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Leeman-Markowski BA, Martin SP, Hardstone R, Tam DM, Devinsky O, Meador KJ. Novelty preference assessed by eye tracking: A sensitive measure of impaired recognition memory in epilepsy. Epilepsy Behav 2024; 155:109749. [PMID: 38636142 DOI: 10.1016/j.yebeh.2024.109749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 03/18/2024] [Accepted: 03/21/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE Epilepsy patients often report memory deficits despite normal objective testing, suggesting that available measures are insensitive or that non-mnemonic factors are involved. The Visual Paired Comparison Task (VPCT) assesses novelty preference, the tendency to fixate on novel images rather than previously viewed items, requiring recognition memory for the "old" images. As novelty preference is a sensitive measure of hippocampal-dependent memory function, we predicted impaired VPCT performance in epilepsy patients compared to healthy controls. METHODS We assessed 26 healthy adult controls and 31 epilepsy patients (16 focal-onset, 13 generalized-onset, 2 unknown-onset) with the VPCT using delays of 2 or 30 s between encoding and recognition. Fifteen healthy controls and 17 epilepsy patients (10 focal-onset, 5 generalized-onset, 2 unknown-onset) completed the task at 2-, 5-, and 30-minute delays. Subjects also performed standard memory measures, including the Medical College of Georgia (MCG) Paragraph Test, California Verbal Learning Test-Second Edition (CVLT-II), and Brief Visual Memory Test-Revised (BVMT-R). RESULTS The epilepsy group was high functioning, with greater estimated IQ (p = 0.041), greater years of education (p = 0.034), and higher BVMT-R scores (p = 0.024) compared to controls. Both the control group and epilepsy cohort, as well as focal- and generalized-onset subgroups, had intact novelty preference at the 2- and 30-second delays (p-values ≤ 0.001) and declined at 30 min (p-values > 0.05). Only the epilepsy patients had early declines at 2- and 5-minute delays (controls with intact novelty preference at p = 0.003 and p ≤ 0.001, respectively; epilepsy groups' p-values > 0.05). CONCLUSIONS Memory for the "old" items decayed more rapidly in overall, focal-onset, and generalized-onset epilepsy groups. The VPCT detected deficits while standard memory measures were largely intact, suggesting that the VPCT may be a more sensitive measure of temporal lobe memory function than standard neuropsychological batteries.
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Affiliation(s)
- Beth A Leeman-Markowski
- Neurology Service, VA New York Harbor Healthcare System, 423 E. 23(rd) St., New York, NY 10010, USA; Comprehensive Epilepsy Center, Department of Neurology, New York University Langone Health, 223 E. 34(th) St., New York, NY 10016, USA; Research Service, VA New York Harbor Healthcare System, 423 E. 23(rd) St., New York, NY 10010, USA.
| | - Samantha P Martin
- Comprehensive Epilepsy Center, Department of Neurology, New York University Langone Health, 223 E. 34(th) St., New York, NY 10016, USA; Research Service, VA New York Harbor Healthcare System, 423 E. 23(rd) St., New York, NY 10010, USA.
| | - Richard Hardstone
- Neuroscience Institute, New York University Langone Health, 550 1st Ave., New York, NY 10016, USA; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Boston, MA 02114, USA.
| | - Danny M Tam
- Division of Psychology, Mental Health Service, VA New York Harbor Healthcare System, 423 E. 23(rd) St., New York, NY 10010, USA.
| | - Orrin Devinsky
- Comprehensive Epilepsy Center, Department of Neurology, New York University Langone Health, 223 E. 34(th) St., New York, NY 10016, USA; Neuroscience Institute, New York University Langone Health, 550 1st Ave., New York, NY 10016, USA.
| | - Kimford J Meador
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, 213 Quarry Road, MC 5979, Palo Alto, CA 94304, USA.
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Hageboutros K, Hewitt KC, Lee GP, Bansal A, Block C, Pedersen NP, Willie JT, Loring DW, Schoenberg MR, Smith KA, Giller CA, Gross RE, Drane DL. Comparison of minimally invasive to standard temporal lobectomy approaches to epilepsy surgery: Seizure relief and visual confrontation naming outcomes. Epilepsy Behav 2024; 155:109669. [PMID: 38663142 DOI: 10.1016/j.yebeh.2024.109669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/05/2024] [Accepted: 01/23/2024] [Indexed: 05/28/2024]
Abstract
The purpose of this study was to systematically examine three different surgical approaches in treating left medial temporal lobe epilepsy (mTLE) (viz., subtemporal selective amygdalohippocampectomy [subSAH], stereotactic laser amygdalohippocampotomy [SLAH], and anterior temporal lobectomy [ATL]), to determine which procedures are most favorable in terms of visual confrontation naming and seizure relief outcome. This was a retrospective study of 33 adults with intractable mTLE who underwent left temporal lobe surgery at three different epilepsy surgery centers who also underwent pre-, and at least 6-month post-surgical neuropsychological testing. Measures included the Boston Naming Test (BNT) and the Engel Epilepsy Surgery Outcome Scale. Fisher's exact tests revealed a statistically significant decline in naming in ATLs compared to SLAHs, but no other significant group differences. 82% of ATL and 36% of subSAH patients showed a significant naming decline whereas no SLAH patient (0%) had a significant naming decline. Significant postoperative naming improvement was seen in 36% of SLAH patients in contrast to 9% improvement in subSAH patients and 0% improvement in ATLs. Finally, there were no statistically significant differences between surgical approaches with regard to seizure freedom outcome, although there was a trend towards better seizure relief outcome among the ATL patients. Results support a possible benefit of SLAH in preserving visual confrontation naming after left TLE surgery. While result interpretation is limited by the small sample size, findings suggest outcome is likely to differ by surgical approach, and that further research on cognitive and seizure freedom outcomes is needed to inform patients and providers of potential risks and benefits with each.
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Affiliation(s)
- Karine Hageboutros
- Neuropsychology Department, Barrow Neurological Institute, Phoenix, AZ 85013, USA
| | - Kelsey C Hewitt
- Department of Neurology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Gregory P Lee
- Neuropsychology Department, Barrow Neurological Institute, Phoenix, AZ 85013, USA; Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Aastha Bansal
- Emory College of Arts and Sciences, Atlanta, GA 30322, USA
| | - Cady Block
- Department of Neurology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Nigel P Pedersen
- Department of Neurology, University of California Davis, Sacramento, CA 95816, USA
| | - Jon T Willie
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - David W Loring
- Department of Neurology, Emory University School of Medicine, Atlanta, GA 30322, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Mike R Schoenberg
- Department of Neurosurgery, University of South Florida, Tampa, FL 33606, USA
| | - Kris A Smith
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ 85013, USA
| | - Cole A Giller
- Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Robert E Gross
- Department of Neurological Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Daniel L Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, GA 30322, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA; Department of Neurology, University of Washington School of Medicine, Seattle, WA 98195, USA.
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Terman SW, Kirkpatrick L, Kerr WT, Akiyama LF, Baajour W, Atilgan D, Dorotan MKC, Choi HW, French JA. Challenges and directions in epilepsy diagnostics and therapeutics: Proceedings of the 17th Epilepsy Therapies and Diagnostics Development conference. Epilepsia 2024; 65:846-860. [PMID: 38135921 PMCID: PMC11018495 DOI: 10.1111/epi.17875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 12/24/2023]
Abstract
Substantial efforts are underway toward optimizing the diagnosis, monitoring, and treatment of seizures and epilepsy. We describe preclinical programs in place for screening investigational therapeutic candidates in animal models, with particular attention to identifying and eliminating drugs that might paradoxically aggravate seizure burden. After preclinical development, we discuss challenges and solutions in the design and regulatory logistics of clinical trial execution, and efforts to develop disease biomarkers and interventions that may be not only seizure-suppressing, but also disease-modifying. As disease-modifying treatments are designed, there is clear recognition that, although seizures represent one critical therapeutic target, targeting nonseizure outcomes like cognitive development or functional outcomes requires changes to traditional designs. This reflects our increasing understanding that epilepsy is a disease with profound impact on quality of life for the patient and caregivers due to both seizures themselves and other nonseizure factors. This review examines selected key challenges and future directions in epilepsy diagnostics and therapeutics, from drug discovery to translational application.
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Affiliation(s)
- Samuel W Terman
- University of Michigan Department of Neurology, Ann Arbor, MI 48109, USA
| | - Laura Kirkpatrick
- University of Pittsburgh Department of Neurology, Pittsburgh, PA 15213, USA
- University of Pittsburgh Department of Pediatrics, Pittsburgh, PA 15213, USA
| | - Wesley T Kerr
- University of Michigan Department of Neurology, Ann Arbor, MI 48109, USA
- University of Pittsburgh Department of Neurology, Pittsburgh, PA 15213, USA
- University of Pittsburgh Department of Biomedical Informatics, Pittsburgh, PA 15213, USA
| | - Lisa F Akiyama
- University of Washington Department of Neurology, Seattle, WA 98105, USA
| | - Wadih Baajour
- University of Texas Health Science Center at Houston, Department of Neurology, Houston, TX 77030, USA
| | - Deniz Atilgan
- University of Texas Health Science Center at Houston, Department of Neurology, Houston, TX 77030, USA
| | | | - Hyoung Won Choi
- Emory University Department of Pediatrics, Division of Neurology, Atlanta, GA 30322
| | - Jacqueline A French
- NYU Grossman School of Medicine and NYU Langone Health, New York, NY 10016, USA
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Drane DL, Acerbo E, Rogers A, Pedersen NP, Williamson A, Stern MA, Dickey AS, Howard BM, Bearden DJ, Okada N, Staikova E, Gutekunst CA, Alwaki A, Gershon T, Jirsa V, Gross RE, Loring DW, Kheder A, Willie JT. Selective Posterior Cerebral Artery Wada Better Predicts Good Memory and Naming Outcomes Following Selective Stereotactic Thermal Ablation for Medial Temporal Lobe Epilepsy Than Internal Carotid Artery Wada. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.24.24304488. [PMID: 38585976 PMCID: PMC10996748 DOI: 10.1101/2024.03.24.24304488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
The conventional intracarotid amobarbital (Wada) test has been used to assess memory function in patients being considered for temporal lobe epilepsy (TLE) surgery. Minimally invasive approaches that target the medial temporal lobe (MTL) and spare neocortex are increasingly used, but a knowledge gap remains in how to assess memory and language risk from these procedures. We retrospectively compared results of two versions of the Wada test, the intracarotid artery (ICA-Wada) and posterior cerebral artery (PCA-Wada) approaches, with respect to predicting subsequent memory and language outcomes, particularly after stereotactic laser amygdalohippocampotomy (SLAH). We included all patients being considered for SLAH who underwent both ICA-Wada and PCA-Wada at a single institution. Memory and confrontation naming assessments were conducted using standardized neuropsychological tests to assess pre- to post-surgical changes in cognitive performance. Of 13 patients who initially failed the ICA-Wada, only one patient subsequently failed the PCA-Wada (p=0.003, two-sided binomial test with p 0 =0.5) demonstrating that these tests assess different brain regions or networks. PCA-Wada had a high negative predictive value for the safety of SLAH, compared to ICA-Wada, as none of the patients who underwent SLAH after passing the PCA-Wada experienced catastrophic memory decline (0 of 9 subjects, p <.004, two-sided binomial test with p 0 =0.5), and all experienced a good cognitive outcome. In contrast, the single patient who received a left anterior temporal lobectomy after failed ICA- and passed PCA-Wada experienced a persistent, near catastrophic memory decline. On confrontation naming, few patients exhibited disturbance during the PCA-Wada. Following surgery, SLAH patients showed no naming decline, while open resection patients, whose surgeries all included ipsilateral temporal lobe neocortex, experienced significant naming difficulties (Fisher's exact test, p <.05). These findings demonstrate that (1) failing the ICA-Wada falsely predicts memory decline following SLAH, (2) PCA-Wada better predicts good memory outcomes of SLAH for MTLE, and (3) the MTL brain structures affected by both PCA-Wada and SLAH are not directly involved in language processing.
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Kaestner E, Stasenko A, Schadler A, Roth R, Hewitt K, Reyes A, Qiu D, Bonilha L, Voets N, Hu R, Willie J, Pedersen N, Shih J, Ben-Haim S, Gross R, Drane D, McDonald CR. Impact of white matter networks on risk for memory decline following resection versus ablation in temporal lobe epilepsy. J Neurol Neurosurg Psychiatry 2024:jnnp-2023-332682. [PMID: 38212059 DOI: 10.1136/jnnp-2023-332682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/19/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND With expanding neurosurgical options in epilepsy, it is important to characterise each options' risk for postoperative cognitive decline. Here, we characterise how patients' preoperative white matter (WM) networks relates to postoperative memory changes following different epilepsy surgeries. METHODS Eighty-nine patients with temporal lobe epilepsy with T1-weighted and diffusion-weighted imaging as well as preoperative and postoperative verbal memory scores (prose recall) underwent either anterior temporal lobectomy (ATL: n=38) or stereotactic laser amygdalohippocampotomy (SLAH; n=51). We computed laterality indices (ie, asymmetry) for volume of the hippocampus and fractional anisotropy (FA) of two deep WM tracts (uncinate fasciculus (UF) and inferior longitudinal fasciculus (ILF)). RESULTS Preoperatively, left-lateralised FA of the ILF was associated with higher prose recall (p<0.01). This pattern was not observed for the UF or hippocampus (ps>0.05). Postoperatively, right-lateralised FA of the UF was associated with less decline following left ATL (p<0.05) but not left SLAH (p>0.05), while right-lateralised hippocampal asymmetry was associated with less decline following both left ATL and SLAH (ps<0.05). After accounting for preoperative memory score, age of onset and hippocampal asymmetry, the association between UF and memory decline in left ATL remained significant (p<0.01). CONCLUSIONS Asymmetry of the hippocampus is an important predictor of risk for memory decline following both surgeries. However, asymmetry of UF integrity, which is only severed during ATL, is an important predictor of memory decline after ATL only. As surgical procedures and pre-surgical mapping evolve, understanding the role of frontal-temporal WM in memory networks could help to guide more targeted surgical approaches to mitigate cognitive decline.
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Affiliation(s)
- Erik Kaestner
- Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California, USA
| | - Alena Stasenko
- Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California, USA
| | - Adam Schadler
- Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California, USA
| | - Rebecca Roth
- Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kelsey Hewitt
- Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Anny Reyes
- Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California, USA
| | - Deqiang Qiu
- Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA
| | - Leonardo Bonilha
- Department of Neurology, University of South Carolina System, Columbia, South Carolina, USA
| | | | - Ranliang Hu
- Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA
| | - Jon Willie
- Neurosurgery, Washington University in St Louis, St Louis, Missouri, USA
| | | | - Jerry Shih
- Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - Sharona Ben-Haim
- Neurosurgery, University of California, San Diego, La Jolla, California, USA
| | - Robert Gross
- Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Daniel Drane
- Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Carrie R McDonald
- Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California, USA
- Psychiatry, University of California, San Diego, La Jolla, California, USA
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Issa NP, Warnke P. Interstitial laser ablation for epilepsy: beauty lies in the eye of the beholder. J Neurol Neurosurg Psychiatry 2023; 94:973-974. [PMID: 37852745 DOI: 10.1136/jnnp-2023-332702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 09/29/2023] [Indexed: 10/20/2023]
Affiliation(s)
- Naoum P Issa
- Neurology, University of Chicago, Chicago, Illinois, USA
| | - Peter Warnke
- Department of Neurological Surgery, University of Chicago, Chicago, Illinois, USA
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Alomar SA, Moshref RH, Moshref LH, Sabbagh AJ. Outcomes after laser interstitial thermal ablation for temporal lobe epilepsy: a systematic review and meta-analysis. Neurosurg Rev 2023; 46:261. [PMID: 37779130 DOI: 10.1007/s10143-023-02164-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 08/01/2023] [Accepted: 09/23/2023] [Indexed: 10/03/2023]
Abstract
Epilepsy is a common condition that affects approximately 1% of the world's population, with about one-third being refractory epilepsy. Temporal lobe epilepsy is the most common type of drug-resistant epilepsy, and laser interstitial thermal therapy (LITT) is an innovative treatment. In this systematic review and meta-analysis, we aimed to summarize the current evidence on outcomes after LITT, including seizure freedom rate, complication rate, and neurocognitive outcome. PubMed and OVID Medline search engines were systematically searched for all indexed publications in the English language up to July15, 2023. The search was limited to human studies. Proportions and 95% confidence interval (CI) values were calculated for seizure, neurocognitive outcome, and complication rate. A total of 836 patients were included. Overall seizure outcomes, regardless of the pathology, included Engel I outcome in 56% (95% CI, 52.4-59.5%), Engel II outcome in 19.2% (95% CI, 15.4-23.6%), Engel III outcome in 17.3% (95% CI, 13.5-21.8%), and Engel IV outcome in 10.5% (95% CI 6.3-17%) of the patients. The overall decline in verbal and visual memory regardless of laterality was 24.2 (95% CI 8.6-52%) and 25.2% (8.3-55.8%). For naming, the decline was 13.4% (6.6-25.4%). The results of the pooled analysis in comparison with available data in the literature showed that seizure outcomes after LITT were slightly inferior to published data after temporal lobectomy. Data on cognitive outcomes after LITT are scarce and heterogeneous.
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Affiliation(s)
- Soha A Alomar
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine, King Abdulaziz University, 22254, Jeddah, Saudi Arabia.
| | - Rana H Moshref
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine, King Abdulaziz University, 22254, Jeddah, Saudi Arabia
| | - Leena H Moshref
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine, King Abdulaziz University, 22254, Jeddah, Saudi Arabia
| | - Abdulrahman J Sabbagh
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine, King Abdulaziz University, 22254, Jeddah, Saudi Arabia
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Zheng B, Abdulrazeq H, Shao B, Liu DD, Leary O, Lauro PM, Bartolini L, Blum AS, Asaad WF. Seizure and anatomical outcomes of repeat laser amygdalohippocampotomy for temporal lobe epilepsy: A single-institution case series. Epilepsy Behav 2023; 146:109365. [PMID: 37523797 DOI: 10.1016/j.yebeh.2023.109365] [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: 05/15/2023] [Revised: 07/12/2023] [Accepted: 07/20/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE In patients with treatment-refractory temporal lobe epilepsy (TLE), a single stereotactic laser interstitial thermotherapy (LITT) procedure is sometimes insufficient to ablate epileptogenic tissue, particularly the medial structures often implicated in TLE. In patients with seizure recurrence after initial ablation, the extent to which a second ablation may achieve improved seizure outcomes is uncertain. The objective of this study was to investigate the feasibility and potential efficacy of repeat LITT amygdalohippocampotomy as a worthwhile strategy for intractable temporal lobe epilepsy by quantifying changes to targeted mesial temporal lobe structures and seizure outcomes. METHODS Patients who underwent two LITT procedures for drug-resistant mesial TLE at our institution were included in the study. Lesion volumes for both procedures were calculated by comparing post-ablation intraoperative sequences to preoperative anatomy. Clinical outcomes after the initial procedure and repeat procedure were classified according to Engel scores. RESULTS Five consecutive patients were included in this retrospective case series: 3 with right- and 2 with left-sided TLE. The median interval between LITT procedures was 294 days (range: 227-1918). After the first LITT, 3 patients experienced class III outcomes, 1 experienced a class IV, and 1 experienced a class IB outcome. All patients achieved increased seizure freedom after a second procedure, with class I outcomes (3 IA, 2 IB). CONCLUSIONS Repeat LITT may be sufficient to achieve satisfactory seizure outcomes in some individuals who might otherwise be considered for more aggressive resection or palliative neuromodulation. A larger study to establish the potential value of repeat LITT amygdalohippocampotomy vs. other re-operation strategies for persistent, intractable temporal lobe epilepsy is worth pursuing.
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Affiliation(s)
- Bryan Zheng
- The Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
| | - Hael Abdulrazeq
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA.
| | - Belinda Shao
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
| | - David D Liu
- Department of Neurosurgery, Brigham and Womens Hospital, Boston, MA, USA
| | - Owen Leary
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Peter M Lauro
- The Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Neuroscience, Brown University, Providence, RI, USA
| | - Luca Bartolini
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA; Deparment of Neurology, Rhode Island Hospital, Providence, RI, USA; Deparment of Pediatrics, Hasbro Children's Hospital, Providence, RI, USA
| | - Andrew S Blum
- Deparment of Neurology, Rhode Island Hospital, Providence, RI, USA
| | - Wael F Asaad
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA; Department of Neuroscience, Brown University, Providence, RI, USA; The Carney Institute for Brain Science, Brown University, Providence, RI, USA; The Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence, RI, USA
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Lam JLW, Levin EL. Acute V3 Hypesthesia following Laser Interstitial Thermal Therapy for Drug-Resistant Epilepsy. Stereotact Funct Neurosurg 2023; 101:332-337. [PMID: 37607522 DOI: 10.1159/000533224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/21/2023] [Indexed: 08/24/2023]
Abstract
Three studies have reported trigeminal hypesthesia following temporal lobe resection. However, no cases of hypesthesia have been reported following laser interstitial thermal therapy (LITT). We report the first case of trigeminal hypesthesia as a complication of otherwise successful LITT in a patient with drug-resistant epilepsy. A 58-year-old male with drug-resistant epilepsy secondary to a left parahippocampal gyrus multinodular and vacuolating neuronal tumor underwent biopsy and MRI-guided LITT. Immediately postoperatively, the patient reported hypesthesia in the left V3 distribution, including inside the mouth and ear. At 6-month follow-up, hypesthesia was present but improving, and the patient was seizure-free. While the cerebellopontine angle and prepontine cisterns are considered thermal insulators, we hypothesize that thermal injury was conducted through these spaces to the cisternal segment of the trigeminal nerve or to the inferior V3 branch in Meckel's cave. Moreover, real-time visualization of the ablation is impacted by a blind spot at the skull base, created from bone disruption of MRI thermography.
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Affiliation(s)
- Jordan L W Lam
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA,
| | - Emily L Levin
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
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Chen JS, Lamoureux AA, Shlobin NA, Elkaim LM, Wang A, Ibrahim GM, Obaid S, Harroud A, Guadagno E, Dimentberg E, Bouthillier A, Bernhardt BC, Nguyen DK, Fallah A, Weil AG. Magnetic resonance-guided laser interstitial thermal therapy for drug-resistant epilepsy: A systematic review and individual participant data meta-analysis. Epilepsia 2023; 64:1957-1974. [PMID: 36824029 DOI: 10.1111/epi.17560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/30/2023] [Accepted: 02/22/2023] [Indexed: 02/25/2023]
Abstract
Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) has emerged as a popular minimally invasive alternative to open resective surgery for drug-resistant epilepsy (DRE). We sought to perform a systematic review and individual participant data meta-analysis to identify independent predictors of seizure outcome and complications following MRgLITT for DRE. Eleven databases were searched from January 1, 2010 to February 6, 2021 using the terms "MR-guided ablation therapy" and "epilepsy". Multivariable mixed-effects Cox and logistic regression identified predictors of time to seizure recurrence, seizure freedom, operative complications, and postoperative neurological deficits. From 8705 citations, 46 studies reporting on 450 MRgLITT DRE patients (mean age = 29.5 ± 18.1 years, 49.6% female) were included. Median postoperative seizure freedom and follow-up duration were 15.5 and 19.0 months, respectively. Overall, 240 (57.8%) of 415 patients (excluding palliative corpus callosotomy) were seizure-free at last follow-up. Generalized seizure semiology (hazard ratio [HR] = 1.78, p = .020) and nonlesional magnetic resonance imaging (MRI) findings (HR = 1.50, p = .032) independently predicted shorter time to seizure recurrence. Cerebral cavernous malformation (CCM; odds ratio [OR] = 7.97, p < .001) and mesial temporal sclerosis/atrophy (MTS/A; OR = 2.21, p = .011) were independently associated with greater odds of seizure freedom at last follow-up. Operative complications occurred in 28 (8.5%) of 330 patients and were independently associated with extratemporal ablations (OR = 5.40, p = .012) and nonlesional MRI studies (OR = 3.25, p = .017). Postoperative neurological deficits were observed in 53 (15.1%) of 352 patients and were independently predicted by hypothalamic hamartoma etiology (OR = 5.93, p = .006) and invasive electroencephalographic monitoring (OR = 4.83, p = .003). Overall, MRgLITT is particularly effective in treating patients with well-circumscribed lesional DRE, such as CCM and MTS/A, but less effective in nonlesional cases or lesional cases with a more diffuse epileptogenic network associated with generalized seizures. This study identifies independent predictors of seizure freedom and complications following MRgLITT that may help further guide patient selection.
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Affiliation(s)
- Jia-Shu Chen
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Audrey-Anne Lamoureux
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Nathan A Shlobin
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lior M Elkaim
- Division of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Andrew Wang
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - George M Ibrahim
- Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Sami Obaid
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Montreal, Quebec, Canada
- Division of Neurosurgery, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Adil Harroud
- Division of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Elena Guadagno
- Harvey E. Beardmore Division of Pediatric Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Evan Dimentberg
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Montreal, Quebec, Canada
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Alain Bouthillier
- Division of Neurosurgery, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Boris C Bernhardt
- McConnell Brain Imaging Center, Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada
| | - Dang K Nguyen
- Division of Neurology, University of Montreal Medical Center, Montreal, Quebec, Canada
| | - Aria Fallah
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Alexander G Weil
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Montreal, Quebec, Canada
- Division of Neurosurgery, University of Montreal Hospital Center, Montreal, Quebec, Canada
- Brain and Child Development Axis, Sainte Justine Research Center, Montreal, Quebec, Canada
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11
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Padda K, Matthews RE, Karakis I, Hewitt KC, Valentin E, Block C, Shade T, Dickey A, Millis S, Willie JT, Gross RE, Drane DL. Psychiatric changes after stereotactic laser amygdalohippocampotomy for medial temporal lobe epilepsy. Epilepsy Behav 2023; 145:109332. [PMID: 37422933 PMCID: PMC10523400 DOI: 10.1016/j.yebeh.2023.109332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE Stereotactic laser amygdalohippocampotomy (SLAH) is a minimally invasive surgical treatment for drug-resistant temporal lobe epilepsy (TLE) that has comparable rates of seizure freedom to traditional open resective TLE surgery. The objective of this study was to determine psychiatric outcome (i.e., depression and anxiety changes, psychosis) after SLAH, to explore possible contributory factors to these changes, and to determine the prevalence of de novo psychopathology. METHODS We explored mood and anxiety in 37 adult patients with TLE undergoing SLAH using the Beck psychiatric symptoms scales (i.e., Beck Depression Inventory-II [BDI-II] and Beck Anxiety Inventory [BAI]) preoperatively and 6 months following surgery. Multivariable regression analysis was conducted to identify predictors of worse depression or anxiety symptoms following SLAH. The prevalence of de novo psychopathology following SLAH was also determined. RESULTS We found a significant decrease in BDI-II (mean decline from 16.3 to 10.9, p = 0.004) and BAI (mean decline from 13.3 to 9.0, p = 0.045) scores following SLAH at the group level. While the rate of resolution of depression (from 62% to 49%) did not achieve statistical significance (p = 0.13, McNemar's), the rate of resolution of anxiety (from 57% to 35%) was statistically significant (p = 0.03, McNemar's). The de novo rate of psychopathology (i.e., new onset depression or anxiety) following SLAH was 1 of 7 (14%). Using a metric of meaningful change rather than complete symptom resolution, 16 of 37 (43%) patients experienced improvement in depression and 6 of 37 (16%) experienced worsening. For anxiety, 14 of 37 (38%) experienced meaningful improvement and 8 of 37 (22%) experienced worsening. Baseline performance on the Beck Scales was the only factor contributing to outcome status. DISCUSSION In one of the first studies to evaluate psychiatric outcomes after SLAH, we found promising overall trends toward stability or significant improvement in symptom burden at the group level for both depression and anxiety. There was also a significant improvement in clinical anxiety, though the decrease in clinical depression was not significant, likely owing to the limitations of sample size. SLAH may improve overall psychiatric symptoms, similarly to traditional resective TLE surgery, but de novo psychopathology and postoperative psychiatric morbidity remain significant issues, and larger samples are necessary to determine causal contributory factors.
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Affiliation(s)
- Karanbir Padda
- Department of Psychiatry, New York-Presbyterian/Weill Cornell Medical Center, New York, NY, USA
| | - Rebecca E Matthews
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Ioannis Karakis
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Kelsey C Hewitt
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Edward Valentin
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Cady Block
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Taylor Shade
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Adam Dickey
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Scott Millis
- Department of Physical Medicine & Rehabilitation, Wayne State University School of Medicine, Detroit, MI, USA
| | - Jon T Willie
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Robert E Gross
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA; Coulter Department of Biomedical Engineering, Emory University, GA, USA
| | - Daniel L Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA.
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12
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Michalak AJ, Greenblatt A, Wu S, Tobochnik S, Dave H, Raghupathi R, Esengul YT, Guerra A, Tao JX, Issa NP, Cosgrove GR, Lega B, Warnke P, Chen HI, Lucas T, Sheth SA, Banks GP, Kwon CS, Feldstein N, Youngerman B, McKhann G, Davis KA, Schevon C. Seizure onset patterns predict outcome after stereo-electroencephalography-guided laser amygdalohippocampotomy. Epilepsia 2023; 64:1568-1581. [PMID: 37013668 PMCID: PMC10247471 DOI: 10.1111/epi.17602] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVE Stereotactic laser amygdalohippocampotomy (SLAH) is an appealing option for patients with temporal lobe epilepsy, who often require intracranial monitoring to confirm mesial temporal seizure onset. However, given limited spatial sampling, it is possible that stereotactic electroencephalography (stereo-EEG) may miss seizure onset elsewhere. We hypothesized that stereo-EEG seizure onset patterns (SOPs) may differentiate between primary onset and secondary spread and predict postoperative seizure control. In this study, we characterized the 2-year outcomes of patients who underwent single-fiber SLAH after stereo-EEG and evaluated whether stereo-EEG SOPs predict postoperative seizure freedom. METHODS This retrospective five-center study included patients with or without mesial temporal sclerosis (MTS) who underwent stereo-EEG followed by single-fiber SLAH between August 2014 and January 2022. Patients with causative hippocampal lesions apart from MTS or for whom the SLAH was considered palliative were excluded. An SOP catalogue was developed based on literature review. The dominant pattern for each patient was used for survival analysis. The primary outcome was 2-year Engel I classification or recurrent seizures before then, stratified by SOP category. RESULTS Fifty-eight patients were included, with a mean follow-up duration of 39 ± 12 months after SLAH. Overall 1-, 2-, and 3-year Engel I seizure freedom probability was 54%, 36%, and 33%, respectively. Patients with SOPs, including low-voltage fast activity or low-frequency repetitive spiking, had a 46% 2-year seizure freedom probability, compared to 0% for patients with alpha or theta frequency repetitive spiking or theta or delta frequency rhythmic slowing (log-rank test, p = .00015). SIGNIFICANCE Patients who underwent SLAH after stereo-EEG had a low probability of seizure freedom at 2 years, but SOPs successfully predicted seizure recurrence in a subset of patients. This study provides proof of concept that SOPs distinguish between hippocampal seizure onset and spread and supports using SOPs to improve selection of SLAH candidates.
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Affiliation(s)
- Andrew J. Michalak
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Adam Greenblatt
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, NY, USA
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Shasha Wu
- Department of Neurology, University of Chicago, Chicago, NY, USA
| | - Steven Tobochnik
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Hina Dave
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ramya Raghupathi
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, NY, USA
| | - Yasar T. Esengul
- Department of Neurology, University of Toledo College of Medicine, Toledo, OH, USA
| | - Antonio Guerra
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - James X. Tao
- Department of Neurology, University of Chicago, Chicago, NY, USA
| | - Naoum P. Issa
- Department of Neurology, University of Chicago, Chicago, NY, USA
| | - Garth R. Cosgrove
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Bradley Lega
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Peter Warnke
- Department of Neurosurgery, University of Chicago, Chicago, NY, USA
| | - H. Isaac Chen
- Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, NY, USA
| | - Timothy Lucas
- Department of Neurosurgery & Biomedical Engineering, Ohio State University; Neurotech Institute, Columbus, OH, USA
| | - Sameer A. Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Garrett P. Banks
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Churl-Su Kwon
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Department of Neurosurgery, Columbia University Irving Medical Center, New York, NY, USA
- Department of Epidemiology, Columbia University Gertrude H Sergievsky Center, New York, NY, USA
| | - Neil Feldstein
- Department of Neurosurgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Brett Youngerman
- Department of Neurosurgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Guy McKhann
- Department of Neurosurgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Kathryn A. Davis
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, NY, USA
| | - Catherine Schevon
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
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13
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Paulo DL, Ball TJ, Englot DJ. Emerging Technologies for Epilepsy Surgery. Neurol Clin 2022; 40:849-867. [DOI: 10.1016/j.ncl.2022.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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14
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Hubbard ME, Yaghi NK, Selden NR. Technical challenges to anterior temporal lobectomy after laser interstitial thermal therapy for mesial temporal lobe epilepsy: technical note. J Neurosurg Pediatr 2022; 30:128-131. [PMID: 35364573 DOI: 10.3171/2022.2.peds21564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/15/2022] [Indexed: 11/06/2022]
Abstract
Mesial temporal sclerosis (MTS) is a frequent cause of medically refractory epilepsy, for which laser interstitial thermal therapy (LITT) is an effective treatment. However, experience with the technical considerations posed by additional surgery after an initial LITT procedure is lacking. The authors present the case of a 12-year-old female with medically refractory temporal lobe epilepsy and left MTS who underwent LITT at a separate institution prior to referral. This patient had no change in early postoperative seizure control (Engel class IVB) and then her seizures worsened despite ongoing medical treatment (Engel class IVC). Post-LITT MRI revealed sparing of the mesial hippocampus head, a poor prognostic factor. The authors describe the technical details illustrated by this case of secondary, stereotactic electroencephalography-guided mesial temporal resection following LITT. The case was managed with anterior temporal lobectomy including the resection of residual hippocampus and amygdala.
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15
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Hedaya AA, Hewitt KC, Hu R, Epstein CM, Gross RE, Drane DL, Willie JT. Open surgery or laser interstitial thermal therapy for low-grade epilepsy-associated tumors of the temporal lobe: A single-institution consecutive series. Epilepsy Behav 2022; 130:108659. [PMID: 35339067 PMCID: PMC9361400 DOI: 10.1016/j.yebeh.2022.108659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/07/2022] [Accepted: 03/02/2022] [Indexed: 11/16/2022]
Abstract
Outcomes of treating low-grade epilepsy-associated tumors (LEATs) in the temporal lobe with MRI-guided laser interstitial thermal therapy (MRgLITT) remain poorly characterized. This study aimed to compare the safety and effectiveness of treating temporal lobe LEATs with MRgLITT versus open resection in a consecutive single-institution series. We reviewed all adult patients with epilepsy that underwent surgery for temporal lobe LEATs at our institution between 2002 and 2019, during which time we switched from open surgery to MRgLITT. Surgical outcome was categorized by Engel classification at >12mo follow-up and Kaplan-Meir analysis of seizure freedom. We recorded hospital length of stay, adverse events, and available neuropsychological results. Of 14 total patients, 7 underwent 9 open resections, 6 patients underwent MRgLITT alone, and 1 patient underwent an open resection followed by MRgLITT. Baseline group demographics differed and were notable for preoperative duration of epilepsy of 9.0 years (range 1-36) for open resection versus 14.0 years (range 2-34) for MRgLITT. Median length of stay was one day shorter for MRgLITT compared to open resection (p=<.0001). There were no major adverse events in the series, but there were fewer minor adverse events following MRgLITT. At 12mo follow-up, 50% (5/10) of patients undergoing open resection and 57% (4/7) of patients undergoing MRgLITT were free of disabling seizures (Engel I). When comparing patients who underwent similar procedures in the dominant temporal lobe, patients undergoing MRgLITT had fewer and milder material-specific neuropsychological declines than patients undergoing open resections. In this small series, MRgLITT was comparably safe and effective relative to open resection of temporal lobe LEATs.
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Affiliation(s)
- Alexander A Hedaya
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, United States
| | - Kelsey C Hewitt
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - Ranliang Hu
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Charles M Epstein
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - Robert E Gross
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, United States; Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - Daniel L Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States; Department of Neurology, University of Washington, Seattle, WA, United States
| | - Jon T Willie
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, United States; Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States; Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, United States.
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16
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Rastogi S, Meador KJ, Barr WB, Devinsky O, Leeman-Markowski BA. Remote Memory in Epilepsy: Assessment, Impairment, and Implications Regarding Hippocampal Function. Front Neurol 2022; 13:855332. [PMID: 35463127 PMCID: PMC9024073 DOI: 10.3389/fneur.2022.855332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 02/10/2022] [Indexed: 11/13/2022] Open
Abstract
Studies of epilepsy patients provide insight into the neuroscience of human memory. Patients with remote memory deficits may learn new information but have difficulty recalling events from years past. The processes underlying remote memory impairment are unclear and likely result from the interaction of multiple factors, including hippocampal dysfunction. The hippocampus likely has a continued role in remote semantic and episodic memory storage over time, and patients with mesial temporal lobe epilepsy (TLE) are at particular risk for deficits. Studies have focused on lateralization of remote memory, often with greater impairment in left TLE, which may relate to verbal task demands. Remote memory testing is restricted by methodological limitations. As a result, deficits have been difficult to measure. This review of remote memory focuses on evidence for its underlying neurobiology, theoretical implications for hippocampal function, and methodological difficulties that complicate testing in epilepsy patients.
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Affiliation(s)
- Sanya Rastogi
- Epilepsy and Cognition Laboratory, Veterans Affairs, New York Harbor Healthcare System, Research Service, New York, NY, United States
- College of Arts and Science, New York University, New York, NY, United States
| | - Kimford J. Meador
- Department of Neurology and Neurological Sciences, Comprehensive Epilepsy Program, Stanford University School of Medicine, Palo Alto, CA, United States
| | - William B. Barr
- Department of Neurology, Comprehensive Epilepsy Center, New York University Langone Health, New York, NY, United States
| | - Orrin Devinsky
- Department of Neurology, Comprehensive Epilepsy Center, New York University Langone Health, New York, NY, United States
- Department of Neurosurgery, New York University Langone Health, New York, NY, United States
- Department of Psychiatry, New York University Langone Health, New York, NY, United States
| | - Beth A. Leeman-Markowski
- Epilepsy and Cognition Laboratory, Veterans Affairs, New York Harbor Healthcare System, Research Service, New York, NY, United States
- Department of Neurology, Comprehensive Epilepsy Center, New York University Langone Health, New York, NY, United States
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