scholarly journals What’s in Your Nomogram? Personalized Prognostication of Verbal Memory Decline after Temporal Lobe Resection in Adults With Epilepsy

2021 ◽  
pp. 153575972110582
Author(s):  
Tracey A. Milligan
Keyword(s):  
Temporal Lobe ◽  
Verbal Memory ◽  
Validation Cohort ◽  
Predictive Accuracy ◽  
Verbal Learning ◽  
Cleveland Clinic ◽  
The United States ◽  
Clinical Predictors ◽  
Memory Decline ◽  
Temporal Lobe Resection

Objective This study aims to develop and externally validate models to predict the probability of postoperative verbal memory decline in adults following temporal lobe resection (TLR) for epilepsy using easily accessible preoperative clinical predictors. Methods Multivariable models were developed to predict delayed verbal memory outcome on 3 commonly used measures: Rey Auditory Verbal Learning Test (RAVLT), and Logical Memory (LM), and Verbal Paired Associates (VPA) subtests from Wechsler Memory Scale-Third Edition. Using Harrell’s step-down procedure for variable selection, models were developed in 359 adults who underwent TLR at Cleveland Clinic and validated in 290 adults at 1 of 5 epilepsy surgery centers in the United States or Canada. Results Twenty-nine percent of the development cohort and 26% of the validation cohort demonstrated significant decline on at least 1 verbal memory measure. Initial models had good-to-excellent predictive accuracy (calibration (c) statistic range = .77–.80) in identifying patients with memory decline; however, models slightly underestimated decline in the validation cohort. Model coefficients were updated using data from both cohorts to improve stability. The model for RAVLT included surgery side, baseline memory score, and hippocampal resection. The models for LM and VPA included surgery side, baseline score, and education. Updated model performance was good to excellent (RAVLT c = .81, LM c = .76, VPA c = .78). Model calibration was very good, indicating no systematic over- or under-estimation of risk. Conclusions Nomograms are provided in 2 easy-to-use formats to assist clinicians in estimating the probability of verbal memory decline in adults considering TLR for treatment of epilepsy.

Nomograms to Predict Verbal Memory Decline After Temporal Lobe Resection in Adults With Epilepsy

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012221
Author(s):  
Robyn M. Busch ◽  
Olivia Hogue ◽  
Margaret Miller ◽  
Lisa Ferguson ◽  
Mary Pat McAndrews ◽  
...  
Keyword(s):  
Temporal Lobe ◽  
Verbal Memory ◽  
Prediction Models ◽  
Validation Cohort ◽  
Predictive Accuracy ◽  
Verbal Learning ◽  
Cleveland Clinic ◽  
The United States ◽  
Memory Decline ◽  
Temporal Lobe Resection

Objective:To develop and externally validate models to predict the probability of postoperative verbal memory decline in adults following temporal lobe resection (TLR) for epilepsy using easily-accessible preoperative clinical predictors.Methods:Multivariable models were developed to predict delayed verbal memory outcome on three commonly used measures: Rey Auditory Verbal Learning Test (RAVLT) and Logical Memory (LM) and Verbal Paired Associates (VPA) subtests from Wechsler Memory Scale–Third Edition. Using Harrell’s step-down procedure for variable selection, models were developed in 359 adults who underwent TLR at Cleveland Clinic and validated in 290 adults at one of five epilepsy surgery centers in the United States or Canada.Results:Twenty-nine percent of the development cohort and 26% of the validation cohort demonstrated significant decline on at least one verbal memory measure. Initial models had good to excellent predictive accuracy (calibration (c) statistic range=0.77-0.80) in identifying patients with memory decline; however, models slightly underestimated decline in the validation cohort. Model coefficients were updated using data from both cohorts to improve stability. The model for RAVLT included surgery side, baseline memory score, and hippocampal resection. The models for LM and VPA included surgery side, baseline score, and education. Updated model performance was good to excellent (RAVLT c=0.81, LM c=0.76, VPA c=0.78). Model calibration was very good, indicating no systematic over- or under-estimation of risk.Conclusions:Nomograms are provided in two easy-to-use formats to assist clinicians in estimating the probability of verbal memory decline in adults considering TLR for treatment of epilepsy.Classification of Evidence:This study provides Class II evidence that multivariable prediction models accurately predict verbal memory decline after temporal lobe resection for epilepsy in adults.

scholarly journals Superior Verbal Memory Outcome After Stereotactic Laser Amygdalohippocampotomy

2021 ◽  
Vol 12 ◽  
Author(s):  
Daniel L. Drane ◽  
Jon T. Willie ◽  
Nigel P. Pedersen ◽  
Deqiang Qiu ◽  
Natalie L. Voets ◽  
...  
Keyword(s):  
Laser Ablation ◽  
Temporal Lobe ◽  
Verbal Memory ◽  
Mesial Temporal Sclerosis ◽  
Open Resection ◽  
Memory Decline ◽  
Exact Test ◽  
Fisher's Exact Test ◽  
Fisher’S Exact Test ◽  
Temporal Lobe Resection

Objective: To evaluate declarative memory outcomes in medically refractory epilepsy patients who underwent either a highly selective laser ablation of the amygdalohippocampal complex or a conventional open temporal lobe resection.Methods: Post-operative change scores were examined for verbal memory outcome in epilepsy patients who underwent stereotactic laser amygdalohippocampotomy (SLAH: n = 40) or open resection procedures (n = 40) using both reliable change index (RCI) scores and a 1-SD change metric.Results: Using RCI scores, patients undergoing open resection (12/40, 30.0%) were more likely to decline on verbal memory than those undergoing SLAH (2/40 [5.0%], p = 0.0064, Fisher's exact test). Patients with language dominant procedures were much more likely to experience a significant verbal memory decline following open resection (9/19 [47.4%]) compared to laser ablation (2/19 [10.5%], p = 0.0293, Fisher's exact test). 1 SD verbal memory decline frequently occurred in the open resection sample of language dominant temporal lobe patients with mesial temporal sclerosis (8/10 [80.0%]), although it rarely occurred in such patients after SLAH (2/14, 14.3%) (p = 0.0027, Fisher's exact test). Memory improvement occurred significantly more frequently following SLAH than after open resection.Interpretation: These findings suggest that while verbal memory function can decline after laser ablation of the amygdalohippocampal complex, it is better preserved when compared to open temporal lobe resection. Our findings also highlight that the dominant hippocampus is not uniquely responsible for verbal memory. While this is at odds with our simple and common heuristic of the hippocampus in memory, it supports the findings of non-human primate studies showing that memory depends on broader medial and lateral TL regions.

Predicting verbal memory decline following temporal lobe resection for epilepsy

2019 ◽  
Vol 140 (5) ◽  
pp. 312-319 ◽  
Author(s):  
Sofia Ljunggren ◽  
Lena Andersson‐Roswall ◽  
Henrik Imberg ◽  
Hans Samuelsson ◽  
Kristina Malmgren
Keyword(s):  
Temporal Lobe ◽  
Verbal Memory ◽  
Memory Decline ◽  
Temporal Lobe Resection

scholarly journals A Functional MRI-Based Model for Individual Memory Assessment in Patients Eligible for Anterior Temporal Lobe Resection

2017 ◽  
Vol 11 (1) ◽  
pp. 1-16 ◽  
Author(s):  
Maria Strandberg ◽  
Peter Mannfolk ◽  
Lars Stenberg ◽  
Hanna Ljung ◽  
Ia Rorsman ◽  
...  
Keyword(s):  
Temporal Lobe ◽  
Verbal Memory ◽  
Anterior Temporal Lobe ◽  
Memory Decline ◽  
Memory Assessment ◽  
Clinical Risk ◽  
Post Surgery ◽  
Increased Risk ◽  
Individual Memory ◽  
Temporal Lobe Resection

Title:A functional (f) MRI-based model for individual memory assessment in patients eligible for temporal lobe resection.Aim:To investigate if pre-operative fMRI memory paradigms, add predictive information with regard to post-surgical memory deficits.Methods:Fourteen pharmacoresistant Temporal Lobe Epilepsy (TLE) patients accepted for Anterior Temporal Lobe Resection (ATLR) were included. A clinical risk assessment score (RAS 0-3) was constructed from structural MRI, neuropsychological testing and hemisphere dominance. fMRI lateralization indices (LIs) over frontal language and medial temporal regions were calculated. Predictive value from clinical risk scoring and added value from fMRI LIs were correlated to post-surgical memory change scores (significant decline -1 SD). Verbal memory outcome was classified either as expected (RAS 2-3 and post-operative decline; RAS 0-1 and intact post-operative verbal memory) or as unexpected (RAS 2-3 and intact post-operative verbal memory post-surgery; RAS 0-1 and post-operative decline).Results:RAS for verbal memory decline exhibited a specificity of 67% and a sensitivity of 75%. Significant correlations were found between frontal language LIs and post-operative verbal memory (r = -0.802; p = 0.017) for left (L) TLE and between medial temporal lobe LIs and visuospatial memory (r = 0.829; p = 0.021), as well as verbal memory (r = 0.714; p = 0.055) for right (R) TLE. Ten patients had expected outcome and four patients had an unexpected outcome. In two MRI-negative RTLE patients that suffered significant verbal memory decline post-operatively, fMRI identified bilateral language and right lateralized medial temporal verbal encoding. In two LTLE patients with MRI pathology and verbal memory dysfunction, neither RAS nor fMRI identified the risk for aggravated verbal memory decline following ATLR.Conclusion:fMRI visualization of temporal-frontal network activation may add value to the pre-surgical work-up in epilepsy patients eligible for ATLR. Frontal language patterns are important for prediction in both L and RTLE. Strong left lateralized language in LTLE, as well as bilateral language combined with right lateralized encoding in RTLE, seems to indicate an increased risk for post-operative verbal memory decline.

scholarly journals Memory fMRI predicts verbal memory decline after anterior temporal lobe resection

Neurology ◽  
2015 ◽  
Vol 84 (15) ◽  
pp. 1512-1519 ◽  
Author(s):  
M. K. Sidhu ◽  
J. Stretton ◽  
G. P. Winston ◽  
M. Symms ◽  
P. J. Thompson ◽  
...  
Keyword(s):  
Temporal Lobe ◽  
Verbal Memory ◽  
Anterior Temporal Lobe ◽  
Memory Decline ◽  
Temporal Lobe Resection

scholarly journals Nomograms to predict naming decline after temporal lobe surgery in adults with epilepsy

Neurology ◽  
2018 ◽  
Vol 91 (23) ◽  
pp. e2144-e2152 ◽  
Author(s):  
Robyn M. Busch ◽  
Olivia Hogue ◽  
Michael W. Kattan ◽  
Marla Hamberger ◽  
Daniel L. Drane ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Epilepsy Surgery ◽  
Validation Cohort ◽  
Medical Center ◽  
External Validation ◽  
Cleveland Clinic ◽  
The United States ◽  
School Of Medicine ◽  
Age At Surgery

ObjectiveTo develop and externally validate models to predict the probability of postoperative naming decline in adults following temporal lobe epilepsy surgery using easily accessible preoperative clinical predictors.MethodsIn this retrospective, prediction model development study, multivariable models were developed in a cohort of 719 patients who underwent temporal lobe epilepsy surgery at Cleveland Clinic and externally validated in a cohort of 138 patients who underwent temporal lobe surgery at one of 3 epilepsy surgery centers in the United States (Columbia University Medical Center, Emory University School of Medicine, University of Washington School of Medicine).ResultsThe development cohort was 54% female with an average age at surgery of 36 years (SD 12). Twenty-six percent of this cohort experienced clinically relevant postoperative naming decline. The model included 5 variables: side of surgery, age at epilepsy onset, age at surgery, sex, and education. When applied to the external validation cohort, the model performed very well, with excellent calibration and a c statistic (reflecting discriminatory ability) of 0.81. A second model predicting moderate to severe postoperative naming decline included 3 variables: side of surgery, age at epilepsy onset, and preoperative naming score. This model generated a c statistic of 0.84 in the external validation cohort and showed good calibration.ConclusionExternally validated nomograms are provided in 2 easy-to-use formats (paper version and online calculator) clinicians can use to estimate the probability of naming decline in patients considering epilepsy surgery for treatment of pharmacoresistant temporal lobe epilepsy.

scholarly journals Pre-Surgical Mood Predicts Memory Decline after Anterior Temporal Lobe Resection for Epilepsy

2011 ◽  
Vol 26 (8) ◽  
pp. 739-745 ◽  
Author(s):  
R. M. Busch ◽  
M. F. Dulay ◽  
K. H. Kim ◽  
J. S. Chapin ◽  
L. Jehi ◽  
...  
Keyword(s):  
Temporal Lobe ◽  
Anterior Temporal Lobe ◽  
Memory Decline ◽  
Temporal Lobe Resection
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