Better object recognition and naming outcome with MRI-guided stereotactic laser amygdalohippocampotomy for temporal lobe epilepsy

• Type of Material: Article
• Authors: Daniel Drane, Emory University; David Loring, Emory University; Natalie Voets, University of Oxford; Michele Price, Emory University; Jeffrey G. Ojemann, University of Washington; Jon Willie, Emory University; Amit Saindane, Emory University; Vaishali Phatak, University of Washington; Mirjana Ivanisevic, Emory University; Scott Millis, Wayne State University; Sandra Helmers, Emory University; John W. Miller, University of Washington; Kimford Meador, Emory University; Robert Gross, Emory University
• Language: English
• Date: 2015-01-01
• Publisher: Wiley
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © Wiley Periodicals, Inc. © 2014 International League Against Epilepsy.
• Final Published Version (URL): http://dx.doi.org/10.1111/epi.12860
• Title of Journal or Parent Work: Epilepsia
• Volume: 56
• Issue: 1
• Start Page: 101
• End Page: 113
• Grant/Funding Information: These grants provided salary support for Dr. Drane and his laboratory staff, and covered the cost of neuroimaging and other study related expenses.; Funding was also provided to Emory University by way of a clinical study agreement from Visualase, Inc., which develops products related to the research described in this paper.; These funds assisted with some of the study-related costs of the patients undergoing the SLAH procedure only.; Dr. Drane has received two grants from the NIH/NINDS, which have partially supported his work on this project at both Emory University and the University of Washington (K23 NSO49100 & K02 NS070960).
• Keywords: IDENTIFICATION; LANGUAGE; Clinical Neurology; SEMANTIC DEMENTIA; LOBECTOMY; Naming and recognition; Laser interstitial thermal therapy; Cognitive outcome; Neurosciences & Neurology; Life Sciences & Biomedicine; MEMORY; SURGERY; RETRIEVAL; Epilepsy surgery; Science & Technology; Famous faces; PROSOPAGNOSIA; FAMOUS FACES; NEURAL BASIS
• Research Categories: Biology, Neuroscience

Abstract

Summary Objectives Patients with temporal lobe epilepsy (TLE) experience significant deficits in category-related object recognition and naming following standard surgical approaches. These deficits may result from a decoupling of core processing modules (e.g., language, visual processing, and semantic memory), due to "collateral damage" to temporal regions outside the hippocampus following open surgical approaches. We predicted that stereotactic laser amygdalohippocampotomy (SLAH) would minimize such deficits because it preserves white matter pathways and neocortical regions that are critical for these cognitive processes. Methods Tests of naming and recognition of common nouns (Boston Naming Test) and famous persons were compared with nonparametric analyses using exact tests between a group of 19 patients with medically intractable mesial TLE undergoing SLAH (10 dominant, 9 nondominant), and a comparable series of TLE patients undergoing standard surgical approaches (n = 39) using a prospective, nonrandomized, nonblinded, parallel-group design. Results Performance declines were significantly greater for the patients with dominant TLE who were undergoing open resection versus SLAH for naming famous faces and common nouns (F = 24.3, p < 0.0001, η2 = 0.57, and F = 11.2, p < 0.001, η2 = 0.39, respectively), and for the patients with nondominant TLE undergoing open resection versus SLAH for recognizing famous faces (F = 3.9, p < 0.02, η2 = 0.19). When examined on an individual subject basis, no SLAH patients experienced any performance declines on these measures. In contrast, 32 of the 39 patients undergoing standard surgical approaches declined on one or more measures for both object types (p < 0.001, Fisher's exact test). Twenty-one of 22 left (dominant) TLE patients declined on one or both naming tasks after open resection, while 11 of 17 right (nondominant) TLE patients declined on face recognition. Significance Preliminary results suggest (1) naming and recognition functions can be spared in TLE patients undergoing SLAH, and (2) the hippocampus does not appear to be an essential component of neural networks underlying name retrieval or recognition of common objects or famous faces.