A-080 Prediction Model for Verbal Memory Decline in Different Epilepsy Surgery Procedures: Temporal Lobectomy vs. Amygdalohippocampectomy

Abstract Objective Mathematical models predicting risk of verbal memory decline after resective epilepsy surgery have been developed for patients undergoing temporal lobectomies. This study was undertaken to determine if application of the Stroup memory loss prediction model was as accurate in foreseeing verbal memory decline after temporal lobectomy as in the less invasive selective amygdalohippocampectomy procedure. Method This retrospective study examined the verbal memory performances of 40 left temporal lobectomy (ATL), and 16 left subtemporal approach selective amygdalohippocampectomy (SA-H), patients before and after epilepsy surgery using word list learning (Rey Auditory-Verbal Learning Test, Buschke Selective Reminding Test) and story memory (WMS Logical Memory) tests. Patients were assigned to one of four groups using the Stroup multiple regression equation: Minimal Risk (61% risk). To classify memory decline in individual patients, a pre-to-post surgery decrease of > 1 SD on at least one memory test constituted memory decline. Results The prediction model accurately classified 82% (9/11) of ATL, and 75% (3/4) of SA-H, High Risk patients. Verbal memory loss was higher among ATLs than SA-Hs in the Moderate Risk (87% vs. 18%) and Low Risk (71% vs. 0%) groups. Conclusion The Stroup verbal memory loss risk model under-predicted memory loss among temporal lobectomy patients (71% of Low Risk patients showed memory decline) and over-predicted memory loss among selective amygdalohippocampectomy patients (only 18% of Moderate Risk patients showed memory decline). Results should be considered preliminary due to methodological limitation including small Ns and unequal sample sizes.

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B-28 Prognostic Utility of a Prediction Model for Memory Decline in Epilepsy Following Selective Amygdalohippocampectomy

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acz034.111 ◽

2019 ◽

Vol 34 (6) ◽

pp. 974-974

Author(s):

A Bono ◽

G Lee

Keyword(s):

Epilepsy Surgery ◽

Verbal Memory ◽

Risk Group ◽

Significant Decline ◽

Temporal Lobectomy ◽

Moderate Risk ◽

Memory Decline ◽

Selective Amygdalohippocampectomy ◽

Post Surgery ◽

Prognostic Utility

Abstract Objective It is important to evaluate risk for post-surgical cognitive decline in a systematic and reliable fashion due to the variable risk of memory decline following epilepsy surgery. Mathematical risk models have been developed to predict post-surgical memory decline (e.g., Stroup et al., 2003), but few studies have evaluated their prognostic utility. This study evaluated the predictive value of the Stroup et al., (2003) multivariate risk factor model in predicting postoperative verbal memory outcome among epilepsy patients who underwent left selective amygdalohippocampectomy. Method This retrospective study included 16 left-sided localization-related epilepsy surgery patients who underwent neuropsychological evaluation pre- and post-surgery. Patients were assigned to two risk groups: mild to moderate risk (15 to 60%) and severe risk (>61%) for postoperative memory decline, which was based on Stroup et al., (2003) criteria, suggesting that individuals with the highest risk had dominant hemisphere resections, no hippocampal sclerosis, normal Wada memory, and normal preoperative immediate and delayed memory scores. Memory decline was determined by pre- minus post-surgery memory test difference scores with 1.5 SD denoting a significant decline. Results The formula predicted postoperative memory decline with 75% accuracy for patients in the high risk group and no significant decline with 92% accuracy for patients in the mild to moderate risk group. Conclusion The results suggest that Stroup’s predictive formula for verbal memory outcome following epilepsy surgery may be useful for patients undergoing left selective amygdalohippocampectomy surgery, consistent with prior research suggesting prognostic utility with left temporal lobectomy patients (e.g., Johnson-Markve et al., 2009).

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Predicting verbal memory decline following anterior temporal lobectomy (ATL)

Neurology ◽

10.1212/01.wnl.0000058765.33878.0d ◽

2003 ◽

Vol 60 (8) ◽

pp. 1266-1273 ◽

Cited By ~ 160

Author(s):

E. Stroup ◽

J. Langfitt ◽

M. Berg ◽

M. McDermott ◽

W. Pilcher ◽

...

Keyword(s):

Verbal Memory ◽

Temporal Lobectomy ◽

Anterior Temporal Lobectomy ◽

Memory Decline

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Seizure and memory outcome following temporal lobe surgery: selective compared with nonselective approaches for hippocampal sclerosis

Journal of Neurosurgery ◽

10.3171/jns.2006.104.1.70 ◽

2006 ◽

Vol 104 (1) ◽

pp. 70-78 ◽

Cited By ~ 108

Author(s):

Eliseu Paglioli ◽

André Palmini ◽

Mirna Portuguez ◽

Eduardo Paglioli ◽

Ney Azambuja ◽

...

Keyword(s):

Temporal Lobe ◽

Verbal Memory ◽

Seizure Control ◽

Hippocampal Sclerosis ◽

Surgical Techniques ◽

Mesial Temporal Lobe Epilepsy ◽

Outcome Data ◽

Temporal Lobectomy ◽

Selective Amygdalohippocampectomy

Object The aim of this study was to compare seizure and memory outcome in patients with medically refractory mesial temporal lobe epilepsy due to hippocampal sclerosis (MTLE/HS) treated using an anterior temporal lobectomy (ATL) or a selective amygdalohippocampectomy (SA). Methods Surgical outcome data were prospectively collected for 2 to 11 years in 161 consecutive patients with MTLE/HS. Eighty patients underwent an ATL and 81 an SA. Seizure control achieved with each technique was compared using the Engel classification scheme. Postoperative memory testing was performed in 86 patients (53%). At the last follow up, 72% of the patients who had undergone an ATL (mean follow up 6.7 years) and 71% of those who had undergone an SA (mean follow up 4.5 years) were seizure free (Engle Class IA). Estimated survival in patients in Engel Classes I, IA, and I and II combined did not differ between the two surgical techniques. Preoperatively, 58% of the patients had verbal memory scores one standard deviation (SD) below the normal mean. One third of the patients with preoperative scores in the normal range worsened after surgery, although this outcome was not related to the surgical technique. In contrast, one third of those whose preoperative scores were less than −1 SD experienced improvement after surgery. Nine (18%) of the 50 patients whose left side had been surgically treated improved their verbal memory scores by more than one SD. Seven (78%) of these nine underwent an SA (p = 0.05). Conclusions Both ATL and SA can lead to similar favorable seizure control in patients with MTLE/HS. Preliminary data suggest that postoperative verbal memory scores may improve in patients who undergo selective resection of a sclerotic hippocampus in the dominant temporal lobe.

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Pre-existing Cardiovascular Disease in United States Population at High Risk for Severe COVID-19 Infection

10.1101/2020.05.11.20089714 ◽

2020 ◽

Author(s):

Adnan I Qureshi

Keyword(s):

United States ◽

Risk Factors ◽

Cardiovascular Disease ◽

At Risk ◽

High Risk ◽

Low Risk ◽

Chronic Obstructive ◽

Moderate Risk ◽

High Risk Patients ◽

Risk Patients

Background and Purpose There is increasing recognition of a relatively high burden of pre-existing cardiovascular disease in Corona Virus Disease 2019 (COVID 19) infected patients. We determined the burden of pre-existing cardiovascular disease in persons residing in United States (US) who are at risk for severe COVID-19 infection. Methods Age (60 years or greater), presence of chronic obstructive pulmonary disease, diabetes, mellitus, hypertension, and/or malignancy were used to identify persons at risk for admission to intensive care unit, or invasive ventilation, or death with COVID-19 infection. Persons were classified as low risk (no risk factors), moderate risk (1 risk factor), and high risk (two or more risk factors present) using nationally representative sample of US adults from National Health and Nutrition Examination Survey 2017 and 2018 survey. Results Among a total of 5856 participants, 2386 (40.7%) were considered low risk, 1325 (22.6%) moderate risk, and 2145 persons (36.6%) as high risk for severe COVID-19 infection. The proportion of patients who had pre-existing stroke increased from 0.6% to 10.5% in low risk patients to high risk patients (odds ratio [OR]19.9, 95% confidence interval [CI]11.6-34.3). The proportion of who had pre-existing myocardial infection (MI) increased from 0.4% to 10.4% in low risk patients to high risk patients (OR 30.6, 95% CI 15.7-59.8). Conclusions A large proportion of persons in US who are at risk for developing severe COVID 19 infection are expected to have pre-existing cardiovascular disease. Further studies need to identify whether targeted strategies towards cardiovascular diseases can reduce the mortality in COVID-19 infected patients.

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Use of preoperative functional MRI to predict verbal memory decline after temporal lobe epilepsy surgery

Epilepsia ◽

10.1111/j.1528-1167.2008.01625.x ◽

2008 ◽

Vol 49 (8) ◽

pp. 1377-1394 ◽

Cited By ~ 145

Author(s):

Jeffrey R. Binder ◽

David S. Sabsevitz ◽

Sara J. Swanson ◽

Thomas A. Hammeke ◽

Manoj Raghavan ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Functional Mri ◽

Temporal Lobe ◽

Epilepsy Surgery ◽

Verbal Memory ◽

Memory Decline

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Surgical Treatment of Mesiotemporal Lobe Epilepsy: Which Approach is Favorable?

Neurosurgery ◽

10.1093/neuros/nyx138 ◽

2017 ◽

Vol 81 (6) ◽

pp. 992-1004 ◽

Cited By ~ 16

Author(s):

Barbara Schmeiser ◽

Kathrin Wagner ◽

Andreas Schulze-Bonhage ◽

Irina Mader ◽

Anne-Sophie Wendling ◽

...

Keyword(s):

Verbal Memory ◽

Postoperative Outcome ◽

Temporal Lobectomy ◽

Surgical Approaches ◽

Seizure Outcome ◽

Consecutive Series ◽

Complication Rates ◽

Pharmacoresistant Epilepsy ◽

Anterior Temporal Lobectomy ◽

Selective Amygdalohippocampectomy

Abstract BACKGROUND Mesiotemporal lobe epilepsy is one of the most frequent causes for pharmacoresistant epilepsy. Different surgical approaches to the mesiotemporal area are used. OBJECTIVE To analyze epileptological and neuropsychological results as well as complications of different surgical strategies. METHODS This retrospective study is based on a consecutive series of 458 patients all harboring pharmacoresistant mesiotemporal lobe epilepsy. Following procedures were performed: standard anterior temporal lobectomy, anterior temporal or key-hole resection, extended lesionectomy, and transsylvian and subtemporal selective amygdalohippocampectomy. Postoperative outcome was evaluated according to different surgical procedures. RESULTS Overall, 1 yr after surgery 315 of 432 patients (72.9%) were classified Engel I; in particular, 72.8% were seizure-free after anterior temporal lobectomy, 76.9% after key-hole resection, 84.4% after extended lesionectomy, 70.3% after transylvian selective amygdalohippocampectomy, and 59.1% after subtemporal selective amygdalohippocampectomy. No significant differences in seizure outcome were found between different resective procedures, neither in short-term nor long-term follow-up. There was no perioperative mortality. Permanent morbidity was encountered in 4.4%. There were no significant differences in complications between different resection types. In the majority of patients, selective attention improved following surgery. Patients after left-sided operations performed significantly worse regarding verbal memory as compared to right-sided procedures. However, surgical approach had no significant effect on memory outcome. CONCLUSION Different surgical approaches for mesiotemporal epilepsy analyzed resulted in similar epileptological, neuropsychological results, and complication rates. Therefore, the approach for the individual patient does not only depend on the specific localization of the epileptogenic area, but also on the experience of the surgeon.

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Verbal memory deficits after left temporal lobectomy for epilepsy

Journal of Neurosurgery ◽

10.3171/jns.1985.62.1.0101 ◽

1985 ◽

Vol 62 (1) ◽

pp. 101-107 ◽

Cited By ~ 250

Author(s):

George A. Ojemann ◽

Carl B. Dodrill

Keyword(s):

Electrical Stimulation ◽

Verbal Memory ◽

Memory Loss ◽

Major Complication ◽

Memory Deficits ◽

Memory Deficit ◽

Temporal Lobectomy ◽

Dominant Hemisphere ◽

Content Type ◽

Intraoperative Localization

✓ Verbal memory deficits remain a major complication of dominant hemisphere temporal lobectomy for epilepsy. The extent of this deficit was assessed preoperatively and 1 month and 1 year postoperatively with the Wechsler Verbal Memory Scale (WMSV) in 14 adults undergoing left temporal lobectomy. Intraoperative localization of language and verbal memory was also performed by electrical stimulation mapping. The WMSV score decreased an average of 22% at 1 month (13 cases), and 11% at 1 year (10 cases), even though in the majority of cases the medial extent of the resections had been significantly modified as a result of preoperative memory changes in response to intracarotid amobarbital perfusion testing. Memory decline was greater in patients who were not seizure-free, and correlated with the lateral (but not the medial) extent of the resection. The memory deficit could be predicted intraoperatively with 80% accuracy from the relationship of the resection to sites identified by electrical stimulation mapping as essential to naming or input or storage aspects of memory. This technique was applied prospectively in two additional cases with left temporal epileptic foci and complete verbal memory loss with left hemisphere amobarbital inactivation. These resections were tailored to avoid the essential naming and memory sites; the WMSV score increased 1 month postoperatively in both cases. This study identifies a lateral cortical component for verbal memory. Sites essential for that component can be localized intraoperatively with stimulation mapping; when they are spared in a resection, verbal memory deficit following dominant hemisphere temporal lobectomy can be prevented even in high-risk cases.

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