Leveraging the resting brain to predict memory decline after temporal lobectomy

Abstract

ObjectivePredicting memory morbidity after temporal lobectomy in patients with temporal lobe epilepsy (TLE) relies on indices of preoperative temporal lobe structural and functional integrity. However, epilepsy is increasingly considered a network disorder, and memory a network phenomenon. We assessed the utility of functional network measures to predict postoperative memory changes.MethodsSeventy‐two adults with TLE (37 left/35 right) underwent preoperative resting‐state functional magnetic resonance imaging and pre‐ and postoperative neuropsychological assessment. We compared functional connectivity throughout the memory network of each patient to a healthy control template (n = 19) to identify differences in global organization. A second metric indicated the degree of integration of the to‐be‐resected temporal lobe with the rest of the memory network. We included these measures in a linear regression model alongside standard clinical variables as predictors of memory change after surgery.ResultsLeft TLE patients with more atypical memory networks, and with greater functional integration of the to‐be‐resected region with the rest of the memory network preoperatively, experienced the greatest decline in verbal memory after surgery. Together, these two measures explained 44% of variance in verbal memory change, outperforming standard clinical and demographic variables. None of the variables examined was associated with visuospatial memory change in patients with right TLE.SignificanceResting‐state connectivity provides valuable information concerning both the integrity of to‐be‐resected tissue and functional reserve across memory‐relevant regions outside of the to‐be‐resected tissue. Intrinsic functional connectivity has the potential to be useful for clinical decision‐making regarding memory outcomes in left TLE, and more work is needed to identify the factors responsible for differences seen in right TLE.

Single voxel autocorrelation reflects hippocampal function in temporal lobe epilepsy

“…Null findings in patients with RTLE have appeared throughout the literature, suggesting that neural changes due to TLE manifest differently in left vs. right TLE. For example, cortico-hippocampal connectivity in LTLE was predictive of post-surgery outcomes, but not in RTLE (Audrain et al, 2023; Stasenko et al, 2023). Additionally, reductions in functional connectivity between the hippocampus and DMN regions are greater in LTLE, but not RTLE (Barnett et al, 2019; Pereira et al, 2010).…”

“…Thus, chronically slower temporal dynamics may not be sufficient to explain variations in complex operations underlying offline performance on clinical memory measures. In that sense, single voxel autocorrelation per se may not be as robust an indicator of functional integrity as measures of intrinsic connectivity (Audrain et al, 2018, 2023).…”