Cognitive and behavioral outcome of stereotactic laser amydalohippocampotomy in a pediatric setting

• Type of Material: Article
• Authors: Kim Ono, Emory University; Donald Bearden, Emory University; Elizabeth Adams, Minnesota Epilepsy Group; Jason Doescher, Minnesota Epilepsy Group; Sookyong Koh, Emory University; Yaman Zorlu Eksioglu, Emory University; Robert Gross, Emory University; Daniel Drane, Emory University
• Language: English
• Date: 2020-01-01
• Publisher: Elsevier Science Inc.
• Publication Version: Final Published Version
• Copyright Statement: © 2020 The Authors. Published by Elsevier Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ebr.2020.100370
• Title of Journal or Parent Work: Epilepsy and Behavior Reports
• Volume: 14
• Start Page: 100370
• End Page: 100370
• Grant/Funding Information: Drs. Ono and Bearden have received partial salary support from the latter project grant.; Dr. Daniel Drane's research efforts related to this project were supported by two grants from the NIH/NINDS (K02 NS070960 & R01NS088748) and a project grant from the Goizueta Business School and Children's Hospital of Atlanta. These grants provide salary support for Dr. Drane and his laboratory staff and covered the cost of all research related activities.
• Keywords: Stereotactic laser ablation; Socio-emotional deficits; Medial temporal lobe epilepsy; Pediatric; Laser interstitial thermal therapy; Cognitive outcome
• Research Categories: Psychology, Behavioral; Psychology, Cognitive; Biology, Neuroscience; Health Sciences, Rehabilitation and Therapy

Abstract

We present neuropsychological and functional outcome data in a teenager undergoing stereotactic laser amygdalohippocampotomy (SLAH) who had drug-resistant mesial temporal lobe epilepsy due to left hippocampal sclerosis. Given strong baseline cognitive performance, there was concern for post-operative declines in language and verbal memory were this patient to undergo open resection. She was evaluated pre- and post-ablation with clinical and experimental neuropsychological measures including semantic memory, category-specific object/face recognition and naming, spatial learning, and socio-emotional processing. The patient became seizure-free following SLAH and experienced significant improvements in school performance and social engagement. She experienced improvement in recognition and naming of multiple object categories, memory functions, and verbal fluency. In contrast, the patient declined significantly in her ability to recognize emotional tone from facial expressions, a socio-emotional process that had been normal prior to surgery. We believe this decline was related to surgical disruption of the limbic system, an area highly involved in emotional processing, and suspect such deficits are an under-assessed and unrecognized risk for all surgeries involving the amygdalohippocampal complex and broader limbic system regions. We hope this positive SLAH outcome will serve as impetus for group level research to establish its safety and efficacy in the pediatric setting.