center, Baptist Memorial Hospital, Department of Neurosurgery, University of Tennessee, Memphis 38103, USA
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Bell BD, Davies KG. Anterior temporal lobectomy, hippocampal sclerosis, and memory: recent neuropsychological findings. Neuropsychol Rev 1998; 8:25-41. [PMID: 9585921 DOI: 10.1023/a:1025679122911] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Anterior temporal lobectomy (ATL) is an effective and increasingly utilized treatment for nonlesional, intractable mesial temporal lobe epilepsy. However, this surgery results in domain-specific neuropsychological morbidity for a subset of patients. Within the past decade, multidisciplinary studies have revealed that left ATL patients without significant sclerosis in the resected hippocampus are most at risk for a substantial postacute decline in the ability to encode new verbal information. These patients are also at risk for a significant decrement in confrontation naming and other retrieval-based language abilities. The memory deficit is not attributable to this disruption of language. A relationship between hippocampal sclerosis (HS) status and memory performance has not been identified consistently in right ATL patients, but investigation of new visuospatial measures continues. The influence of variables other than HS on neuropsychological outcome is also discussed.
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Affiliation(s)
- B D Bell
- Epi-Care Center, Baptist Memorial Hospital, Memphis, Tennessee, USA
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Baxendale SA, van Paesschen W, Thompson PJ, Connelly A, Duncan JS, Harkness WF, Shorvon SD. The relationship between quantitative MRI and neuropsychological functioning in temporal lobe epilepsy. Epilepsia 1998; 39:158-66. [PMID: 9577995 DOI: 10.1111/j.1528-1157.1998.tb01353.x] [Citation(s) in RCA: 115] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Quantitative MRI techniques provide an unparalleled opportunity to examine in vivo the relationship between the extent and laterality of hippocampal pathology and associated neuropsychological deficits. The purpose of this study was to examine the nature of the relationship between quantitative measures of hippocampal pathology and neuropsychological measures, using a multivariate approach. METHODS We examined the relationship between two MRI measures of hippocampal structure; hippocampal volumes (HCvol) and T2 relaxation times (HCT2), and memory performance, in 80 presurgical temporal lobe epilepsy patients. RESULTS As a group, patients with left hippocampal sclerosis (LHS) performed more poorly that those with right hippocampal sclerosis (RHS) on immediate and delayed prose recall. In the group as a whole, right hippocampal volume was significantly correlated with the delayed recall of a complex figure. None of the verbal memory test scores were significantly correlated with the right or left HCvol or HCT2 measures. However, stepwise multiple regression analyses indicated that up to a third of the variation in specific test scores could be explained by the quantitative MRI hippocampal measures in conjunction with chronological age, and age at onset of habitual epilepsy. Left hippocampal measures explained 24% of the variance in the story-recall tasks, while right hippocampal measures explained 18% of the variance in a design-learning task and 32% of the variance in a figure-recall task. CONCLUSIONS Our results provide some support for the lateralised model of material specific memory deficits, but suggest that a number of demographic and epilepsy-related factors may interact with the extent and laterality of hippocampal pathology in shaping the nature of the associated neuropsychological deficit.
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Affiliation(s)
- S A Baxendale
- The National Hospital for Neurology and Neurosurgery, London, UK
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Janowsky JS, Chavez B, Zamboni BD, Orwoll E. The cognitive neuropsychology of sex hormones in men and women. Dev Neuropsychol 1998. [DOI: 10.1080/87565649809540719] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Stein MB, Hanna C, Koverola C, Torchia M, McClarty B. Structural brain changes in PTSD. Does trauma alter neuroanatomy? Ann N Y Acad Sci 1997; 821:76-82. [PMID: 9238195 DOI: 10.1111/j.1749-6632.1997.tb48270.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Although the impetus for studying hippocampal morphology and functioning in PTSD was the finding that stress could result in hippocampal damage in rodent and primate models, it is far from proven that the findings to date in PTSD represent defects that have been caused by trauma. It is equally possible that the findings represent a preexisting anomaly which might serve as a risk factor for the development of PTSD following trauma exposure. To resolve this dilemma, it is necessary to study persons at high risk for trauma (e.g., soldiers) prior to trauma exposure and ag in after exposure. Such methods will permit the determination not only of whether trauma alters hippocampal morphology, but also, if so, of whether this effect is limited to persons with PTSD. At the present time, the field would be well advised to proceed vigorously but with appropriate caution along these lines of research. As just outlined, sample sizes have been small, and potentially confounding variables have abounded in most studies. The next few years of research may well continue to replicate the finding of abnormal hippocampal morphology in PTSD. However, it would not be surprising to find that other brain regions are also involved and that these represent part of a broader risk spectrum for the development of psychopathology under stress. Until these issues are clarified, the neuroanatomical findings to date in PTSD should be viewed as tentative, tantalizing, and in need of additional study.
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Affiliation(s)
- M B Stein
- Department of Psychiatry, San Diego Veterans Affairs Medical Center, California 92161, USA
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Abstract
Improved neuroanatomical knowledge, technical and methodological innovations (such as PET), and more refined conceptualizations of memory have inspired a reappraisal of theoretical beliefs regarding the role of the hippocampus in memory. In the past few years, it has become apparent that the influence of the medial temporal lobe regions extends beyond memory and that memory processes (such as encoding, consolidation and retrieval) involve not only the hippocampus and the medial temporal and diencephalic regions, but also widely distributed neocortical and perhaps even cerebellar regions.
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Affiliation(s)
- E Tulving
- Rotman Research Institute of Baycrest Centre, 3560 Bathurst Street, North York, Ontario, Canada M6A 2E1.
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48
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Abstract
Neuropsychologic assessment has long been an integral part of evaluation for surgical treatment of epilepsy. Neuropsychologic evaluation and consultation continue to be an important part of the assessment for operative intervention for epilepsy, but the role of neuropsychology has changed over time. At one time, neuropsychologic assessment assumed a diagnostic role in preoperative evaluation for epilepsy and also contributed to the lateralization and localization of the seizure focus. Sophisticated electroencephalographic techniques and especially neuroimaging have revolutionized the diagnosis and management in epilepsy surgical treatment centers. Although still helpful, neuropsychology no longer has a major role in lateralization or localization of seizure onset. This report describes neuropsychologic evaluation and its current role in surgical treatment of epilepsy. The characteristics and purposes of neuropsychologic assessment and Wada testing (intracarotid injection of amobarbital) are described. Current research on assessment of emotional adjustment and on its predictors before and after surgical therapy for epilepsy is reviewed. Finally, the risk for neuropsychologic decline after temporal lobectomy is discussed in light of recent research on preoperative memory, hippocampal pathologic lesions, and quantitative neuroimaging data.
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Affiliation(s)
- M R Trenerry
- Department of Psychiatry and Psychology, Mayo Clinic Rochester, Minnesota 55905, USA
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49
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Abstract
In order to analyse mechanisms of sex differentiation of the hippocampus at the cellular level, the differentiation of hippocampal GABAergic neurons was studied in vitro. Serum-supplemented and serum-free dissociated cell cultures were raised from the hippocampus of embryonic day 17 male and female rat embryos for up to 14 days in vitro. This time period roughly corresponds to the critical phase for sex differentiation of the rat brain as determined in vivo. Serum-free cultures were treated with testosterone and/or 17 beta-oestradiol for the entire culture period. Control cultures from male donors contained twice as many GABA-immunoreactive neurons as those from female donors, while there was no sex difference in overall counts of neurons stained for microtubule-associated protein 5. Measurements of high-affinity uptake of [3H]GABA essentially confirmed this sex difference. The development of the sex difference could not be influenced by long-term treatment with androgen or oestrogen. It is concluded that sex differentiation of a specific subpopulation of hippocampal neurons may take place independently of the environment provided by gonadal steroids and in the absence of extrinsic connections with the hypothalamus or other relays of the limbic circuit.
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Affiliation(s)
- I Reisert
- Abteilung Anatomie und Zellbiologie, Universität Ulm, Germany
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50
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Trenerry MR, Jack CR, Cascino GD, Sharbrough FW, So EL. Bilateral magnetic resonance imaging-determined hippocampal atrophy and verbal memory before and after temporal lobectomy. Epilepsia 1996; 37:526-33. [PMID: 8641228 DOI: 10.1111/j.1528-1157.1996.tb00604.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We investigated pre- and postoperative verbal memory in temporal lobectomy patients who had volumetrically symmetric hippocampi. Pre- and postoperative verbal memory data based on the Logical Memory subtest of the Wechsler Memory Scale-Revised (WMS-R) were obtained from 15 left and 18 right temporal lobectomy patients. The difference between hippocampal volumes (R/L) was between -0.1 and 0.3 cm3, which is indeterminate for lateralizing hippocampal atrophy. Patients were divided into four groups based on side of operation and combined hippocampal volume expressed as a function of total intracranial volume (R + L volume/total intracranial volume). Patients with a combined hippocampal volume that was smaller than any combined hippocampal value of a normal control group were defined as bilaterally atrophic. Left temporal lobectomy patients demonstrated the expected decrease in verbal memory postoperatively regardless of whether the volumetrically symmetric hippocampi were nonatrophic or atrophic. Left temporal lobectomy patients with bilaterally atrophic hippocampi, however, had the poorest verbal memory before and after operation. Right temporal lobectomy patients tended to have improved verbal memory after operation whether or not the volumetrically symmetric hippocampi were atrophic. We conclude that side of operation is a more potent predictor of verbal memory outcome than is hippocampal atrophy when hippocampi are bilaterally symmetric and that left temporal lobectomy patients with bilateral atrophy may be at risk for greater functional deficits after operation.
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Affiliation(s)
- M R Trenerry
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
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