INS NYC 2024 Program

Poster	Poster Session 09 Program Schedule 02/16/2024 03:30 pm - 04:45 pm Room: Majestic Complex (Posters 61-120) Poster Session 09: Epilepsy \| Oncology \| MS \| Infectious Disease Final Abstract #111 Exploring Changes in Verbal and Visual Memory in Patients with Medically Intractable Epilepsy Following Stereotactic Laser Amygdalohippocampectomy (SLAH) Nataliya Turchmanovych-Hienkel, Illinois Institute of Technology, Chicago, United States Naoum Issa, The University of Chicago Medical Center, Chicago, United States James Tao, The University of Chicago Medical Center, Chicago, United States Shasha Wu, The University of Chicago Medical Center, Chicago, United States Peter Warnke, The University of Chicago Medical Center, Chicago, United States Maureen Lacy, The University of Chicago Medical Center, Chicago, United States Category: Epilepsy/Seizures Keyword 1: epilepsy / seizure disorders Keyword 2: epilepsy / seizure disorders - surgical treatment Keyword 3: cognitive functioning Objective: Temporal lobe epilepsy (TLE) is the most common type of medically intractable epilepsy with 30-40% of patients becoming resistant to anti-seizure medication and seeking surgical intervention (Chen et al., 2018; Wu et al., 2021). Recent literature has demonstrated that stereotactic laser amygdalohippocampectomy (SLAH) is an effective treatment for TLE with many patients reporting being either seizure free or a decrease in seizure activity post-surgery (Drane, 2018; Wicks et al., 2016). However, literature has mixed findings on memory outcomes following SLAH, with some patients experiencing memory improvements while others experiencing declines (Bermudez et al., 2020; Drane, 2018; Jermakowicz et al., 2017; Kang et al., 2016). These findings highlight a need to further evaluate memory functioning post-laser ablation. Participants and Methods: A retrospective review of demographic, imaging, and memory data in patients with medically intractable epilepsy referred for neuropsychological assessment before and after SLAH was conducted. Seizure focus was identified based on extended Video EEG, MRI, Stereo-EEG, and PET. Means, standard deviations, and reliable change analyses were computed for demographic variables and performances on visual memory (Wechsler Memory Scale, Fourth Edition, Visual Reproductions 2 subtest (WMS-IV VR2)) and verbal memory (California Verbal Learning Test, Second Edition, Long Delay Free Recall subtest (CVLT-II LDFR)) tests. Reliable Change Index (RCI) analyses were used to evaluate meaningful change in verbal and visual memory pre- and post-laser ablation. Results: Sample included 21 patients (9 right temporal lobe epilepsy (RTLE); 12 left temporal lobe epilepsy (LTLE)) with a mean age of 42.14 (SD = 14.11) and a mean of 14.62 years of education (SD = 1.91). 57.1% of participants were female and 42.9% were from minority racial/ethnic groups. On average neuropsychological evaluations were conducted 4.72 months pre-laser ablation and 12.74 months post-laser ablation. Post left sided SLAH, 41.7% demonstrated stable verbal memory, while 58.3% showed a decline in verbal memory. Of those participants 77.8% displayed a decline in visual memory, 11.1% remained stable, and 11.1% had improvement in visual memory. Post right sided SLAH, 33.3% demonstrated improved visual memory, 44.4% displayed stability, and 22.2% displayed a decline in visual memory. Additionally, for right sided SLAH, 77.8% displayed stability in verbal memory performance, while 22.2% demonstrated a decline. Conclusions: Consistent with prior studies assessing memory performance post-laser ablation for medically intractable epilepsy our data indicate mixed outcomes. 58.3% of patients (LTLE) displayed verbal memory declines following left temporal lobe ablation and none displayed improvements. However, 33.3% of RTLE patients post right temporal lobe ablation displayed visual memory improvements. While the sample size is small, surgeons are often seeking real time information regarding cognition to fine tune surgical approaches and improve outcomes. This study offers further evidence of potential adverse outcomes and need for review of surgical approach and/or patient selection. Larger studies of cognitive outcome will allow patients to be better informed regarding potential outcomes.

Poster

02/16/2024
03:30 pm - 04:45 pm
Room: Majestic Complex (Posters 61-120)

Poster Session 09: Epilepsy | Oncology | MS | Infectious Disease

Final Abstract #111

Exploring Changes in Verbal and Visual Memory in Patients with Medically Intractable Epilepsy Following Stereotactic Laser Amygdalohippocampectomy (SLAH)

Nataliya Turchmanovych-Hienkel, Illinois Institute of Technology, Chicago, United States
Naoum Issa, The University of Chicago Medical Center, Chicago, United States
James Tao, The University of Chicago Medical Center, Chicago, United States
Shasha Wu, The University of Chicago Medical Center, Chicago, United States
Peter Warnke, The University of Chicago Medical Center, Chicago, United States
Maureen Lacy, The University of Chicago Medical Center, Chicago, United States

Category: Epilepsy/Seizures

Keyword 1: epilepsy / seizure disorders
Keyword 2: epilepsy / seizure disorders - surgical treatment
Keyword 3: cognitive functioning

Objective:

Temporal lobe epilepsy (TLE) is the most common type of medically intractable epilepsy with 30-40% of patients becoming resistant to anti-seizure medication and seeking surgical intervention (Chen et al., 2018; Wu et al., 2021). Recent literature has demonstrated that stereotactic laser amygdalohippocampectomy (SLAH) is an effective treatment for TLE with many patients reporting being either seizure free or a decrease in seizure activity post-surgery (Drane, 2018; Wicks et al., 2016). However, literature has mixed findings on memory outcomes following SLAH, with some patients experiencing memory improvements while others experiencing declines (Bermudez et al., 2020; Drane, 2018; Jermakowicz et al., 2017; Kang et al., 2016). These findings highlight a need to further evaluate memory functioning post-laser ablation.

Participants and Methods:

A retrospective review of demographic, imaging, and memory data in patients with medically intractable epilepsy referred for neuropsychological assessment before and after SLAH was conducted. Seizure focus was identified based on extended Video EEG, MRI, Stereo-EEG, and PET. Means, standard deviations, and reliable change analyses were computed for demographic variables and performances on visual memory (Wechsler Memory Scale, Fourth Edition, Visual Reproductions 2 subtest (WMS-IV VR2)) and verbal memory (California Verbal Learning Test, Second Edition, Long Delay Free Recall subtest (CVLT-II LDFR)) tests. Reliable Change Index (RCI) analyses were used to evaluate meaningful change in verbal and visual memory pre- and post-laser ablation.

Results:

Sample included 21 patients (9 right temporal lobe epilepsy (RTLE); 12 left temporal lobe epilepsy (LTLE)) with a mean age of 42.14 (SD = 14.11) and a mean of 14.62 years of education (SD = 1.91). 57.1% of participants were female and 42.9% were from minority racial/ethnic groups. On average neuropsychological evaluations were conducted 4.72 months pre-laser ablation and 12.74 months post-laser ablation. Post left sided SLAH, 41.7% demonstrated stable verbal memory, while 58.3% showed a decline in verbal memory. Of those participants 77.8% displayed a decline in visual memory, 11.1% remained stable, and 11.1% had improvement in visual memory. Post right sided SLAH, 33.3% demonstrated improved visual memory, 44.4% displayed stability, and 22.2% displayed a decline in visual memory. Additionally, for right sided SLAH, 77.8% displayed stability in verbal memory performance, while 22.2% demonstrated a decline.

Conclusions:

Consistent with prior studies assessing memory performance post-laser ablation for medically intractable epilepsy our data indicate mixed outcomes. 58.3% of patients (LTLE) displayed verbal memory declines following left temporal lobe ablation and none displayed improvements. However, 33.3% of RTLE patients post right temporal lobe ablation displayed visual memory improvements. While the sample size is small, surgeons are often seeking real time information regarding cognition to fine tune surgical approaches and improve outcomes. This study offers further evidence of potential adverse outcomes and need for review of surgical approach and/or patient selection. Larger studies of cognitive outcome will allow patients to be better informed regarding potential outcomes.