TY - JOUR
T1 - Precision medicine in pediatric temporal epilepsy surgery
T2 - optimization of outcomes through functional MRI memory tasks and tailored surgeries
AU - Goldstein, Hannah E.
AU - Poliakov, Andrew
AU - Shaw, Dennis W.
AU - Barry, Dwight
AU - Tran, Kieu
AU - Novotny, Edward J.
AU - Saneto, Russell P.
AU - Marashly, Ahmad
AU - Warner, Molly H.
AU - Wright, Jason N.
AU - Hauptman, Jason S.
AU - Ojemann, Jeffrey G.
AU - Shurtleff, Hillary A.
N1 - Publisher Copyright:
©AANS 2022, except where prohibited by US copyright law.
PY - 2022/9
Y1 - 2022/9
N2 - OBJECTIVE The goal of epilepsy surgery is both seizure cessation and maximal preservation of function. In temporal lobe (TL) cases, the lack of functional MRI (fMRI) tasks that effectively activate mesial temporal structures hampers preoperative memory risk assessment, especially in children. This study evaluated pediatric TL surgery outcome optimization associated with tailored resection informed by an fMRI memory task. METHODS The authors identified focal onset TL epilepsy patients with 1) TL resections; 2) viable fMRI memory scans; and 3) pre- and postoperative neuropsychological (NP) evaluations. They retrospectively evaluated preoperative fMRI memory scans, available Wada tests, pre- and postoperative NP scores, postoperative MRI scans, and postoperative Engel class outcomes. To assess fMRI memory task outcome prediction, the authors 1) overlaid preoperative fMRI activation onto postoperative structural images; 2) classified patients as having “overlap” or “no overlap” of activation and resection cavities; and 3) compared these findings with memory improvement, stability, or decline, based on Reliable Change Index calculations. RESULTS Twenty patients met the inclusion criteria. At a median of 2.1 postoperative years, 16 patients had Engel class IA outcomes and 1 each had Engel class IB, ID, IIA, and IID outcomes. Functional MRI activation was linked to NP memory outcome in 19 of 20 cases (95%). Otherwise, heterogeneity characterized the cohort. CONCLUSIONS Functional MRI memory task activation effectively predicted individual NP outcomes in the context of tailored TL resections. Patients had excellent seizure and overall good NP outcomes. This small study adds to extant literature indicating that pediatric TL epilepsy does not represent a single clinical syndrome. Findings support individualized surgical intervention using fMRI memory activation to help guide this precision medicine approach.
AB - OBJECTIVE The goal of epilepsy surgery is both seizure cessation and maximal preservation of function. In temporal lobe (TL) cases, the lack of functional MRI (fMRI) tasks that effectively activate mesial temporal structures hampers preoperative memory risk assessment, especially in children. This study evaluated pediatric TL surgery outcome optimization associated with tailored resection informed by an fMRI memory task. METHODS The authors identified focal onset TL epilepsy patients with 1) TL resections; 2) viable fMRI memory scans; and 3) pre- and postoperative neuropsychological (NP) evaluations. They retrospectively evaluated preoperative fMRI memory scans, available Wada tests, pre- and postoperative NP scores, postoperative MRI scans, and postoperative Engel class outcomes. To assess fMRI memory task outcome prediction, the authors 1) overlaid preoperative fMRI activation onto postoperative structural images; 2) classified patients as having “overlap” or “no overlap” of activation and resection cavities; and 3) compared these findings with memory improvement, stability, or decline, based on Reliable Change Index calculations. RESULTS Twenty patients met the inclusion criteria. At a median of 2.1 postoperative years, 16 patients had Engel class IA outcomes and 1 each had Engel class IB, ID, IIA, and IID outcomes. Functional MRI activation was linked to NP memory outcome in 19 of 20 cases (95%). Otherwise, heterogeneity characterized the cohort. CONCLUSIONS Functional MRI memory task activation effectively predicted individual NP outcomes in the context of tailored TL resections. Patients had excellent seizure and overall good NP outcomes. This small study adds to extant literature indicating that pediatric TL epilepsy does not represent a single clinical syndrome. Findings support individualized surgical intervention using fMRI memory activation to help guide this precision medicine approach.
KW - fMRI
KW - memory outcomes
KW - precision medicine
KW - surgical epilepsy
KW - temporal lobe epilepsy
UR - http://www.scopus.com/inward/record.url?scp=85138505273&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85138505273&partnerID=8YFLogxK
U2 - 10.3171/2022.5.PEDS22148
DO - 10.3171/2022.5.PEDS22148
M3 - Article
C2 - 35901731
AN - SCOPUS:85138505273
SN - 1933-0707
VL - 30
SP - 272
EP - 283
JO - Journal of Neurosurgery: Pediatrics
JF - Journal of Neurosurgery: Pediatrics
IS - 3
ER -