Functional MRI Predicts Memory Performance after Right Mesiotemporal Epilepsy Surgery

Purpose: Anterior temporal lobe resection (ATR) is a treatment option in drug‐resistant epilepsy. An important risk of ATR is loss of memory because mesiotemporal structures contribute substantially to memory function. We investigated whether memory‐activated functional MRI (fMRI) can predict postop...

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Bibliographic Details
Published in:Epilepsia (Copenhagen) 2005-02, Vol.46 (2), p.244-250
Main Authors: Janszky, Jozsef, Jokeit, Hennric, Kontopoulou, Konstantina, Mertens, Markus, Ebner, Alois, Pohlmann‐Eden, Bernd, Woermann, Friedrich G.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Anticonvulsants. Antiepileptics. Antiparkinson agents
Biological and medical sciences
Epilepsy surgery
Epilepsy, Temporal Lobe - surgery
Female
fMRI
Functional Laterality - physiology
Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy
Humans
Image Processing, Computer-Assisted - statistics & numerical data
Investigative techniques, diagnostic techniques (general aspects)
Magnetic Resonance Imaging - instrumentation
Magnetic Resonance Imaging - statistics & numerical data
Male
Medical sciences
Memory Disorders - diagnosis
Middle Aged
Nervous system
Nervous system (semeiology, syndromes)
Neurology
Neuropharmacology
Pharmacology. Drug treatments
Postoperative Complications - diagnosis
Postoperative memory loss
Predictive Value of Tests
Radiodiagnosis. Nmr imagery. Nmr spectrometry
Right‐sided temporal lobe epilepsy
Visuospatial memory
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Summary:Purpose: Anterior temporal lobe resection (ATR) is a treatment option in drug‐resistant epilepsy. An important risk of ATR is loss of memory because mesiotemporal structures contribute substantially to memory function. We investigated whether memory‐activated functional MRI (fMRI) can predict postoperative memory loss after anterior temporal lobectomy in right‐sided medial temporal lobe epilepsy (MTLE). Methods: We included 16 patients (10 women) aged 16–54 years. The mean age at epilepsy onset was 12.5 years (range, 1–26 years). The patients' mean Wechsler IQ score was 95.2 (range, 62–125). The activation condition of fMRI consisted of retrieval from long‐term memory induced by self‐paced performance of an imaginative walk. All but one patient had left‐sided speech dominance according to speech‐activated fMRI. Outside the scanner, we evaluated the pre‐ and postoperative visual memory retention by using Rey Visual Design Learning Test. Results: We found a correlation between the preoperative asymmetry index of memory‐fMRI and the change between pre‐ and postsurgical measures of memory retention. Reduced activation of the mesiotemporal region ipsilateral to the epileptogenic region correlated with a favorable memory outcome after right‐sided ATR. Conclusions: In light of the postoperative results, the theoretical implication of our study is that fMRI based on a simple introspective retrieval task measures memory functions. The main clinical implication of our study is that memory‐fMRI might replace the invasive Wada test in MTLE by using a simple fMRI paradigm. Predictive power, however, will be studied in larger patient samples. Other studies are required for left‐sided MTLE and neocortical epilepsies to assess the clinical usefulness of memory‐fMRI.
ISSN:0013-9580
1528-1167
DOI:10.1111/j.0013-9580.2005.10804.x