Clinical recommendations for conducting pediatric functional language and memory mapping during the phase I epilepsy presurgical workup.

IF 3 3区 心理学 Q2 CLINICAL NEUROLOGY Clinical Neuropsychologist Pub Date : 2024-07-01 Epub Date: 2023-11-20 DOI:10.1080/13854046.2023.2281708
Alyssa Ailion, Priscilla Duong, Moshe Maiman, Melissa Tsuboyama, Mary Lou Smith
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Abstract

Objective: Pediatric epilepsy surgery effectively controls seizures but may risk cognitive, language, or memory decline. Historically, the intra-carotid anesthetic procedure (IAP or Wada Test) was pivotal for language and memory function. However, advancements in noninvasive mapping, notably functional magnetic resonance imaging (fMRI), have transformed clinical practice, reducing IAP's role in presurgical evaluations. Method: We conducted a critical narrative review on mapping technologies, including factors to consider for discordance. Results: Neuropsychological findings suggest that if pre-surgery function remains intact and the surgery targets the eloquent cortex, there is a high chance for decline. Memory and language decline are particularly pronounced post-left anterior temporal lobe resection (ATL), making presurgical cognitive assessment crucial for predicting postoperative outcomes. However, the risk of functional decline is not always clear - particularly with higher rates of atypical organization in pediatric epilepsy patients and discordant findings from cognitive mapping. We found little research to date on the use of IAP and other newer technologies for lateralization/localization in pediatric epilepsy. Based on this review, we introduce an IAP decision tree to systematically navigate discordance in IAP decisions for epilepsy presurgical workup. Conclusions: Future research should be aimed at pediatric populations to improve the precision of functional mapping, determine which methods predict post-surgical deficits and then create evidence-based practice guidelines to standardize mapping procedures. Explicit directives are needed for resolving conflicts between developing mapping procedures and established clinical measures. The proposed decision tree is the first step to standardize when to consider IAP or invasive mapping, in coordination with the multidisciplinary epilepsy surgical team.

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在I期癫痫术前检查中进行儿科功能语言和记忆绘图的临床建议。
目的:小儿癫痫手术可有效控制癫痫发作,但可能存在认知、语言或记忆衰退的风险。历史上,颈动脉内麻醉程序(IAP或Wada测试)对语言和记忆功能至关重要。然而,无创测绘技术的进步,尤其是功能性磁共振成像(fMRI),已经改变了临床实践,减少了IAP在术前评估中的作用。方法:我们对制图技术进行了批判性的叙述回顾,包括考虑不一致的因素。结果:神经心理学研究结果表明,如果术前功能保持完整,手术的目标是雄辩皮层,则有很高的机会下降。记忆和语言衰退在左颞叶前切除术(ATL)后尤为明显,这使得术前认知评估对预测术后结果至关重要。然而,功能衰退的风险并不总是明确的,特别是儿童癫痫患者的非典型组织发生率较高,认知图谱的结果也不一致。迄今为止,我们发现关于IAP和其他新技术用于小儿癫痫侧化/定位的研究很少。基于这一综述,我们引入IAP决策树来系统地导航癫痫术前检查IAP决策中的不一致。结论:未来的研究应针对儿童人群,以提高功能制图的精度,确定哪些方法可以预测术后缺陷,然后制定循证实践指南来规范制图程序。需要明确的指示来解决正在开发的制图程序和已建立的临床措施之间的冲突。建议的决策树是标准化何时考虑IAP或侵入性测绘的第一步,与多学科癫痫外科团队协调。
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来源期刊
Clinical Neuropsychologist
Clinical Neuropsychologist 医学-临床神经学
CiteScore
8.40
自引率
12.80%
发文量
61
审稿时长
6-12 weeks
期刊介绍: The Clinical Neuropsychologist (TCN) serves as the premier forum for (1) state-of-the-art clinically-relevant scientific research, (2) in-depth professional discussions of matters germane to evidence-based practice, and (3) clinical case studies in neuropsychology. Of particular interest are papers that can make definitive statements about a given topic (thereby having implications for the standards of clinical practice) and those with the potential to expand today’s clinical frontiers. Research on all age groups, and on both clinical and normal populations, is considered.
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