Epilepsia最新文献

{"title":"Surgical outcomes and motor function in pediatric peri-Rolandic epilepsy: A single center's experience with 152 cases.","authors":"Qingzhu Liu, Renqing Zhu, Yao Wang, Hao Yu, Chang Liu, Yu Sun, Yi Wang, Xiaoyan Liu, Shuang Wang, Taoyun Ji, Lixin Cai","doi":"10.1111/epi.18368","DOIUrl":"https://doi.org/10.1111/epi.18368","url":null,"abstract":"<p><strong>Objective: </strong>Peri-Rolandic epilepsy in pediatric patients presents unique surgical challenges due to the involvement of eloquent cortical regions, where resective surgery carries risks of permanent neurological deficits. This study investigates lesion distribution, surgical outcomes, and the relationship between lesion location and postoperative motor function in children undergoing surgery for drug-resistant epilepsy in the peri-Rolandic area.</p><p><strong>Methods: </strong>This retrospective study included 152 pediatric patients who underwent craniotomy for peri-Rolandic epilepsy between September 2014 and January 2023. Patients met the criteria of drug-resistant epilepsy, peri-Rolandic surgical resection, and a minimum follow-up of 6 months. Preoperative evaluations included video electroencephalography (VEEG), magnetic resonance imaging, and positron emission tomography, with invasive monitoring in select cases. Motor function and seizure outcomes were assessed using Engel classification and multivariate logistic regression to examine correlations between lesion location, motor deficits, and seizure prognosis.</p><p><strong>Results: </strong>Lesions were most commonly found in the central operculum, affecting 66% of patients. Postoperative seizure freedom (Engel class I) was achieved in 80% of cases. Among patients with preoperative motor deficits (28%), 39.5% fully recovered after surgery, whereas 27.9% experienced permanent severe impairments. Resecting lesions in the precentral gyrus, paracentral lobule, and premotor cortex was significantly associated with long-term motor dysfunction. There was no significant association between the location of the lesion and postoperative seizure control.</p><p><strong>Significance: </strong>Surgery for peri-Rolandic epilepsy in children is effective in achieving seizure control, although it carries risks of motor dysfunction. Lesion location should be carefully considered to optimize surgical outcomes, balancing seizure control with the preservation of motor function.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Synaptic inhibitory dynamics drive benzodiazepine response in pediatric status epilepticus.","authors":"Tommaso Fedele, Richard J Burman, Anne Steinberg, Giorgio Selmin, Georgia Ramantani, Richard E Rosch","doi":"10.1111/epi.18398","DOIUrl":"https://doi.org/10.1111/epi.18398","url":null,"abstract":"<p><strong>Objective: </strong>Pediatric status epilepticus (SE) is a medical emergency associated with significant morbidity. Benzodiazepines (BZPs) are the current first-line treatment, but do not work in more than one third of children presenting with SE. Animal studies have shown that SE can cause changes in synaptic inhibition signaling that can ultimately lead to BZPs becoming ineffective. However, the relevance of these mechanisms in pediatric patients with SE remains unknown.</p><p><strong>Methods: </strong>To test this hypothesis, we combine clinical electroencephalographic (EEG) recordings with dynamic causal modeling (DCM). This approach allows model-based inference of cortical synaptic coupling parameters based on EEG recorded across distinct oscillatory states.</p><p><strong>Results: </strong>Our DCM revealed that dynamic changes in inhibitory synaptic coupling explain differences in EEG power spectra associated with BZP treatment responsiveness and guide the transition from ictal to interictal state. Furthermore, in silico simulations demonstrate that there are alternative routes to seizure termination even in cortical circuit models unresponsive to BZPs.</p><p><strong>Significance: </strong>Together, our findings confirm that alterations in synaptic inhibition underlie BZP response during pediatric SE. More broadly, this work further demonstrates the utility of computational modeling to validate insights from basic science in clinically accessible recordings in neurological disorders characterized by abnormal brain states.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developmental and epileptic encephalopathy in patients with epilepsy due to hypothalamic hamartomas.","authors":"Kathrin Wagner, Theo Demerath, Sarah Metzger, Friederike Niedermoser, Birgitta Metternich, Lisa Putzar, Horst Urbach, Victoria San Antonio-Arce, Kerstin Alexandra Klotz, Andreas Schulze-Bonhage","doi":"10.1111/epi.18404","DOIUrl":"https://doi.org/10.1111/epi.18404","url":null,"abstract":"<p><strong>Objective: </strong>What factors influence cognition and behavior in patients with epilepsy caused by hypothalamic hamartoma (HH)?</p><p><strong>Methods: </strong>We conducted a retrospective study of 103 patients referred to the Epilepsy Center in Freiburg, Germany, over the past 24 years. Analyzed parameters included development/intellectual functioning, behavior, seizure types and frequency, as well as electroencephalography (EEG) and magnetic resonance imaging (MRI) analyses.</p><p><strong>Results: </strong>Half of the patients showed signs of global developmental delay (GDD) or intellectual disability (ID). Patients with GDD/ID were younger at epilepsy onset (p < .05) and at first referral (p < .001), had shorter disease durations (p < .01), experienced more frequent seizures (p < .001), and were prescribed more antiseizure medication (ASM; p < .01). They also had larger HH volumes (hamartoma types Delalande III and IV, both p < .001) and more frequent pathological EEG background activity (p < .001), as well as more extended interictal epileptiform discharges (IEDs; p < .05, the rate of IED and seizure types were comparable, p > .05). Of interest, pathological EEG background activity and HH type were the only predictors of GDD/ID resulting in a highly predictive model (R² = 0.75, p < .001). Patients with GDD/ID also experienced more externalized behavioral problems, particularly aggression, which was predicted only by EEG background activity (R² = 0.36, p < .001). None of the epilepsy-specific parameters, such as duration and seizure type or frequency, were significant predictors.</p><p><strong>Significance: </strong>Our findings support the idea that patients with epilepsy due to HH and GDD/ID may have a more severe underlying condition with a likely genetic etiology, characterized by developmental and epileptic encephalopathy.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical targeting of lateralized ¹⁸F-fluorodeoxyglucose positron emission tomography hypometabolism relates to long-term epilepsy surgery outcomes.","authors":"Lucas E Sainburg, Joseph Hoang, Derek J Doss, Virginia Berry, Alexandra Roche, Andre H Lagrange, Todd E Peterson, Gary T Smith, Dario J Englot, Victoria L Morgan","doi":"10.1111/epi.18402","DOIUrl":"https://doi.org/10.1111/epi.18402","url":null,"abstract":"<p><strong>Objective: </strong>Surgical resection of the seizure onset zone can be an effective treatment for patients with drug-resistant focal epilepsy. Clinical, electrophysiological, and imaging data are all gathered prior to surgery to localize the seizure onset zone. However, only ~62% of patients become seizure-free after surgery, highlighting the need for improved methods to prospectively predict seizure recurrence after resection. ¹⁸F-Fluorodeoxyglucose (FDG) positron emission tomography (PET) is routinely acquired to guide epilepsy surgery; however, these scans are often assessed qualitatively in the clinic. Here, we quantified the surgical targeting of lateralized FDG-PET hypometabolism and assessed its relationship to surgical outcomes.</p><p><strong>Methods: </strong>We included 55 patients who underwent resective epilepsy surgery (46 with temporal lobe epilepsy). We calculated laterality of the patients' presurgical FDG-PET scans and used pre- and postsurgical magnetic resonance imaging to delineate the surgically resected regions. Surgical targeting of FDG-PET laterality was computed using the discriminability between resected and spared regions statistic.</p><p><strong>Results: </strong>We found that surgical targeting of FDG-PET laterality could distinguish temporal lobe epilepsy patients who achieve freedom from disabling seizures in the long term (3 years) from those who do not (area under the curve [AUC] = .83), outperforming the standard clinical assessment (AUC = .68). We additionally found that this method generalized to the nine patients with extratemporal lobe focal epilepsy.</p><p><strong>Significance: </strong>This study highlights the benefit of quantifying FDG-PET to guide epilepsy surgery. The presented quantitative FDG-PET method could be used prospectively in the clinic to aid in surgical guidance and patient counseling.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EEG signal dimension is an index of seizure propensity and antiseizure medication effects in a mouse model of acquired epilepsy.","authors":"Massimo Rizzi, Peter J West, Annamaria Vezzani, Karen S Wilcox, Alessandro Giuliani","doi":"10.1111/epi.18397","DOIUrl":"https://doi.org/10.1111/epi.18397","url":null,"abstract":"<p><strong>Objective: </strong>Variability in the frequency, timing, and pattern of seizures may influence the assessment of the effect of antiseizure medications (ASMs) when measuring seizure frequency, especially in patients with infrequent seizures. A low seizure rate is an exclusion criterion for enrollment of patients with epilepsy in clinical trials and requires prolonged periods of seizure monitoring, thus delaying appropriate treatment interventions. We investigated whether an electroencephalogram (EEG)-based complexity measure of seizure susceptibility of epileptic mice provides a reliable alternative to seizure frequency for evaluating the efficacy of ASMs.</p><p><strong>Methods: </strong>We used a mouse model of acquired epilepsy characterized by variability in seizure frequency over time and among mice, as observed in humans. We analyzed EEG recordings from chronic epileptic mice (n = 106) at baseline and during treatment with phenobarbital, valproate, carbamazepine, or phenytoin. We used recurrence quantification analysis to detect increased autocorrelation and critical slowing-down, two signatures of criticality that together contribute to estimate the dimension of phase-space of the EEG signals. The measurements of dimension and seizure frequency were compared as proxies for seizure susceptibility by correlation tests and evaluation of ASM efficacy.</p><p><strong>Results: </strong>Dimension provided a statistically robust (inverse) estimate of seizure susceptibility of mice, including mice with low seizure frequency or no seizures during the observation periods. In contrast, seizure frequency provided a reliable measure only in mice with a high seizure rate. Consistently, evaluation of ASM efficacy using dimension variations accurately reproduced seizure responsiveness patterns in this mouse model.</p><p><strong>Significance: </strong>EEG-based dimension provides a reliable measure of mouse propensity to experience seizures as well as ASM efficacy, regardless of seizure rates. Measuring dimension variation should facilitate the inclusion of subjects with low seizure rate in preclinical and clinical trials while also shortening the periods of monitoring. This could accelerate both the development of new treatments and therapeutic decisions in the medical field.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Embracing the future: Neonatal screening for epileptic syndromes.","authors":"Rima Nabbout, Mathieu Kuchenbuch","doi":"10.1111/epi.18285","DOIUrl":"https://doi.org/10.1111/epi.18285","url":null,"abstract":"","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Circumstances surrounding sudden unexpected death in epilepsy in children: A national case series.","authors":"Robyn Whitney, Anne Keller, Shelly-Anne Li, Anita N Datta, Matthew MacDonald, Maryam Nabavi Nouri, Daniela Pohl, Erick Sell, Gabriel M Ronen, Mandeep Sidhu, Elisabeth Simard-Tremblay, Michael S Pollanen, Elizabeth J Donner","doi":"10.1111/epi.18339","DOIUrl":"https://doi.org/10.1111/epi.18339","url":null,"abstract":"<p><strong>Objective: </strong>This study was undertaken to understand the circumstances surrounding pediatric sudden unexpected death in epilepsy (SUDEP) and identify clinical factors that may be associated with SUDEP in childhood.</p><p><strong>Methods: </strong>A retrospective case series was conducted. Pediatric SUDEP cases were collected across Canada from the Ontario Forensic Pathology Service, Canadian Pediatric Surveillance Program, and Canadian Pediatric Epilepsy Network. Demographics, epilepsy history, comorbidities, and circumstances surrounding death were analyzed.</p><p><strong>Results: </strong>Forty-nine children with pediatric SUDEP were analyzed; 25 (51%) were females, and the median age at death was 8 years. Six children (12%) were <2 years of age at the time of death. Information on seizure types 6 months before death was known in 35 children. Twenty-two had tonic-clonic seizures within the last 6 months prior to death (63%). Seven children (18%) had no tonic-clonic seizures in their lifetime. Two thirds of children were treated with ≥2 antiseizure medications. Genetic etiologies were most common (55%). Data on global developmental delay (GDD) was known in 46 children; 12 children (26%) had no impairment, and 34 were globally delayed (74%). Children with GDD had earlier age at seizure onset (p < .001); however, epilepsy duration was similar to those without GDD (p = .170). Similar to adult cohorts, death was often unwitnessed (n = 41/46, 89%). Information on recent infection before death was known in 37 children. Seventeen children (46%) had a recent infection.</p><p><strong>Significance: </strong>Our study represents the largest pediatric SUDEP case series to date. SUDEP occurred in children of all ages, including infants, with a spectrum of epilepsies with and without neurodevelopmental impairment. The circumstances around death (i.e., timing of death, witnessed/unwitnessed) were similar to previous SUDEP cohorts. A recent infection was often observed, which could decrease seizure threshold and trigger a terminal seizure and may suggest that times of increased seizure risk could warrant heightened surveillance for SUDEP. However, further research is needed to determine the significance of this finding.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical whole genome sequencing in pediatric epilepsy: Genetic and phenotypic spectrum of 733 individuals.","authors":"Olivia J Henry, Sofia Ygberg, Michela Barbaro, Nicole Lesko, Leif Karlsson, Lucía Peña-Pérez, Ann Båvner, Virpi Töhönen, Anna Lindstrand, Tommy Stödberg, Anna Wedell","doi":"10.1111/epi.18403","DOIUrl":"https://doi.org/10.1111/epi.18403","url":null,"abstract":"<p><strong>Objective: </strong>A large proportion of pediatric epilepsies have an underlying genetic etiology. Limited studies have explored the efficacy of whole genome sequencing (WGS) in a clinical setting. Our academic-clinical center implemented clinical whole exome sequencing (WES) in 2014, then transitioned to WGS from 2015. We report the diagnostic yield, genetic and phenotypic findings, and prognostic factors following WGS/WES in pediatric epilepsy.</p><p><strong>Methods: </strong>The cohort included 733 families with pediatric epilepsy who received clinical WGS/WES between 2014 and 2022. WGS/WES was performed at the Genomic Medicine Center Karolinska for Rare Diseases and analyzed at the Center for Inherited Metabolic Diseases at Karolinska University Hospital. Phenotypic information was extracted from referrals and medical records. Genetic and phenotypic data were analyzed using descriptive statistics, and univariable and multivariable analyses.</p><p><strong>Results: </strong>The median age at seizure onset was 9 months. Developmental delay and/or intellectual disability (DD/ID) was observed in 61.3% of the cohort; 38.1% of individuals received an International League Against Epilepsy epilepsy syndrome diagnosis. WGS/WES was performed in 640 (87.3%) and 143 (19.5%) families, respectively, totaling 2029 individuals. A molecular diagnosis was identified in 278 of 733 individuals (37.9%), including 51 of 211 individuals analyzed more than once (24.2% of reanalyzed cases). Independent predictors for receiving a genetic diagnosis included female sex (adjusted odds ratio [aOR] = 1.8, 95% confidence interval [CI] = 1.3-2.4, p < .001), neonatal seizure onset (aOR = 2.5, 95% CI = 1.6-4, p < .001), mortality (aOR = 2.2, 95% CI = 1.3-4.0, p = .0048), and an ID/DD/developmental and epileptic encephalopathy (DEE) diagnosis (aOR = 1.8, 95% CI = 1.2-2.5, p = .0019). The strongest independent predictor of ID/DD/DEE was microcephaly (aOR = 7.8, 95% CI = 2-53, p = .0099). In the solved cohort, gene group did not predict cognitive outcome.</p><p><strong>Significance: </strong>Clinical WGS is an effective diagnostic tool in pediatric epilepsy. We identified female sex as a novel prognostic factor for receiving a genetic diagnosis and highlight the value of reanalyzing previously unsolved cases to improve diagnostic yield.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurobehavioral therapy in functional seizures: Investigation of mechanism of action with resting-state functional magnetic resonance imaging.","authors":"Jerzy P Szaflarski, W Curt LaFrance, Rodolphe Nenert, Jane B Allendorfer, Stephen Correia, Tyler E Gaston, Adam M Goodman, Leslie E Grayson, Noah Philip","doi":"10.1111/epi.18401","DOIUrl":"https://doi.org/10.1111/epi.18401","url":null,"abstract":"<p><strong>Objective: </strong>Functional seizures (FS) often disrupt the key regions integral to cognitive processing and emotional regulation (anterior insula, anterior cingulate, and temporoparietal junction). We investigated the potential neurophysiologic mechanism of action (MOA) of neurobehavioral therapy (NBT) using resting-state functional MRI seed-based whole-brain functional connectivity within these regions in adults with FS. We hypothesized that NBT would induce changes in functional connectivity in parallel with improving seizure frequency and behavioral outcomes.</p><p><strong>Methods: </strong>Forty patients with traumatic brain injury and FS (TBI+FS) underwent 12 weekly sessions of NBT and provided pre-/post-intervention resting-state functional magnetic resonance imaging (MRI), seizure logs, and behavioral assessments. Fifty-five individuals with TBI without FS (TBI-only) completed the same measures, received standard medical care but not NBT, and functional MRI ~12 weeks apart. For each key region, two-sample t-tests assessed direct group comparison. Repeated measures analysis of covariance assessed how group differences evolved over time and how these changes were modulated by the changes in seizure frequency, diagnosis duration, or behavioral scores (false discovery rate corrected at p < .05).</p><p><strong>Results: </strong>With NBT, seed-based whole-brain functional connectivity was significantly higher between right anterior insula and left supplementary motor area in TBI+FS compared to TBI-only, and between left anterior insula and left postcentral gyrus in seizure-free TBI+FS compared to those who were not seizure-free. Percentage decrease in seizure frequency with NBT was associated with lower functional connectivity between bilateral insula and left superior medial frontal gyrus in patients with FS. Improvements in behavioral measures did not correspond to changes in functional connectivity.</p><p><strong>Significance: </strong>The study underscores the relationship between the changes in resting-state functional connectivity of the anterior insula in FS and treatment response to NBT and illustrates the potential neurophysiologic MOA of NBT for the treatment of FS; it suggests an independence of this MOA from the potential effects of NBT on behavioral measures.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuropsychological outcomes of hippocampus-sparing anterior temporal lobectomy versus stereotactic laser amygdalohippocampectomy in language-dominant temporal lobe epilepsy.","authors":"Zeegan George, Keaton Piper, Elliot G Neal, Adam Alayli, Samantha Schimmel, Molly Monsour, Long Di, Ushtar Amin, Joseph J Boscarino, Michael R Schoenberg, Fernando L Vale, Yarema B Bezchlibnyk","doi":"10.1111/epi.18388","DOIUrl":"https://doi.org/10.1111/epi.18388","url":null,"abstract":"<p><strong>Objective: </strong>Postoperative neuropsychological deficits pose a significant challenge for temporal lobe epilepsy (TLE) surgery, particularly in the language-dominant hemisphere. Two surgical approaches have been suggested to mitigate such adverse outcomes: stereotactic laser amygdalohippocampectomy (SLAH) and hippocampus-sparing anterior temporal lobectomy (HSATL). This retrospective cohort study compares the seizure control and neuropsychological outcomes of HSATL and SLAH in language-dominant TLE.</p><p><strong>Methods: </strong>A retrospective cohort study compared 27 patients (nine male, mean age = 35.8 years) with drug-resistant TLE and normal imaging localized to the language-dominant left temporal lobe, undergoing either HSATL (n = 22) or SLAH (n = 5) between 2014 and 2021. Comprehensive pre- and ≥1-year postoperative neuropsychological testing and imaging were performed, with seizure outcomes tracked for at least 1 year postoperatively. However, to assess the impact of mesial temporal sclerosis (MTS) on SLAH outcomes, we included seven additional patients with MTS who underwent SLAH in a secondary analysis.</p><p><strong>Results: </strong>HSATL led to significant declines in logical memory (p = .04) despite sparing the hippocampus, which were not seen following SLAH in patients regardless of MTS status. SLAH trended toward improved semantic fluency, immediate verbal memory, and executive function despite hippocampal ablation. Including both MTS(+) and MTS(-) patients, there was a significant decline in letter fluency following SLAH (.04), with subgroup analyses demonstrating significantly greater declines in MTS(+) patients undergoing SLAH (.02). Additionally, 100% of patients undergoing SLAH achieved seizure freedom versus 72.7% following HSATL (p = .046, including MTS[+] patients) at last follow-up.</p><p><strong>Significance: </strong>In language-dominant TLE, SLAH demonstrated comparable seizure outcomes and superior verbal memory retention compared to HSATL, albeit with greater letter fluency impairment. Preliminary findings challenge prioritizing hippocampal preservation for verbal memory function, suggesting potential cognitive advantages with SLAH specifically targeting mesial structures while maximally preserving cortical structures and white matter tracts critical for language networks. However, this intervention may negatively impact letter fluency, suggesting careful preoperative screening and discussion.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}