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Bruce P. Hermann - One of the best experts on this subject based on the ideXlab platform.
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The acquisition of face and person identity information following Anterior Temporal Lobectomy.
Journal of The International Neuropsychological Society, 2005Co-Authors: Maria T. Moran, Dave Sabsevitz, Sara J Swanson, Michael Seidenberg, Bruce P. HermannAbstract:Thirty unilateral Anterior Temporal Lobectomy (ATL) subjects (15 right and 15 left) and 15 controls were presented a multitrial learning task in which unfamiliar faces were paired with biographical information (occupation, city location, and a person's name). Face recognition hits were similar between groups, but the right ATL group committed more false-positive errors to face foils. Both left and right ATL groups were impaired relative to controls in acquiring biographical information, but the deficit was more pronounced for the left ATL group. Recall levels also varied for the different types of biographical information; occupation was most commonly recalled followed by city name and person name. In addition, city and person name recall was more likely when occupation was also recalled. Overall, recall of biographical information was positively correlated with clinical measures of anterograde episodic memory. Findings are discussed in terms of the role of the Temporal lobe and associative learning ability in the successful acquisition of new face semantic (biographical) representations.
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long term psychosocial outcomes of Anterior Temporal Lobectomy
Epilepsia, 2002Co-Authors: Jana E Jones, Norman L Berven, Lincoln F Ramirez, Austin Woodard, Bruce P. HermannAbstract:Summary: Purpose: To examine the long-term psychosocial outcomes of a consecutive series of patients who underwent Anterior Temporal Lobectomy (ATL) compared with medically managed patients. This study focused primarily on actual long-term changes (mean, 5 years) in life performance. There are relatively few long-term controlled studies of actual lifetime performance changes. Methods: The sample consisted of 61 adults who underwent ATL and 23 individuals who were evaluated for surgery but did not proceed to surgery and continued to receive medical management. Participants were interviewed 2–9 years after surgery. A structured clinical interview and review of medical records was conducted to obtain information regarding seizure frequency and psychosocial status, focusing on employment, education, driving status, financial assistance, and independent living. In addition, two questions regarding quality of life were included. Seizure frequency was evaluated for the year before the interview. Results: Significant differences in psychosocial outcome were found between the surgery group and medical management group. Favorable psychosocial outcomes were more common among those who had surgery (46 vs. 4%). Results indicated that 68% of the surgery group exhibited improved psychosocial status compared with 5% of the medical management group. Individuals who had surgery were more likely to be driving, working full-time, living independently, and being financially independent. Remaining seizure free was not a prerequisite for improvements in psychosocial outcomes. Conclusions: Compared with medical management, surgery has a significant positive impact on psychosocial outcomes in terms of employment, independent living, driving, and financial independence. Additionally, a person does not necessarily have to be seizure free to achieve positive changes in psychosocial outcomes.
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confrontation naming after Anterior Temporal Lobectomy is related to age of acquisition of the object names
Neuropsychologia, 2000Co-Authors: Brian Bell, Bruce P. Hermann, Keith G. Davies, Gina WaltersAbstract:Abstract Decline in visual confrontation naming ability may occur as a postacute complication of left Anterior Temporal Lobectomy (ATL) for the treatment of intractable mesial Temporal lobe epilepsy. In this study of 26 left ATL patients who demonstrated postsurgery decline on a standardized naming measure, it was hypothesized that naming performance would be significantly associated with specific attributes of the object names. We investigated the relation between performance on the Boston Naming Test (BNT) and the following attributes of the test items: living versus nonliving category (L/NL), word length (WL), written word frequency (WF), and age of acquisition (AoA). Regression analyses revealed that AoA and WF were significant predictors of preoperative group performance. AoA was the only significant predictor of performance after left ATL. For the 17 individuals who demonstrated a statistically meaningful decline on the BNT, as indicated by a Reliable Change Index, individual logistic regressions demonstrated that AoA was the strongest and most consistent predictor of postoperative success/failure for items that had been named correctly preoperatively. Consistent with the literature on naming errors in elderly normals and patients with aphasia or semantic dementia, the results provide evidence that object names learned in late childhood are among the most vulnerable when there is a decline in object naming ability. Investigation of additional attributes and semantic knowledge for the concepts represented by the pictured objects will be necessary to determine whether the naming deficit associated with TLE and ATL reflects an impairment of phonological word-form retrieval, semantics, or both.
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Visual confrontation naming outcome after standard left Anterior Temporal Lobectomy with sparing versus resection of the superior Temporal gyrus: a randomized prospective clinical trial.
Epilepsia, 1999Co-Authors: Bruce P. Hermann, Keith G. Davies, Kevin T. Foley, Brian BellAbstract:Summary: Purpose: Intraoperative mapping of eloquent cortex during left (speech dominant) Anterior Temporal Lobectomy has shown a significant proportion of patients to have sites on the Anterior superior Temporal gyrus at which visual confrontation naming can be disrupted by electrical stimulation. The purpose of this investigation was to conduct a randomized clinical trial to determine whether sparing versus resection of the superior Temporal gyrus affected visual confrontation naming outcome after standard left Anterior Temporal Lobectomy. Also examined was the degree to which inherent patient characteristics were associated with language outcome regardless of surgical technique. Methods: Thirty patients with intractable left Temporal lobe epilepsy undergoing standard Anterior Temporal Lobectomy were randomized in regard to whether the superior Temporal gyrus was resected or spared. Patients were tested preoperatively and 6–8 months postoperatively by using two conventional tests of visual confrontation naming ability. Results: No significant differences were found between the groups in either confrontation naming or surgical outcome. Postoperative decline in nominal speech was most closely associated with later age at onset of epilepsy/absence of hippocampal sclerosis. Conclusions: It appears that specific types of localization-related Temporal lobe epilepsy are more closely associated with the risk of adverse language outcome after Anterior Temporal Lobectomy than with the surgical variations investigated in this study.
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visual confrontation naming following left Anterior Temporal Lobectomy a comparison of surgical approaches
Neuropsychology (journal), 1999Co-Authors: Bruce P. Hermann, David W Loring, Max R Trenerry, Kenneth Perrine, Gordon J Chelune, William B Barr, Esther Strauss, Michael WesterveldAbstract:Change in visual confrontation naming was examined following left (speech dominant) Anterior Temporal Lobectomy (ATL) as a function of surgical technique and patient characteristics. Two hundred seventeen patients with intractable left Temporal lobe epilepsy were selected according to standard criteria across 8 centers, and combined into 4 surgical approaches to ATL: (a) tailored resections with intraoperative mapping of eloquent cortex, (b) tailored resections with extraoperative mapping, (c) standard resections with sparing of superior Temporal gyrus, and (d) standard resections including excision of superior Temporal gyrus. Changes in visual confrontation naming were examined with an index of reliable change derived from an independent sample of 90 nonsurgical patients with complex partial seizures. Results showed significant decline in visual confrontation naming following left ATL., regardless of surgical technique. Across surgical approaches, the risk for decline in visual confrontation naming was associated with a later age of seizure onset and more extensive resection of lateral Temporal neocortex.
Kurupath Radhakrishnan - One of the best experts on this subject based on the ideXlab platform.
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Memory outcome following left Anterior Temporal Lobectomy in patients with a failed Wada test
Epilepsy & behavior : E&B, 2015Co-Authors: Chaturbhuj Rathore, Aley Alexander, P. Sankara Sarma, Kurupath RadhakrishnanAbstract:Abstract Purpose This study aimed to compare the memory outcome following left Anterior Temporal Lobectomy (ATL) between patients with a failed Wada test and patients who passed the Wada test. Methods From 1996 to 2002, we performed the Wada test on all patients with unilateral left mesial Temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) and concordant electroclinical data before ATL. We used a 12-item recognition paradigm for memory testing and awarded a score of + 1 for each correct response and − 0.5 for each incorrect response. No patient was denied surgery on the basis of Wada scores. We assessed cognitive and memory functions using the Wechsler Adult Intelligence Scale and the Wechsler Memory Scale preoperatively and at one year after ATL. We compared the number of patients who showed decline in memory scores, as per the published reliable change indices, between the patients with a failed Wada test and the patients who passed the Wada test. Results Out of the 116 eligible patients with left MTLE-HS, 88 underwent bilateral Wada test, while 28 underwent ipsilateral Wada test. None of them developed postoperative amnesia. Approximately, one-third of patients with a failed Wada memory test when the failure was defined as a contralateral score of 8, and as an asymmetry score of Conclusion The patients with left MTLE-HS with concordant electroclinical, MRI, and neuropsychological data should not be denied ATL solely on the basis of Wada memory test results.
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prognostic importance of serial postoperative eegs after Anterior Temporal Lobectomy
Neurology, 2011Co-Authors: Chaturbhuj Rathore, Sankara P Sarma, Kurupath RadhakrishnanAbstract:Objective: To assess the value of postoperative EEG in predicting seizure outcome and seizure recurrence following antiepileptic drug (AED) withdrawal in patients with mesial Temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS). Methods: We studied 262 consecutive patients with MTLE-HS with serial EEGs at 3 months, and at 1, 2, and 3 years after Anterior Temporal Lobectomy (ATL), and considered the presence of interictal epileptiform discharges (IED) as abnormal. We attempted AED withdrawal in all seizure-free patients. We defined favorable outcome as freedom from seizures/auras during the entire follow-up period (outcome 1) and during terminal 1-year follow-up (outcome 2). Results: During mean follow-up period of 7.6 (range 5–12) years, 129 (49.2%) patients had favorable outcome 1 and 218 (83.2%) had favorable outcome 2. Of 225 (85.9%) patients in whom AED withdrawal was attempted, 61 (27.1%) had seizure recurrence. Compared to patients with normal EEG, those with IED on 1-year post-ATL EEG had a 3-fold increased risk for unfavorable outcome 1 and 7-fold increased risk for unfavorable outcome 2. The patients in whom all the 4 EEGs were abnormal had 9-fold odds for unfavorable outcome 1 and 26-fold odds for unfavorable outcome 2. An abnormal EEG at 1 year increased the risk of seizure recurrence following AED withdrawal by 2.6-fold. Conclusions: Post-ATL EEG predicts seizure outcome and seizure recurrence following AED withdrawal. Serial EEGs predict outcome better than single EEG. This information will be helpful in counseling of patients after ATL, and in making rational decisions on AED withdrawal.
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employment outcome and satisfaction after Anterior Temporal Lobectomy for refractory epilepsy a developing country s perspective
Epilepsy & Behavior, 2009Co-Authors: Lincy George, Sankara P Sarma, Rajesh Shankar Iyer, Renjith James, Kurupath RadhakrishnanAbstract:We examined employment outcome and its determinants in 172 south Indian patients who had undergone Anterior Temporal Lobectomy (ATL) for medically refractory epilepsy. Despite seizure-free outcome in the majority, a significant change in post-ATL employment status occurred only in those involved in skilled jobs. Although factors such as younger age at surgery, shorter duration of epilepsy, longer post-ATL follow-up duration, and lower income were associated with favorable employment outcome in univariate analysis, only shorter duration of epilepsy was independently predictive in the multivariate model. A majority of homemakers appreciated marked improvement in their own day-to-day activities. Our patients did not express their desire to work as a principal aim of epilepsy surgery. To enhance occupational attainment, patients require, before epilepsy surgery, occupational assessment to identify their individual abilities and limitations and counseling in formulating realistic goals. After surgery, they require continued support in vocational training and job seeking.
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prognostic implications of seizure recurrence in the first year after Anterior Temporal Lobectomy
Epilepsia, 2003Co-Authors: Kurupath Radhakrishnan, Elson L So, G D Cascino, Peter L Silbert, Richard W Marsh, P C ObrienAbstract:Summary: Purpose: Seizure recurrence after Anterior Temporal Lobectomy (ATL) incites concerns of whether seizures will eventually be successfully controlled. Our study evaluated the prognostic significance of seizure recurrence in the first year after ATL. Methods: The postoperative courses of 175 consecutive patients who had undergone ATL and had ≥2 years of follow-up were studied. Recurrence was considered early if the first seizure occurred within 7 days after ATL and late if it occurred >7 days after ATL. Recurrent seizures were considered provoked when precipitating factors were present, such as interruption of antiepileptic drug (AED) intake. Subsequent outcome was determined at terminal follow-up. Results: Percentage of excellent outcome was comparable between patients whose initial recurrent seizures were auras or simple partial seizures and patients without seizure recurrence in the first year (86.7 vs. 93.1%; p ≥ 0.05). However, percentage of excellent outcome was less when the initial recurrent seizure was complex partial, either with or without secondary generalization (44.8%; p ≤ 0.01). Outcome was not different between early and late seizure recurrence (excellent in 41.7 vs. 55.7%; p ≥ 0.05). Nonetheless, patients with either early or late seizure recurrence were less likely to have excellent outcome than were patients with no seizure recurrence in the first year (p ≤ 0.001). Percentage of excellent outcome was best when patients were seizure free in the first year (93.1%), intermediate when initial recurrent seizure was provoked (72.0%), and worst when unprovoked (27.8%) (p ≤ 0.001). Conclusions: In the first postoperative year, the type of initial recurrent seizure, whether aura or complex partial and whether provoked or unprovoked, is associated with long-term prognosis in seizure control after ATL. The timing of the initial seizure recurrence is not as important.
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acute postoperative seizures following Anterior Temporal Lobectomy for intractable partial epilepsy
Journal of Neurosurgery, 1998Co-Authors: Bhaskara Rao Malla, Kurupath Radhakrishnan, Elson L So, G D Cascino, Terence J Obrien, Peter L Silbert, Richard W MarshAbstract:Object. Recurrence of seizures immediately following epilepsy surgery can be emotionally devastating, and raises concerns about the chances of successfully attaining long-term seizure control. The goals of this study were to investigate the frequency of acute postoperative seizures (APOS) occurring in the 1st postoperative week following Anterior Temporal Lobectomy (ATL) to identify potential risk factors and to determine their prognostic significance. Methods. One hundred sixty consecutive patients who underwent an ATL for intractable nonlesional Temporal lobe epilepsy were retrospectively studied. Acute postoperative seizures occurred in 32 patients (20%). None of the following factors were shown to be significantly associated with the occurrence of APOS: age at surgery, duration of epilepsy, side of surgery, extent of neocortical resection, electrocorticography findings, presence of mesial Temporal sclerosis, and hippocampal volume measurements (p > 0.05). Patients who suffered from APOS overall had a ...
Michael R Sperling - One of the best experts on this subject based on the ideXlab platform.
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distinct types of white matter changes are observed after Anterior Temporal Lobectomy in epilepsy
PLOS ONE, 2014Co-Authors: Dorian Pustina, Michael R Sperling, Ashwini Sharan, Gaelle Doucet, James J Evans, Christopher Skidmore, Joseph I TracyAbstract:Anterior Temporal Lobectomy (ATL) is commonly adopted to control medically intractable Temporal lobe epilepsy (TLE). Depending on the side of resection, the degree to which Wallerian degeneration and adaptive plasticity occur after ATL has important implications for understanding cognitive and clinical outcome. We obtained diffusion tensor imaging from 24 TLE patients (12 left) before and after surgery, and 12 matched controls at comparable time intervals. Voxel-based analyses were performed on fractional anisotropy (FA) before and after surgery. Areas with postoperative FA increase were further investigated to distinguish between genuine plasticity and processes related to the degeneration of crossing fibers. Before surgery, both patient groups showed bilateral reduced FA in numerous tracts, but left TLE patients showed more extensive effects, including language tracts in the contralateral hemisphere (superior longitudinal fasciculus and uncinate). After surgery, FA decreased ipsilaterally in both ATL groups, affecting the fornix, uncinate, stria terminalis, and corpus callosum. FA increased ipsilaterally along the superior corona radiata in both left and right ATL groups, exceeding normal FA values. In these clusters, the mode of anisotropy increased as well, confirming fiber degeneration in an area with crossing fibers. In left ATL patients, pre-existing low FA values in right superior longitudinal and uncinate fasciculi normalized after surgery, while MO values did not change. Preoperative verbal fluency correlated with FA values in all areas that later increased FA in left TLE patients, but postoperative verbal fluency correlated only with FA of the right superior longitudinal fasciculus. Our results demonstrate that genuine reorganization occurs in non-dominant language tracts after dominant hemisphere resection, a process that may help implement the inter-hemispheric shift of language activation found in fMRI studies. The results indicate that left TLE patients, despite showing more initial white matter damage, have the potential for greater adaptive changes postoperatively than right TLE patients.
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employment after Anterior Temporal Lobectomy
Epilepsia, 2011Co-Authors: Katherine Zarroli, Joseph I Tracy, Maromi Nei, Ashwini Sharan, Michael R SperlingAbstract:Summary Purpose: To explore the effect of Anterior Temporal Lobectomy on employment and define demographic and clinical predictors of postoperative employment in a large cohort with a prolonged observational period. Methods: Subjects had an Anterior Temporal Lobectomy for refractory epilepsy. All had an assessment period of 4 years or more with documentation of demographic factors, employment status, and seizure frequency prospectively registered in a database at surgery and at each contact after surgery. McNemar chi-square and a Wilcoxon matched pairs test were used to compare employment status before and after surgery. A multiple logistic regression assessed independent predictors of postoperative employment status based on preoperative employment status. Key Findings: Three hundred sixty-nine patients were evaluated. Employment levels were higher and unemployment levels were lower after surgery (McNemar χ2 = 3.96; p = 0.047). Working before surgery (Wald’s χ2 = 22.69, p < 0.0001) and having a greater percent of seizure-free years (Wald’s χ2 = 34.43, p < 0.0001) were associated with being employed after surgery. Of 131 patients who were unemployed or homemakers before surgery, 67 (51.1%) became employed postoperatively, with a younger age at surgery, a younger age of epilepsy onset, and driving a motor vehicle associated with gaining employment. Of 172 patients who were working at baseline, 27 (15.7%) became unemployed or homemakers after surgery. Gender was the only variable associated with loss of employment, with women being more likely to become homemakers (χ2 = 14.98, d.f. = 6, p = 0.02). Most students were working after surgery, with seizure control influencing outcome. Significance: Anterior Temporal Lobectomy is followed by reduced unemployment and underemployment, with elimination of seizures, relative youth, and operating a motor vehicle serving as the main driving forces for improvement. This is important information for patients and physicians who contemplate surgery as it helps define reasonable expectations, and provides further objective evidence for benefits beyond purely medical outcomes after epilepsy surgery.
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psychiatric aspects of Temporal lobe epilepsy before and after Anterior Temporal Lobectomy
Journal of Neurology Neurosurgery and Psychiatry, 2000Co-Authors: G Glosser, Michael J Oconnor, Alexander S Zwil, David Glosser, Michael R SperlingAbstract:OBJECTIVES—Psychopathology has been reported to be prevalent both before and after surgical treatment for medically intractable Temporal lobe epilepsy. Individual patients were evaluated prospectively to assess the effect of Anterior Temporal Lobectomy (ATL) on prevalence and severity of psychiatric disease. METHODS—Psychiatric status was assessed in a consecutive series of epilepsy patients before and 6 months after ATL using a structured psychiatric interview, psychiatric rating scales, and self report mood measures. RESULTS—A DSM-III-R axis I diagnosis was present in 65% of patients before and after surgery. The most common diagnoses were depression, anxiety, and organic mood/personality disorders. There was a trend for major psychiatric diagnoses to be more common in patients with right compared to left Temporal lobe seizure focus, both before and after surgery. The apparent stability in the overall rate of psychiatric dysfunction concealed onset of new psychiatric problems in 31% of patients in the months shortly after surgery, and resolution of psychiatric diagnoses in 15% of patients. In the group as a whole, the severity of psychiatric symptoms was lower at 6 months postsurgery than before Temporal Lobectomy. CONCLUSIONS—The overall prevalence of psychiatric dysfunction was comparably high before and after ATL, but individual changes in psychiatric status and changes in severity of symptoms occurred in many patients in the 6 months after surgery.
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a cost effectiveness analysis of Anterior Temporal Lobectomy for intractable Temporal lobe epilepsy
Journal of Neurosurgery, 1997Co-Authors: Joseph T King, Michael R Sperling, Amy C Justice, Michael J OconnorAbstract:✓ Patients with medically intractable Temporal lobe epilepsy are potential candidates for Anterior Temporal Lobectomy (ATL), in which epileptogenic Temporal lobe tissue is localized and surgically removed. This surgical approach can eliminate or drastically reduce seizures in the majority of patients. The authors used a decision-analysis model to examine the cost-effectiveness of a surgical evaluation and treatment protocol for medically intractable Temporal lobe epilepsy. This model compared a cohort treated with the new protocol with a continuation of their immediate preoperative medical management and projected these differences over the patient's lifetime. The Markov model incorporated postoperative seizure status, patient quality of life, death from surgical and natural causes, discounting, and the direct medical costs associated with outpatient evaluation, hospitalization, surgery, antiepileptic drugs, and lifetime outpatient treatment. The intent-to-treat analysis included patients who underwent ev...
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a cost effectiveness analysis of Anterior Temporal Lobectomy for intractable Temporal lobe epilepsy
Journal of Neurosurgery, 1997Co-Authors: Joseph T King, Michael R Sperling, Amy C Justice, Michael J OconnorAbstract:Patients with medically intractable Temporal lobe epilepsy are potential candidates for Anterior Temporal Lobectomy (ATL), in which epileptogenic Temporal lobe tissue is localized and surgically removed. This surgical approach can eliminate or drastically reduce seizures in the majority of patients. The authors used a decision-analysis model to examine the cost-effectiveness of a surgical evaluation and treatment protocol for medically intractable Temporal lobe epilepsy. This model compared a cohort treated with the new protocol with a continuation of their immediate preoperative medical management and projected these differences over the patient's lifetime. The Markov model incorporated postoperative seizure status, patient quality of life, death from surgical and natural causes, discounting, and the direct medical costs associated with outpatient evaluation, hospitalization, surgery, antiepileptic drugs, and lifetime outpatient treatment. The intent-to-treat analysis included patients who underwent evaluation but were not eligible for ATL. Sensitivity analyses were also performed on the variables in the model. Data from the baseline model indicated that evaluation for ATL provided an average of 1.1 additional quality-adjusted life years (QALYs) compared with continued medical management, at an additional cost of $29,800. Combining the clinical and economic outcomes yielded a cost-effectiveness ratio of $27,200 per QALY. This value is comparable to other accepted medical or surgical interventions, such as total knee arthroplasty ($16,700/QALY) or coronary artery balloon angioplasty ($40,800/QALY). Sensitivity analyses demonstrate that the results are critically dependent on postoperative seizure status and improvement in quality of life. Although further work is necessary to quantify the improvement in quality of life after epilepsy surgery better, the present data indicate that ATL for treatment of intractable Temporal lobe epilepsy is a cost-effective use of medical resources.
Allen R. Wyler - One of the best experts on this subject based on the ideXlab platform.
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prediction of verbal memory loss in individuals after Anterior Temporal Lobectomy
Epilepsia, 1998Co-Authors: Brian D. Bell, Keith G. Davies, Andrew J Bush, Allen R. WylerAbstract:Summary: Purpose: Decreased memory function represents the area of greatest neuropsychological morbidity after Anterior Temporal Lobectomy (ATL), particularly for left ATL candidates. We wished to identify easily derived demographic and neuropsychological predictors of risk of pre-to postoperative memory decline using only information available preoperatively. Methods: We assessed decline in memory as measured by the California Verbal Learning Test (CVLT) by deriving multiple regression equations using the following measures as independent variables: age at onset, chronological age at time of surgery, sex, Full Scale IQ (FSIQ), level of education, and preoperative memory scores. In all, 203 patients (93 males, 110 females), undergoing ATL (107 left, 96 right) with preoperative and 6-month postoperative testing, were examined. Results: The combination of age, FSIQ, sex, side of surgery and preoperative score was highly predictive (p-values <0.0001) of postoperative memory scores. Higher postoperative scores were associated with higher preoperative score, younger chronological age, higher FSIQ, female sex, and right side of resection. Reliable change index (RCI) values were used to estimate meaningful decline on the total score across five trials. Logistic regression analysis showed preoperative score and age to be predictors of RCI decline for left-sided resections. Sensitivity of decline (≥90th centile RCI) prediction was 56%, and specificity was 95%. Validation in 30 patients from a separate population of patients undergoing left ATL produced similar figures. Conclusions: The derived regression equations can accurately predict verbal memory decline on a list-learning task in-50% of individual patients undergoing ATL, and false-positive prediction errors are very rare.
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neuropsychological outcome following Anterior Temporal Lobectomy in patients with and without the syndrome of mesial Temporal lobe epilepsy
Neuropsychology (journal), 1998Co-Authors: Michael Seidenberg, Allen R. Wyler, Bruce P. Hermann, Keith G. Davies, Curtis F Dohan, Catherine L LeveroniAbstract:The nature, pattern, and degree of neuropsychological change following Anterior Temporal Lobectomy (ATL) were examined as a function of the presence or absence of the syndrome of mesial Temporal lobe epilepsy (MTLE). Fifty-four patients exhibited the syndrome of MTLE, while 34 patients were without the syndrome (non-MTLE). The test-retest performance of a group of 40 epilepsy patients who did not undergo surgery was used to derive regression-based estimates of test-retest change. Overall, the MTLE group did not show significant cognitive decline following ATL. In contrast, the left non-MTLE group showed significant declines on verbal memory, confrontation naming, and verbal conceptual ability. Further, verbal memory was the most substantial area of decline, and was independent of seizure outcome. Clinical and theoretical implications of these findings are discussed.
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relationship of age at onset chronologic age and adequacy of preoperative performance to verbal memory change after Anterior Temporal Lobectomy
Epilepsia, 1995Co-Authors: Bruce P. Hermann, Michael Seidenberg, Allan Haltiner, Allen R. WylerAbstract:Summary We examined the relationship of age of onset of epilepsy, chronological age at time of operation, and adequacy of preoperative memory performance to pre- to postoperative verbal memory decline. Patients who underwent left (n = 50) or right (n = 51) Anterior Temporal Lobectomy (ATL) were administered tests of verbal episodic (list learning, paragraph recall) and semantic memory (visual naming, vocabulary), both preoperatively and 6 months postoperatively. As a group, left ATL patients showed the classic selective decrease on measures of episodic but not semantic memory. However, examination of episodic memory outcome showed considerable individual variability. Stepwise regression analyses indicated that both later age at onset and older chronologic age were significant and selective predictors of episodic memory decrease for left ATL patients. Adequacy of preoperative memory performance was a nonspecific predictor, associated with decrease in postoperative memory performance for both left and right ATL patients and for multiple types of memory indices. The clinical and theoretical implications are discussed.
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reports by patients and their families of memory change after left Anterior Temporal Lobectomy relationship to degree of hippocampal sclerosis
Neurosurgery, 1995Co-Authors: Bruce P. Hermann, Allen R. Wyler, Michael Seidenberg, F Dohan, Alan M Haltiner, Julia Bobholz, Alicia PerrineAbstract:Memory decline represents the primary neuropsychological morbidity of Anterior Temporal Lobectomy. Recent investigations using laboratory tests of memory have reported an association between the neuropathological status of the resected left mesial Temporal region and memory outcome, with adverse memory outcome associated with a lack of significant left hippocampal pathology. The purpose of this investigation was to examine the relationship between the reports by the patients and their families of observed postoperative changes in day-to-day memory function and the degree of hippocampal sclerosis in resected left mesial Temporal lobes. Twenty patients and a close family member (parent or spouse) of each of the patients completed standardized questionnaires assessing pre- to postoperative changes in verbal and spatial memory; these were related to the neuropathological findings. The results indicated that patients without left hippocampal sclerosis reported significantly worse memory outcome than those with hippocampal sclerosis. The ratings provided by the relatives of the patients yielded a comparable effect, and objective memory tests supported the reports by the patients and their families. The neuropsychological findings associated with left hippocampal pathology are of clinical significance and should be considered in surgical evaluation and in the counseling process.
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Dysnomia after left Anterior Temporal Lobectomy without functional mapping: frequency and correlates.
Neurosurgery, 1994Co-Authors: Bruce P. Hermann, Allen R. Wyler, Grant Somes, Lu ClementAbstract:The integrity of language function after a left (dominant) Anterior Temporal Lobectomy performed without the use of functional mapping remains controversial. Much of the controversy concerns the degree to which analyses of group data obscure the identification of surgically induced dysnomia in individual patients. This study investigated postoperative language outcome in our entire series (n = 162) of nonretarded, left hemisphere speech dominant patients with intractable nonlesional epilepsy who underwent a left (n = 85) or right (n = 77) Anterior Temporal Lobectomy without functional mapping. A comparison of preoperative to (6 mo) postoperative performance on a standardized test of nominal speech revealed the following: 1) a statistically significant but clinically modest difference in outcome between left and right Anterior Temporal Lobectomy groups; 2) a subgroup (7%) of left Anterior Temporal Lobectomy patients exhibited a postoperative dysnomia (a decline in nominal speech that exceeded the worst performance in the right Anterior Temporal Lobectomy group); and 3) a postoperative decline in nominal speech after left Anterior Temporal Lobectomy was specifically associated with a later age at the onset of epilepsy. Within the context of group data suggesting minimal risk to language function when functional mapping is not used, a small subgroup of individuals characterized by a later onset of epilepsy can be identified who exhibit a surgically induced dysnomia after a standard left Anterior Temporal Lobectomy. Whether these results differ from the outcome of functional mapping remains to be determined.
G D Cascino - One of the best experts on this subject based on the ideXlab platform.
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use of Anterior Temporal Lobectomy for epilepsy in a community based population
JAMA Neurology, 2012Co-Authors: Jamie J Van Gompel, G D Cascino, Richard W Marsh, Ruth Ottman, Gregory A Worrell, Nicholas M Wetjen, Fredric B MeyerAbstract:EPILEPSY AFFECTS APPROXI-mately 3% of individuals at some time in their lives and occurs in more than 50 million people worldwide.1–3 There are approximately 2.5 million Americans with epilepsy currently receiving antiepileptic drug therapy, and of these, approximately 30% continue to have seizures despite treatment.4,5 Much of the cost of epilepsy in the United States is accounted for by these refractory cases.4,5 Focal or localization-related epilepsy is most common and is often responsible for medically intractable epilepsy. Fortunately, focal epilepsy can be surgically remedied.6,7 The most common surgical procedure aimed at cure is Anterior Temporal Lobectomy (ATL) for Temporal lobe epilepsy (TLE), the largest subset of focal epilepsy. In a recent multicenter study, 88% of surgical epilepsy cases with craniotomy and resection for therapy had ATL with mesial Temporal resection.8 Anterior Temporal Lobectomy was popularized in the early 1980s for the treatment of TLE and has been found to be an effective therapy, rendering 60% to 90% of patients undergoing the procedure seizure-free.9 Despite an increasing population in the United States and locally (Olmsted County [OC], Minnesota), we have suspected that the number of ATLs performed for epilepsy has declined over the past 2 decades. This trend has been suspected nationally; however, it has yet to be substantiated. Therefore, we assessed whether this trend could be documented. The Rochester Epidemiology Project (REP) offers a unique opportunity to study whether ATL use is in fact declining because it is a well-detailed stable patient population described in more than 2000 articles to date.1,10 Most importantly, it has been documented that the patients in the REP receive all care within the county, ie, at the Mayo Clinic.1,10 Consequently, this population has an advantage both in assessing the Temporal trends of this procedure use as well as in eliminating referral bias as a possible cause for trend changes. Therefore, we undertook this study to assess the hypothesis that at our institution, a tertiary referral center for epilepsy, the frequency of ATLs performed has declined over time. Further, using the REP, we investigated the previously unknown use rate of ATL in a population-based manner. Clinically, a reduction in ATL use may indicate a plethora of causes such as a reduction in incident cases or more effective medical treatment, representing an opportunity for further investigation.
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prospective analysis of diplopia after Anterior Temporal Lobectomy for mesial Temporal lobe sclerosis
Journal of Neurosurgery, 2003Co-Authors: Aaron A Cohengadol, Richard W Marsh, Jacqueline A Leavitt, James J Lynch, G D CascinoAbstract:Object. In this prospective study the authors investigated the incidence and natural history of postoperative diplopia in patients undergoing Anterior Temporal Lobectomy (ATL) and amygdalohippocampectomy for medically intractable mesial Temporal lobe epilepsy. Methods. Forty-seven patients scheduled for ATL for medically refractory seizures were examined preoperatively, 2 to 7 days postoperatively, and 3 to 6 months postoperatively. Ophthalmological examination including pupillary measurements, stereoacuity measurements, palpebral fissure measurements, vertical fusional amplitudes, Lancaster red green testing, visual field testing, and alternate cover testing was performed. Antiepileptic drug levels were monitored. Nine (19%) of 47 patients developed diplopia postoperatively. The diplopia was caused by trochlear nerve palsy in every case. No oculomotor nerve dysfunction was documented. Trochlear nerve function recovered completely in all patients within 3 to 6 months postoperatively. Conclusions. Postoper...
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prognostic implications of seizure recurrence in the first year after Anterior Temporal Lobectomy
Epilepsia, 2003Co-Authors: Kurupath Radhakrishnan, Elson L So, G D Cascino, Peter L Silbert, Richard W Marsh, P C ObrienAbstract:Summary: Purpose: Seizure recurrence after Anterior Temporal Lobectomy (ATL) incites concerns of whether seizures will eventually be successfully controlled. Our study evaluated the prognostic significance of seizure recurrence in the first year after ATL. Methods: The postoperative courses of 175 consecutive patients who had undergone ATL and had ≥2 years of follow-up were studied. Recurrence was considered early if the first seizure occurred within 7 days after ATL and late if it occurred >7 days after ATL. Recurrent seizures were considered provoked when precipitating factors were present, such as interruption of antiepileptic drug (AED) intake. Subsequent outcome was determined at terminal follow-up. Results: Percentage of excellent outcome was comparable between patients whose initial recurrent seizures were auras or simple partial seizures and patients without seizure recurrence in the first year (86.7 vs. 93.1%; p ≥ 0.05). However, percentage of excellent outcome was less when the initial recurrent seizure was complex partial, either with or without secondary generalization (44.8%; p ≤ 0.01). Outcome was not different between early and late seizure recurrence (excellent in 41.7 vs. 55.7%; p ≥ 0.05). Nonetheless, patients with either early or late seizure recurrence were less likely to have excellent outcome than were patients with no seizure recurrence in the first year (p ≤ 0.001). Percentage of excellent outcome was best when patients were seizure free in the first year (93.1%), intermediate when initial recurrent seizure was provoked (72.0%), and worst when unprovoked (27.8%) (p ≤ 0.001). Conclusions: In the first postoperative year, the type of initial recurrent seizure, whether aura or complex partial and whether provoked or unprovoked, is associated with long-term prognosis in seizure control after ATL. The timing of the initial seizure recurrence is not as important.
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age of meningitis or encephalitis is independently predictive of outcome from Anterior Temporal Lobectomy
Neurology, 2002Co-Authors: Terence J Obrien, Harold L Moses, D M Cambier, G D CascinoAbstract:Background: The occurrence of meningitis or encephalitis in early childhood, i.e., ≤4 years of age, may be associated with both the development of medial Temporal lobe epilepsy (MTLE) and an excellent operative outcome following an Anterior Temporal Lobectomy (ATL). However, whether the predictive value of this risk factor for partial epilepsy is independent of the finding of mesial Temporal sclerosis (MTS) on MRI is not known. Methods: Consecutive patients (n = 39) with a remote history of meningitis or encephalitis who underwent an ATL were compared with 78 sex- and age-matched control subjects who had not experienced a CNS infection before ATL. All patients in both groups had nonlesional Temporal lobe epilepsy and were followed up for at least 12 months postoperatively. Results: There was a trend for the patients with a history of meningitis or encephalitis to have a lower frequency of class I postoperative outcome (61.5% vs 73.1%, p = 0.21). In the meningitis or encephalitis group, a class I outcome was more frequent in those with a history of meningitis or encephalitis at a young age ( p = 0.002), those with MTS detected on a preoperative MRI (22/31 vs 2/8, p = 0.04), and those with a history of meningitis (16/21 vs 8/18, p = 0.05). Multivariate logistic regression analysis found that a history of meningitis or encephalitis at a young age ( b = 2.0, O.R. = 7.5, p = 0.048) was predictive of a class I outcome independent of the presence of MRI-identified MTS ( b = 2.0, O.R. = 7.3, p = 0.07). Conclusion: The age of occurrence of a remote history of meningitis or encephalitis, but not the type of infection, is predictive of outcome after an ATL independent of the finding of MTS on the preoperative MRI.
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acute postoperative seizures following Anterior Temporal Lobectomy for intractable partial epilepsy
Journal of Neurosurgery, 1998Co-Authors: Bhaskara Rao Malla, Kurupath Radhakrishnan, Elson L So, G D Cascino, Terence J Obrien, Peter L Silbert, Richard W MarshAbstract:Object. Recurrence of seizures immediately following epilepsy surgery can be emotionally devastating, and raises concerns about the chances of successfully attaining long-term seizure control. The goals of this study were to investigate the frequency of acute postoperative seizures (APOS) occurring in the 1st postoperative week following Anterior Temporal Lobectomy (ATL) to identify potential risk factors and to determine their prognostic significance. Methods. One hundred sixty consecutive patients who underwent an ATL for intractable nonlesional Temporal lobe epilepsy were retrospectively studied. Acute postoperative seizures occurred in 32 patients (20%). None of the following factors were shown to be significantly associated with the occurrence of APOS: age at surgery, duration of epilepsy, side of surgery, extent of neocortical resection, electrocorticography findings, presence of mesial Temporal sclerosis, and hippocampal volume measurements (p > 0.05). Patients who suffered from APOS overall had a ...