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Wang B, Li Q, Wang H, Du X, Lai Q, Li X, Wang Y, Hu P, Fan H. TNF-α: A serological marker for evaluating the severity of hippocampal sclerosis in medial temporal lobe epilepsy? J Clin Neurosci 2024; 123:123-129. [PMID: 38569383 DOI: 10.1016/j.jocn.2024.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE By analysing the difference in TNF-α levels in the peripheral blood of patients with medial temporal lobe epilepsy (mTLE) with or without hippocampal sclerosis and the correlation between TNF-α and N-acetylaspartate levels in the hippocampus, we explored the relationship between TNF-α and the degree of damage to hippocampal sclerosis neurons in medial temporal lobe epilepsy. METHODS This is a prospective, population-based study. A total of 71 Patients with medial temporal lobe epilepsy diagnosed by clinical seizures, video-EEG, epileptic sequence MRI, and other imaging examinations were recruited from October 2020 to July 2022 in the Department of Neurology, Affiliated Hospital of Xuzhou Medical University. Twenty age-matched healthy subjects were selected as the control group. The patients were divided into two groups: the medial temporal epilepsy with hippocampal sclerosis group (positive group, mTLE-HS-P group) and the medial temporal epilepsy without hippocampal sclerosis group (negative group, mTLE-HS-N group). The levels of IL-1β, IL-5, IL-6, IL-8, IL-17, IFN-γ and TNF-α in the peripheral blood of the patients in the three groups were detected by multimicrosphere flow immunofluorescence assay. The level of N-acetylaspartate (NAA) in the hippocampus was measured by 1H-MRS. The differences in cytokine levels among the three groups were analysed, and the correlation between cytokine and NAA levels was analysed. RESULTS The level of TNF-α in the peripheral blood of the patients in the mTLE-HS-P group was significantly higher than that of the patients in the mTLE-HS-N and healthy control groups, and the level of TNF-α in the patients in the mTLE-HS-N group was significantly higher than that of the patients in the healthy control group. The NAA level in mTLE-HS-P group patients was significantly lower than that of mTLE-HS-N patients and healthy controls, but there was no significant difference between mTLE-HS-N patients and healthy controls (P > 0.05). Spearman correlation analysis showed that TNF-α level (rs = -0.437, P < 0.05) and the longest duration of a single seizure (rs = -0.398, P < 0.05) were negatively correlated with NAA level. Logistic regression analysis showed that there was no significant correlation between the longest duration of a single seizure and hippocampal sclerosis, but TNF-α level was closely related to hippocampal sclerosis in patients with mTLE (OR = 1.315, 95 % CI 1.084-1.595, P = 0.005). CONCLUSION The level of TNF-α in the peripheral blood of patients with medial temporal lobe epilepsy with hippocampal sclerosis was higher, and it was correlated with NAA and hippocampal sclerosis. The high expression of TNF-α may be of important value in the evaluation of hippocampal sclerosis patients.
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Affiliation(s)
- Bingbing Wang
- Department of Neurology, Suining County People's Hospital, Affiliated Hospital of Xuzhou Medical University, China
| | - Qingyun Li
- Department of Neurology, Affiliated Hospital of Xuzhou Medical University, China
| | - Heng Wang
- Department of Neurology, Affiliated Hospital of Xuzhou Medical University, China
| | - Xin Du
- Department of Neurology, Xuzhou Municipal Hospital, China
| | - Qingwei Lai
- Department of Neurology, Affiliated Hospital of Xuzhou Medical University, China
| | - Xinyu Li
- Department of Neurology, Affiliated Hospital of Xuzhou Medical University, China
| | - Yinan Wang
- Department of Neurology, Affiliated Huaihai Hospital of Xuzhou Medical University, China
| | - Peng Hu
- Department of Neurology, Affiliated Hospital of Xuzhou Medical University, China
| | - Hongbin Fan
- Department of Neurology, Affiliated Hospital of Xuzhou Medical University, China.
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Nineuil C, Houot M, Dellacherie D, Méré M, Denos M, Dupont S, Samson S. Revisiting emotion recognition in different types of temporal lobe epilepsy: The influence of facial expression intensity. Epilepsy Behav 2023; 142:109191. [PMID: 37030041 DOI: 10.1016/j.yebeh.2023.109191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 02/27/2023] [Accepted: 03/18/2023] [Indexed: 04/10/2023]
Abstract
Temporal lobe epilepsy (TLE) can induce various difficulties in recognizing emotional facial expressions (EFE), particularly for negative valence emotions. However, these difficulties have not been systematically examined according to the localization of the epileptic focus. For this purpose, we used a forced-choice recognition task in which faces expressing fear, sadness, anger, disgust, surprise, or happiness were presented in different intensity levels from moderate to high intensity. The first objective of our study was to evaluate the impact of emotional intensity on the recognition of different categories of EFE in TLE patients compared to control participants. The second objective was to assess the effect of localizationof epileptic focus on the recognition of EFE in patients with medial temporal lobe epilepsy (MTLE) associated or not with hippocampal sclerosis (HS), or lateral temporal lobe epilepsy (LTLE). The results showed that the 272 TLE patients and the 68 control participants were not differently affected by the intensity of EFE. However, we obtained group differences within the clinical population when we took into account the localization of the temporal lobe epileptic focus. As predicted, TLE patients were impaired in recognizing fear and disgust relative to controls. Moreover, the scores of these patients varied according to the localization of the epileptic focus, but not according to the cerebral lateralization of TLE. The facial expression of fear was less well recognized by MTLE patients, with or without HS, and the expression of disgust was less well recognized by LTLE as well as MTLE without HS patients. Moreover, emotional intensity modulated differently the recognition of disgust and surprise of the three patient groups underlying the relevance of using moderate emotional intensity to distinguish the effect of epileptic focus localization. These findings should be taken into account for interpreting the emotional behaviors and deserve to befurther investigated before considering TLE surgical treatment or social cognition interventions in TLE patients.
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Affiliation(s)
- C Nineuil
- Univ. Lille, ULR 4072 - PSITEC - Psychologie : Interactions Temps Émotions Cognition, F-59000 Lille, France
| | - M Houot
- Centre of Excellence of Neurodegenerative Disease (CoEN), AP-HP, Pitié-Salpêtrière Hospital, Paris, France; Institute of Memory and Alzheimer's Disease (IM2A), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris, France; Clinical Investigation Centre, Institut du Cerveau et de la Moelle épinière (ICM), Pitié-Salpêtrière Hospital, Paris, France
| | - D Dellacherie
- Univ. Lille, ULR 4072 - PSITEC - Psychologie : Interactions Temps Émotions Cognition, F-59000 Lille, France; CHU Lille, Department of Pediatric Neurology, F-59000 Lille, France
| | - M Méré
- Epilepsy Unit, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - M Denos
- Rehabilitation Unit, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - S Dupont
- Epilepsy Unit, AP-HP, Pitié-Salpêtrière Hospital, Paris, France; Centre de Recherche de l'Institut du Cerveau Et de La Moelle Épinière (ICM), UMPC-UMR 7225 CNRS-UMRS 975 Inserm, Paris, France
| | - S Samson
- Univ. Lille, ULR 4072 - PSITEC - Psychologie : Interactions Temps Émotions Cognition, F-59000 Lille, France; Epilepsy Unit, AP-HP, Pitié-Salpêtrière Hospital, Paris, France; Centre de Recherche de l'Institut du Cerveau Et de La Moelle Épinière (ICM), UMPC-UMR 7225 CNRS-UMRS 975 Inserm, Paris, France.
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Sharifi G, Hallajnejad M, Dastgheib SS, Lotfinia M, Mirghaed OR, Amin AM. Clinical outcome of selective amygdalectomy in a series of patients with resistant temporal lobe epilepsy. Surg Neurol Int 2021; 12:575. [PMID: 34877061 PMCID: PMC8645478 DOI: 10.25259/sni_199_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 10/23/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Selective amygdalohippocampectomy is one of the main approaches for treating medial temporal lobe epilepsy (TLE). We herewith describe seven cases of amygdala lesions treated with selective amygdalectomy with the hippocampus saving procedure. Furthermore, we explain the trans-middle temporal gyrus transventricular approach for selective amygdalectomy. Methods: We studied patients with TLE who underwent selective amygdalectomy with hippocampal saving procedure between March 2012 and July 2018. We preferred the trans-middle temporal gyrus transventricular approach. We adopted pterional craniotomy with extensive exposure of the base and posterior of the temporal lobe. The posterior margin of resection in the intraventricular part of the amygdala was considered the inferior choroidal point. Medially anterior part of the uncus was resected until reaching the ambient cistern. We applied the transcortical transventricular approach for selective amygdalectomy in all patients. Results: We present 11 cases having an amygdala lesion in our series, seven of whom underwent selective amygdalectomy with hippocampal sparing. Nine patients had neoplastic lesions, and in two of them, gliosis was evident. Total resection of the lesion was achieved in all cases based on postoperative magnetic resonance imaging. No unusual complication or surgically-related new neurological deficit occurred. Conclusion: We consider the resection of the amygdala until the inferior choroidal point sufficient for the disconnection of its circuits, which results in more effective control of seizures and reduction of surgery time and complications.
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Affiliation(s)
- Guive Sharifi
- Department of Neurosurgery, Skull Base Research Center, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Mohammad Hallajnejad
- Department of Neurosurgery, Skull Base Research Center, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Samaneh Sadat Dastgheib
- Department for General Psychology and Cognitive Neuroscience, Friedrich Schiller University of Jena, Jena, Thuringia
| | - Mahmoud Lotfinia
- Department of Neurosurgery, Klinikum Saarbrücken, University of Saarland, Saarbrücken, Saarland, Germany
| | - Omidvar Rezaei Mirghaed
- Department of Neurosurgery, Skull Base Research Center, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Arsalan Medical Amin
- Department of Neurosurgery, Skull Base Research Center, Shahid Beheshti University of Medical Science, Tehran, Iran
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Zhang W, Wang J, Zhao Q, Wang T, Wang P. MRI-negative medial temporal lobe epilepsy can benefit from stereotactic radiofrequency thermocoagulation applied to the amygdalohippocampal complex. Curr Med Imaging 2021; 18:712-718. [PMID: 34636305 DOI: 10.2174/1573405617666211005144936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 08/16/2021] [Accepted: 08/30/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Seizure control [SC] is often poor in cases of magnetic resonance imaging-negative epilepsy after resection surgery. <P> Objective: This study aimed to evaluate the therapeutic efficacy of depth-electrode-guided stereotactic radiofrequency thermocoagulation [RFTC] applied to the amygdalohippocampal complex [AHC] for the treatment of patients with MRI-negative medial temporal lobe epilepsy. <P> Methods: A total of 62 cases with magnetic resonance imaging-negative medial temporal lobe epilepsy were retrospectively studied after the application of depth-electrode-guided RFTC to the AHC. Single-target coagulations were applied to all patients, and multi-target coagulations were applied to those patients who did not experience significant reductions in discharges after the first target ablation. Bilateral-target coagulations were applied to bilateral medial temporal lobe epilepsy patients, using single target ablation applied to each side. <P> Results: After 24-83 months of follow-up, 32/62 [51.61%] patients became seizure-free, and 35/62 [56.45%] patients reported significant reductions in seizure episodes. The total effective rate was 69.35% [43/62]. No significant differences were observed for SC among the single-target, multi-target and bilateral-target groups. However, a significant difference was observed for the reduction in epileptic discharges after coagulations between those patients who became seizure-free and those who did not. Magnetic resonance imaging-negative medial temporal lobe epilepsy patients can benefit from RFTC applied to the AHC. A significant reduction in epileptic discharges observed during operations after RFTC is applied may be a predictor of good SC. <P> Conclusion: RFTC applied to the AHC could be considered a promising method for the treatment of magnetic resonance imaging-negative medial temporal lobe epilepsy patients.
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Affiliation(s)
- Wenqian Zhang
- 306th Clinical College of PLA, The Fifth Clinlcal Medical College, Anhui Medical University. 0
| | - Jia Wang
- 306th Clinical College of PLA, The Fifth Clinlcal Medical College, Anhui Medical University. 0
| | - Quanjun Zhao
- Department of Neurosurgery, PLA Strategic Support Force Characteristic Medical Center. 0
| | - Tao Wang
- Department of Neurosurgery, PLA Strategic Support Force Characteristic Medical Center. 0
| | - Peixin Wang
- Department of Neurosurgery, PLA Strategic Support Force Characteristic Medical Center. 0
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Ono KE, Bearden DJ, Adams E, Doescher J, Koh S, Eksioglu Y, Gross RE, Drane DL. Cognitive and behavioral outcome of stereotactic laser amydalohippocampotomy in a pediatric setting. Epilepsy Behav Rep 2020; 14:100370. [PMID: 32642637 PMCID: PMC7334373 DOI: 10.1016/j.ebr.2020.100370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/16/2020] [Accepted: 05/18/2020] [Indexed: 11/28/2022] Open
Abstract
We present neuropsychological and functional outcome data in a teenager undergoing stereotactic laser amygdalohippocampotomy (SLAH) who had drug-resistant mesial temporal lobe epilepsy due to left hippocampal sclerosis. Given strong baseline cognitive performance, there was concern for post-operative declines in language and verbal memory were this patient to undergo open resection. She was evaluated pre- and post-ablation with clinical and experimental neuropsychological measures including semantic memory, category-specific object/face recognition and naming, spatial learning, and socio-emotional processing. The patient became seizure-free following SLAH and experienced significant improvements in school performance and social engagement. She experienced improvement in recognition and naming of multiple object categories, memory functions, and verbal fluency. In contrast, the patient declined significantly in her ability to recognize emotional tone from facial expressions, a socio-emotional process that had been normal prior to surgery. We believe this decline was related to surgical disruption of the limbic system, an area highly involved in emotional processing, and suspect such deficits are an under-assessed and unrecognized risk for all surgeries involving the amygdalohippocampal complex and broader limbic system regions. We hope this positive SLAH outcome will serve as impetus for group level research to establish its safety and efficacy in the pediatric setting. Stereotactic laser ablation can be used successfully in pediatric epilepsy. At risk cognitive abilities did not decline after focal ablation in this teenager. Functional improvement was observed that paralleled gains in seizure status and cognition. Deficits still occurred in select areas related to focal structures ablated. Socio-emotional deficits can result from surgeries restricted to the amygdalohippocampal complex.
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Affiliation(s)
- Kim E Ono
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Children's Hospital of Atlanta, Atlanta, GA, USA
| | - Donald J Bearden
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Children's Hospital of Atlanta, Atlanta, GA, USA
| | - Elizabeth Adams
- Department of Neurology, Minnesota Epilepsy Group, Minneapolis, MN, USA
| | - Jason Doescher
- Department of Neurology, Minnesota Epilepsy Group, Minneapolis, MN, USA
| | - Sookyong Koh
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Children's Hospital of Atlanta, Atlanta, GA, USA
| | - Yaman Eksioglu
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Children's Hospital of Atlanta, Atlanta, GA, USA
| | - Robert E Gross
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA.,Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.,Coulter Department of Biomedical Engineering, Emory University, GA, USA
| | - Daniel L Drane
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.,Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA
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Lu J, Huang H, Zeng Q, Zhang X, Xu M, Cai Y, Wang Q, Huang Y, Peng Q, Deng L. Hippocampal neuron loss and astrogliosis in medial temporal lobe epileptic patients with mental disorders. J Integr Neurosci 2020; 18:127-132. [PMID: 31321953 DOI: 10.31083/j.jin.2019.02.16] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 04/25/2019] [Indexed: 11/06/2022] Open
Abstract
Hippocampal neuron loss and reactive astrogliosis are pathological features of medial temporal lobe epilepsy. Here, the expression of hippocampal astrogliosis-associated genes are studied in subjects with medial temporal lobe epilepsy and mental disorders (such as depression, anxiety and psychiatric comorbidities). The relationship between functional changes in hippocampus astrocytes and concurrent mental disorders are discussed. Nissl staining identified medial temporal lobe epilepsy-induced neuronal loss in the CA1 region of hippocampus. Quantitative real-time polymerase chain reaction and immunofluorescence technology were used to detect hippocampus glial fibrillary acidic protein, metallothionein, and aquaporin-4. The hippocampus area of subjects with medial temporal lobe epilepsy (with or without mental disorders) were smaller than the control group. Hippocampal neuronal loss and astrogliosis were more obvious in groups of medial temporal lobe epileptic patients with mental disorders. Relative protein levels of glial fibrillary acidic protein, metallothionein-I/II, and aquaporin-4 were significantly higher in subjects with medial temporal lobe epilepsy than seen in controls. Medial temporal lobe epileptic patients with mental disorder or depression had elevated metallothionein-I/II protein level when compared to controls and medial temporal lobe epileptic patients without mental disorder. Protein levels of glial fibrillary acidic protein and aquaporin-4 in medial temporal lobe epileptic patients with mental disorders were significantly lower than that in medial temporal lobe epileptic patients with no mental disorder. It is concluded that functional changes in hippocampus astrocytes are associated with mental disorders in medial temporal lobe epileptic patients and the astrogliosis-related genes of glial fibrillary acidic protein, metallothionein-I/II and aquaporin-4, are involved in this process.
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Affiliation(s)
- Jun Lu
- Department of Neurosurgery, Hunan Provincial Brain Hospital, 410007, P. R. China
| | - Hongxing Huang
- Department of Neurosurgery, Hunan Provincial Brain Hospital, 410007, P. R. China
| | - Qichang Zeng
- Department of Neurosurgery, Hunan Provincial Brain Hospital, 410007, P. R. China
| | - Xinmei Zhang
- Department of Neurology, Central South University, 410000, P. R. China
| | - Min Xu
- Department of Pathology, Hunan Provincial Brain Hospital, 410007, P. R. China
| | - Yi Cai
- Department of Psychiatry, Hunan Provincial Brain Hospital, 410007, P. R. China
| | - Qin Wang
- Department of Neurosurgery, Hunan Provincial Brain Hospital, 410007, P. R. China
| | - Yahui Huang
- Department of Neurosurgery, Hunan Provincial Brain Hospital, 410007, P. R. China
| | - Qiong Peng
- Department of Neurology, Hunan Provincial Brain Hospital, 410007, P. R. China
| | - Lanqiuzi Deng
- Department of Neurosurgery, Hunan Provincial Brain Hospital, 410007, P. R. China
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Shan YZ, Wang ZM, Fan XT, Zhang HQ, Ren LK, Wei PH, Zhao GG. Automatic labeling of the fanning and curving shape of Meyer's loop for epilepsy surgery: an atlas extracted from high-definition fiber tractography. BMC Neurol 2019; 19:302. [PMID: 31779601 PMCID: PMC6882219 DOI: 10.1186/s12883-019-1537-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 11/19/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Visual field defects caused by injury to Meyer's loop (ML) are common in patients undergoing anterior temporal lobectomy during epilepsy surgery. Evaluation of the anatomical shapes of the curving, fanning and sharp angles of ML to guide surgeries is important but still challenging for diffusion tensor imaging. We present an advanced diffusion data-based ML atlas and labeling protocol to reproduce anatomical features in individuals within a short time. METHODS Thirty Massachusetts General Hospital-Human Connectome Project (MGH-HCP) diffusion datasets (ultra-high magnetic gradient & 512 directions) were warped to standard space. The resulting fibers were projected together to create an atlas. The anatomical features and the tractography correspondence rates were evaluated in 30 MGH-HCP individuals and local diffusion spectrum imaging data (eight healthy subjects and six hippocampal sclerosis patients). RESULTS In the atlas, features of curves, sharp angles and fanning shapes were adequately reproduced. The distances from the anterior tip of the temporal lobe to the anterior ridge of Meyer's loop were 23.1 mm and 26.41 mm on the left and right sides, respectively. The upper and lower divisions of the ML were revealed to be twisting. Eighty-eight labeled sides were achieved, and the correspondence rates were 87.44% ± 6.92, 80.81 ± 10.62 and 72.83% ± 14.03% for MGH-HCP individuals, DSI-healthy individuals and DSI-patients, respectively. CONCLUSION Atlas-labeled ML is comparable to high angular resolution tractography in healthy or hippocampal sclerosis patients. Therefore, rapid identification of the ML location with a single modality of T1 is practical. This protocol would facilitate functional studies and visual field protection during neurosurgery.
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Affiliation(s)
- Yong-Zhi Shan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xuanwu District, Beijing, 100053, China
| | - Zhen-Ming Wang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Xiao-Tong Fan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xuanwu District, Beijing, 100053, China
| | - Hua-Qiang Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xuanwu District, Beijing, 100053, China
| | - Lian-Kun Ren
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Peng-Hu Wei
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xuanwu District, Beijing, 100053, China.
| | - Guo-Guang Zhao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xuanwu District, Beijing, 100053, China.
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Cabrera OS, Lehéricy S, Masson V, Samson S, Dupont S. Adapting a memory fMRI research protocol in clinical routine: Feasibility and results. Epilepsy Behav 2018; 81:49-54. [PMID: 29477011 DOI: 10.1016/j.yebeh.2017.11.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/10/2017] [Accepted: 11/19/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective of this study was to test the reliability of functional magnetic resonance imaging (fMRI) evaluation of memory function in clinical practice to predict postoperative memory decline in patients with refractory medial temporal lobe epilepsy (MTLE) candidate to surgery. METHODS Twenty-six consecutive patients with MTLE who underwent a complete presurgical evaluation were included. All patients underwent fMRI memory study and complete neuropsychological assessment. Lesions consisted in hippocampal sclerosis in 18 patients (12 right and 6 left), dysembryoplastic neuroepithelial tumor (DNET) in 5 cases (4 right, 1 left), epidermoid cyst in one patient (right). Two patients had no lesion (2 left). RESULTS Nineteen patients (73%) underwent surgery. The other seven patients (27%) declined surgery, mainly because of the risk of memory deficit. The fMRI procedure correctly predicted both verbal and nonverbal memory postoperative outcome in 13 of the patients (72%), failed to predict a postoperative memory worsening in only two patients (12%), and predicted worsening in three patients (17%) that remained stable (versus 44%, 39%, and 17% with the sole neuropsychological testing). The reliability of the fMRI procedure was not influenced by the type of lesion, the side of the epileptic focus, or the type of preoperative memory profile (typical or atypical). SIGNIFICANCE Appearing as a valuable clinical tool to predict postoperative memory outcome, fMRI may add information over and above other available tests.
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Affiliation(s)
- Ovidio Solano Cabrera
- Epilepsy unit, AP-HP Groupe hospitalier Pitié-Salpêtrière-Charles Foix, F-75013 Paris, France; Epilepsy Clinic, Neurology department, Social Security Salvadoran Institute, San Salvador, El Salvador
| | - Stéphane Lehéricy
- Neuroradiology unit, AP-HP Groupe hospitalier Pitié-Salpêtrière-Charles Foix, F-75013 Paris, France; Inserm U 1127, CNRS UMR 7225, UMR S 1127, Institut du Cerveau et de la Moelle épinière - ICM, Centre de Neuroimagerie de Recherche - CENIR, F-75013 Paris, France; Sorbonne University, UPMC Univ. Paris 06, F-75005 Paris, France
| | - Véronique Masson
- Epilepsy unit, AP-HP Groupe hospitalier Pitié-Salpêtrière-Charles Foix, F-75013 Paris, France
| | - Séverine Samson
- Laboratoire PSITEC (EA 4072), Université de Lille, F-59000 Lille, France
| | - Sophie Dupont
- Epilepsy unit, AP-HP Groupe hospitalier Pitié-Salpêtrière-Charles Foix, F-75013 Paris, France; Inserm U 1127, CNRS UMR 7225, UMR S 1127, Institut du Cerveau et de la Moelle épinière - ICM, Centre de Neuroimagerie de Recherche - CENIR, F-75013 Paris, France; Sorbonne University, UPMC Univ. Paris 06, F-75005 Paris, France; Rehabilitation unit, AP-HP Groupe hospitalier Pitié-Salpêtrière-Charles Foix, F-75013 Paris, France.
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No YJ, Zavanone C, Bielle F, Nguyen-Michel VH, Samson Y, Adam C, Navarro V, Dupont S. Medial temporal lobe epilepsy associated with hippocampal sclerosis is a distinctive syndrome. J Neurol 2017; 264:875-881. [PMID: 28255730 DOI: 10.1007/s00415-017-8441-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/22/2017] [Accepted: 02/23/2017] [Indexed: 11/24/2022]
Abstract
Epileptic syndromes are distinctive disorders with specific features, which when taken together, permit a specific diagnosis. There is actually a debate on that medial temporal lobe epilepsy with hippocampal sclerosis is an epileptic syndrome. To address this issue, we searched for discriminative semiological features between temporal lobe epilepsy patients with hippocampal sclerosis (TLE-HS patients or group 1), TLE patients with medial structural lesion other than hippocampal sclerosis or in MRI-negative cases with medial onset on further investigations (group 2) and lateral TLE patients (LTLE or group 3). We retrospectively collected data from medical and EEG-video records of 523 TLE patients, referred for surgery to the Pitié-Salpêtrière Epileptology Unit between 1991 and 2014. We identified 389 patients belonging to group 1, 61 patients belonging to group 2, and 73 patients belonging to group 3 and performed a comparative analysis of their clinical data and surgical outcomes. TLE-HS patients (group 1): (1) began epilepsy earlier (11 ± 9 vs. 20 ± 10 vs. 15 ± 9 years); (2) exhibited more frequently early febrile convulsions (FC) (59 vs 7 vs 5%); (3) presented more: ictal gestural automatisms (90 vs 54 vs 67%), dystonic posturing (47 vs 20 vs 23%), and secondary generalized tonic-clonic seizures (GTCS) (70 vs 44% vs 48%) as compared to both groups 2 and 3 patients (all p < 0.001). With respect to auras, abdominal visceral auras were more reported by TLE-HS than by LTLE patients (49 vs 16%). Three cardinal criteria correctly classified 94% of patients into TLE-HS group: history of FC, dystonic posturing, and secondary GTCS. Postoperative outcome was significantly better in TLE-HS group than in the two other groups (p = 0.03 and 0.003). Our study demonstrates that cardinal criteria are reliably helpful to distinguish patients with TLE-HS from those with other TLE and may allow considering TLE-HS as a distinctive syndrome.
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Affiliation(s)
- Young Joo No
- Rehabilitation Unit, AP-HP, GH Pitie-Salpêtrière-Charles Foix, 75013, Paris, France
| | - Chiara Zavanone
- Rehabilitation Unit, AP-HP, GH Pitie-Salpêtrière-Charles Foix, 75013, Paris, France
| | - Franck Bielle
- Department of Neuropathology, AP-HP, GH Pitie-Salpêtrière-Charles Foix, 75013, Paris, France.,Brain and Spine Institute (ICM; INSERM UMRS1127, CNRS UMR7225, UPMC), 75013, Paris, France.,Sorbonne University, UPMC Univ. Paris 06, 75005, Paris, France
| | - Vi-Huong Nguyen-Michel
- Department of Clinical Neurophysiology, AP-HP, GH Pitie-Salpêtrière-Charles Foix, 75013, Paris, France
| | - Yves Samson
- Stroke Unit, Hôpital de la Pitié-Salpêtrière, AP-HP, GH Pitie-Salpêtrière-Charles Foix, 75013, Paris, France.,Brain and Spine Institute (ICM; INSERM UMRS1127, CNRS UMR7225, UPMC), 75013, Paris, France.,Sorbonne University, UPMC Univ. Paris 06, 75005, Paris, France
| | - Claude Adam
- Brain and Spine Institute (ICM; INSERM UMRS1127, CNRS UMR7225, UPMC), 75013, Paris, France.,Epileptology Unit, AP-HP, GH Pitie-Salpêtrière-Charles Foix, 75013, Paris, France
| | - Vincent Navarro
- Department of Clinical Neurophysiology, AP-HP, GH Pitie-Salpêtrière-Charles Foix, 75013, Paris, France.,Brain and Spine Institute (ICM; INSERM UMRS1127, CNRS UMR7225, UPMC), 75013, Paris, France.,Sorbonne University, UPMC Univ. Paris 06, 75005, Paris, France.,Epileptology Unit, AP-HP, GH Pitie-Salpêtrière-Charles Foix, 75013, Paris, France
| | - Sophie Dupont
- Rehabilitation Unit, AP-HP, GH Pitie-Salpêtrière-Charles Foix, 75013, Paris, France. .,Brain and Spine Institute (ICM; INSERM UMRS1127, CNRS UMR7225, UPMC), 75013, Paris, France. .,Sorbonne University, UPMC Univ. Paris 06, 75005, Paris, France. .,Epileptology Unit, AP-HP, GH Pitie-Salpêtrière-Charles Foix, 75013, Paris, France. .,Epileptology Unit and Rehabilitation Unit, Hôpital de la Salpêtrière, 47, boulevard de l'Hôpital, 75651, Paris Cedex 13, France.
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10
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Weiss AR, Bachevalier J. Object and spatial memory after neonatal perirhinal lesions in monkeys. Behav Brain Res 2015; 298:210-7. [PMID: 26593109 DOI: 10.1016/j.bbr.2015.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 11/02/2015] [Accepted: 11/09/2015] [Indexed: 12/19/2022]
Abstract
The contribution of the perirhinal cortex (PRh) to recognition memory is well characterized in adults, yet the same lesions have limited effect on recognition of spatial locations. Here, we assessed whether the same outcomes will follow when perirhinal lesions are performed in infancy. Monkeys with neonatal perirhinal (Neo-PRh) lesions and control animals were tested in three operant recognition tasks as they reached adulthood: Delayed Nonmatching-to-Sample (DNMS) and Object Memory Span (OMS), measuring object recognition, and Spatial Memory Span (SMS), measuring recognition of spatial locations. Although Neo-PRh lesions did not impact acquisition of the DNMS rule, they did impair performance when the delays were extended from 30s to 600s. In contrast, the same neonatal lesions had no impact on either the object or spatial memory span tasks, suggesting that the lesions impacted the maintenance of information across longer delays and not memory capacity. Finally, the magnitude of recognition memory impairment after the Neo-PRh lesions was similar to that previously observed after adult-onset perirhinal lesions, indicating minimal, or no, functional compensation after the early PRh lesions. Overall, the results indicate that the PRh is a cortical structure that is important for the normal development of mechanisms supporting object recognition memory. Its contribution may be relevant to the memory impairment observed with human cases of temporal lobe epilepsy without hippocampal sclerosis, but not to the memory impairment found in developmental amnesia cases.
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Affiliation(s)
| | - Jocelyne Bachevalier
- Emory University, Georgia; Yerkes National Primate Research Center, Atlanta, Georgia
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11
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Abstract
Medial temporal lobe epilepsy associated with mesial temporal sclerosis (MTS) is perhaps the most well-defined epilepsy syndrome that is responsive to structural interventions such as surgery. Several minimally invasive techniques have arisen that provide additional options for the treatment of MTS while potentially avoiding many of open surgery's associated risks. By evading these risks, they also open up treatment options to patients who otherwise are poor surgical candidates. Radiosurgery is one of the most intensively studied of these alternatives and has found a growing role in the treatment of medial temporal lobe epilepsy.
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Affiliation(s)
- Thomas Gianaris
- Department of Neurological Surgery, Indiana University School of Medicine, 355 W. 16th St., Suite 5100, Indianapolis, IN 46202, USA
| | - Thomas Witt
- Department of Neurological Surgery, Indiana University School of Medicine, 355 W. 16th St., Suite 5100, Indianapolis, IN 46202, USA
| | - Nicholas M Barbaro
- Department of Neurological Surgery, Indiana University School of Medicine, 355 W. 16th St., Suite 5100, Indianapolis, IN 46202, USA.
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12
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Peng B, Wu L, Zhang L, Chen Y. Volumetric changes in amygdala and entorhinal cortex and their relation to memory impairment in patients with medial temporal lobe epilepsy with visually normal MR imaging findings. Epilepsy Res 2015; 114:66-72. [PMID: 26088887 DOI: 10.1016/j.eplepsyres.2015.04.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 04/18/2015] [Accepted: 04/23/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To explore the relation between parahippocampal structures, such as the amygdala and the entorhinal cortex (EC), with verbal and nonverbal memory in patients with medial temporal lobe epilepsy (MTLE) with visually normal MR imaging findings by volumetric measurements using magnetic resonance imaging (MRI). METHODS Thirty-six consecutive patients with MTLE presenting a non-sclerotic hippocampus though visual inspection were assessed by MRI to measure the volumes of the hippocampus, amygdale and EC, and by using the clinical memory scale (CMS), a test battery for verbal and nonverbal memory, where summation of all CMS subscale scores equals the memory quotient (MQ). The correlations between MRI volumetric data (Z scores or asymmetry indexes (AI; (L-R)/(L+R)), "L" and "R" refer to the left and right volumes of each structure, respectively), clinical variables and memory scale scores were analyzed using a principal component regression model. RESULTS Volumetric MRI revealed significant differences between the volumes of the hippocampus, EC, and right amygdala, but no differences in the volume of the left amygdala between the controls and the patients group. The patients group performed significantly worse in MQ (p < 0.01), the associate memory test (p < 0.01), directed memory test (p < 0.05), and the nonsense graphical recognition test (p < 0.05) compared to the control group. The asymmetry of the amygdala negatively correlated to verbal paired associates' recall and nonsense graphical recognition. The direct memory was positively related to the volume of the EC. CONCLUSION The volumetric asymmetry of the amygdala contributes to either verbal or nonverbal memory impairment in MTLE patients. Verbal memory may correlate with the volume of the EC.
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Affiliation(s)
- Bingwei Peng
- Department of Neurology, Guang Zhou Women and Children's Medical Center, China.
| | - Liwen Wu
- Department of Neurology, Peking Union Medical College Hospital, China.
| | - Lihua Zhang
- Department of Neurology, Peking Union Medical College Hospital, China.
| | - Yan Chen
- Department of Neurology, Peking Union Medical College Hospital, China.
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13
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Dupont S. Imaging memory and predicting postoperative memory decline in temporal lobe epilepsy: Insights from functional imaging. Rev Neurol (Paris) 2015; 171:307-14. [PMID: 25726354 DOI: 10.1016/j.neurol.2014.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 12/23/2014] [Accepted: 12/29/2014] [Indexed: 11/24/2022]
Abstract
After medial temporal lobe epilepsy (MTLE) surgery, there is considerable individual variation in the extent, nature and direction of postoperative memory change. Before surgery, epileptic patients who are surgery candidates need precise information about the potential cognitive after effects, and particularly in temporal lobe epilepsy, postoperative memory changes. Clinical and neuropsychological data may bring useful information to predict the postoperative memory outcome, but, these data are not always sufficient to replace the Wada test, considered for a long time, as the gold standard to predict postoperative decline following surgery. In any case, numerous studies demonstrate that the Wada procedure can be nowadays reliably replaced by functional MRI (fMRI) activation studies. A vast majority of fMRI studies suggest that it is the functional adequacy of the resected hippocampus rather than the functional reserve of the contralateral hippocampus that determines the extent of postoperative memory decline. In addition, new functional neuroimaging procedures that explore more widespread network disruptions commonly found in MTLE such as diffusion-tensor imaging (DTI) or connectivity studies could in the future constitute a reliable approach combined with fMRI activation studies to significantly improve the prediction of postsurgical memory decline.
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McCormick C, Protzner AB, Barnett AJ, Cohn M, Valiante TA, McAndrews MP. Linking DMN connectivity to episodic memory capacity: what can we learn from patients with medial temporal lobe damage? Neuroimage Clin 2014; 5:188-96. [PMID: 25068108 DOI: 10.1016/j.nicl.2014.05.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 05/14/2014] [Accepted: 05/14/2014] [Indexed: 11/24/2022]
Abstract
Computational models predict that focal damage to the Default Mode Network (DMN) causes widespread decreases and increases of functional DMN connectivity. How such alterations impact functioning in a specific cognitive domain such as episodic memory remains relatively unexplored. Here, we show in patients with unilateral medial temporal lobe epilepsy (mTLE) that focal structural damage leads indeed to specific patterns of DMN functional connectivity alterations, specifically decreased connectivity between both medial temporal lobes (MTLs) and the posterior part of the DMN and increased intrahemispheric anterior–posterior connectivity. Importantly, these patterns were associated with better and worse episodic memory capacity, respectively. These distinct patterns, shown here for the first time, suggest that a close dialogue between both MTLs and the posterior components of the DMN is required to fully express the extensive repertoire of episodic memory abilities. Focal structural damage correlates with widespread functional change in DMN in mTLE. Greater DMN connectivity alterations reflect worse clinical memory measures. Structural integrity moderates influence of functional connectivity on memory. Interhemispheric integration of MTL into posterior DMN may be key to better memory.
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