Prediction of Memory Impairment in Epilepsy Surgery by White Matter Diffusion

García-Pallero, María A.; Torres, Cristina V.; Hernando, Concepción González; Plasencia, Pilar Martín; Manzanares, Rafael; García, Laura Esteban; Navas, Marta; Pulido, Paloma Contreras; Delgado-Fernández, Juan; Rubio, José I. Aragón; Sola, Rafael G.

doi:10.1016/j.wneu.2020.03.103

Cited by 4 publications

(1 citation statement)

References 35 publications

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“…Preserved memory function in the hippocampus to be resected is associated with poorer postoperative cognitive outcomes. 30 Although several factors have been associated with worse cognitive outcomes in temporal lobectomy for unilateral mesial temporal sclerosis, 6,9,29,31,32 the role of bilateral epileptiform activity on cognitive outcome in mesial temporal sclerosis surgery has not been clearly evaluated. A small retrospective study has shown favorable prognosis for patients with bilateral epileptogenesis in temporal lobe epilepsy to unilateral hippocampal sclerosis.…”

Section: Discussionmentioning

confidence: 99%

Bilateral ictal EEG is associated with better memory outcome after hippocampal sclerosis surgery

Castro‐Lima,

Passarelli,

Ribeiro

et al. 2023

Epilepsia Open

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ObjectiveTo compare memory outcomes after surgery for unilateral Hippocampal Sclerosis (HS) associated epilepsy in patients with unilateral and bilateral ictal electrographic involvement.MethodsWe prospectively evaluated HS patients, aged 18 to 55 years and IQ≥70. Left (L) and right (R) surgical groups underwent noninvasive video‐EEG monitoring and Wada test. We classified patients as Ipsilateral if ictal EEG was restricted to the HS side, or Bilateral, if at least one seizure onset occurred contralaterally to the HS, or if ictal discharge evolved to the opposite temporal region. Patients who declined surgery served as controls. Memory was evaluated on two occasions with Rey Auditory‐Verbal Learning Test and Rey Visual‐Design Learning Test. Baseline neuropsychological test scores were compared between groups. Pre‐ and postoperative scores were compared within each group. Reliable Change Index Z‐scores (RCI) were obtained using controls as references, and compared between surgical groups.ResultsWe evaluated 64 patients. Patients were classified as: L‐Ipsilateral(9), L‐Bilateral(15), L‐Control(9), R‐Ipsilateral(10), R‐Bilateral (9), R‐Control(12). On preoperative evaluation, memory performance did not differ among surgical groups. Right HS patients did not present postoperative memory decline. L‐Ipsilateral group presented postoperative decline on immediate (p=0.036) and delayed verbal recall (p=0.011), while L‐Bilateral did not decline. L‐Ipsilateral had lower RCI Z‐scores, indicating delayed verbal memory decline compared to L‐Bilateral (p=0.012).SignificanceDominant HS patients with bilateral ictal involvement presented less pronounced postoperative verbal memory decline compared to patients with exclusive ipsilateral ictal activity. Surgery was indicated in these patients regardless of memory impairment on neuropsychological testing, since resection of the left sclerotic hippocampus could result in cessation of contralateral epileptiform activity, and, therefore, improved memory function.

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Section: Discussionmentioning

confidence: 99%

Bilateral ictal EEG is associated with better memory outcome after hippocampal sclerosis surgery

Castro‐Lima,

Passarelli,

Ribeiro

et al. 2023

Epilepsia Open

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Advances in Neuroimaging and Multiple Post‐Processing Techniques for Epileptogenic Zone Detection of Drug‐Resistant Epilepsy

Yao,

Cheng,

Chen

et al. 2023

Magnetic Resonance Imaging

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Among the approximately 20 million patients with drug‐resistant epilepsy (DRE) worldwide, the vast majority can benefit from surgery to minimize seizure reduction and neurological impairment. Precise preoperative localization of epileptogenic zone (EZ) and complete resection of the lesions can influence the postoperative prognosis. However, precise localization of EZ is difficult, and the structural and functional alterations in the brain caused by DRE vary by etiology. Neuroimaging has emerged as an approach to identify the seizure‐inducing structural and functional changes in the brain, and magnetic resonance imaging (MRI) and positron emission tomography (PET) have become routine noninvasive imaging tools for preoperative evaluation of DRE in many epilepsy treatment centers. Multimodal neuroimaging offers unique advantages in detecting EZ, especially in improving the detection rate of patients with negative MRI or PET findings. This approach can characterize the brain imaging characteristics of patients with DRE caused by different etiologies, serving as a bridge between clinical and pathological findings and providing a basis for individualized clinical treatment plans. In addition to the integration of multimodal imaging modalities and the development of special scanning sequences and image post‐processing techniques for early and precise localization of EZ, the application of deep machine learning for extracting image features and deep learning‐based artificial intelligence have gradually improved diagnostic efficiency and accuracy. These improvements can provide clinical assistance for precisely outlining the scope of EZ and indicating the relationship between EZ and functional brain areas, thereby enabling standardized and precise surgery and ensuring good prognosis. However, most existing studies have limitations imposed by factors such as their small sample sizes or hypothesis‐based study designs. Therefore, we believe that the application of neuroimaging and post‐processing techniques in DRE requires further development and that more efficient and accurate imaging techniques are urgently needed in clinical practice.Level of Evidence5Technical EfficacyStage 2

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Clinical utility of Epitrack for differentiating profiles and patterns of post-surgical change in memory and quality of life in patients with drug-resistant epilepsy

Lozano-García

Hampel

Gutiérrez

et al. 2022

Applied Neuropsychology: Adult

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Prediction of Memory Impairment in Epilepsy Surgery by White Matter Diffusion

Cited by 4 publications

References 35 publications

Bilateral ictal EEG is associated with better memory outcome after hippocampal sclerosis surgery

Bilateral ictal EEG is associated with better memory outcome after hippocampal sclerosis surgery

Advances in Neuroimaging and Multiple Post‐Processing Techniques for Epileptogenic Zone Detection of Drug‐Resistant Epilepsy

Clinical utility of Epitrack for differentiating profiles and patterns of post-surgical change in memory and quality of life in patients with drug-resistant epilepsy

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