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Author Notes:

Corresponding Author: Daniel L. Drane, Ph.D., Departments of Neurology and Pediatrics, Emory University School of Medicine, Woodruff Memorial Research Building, 101 Woodruff Circle, Suite 6111, Mailstop 1930-001-1AN, Atlanta, GA 30322, USA, (404)727-2844 (office phone)

Our thanks and appreciation is extended to our study coordinator, Gloria Novak, and a number of research assistants and psychometricians who provided support for the project (Natasha Ramsey, Paul Woody, Gail Rosenbaum, Tom Erickson, Nathan Hantke, Jaclyn Tucker, Brie Sullivan, Eric Samuelson, and Greg Tesnar).

We would also like to thank Robert Smith for his assistance with MRI acquisition at Emory University.

Dr. Drane has received three grants from the NIH/NINDS, which have supported his work in this area at both Emory University and the University of Washington (K23 NSO49100, K02 NS070960, R01NS088748). 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 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 the study-related costs of the patients undergoing the SLAH procedure only. In addition, Dr. Gross serves as a consultant to Visualase and receives compensation for these services. The terms of this arrangement have been reviewed and approved by Emory University in accordance with its conflict of interest policies.

Dr. Gross also receives consulting fees from Medtronic, Eli Lilly, Neuropace, St. Jude Medical Corp., Deep Brain Innovations, and Duke University.

Dr. Loring reports receiving consulting fees from NeuroPace and Supernus and current grant support from PCORI and NIH; receives royalties from Oxford University Press; serves on the Professional Advisory Board for the Epilepsy Foundation, and sits on the editorial boards for Epilepsia, Epilepsy Research, and Neuropsychology Review. He also receives funds related to neuropsychological assessment of patients with epilepsy including Wada testing

Dr. Meador reports active grants included NIH/NINDS 2U01-NS038455-11A1, NIH R01 NS076665-01A1, PC0RI 527 and a UCB Pharma grant; other grants include money from: NIH Epilepsy Foundation, Cybertronics, GSK, Eisai, Marius, Myriad, Neuropace, Pfizer, SAM Technology, Schwartz Bioscience (UCB Pharma) and UCB Pharma; consultancies: Epilepsy Study Consortium which received money from multiple pharmaceutical companies: Eisai, Neuropace, Novartis, Supernus, Upsher Smith Laboratories, UCB Pharma and Vivus Pharmaceuticals; funds from consulting were paid to his university; travel support from Sanofi Aventis to a lecture in 2010; clinical income from EEG procedures and care of neurological patients.

Dr. Miller receives research funding from the NIH, CDC, Pfizer, UCB Pharma, and Sunovion. He is on the editorial boards for Neurology® and Epilepsy Currents.

No other co-investigators have any financial disclosures or conflicts of interest to report related to this project.

Subject:

Research Funding:

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).

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.

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Clinical Neurology
  • Neurosciences & Neurology
  • Epilepsy surgery
  • Naming and recognition
  • Cognitive outcome
  • Famous faces
  • Laser interstitial thermal therapy
  • FAMOUS FACES
  • SEMANTIC DEMENTIA
  • NEURAL BASIS
  • SURGERY
  • LOBECTOMY
  • MEMORY
  • RETRIEVAL
  • LANGUAGE
  • IDENTIFICATION
  • PROSOPAGNOSIA

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

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Journal Title:

Epilepsia

Volume:

Volume 56, Number 1

Publisher:

, Pages 101-113

Type of Work:

Article | Post-print: After Peer Review

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.

Copyright information:

© Wiley Periodicals, Inc. © 2014 International League Against Epilepsy.

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