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Goldstein HE, Poliakov A, Shaw DW, Barry D, Tran K, Novotny EJ, Saneto RP, Marashly A, Warner MH, Wright JN, Hauptman JS, Ojemann JG, Shurtleff HA. Precision medicine in pediatric temporal epilepsy surgery: optimization of outcomes through functional MRI memory tasks and tailored surgeries. J Neurosurg Pediatr 2022; 30:1-12. [PMID: 35901731 DOI: 10.3171/2022.5.peds22148] [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: 04/22/2022] [Accepted: 05/27/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The goal of epilepsy surgery is both seizure cessation and maximal preservation of function. In temporal lobe (TL) cases, the lack of functional MRI (fMRI) tasks that effectively activate mesial temporal structures hampers preoperative memory risk assessment, especially in children. This study evaluated pediatric TL surgery outcome optimization associated with tailored resection informed by an fMRI memory task. METHODS The authors identified focal onset TL epilepsy patients with 1) TL resections; 2) viable fMRI memory scans; and 3) pre- and postoperative neuropsychological (NP) evaluations. They retrospectively evaluated preoperative fMRI memory scans, available Wada tests, pre- and postoperative NP scores, postoperative MRI scans, and postoperative Engel class outcomes. To assess fMRI memory task outcome prediction, the authors 1) overlaid preoperative fMRI activation onto postoperative structural images; 2) classified patients as having "overlap" or "no overlap" of activation and resection cavities; and 3) compared these findings with memory improvement, stability, or decline, based on Reliable Change Index calculations. RESULTS Twenty patients met the inclusion criteria. At a median of 2.1 postoperative years, 16 patients had Engel class IA outcomes and 1 each had Engel class IB, ID, IIA, and IID outcomes. Functional MRI activation was linked to NP memory outcome in 19 of 20 cases (95%). Otherwise, heterogeneity characterized the cohort. CONCLUSIONS Functional MRI memory task activation effectively predicted individual NP outcomes in the context of tailored TL resections. Patients had excellent seizure and overall good NP outcomes. This small study adds to extant literature indicating that pediatric TL epilepsy does not represent a single clinical syndrome. Findings support individualized surgical intervention using fMRI memory activation to help guide this precision medicine approach.
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Affiliation(s)
- Hannah E Goldstein
- 1Neurosciences Center, Seattle Children's Hospital, Seattle
- 2Department of Neurological Surgery, University of Washington School of Medicine, Seattle
- 3Division of Neurosurgery, Seattle Children's Hospital, Seattle
- 9Center for Integrated Brain Research, Seattle Children's Hospital, Seattle, Washington; and
| | - Andrew Poliakov
- 1Neurosciences Center, Seattle Children's Hospital, Seattle
- 3Division of Neurosurgery, Seattle Children's Hospital, Seattle
- 4Department of Radiology, Seattle Children's Hospital, Seattle
| | - Dennis W Shaw
- 4Department of Radiology, Seattle Children's Hospital, Seattle
- 5Department of Radiology, University of Washington School of Medicine, Seattle
| | - Dwight Barry
- 6Clinical Analytics, Seattle Children's Hospital, Seattle
| | - Kieu Tran
- 2Department of Neurological Surgery, University of Washington School of Medicine, Seattle
- 3Division of Neurosurgery, Seattle Children's Hospital, Seattle
| | - Edward J Novotny
- 1Neurosciences Center, Seattle Children's Hospital, Seattle
- 7Division of Pediatric Neurology, Seattle Children's Hospital, Seattle
- 8Department of Neurology, University of Washington School of Medicine, Seattle
- 9Center for Integrated Brain Research, Seattle Children's Hospital, Seattle, Washington; and
| | - Russell P Saneto
- 1Neurosciences Center, Seattle Children's Hospital, Seattle
- 7Division of Pediatric Neurology, Seattle Children's Hospital, Seattle
- 8Department of Neurology, University of Washington School of Medicine, Seattle
- 9Center for Integrated Brain Research, Seattle Children's Hospital, Seattle, Washington; and
| | - Ahmad Marashly
- 10Epilepsy Center, Department of Neurology, The Johns Hopkins University Medical Center, Baltimore, Maryland
| | - Molly H Warner
- 1Neurosciences Center, Seattle Children's Hospital, Seattle
- 7Division of Pediatric Neurology, Seattle Children's Hospital, Seattle
- 9Center for Integrated Brain Research, Seattle Children's Hospital, Seattle, Washington; and
| | - Jason N Wright
- 4Department of Radiology, Seattle Children's Hospital, Seattle
- 5Department of Radiology, University of Washington School of Medicine, Seattle
| | - Jason S Hauptman
- 1Neurosciences Center, Seattle Children's Hospital, Seattle
- 2Department of Neurological Surgery, University of Washington School of Medicine, Seattle
- 3Division of Neurosurgery, Seattle Children's Hospital, Seattle
- 9Center for Integrated Brain Research, Seattle Children's Hospital, Seattle, Washington; and
| | - Jeffrey G Ojemann
- 1Neurosciences Center, Seattle Children's Hospital, Seattle
- 2Department of Neurological Surgery, University of Washington School of Medicine, Seattle
- 3Division of Neurosurgery, Seattle Children's Hospital, Seattle
- 5Department of Radiology, University of Washington School of Medicine, Seattle
- 9Center for Integrated Brain Research, Seattle Children's Hospital, Seattle, Washington; and
| | - Hillary A Shurtleff
- 1Neurosciences Center, Seattle Children's Hospital, Seattle
- 7Division of Pediatric Neurology, Seattle Children's Hospital, Seattle
- 9Center for Integrated Brain Research, Seattle Children's Hospital, Seattle, Washington; and
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Abstract
The present experiment aimed to examine how fabrication can affect memory. In particular, we examined whether different types of fabrication can lead to different mnemonic effects. A sample of 159 participants watched a video of a robbery and subsequently answered some questions about it. Participants were divided into three conditions: one group was instructed to tell the truth (i.e., truth-telling group), while the other two groups were instructed to lie either by partially distorting details (i.e., distortion group) or by completely making up wrong details of the event seen in the video (i.e., fabrication group). Two days later, participants completed a final memory test where they honestly answered recognition and recall questions concerning: (i) memory for the video and (ii) memory for having discussed details during the interview. Results showed that different types of fabrication affect liars' memory differently. Fabricators reported an undermining of memory for the event, whereas those who partially distorted details reported a higher impairment for the interview. Our findings showed that the effects of lying on liars' memory might be determined by the cognitive resources required to lie.
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Affiliation(s)
- Fabiana Battista
- Department of Education, Psychology, Communication, University of Bari "Aldo Moro", Bari, Italy.,Leuven Institute of Criminology, Catholic University of Leuven, Leuven, Belgium
| | - Ivan Mangiulli
- Leuven Institute of Criminology, Catholic University of Leuven, Leuven, Belgium
| | - Paul Riesthuis
- Leuven Institute of Criminology, Catholic University of Leuven, Leuven, Belgium
| | - Antonietta Curci
- Department of Education, Psychology, Communication, University of Bari "Aldo Moro", Bari, Italy
| | - Henry Otgaar
- Leuven Institute of Criminology, Catholic University of Leuven, Leuven, Belgium.,Section Forensic Psychology, Maastricht University, Maastricht, The Netherlands
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Kishima H, Kato A, Oshino S, Tani N, Maruo T, Khoo HM, Yanagisawa T, Edakawa K, Kobayashi M, Tanaka M, Hosomi K, Hirata M, Yoshimine T. Navigation-assisted trans-inferotemporal cortex selective amygdalohippocampectomy for mesial temporal lobe epilepsy; preserving the temporal stem. Neurol Res 2017; 39:223-230. [PMID: 28067149 DOI: 10.1080/01616412.2016.1275458] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Selective amygdalohippocampectomy (SAH) can be used to obtain satisfactory seizure control in patients with mesial temporal lobe epilepsy (MTLE). Several SAH procedures have been reported to achieve satisfactory outcomes for seizure control, but none yield fully satisfactory outcomes for memory function. We hypothesized that preserving the temporal stem might play an important role. To preserve the temporal stem, we developed a minimally invasive surgical procedure, 'neuronavigation-assisted trans-inferotemporal cortex SAH' (TITC-SAH). METHODS TITC-SAH was performed in 23 patients with MTLE (MTLE on the language-non-dominant hemisphere, n = 11). The inferior horn of the lateral ventricle was approached via the inferior or middle temporal gyrus along the inferior temporal sulcus under neuronavigation guidance. The hippocampus was dissected in a subpial manner and resected en bloc together with the parahippocampal gyrus. Seizure control at one year and memory function at 6 months postoperatively were evaluated. RESULTS One year after TITC-SAH, 20 of the 23 patients were seizure-free (ILAE class 1), 2 were class 2, and 1 was class 3. Verbal memory improved significantly in 13 patients with a diagnosis of hippocampal sclerosis, for whom WMS-R scores were available both pre- and post-operatively. Improvements were seen regardless of whether the SAH was on the language-dominant or non-dominant hemisphere. No major complication was observed. CONCLUSION Navigation-assisted TITC-SAH performed for MTLE offers a simple, minimally invasive procedure that appears to yield excellent outcomes in terms of seizure control and preservation of memory function, because this procedure does not damage the temporal stem. TITC-SAH should be one of the feasible surgical procedures for MTLE. ABBREVIATIONS SAH: Amygdalohippocampectomy; MTLE: Mesial temporal lobe epilepsy (MTLE); TITC-SAH: Ttrans-inferotemporal cortex SAH; ILAE: International League Against Epilepsy (ILAE); MRI: Magnetic resonance imaging; EEG: Electroencephalography (EEG); FDG-PET: 8F-fluorodeoxyglucose (FDG)-positron emission tomography; ECoG: Electrocorticography; MEG: Magnetoencephalography; IMZ-SPECT: N-isopropyl-p(123I)-iodoamphetamine single photon emission computed tomography; WMS-R: Wechsler Memory Scale-Revised.
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Affiliation(s)
- Haruhiko Kishima
- a Department of Neurosurgery , Osaka University Graduate School of Medicine , Suita, Osaka , Japan.,b Epilepsy Center , Osaka University Hospital , Suita , Japan
| | - Amami Kato
- c Department of Neurosurgery , Kinki University School of Medicine , Osaka-sayama , Japan
| | - Satoru Oshino
- a Department of Neurosurgery , Osaka University Graduate School of Medicine , Suita, Osaka , Japan.,b Epilepsy Center , Osaka University Hospital , Suita , Japan
| | - Naoki Tani
- b Epilepsy Center , Osaka University Hospital , Suita , Japan.,d Department of Neurosurgery , Osaka General Medical Center , Osaka , Japan
| | - Tomoyuki Maruo
- b Epilepsy Center , Osaka University Hospital , Suita , Japan.,e Department of Neurosurgery , Otemae Hospital , Osaka-sayama , Japan
| | - Hui Ming Khoo
- a Department of Neurosurgery , Osaka University Graduate School of Medicine , Suita, Osaka , Japan.,b Epilepsy Center , Osaka University Hospital , Suita , Japan
| | - Takufumi Yanagisawa
- a Department of Neurosurgery , Osaka University Graduate School of Medicine , Suita, Osaka , Japan.,b Epilepsy Center , Osaka University Hospital , Suita , Japan.,f Global Center for Medical Engineering and Informatics Division of Clinical Neuroengineering , Osaka University , Osaka , Japan
| | - Kotaro Edakawa
- a Department of Neurosurgery , Osaka University Graduate School of Medicine , Suita, Osaka , Japan.,b Epilepsy Center , Osaka University Hospital , Suita , Japan
| | - Maki Kobayashi
- a Department of Neurosurgery , Osaka University Graduate School of Medicine , Suita, Osaka , Japan.,b Epilepsy Center , Osaka University Hospital , Suita , Japan
| | - Masataka Tanaka
- a Department of Neurosurgery , Osaka University Graduate School of Medicine , Suita, Osaka , Japan.,b Epilepsy Center , Osaka University Hospital , Suita , Japan
| | - Koichi Hosomi
- a Department of Neurosurgery , Osaka University Graduate School of Medicine , Suita, Osaka , Japan.,b Epilepsy Center , Osaka University Hospital , Suita , Japan
| | - Masayuki Hirata
- a Department of Neurosurgery , Osaka University Graduate School of Medicine , Suita, Osaka , Japan.,b Epilepsy Center , Osaka University Hospital , Suita , Japan.,f Global Center for Medical Engineering and Informatics Division of Clinical Neuroengineering , Osaka University , Osaka , Japan
| | - Toshiki Yoshimine
- f Global Center for Medical Engineering and Informatics Division of Clinical Neuroengineering , Osaka University , Osaka , Japan
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