High-gamma modulation language mapping and cognitive outcomes after epilepsy surgery

IF 6.6 1区医学 Q1 CLINICAL NEUROLOGY Epilepsia Pub Date : 2024-08-20 DOI:10.1111/epi.18096

Brian Ervin, Christina Kargol, Anna W. Byars, Jason Buroker, Leonid Rozhkov, Jesse Skoch, Francesco T. Mangano, Hansel M. Greiner, Paul S. Horn, Katherine Holland, Ravindra Arya

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Abstract

Objective

We evaluated changes in cognitive domains after neurosurgical lesioning of cortical sites with significant high-gamma power modulations (HGM) during a visual naming task, although these sites were found language-negative on standard-of-care electrical stimulation mapping (ESM).

Methods

In drug-resistant epilepsy patients who underwent resection/ablation after stereo-electroencephalography (SEEG), we computed reliable change indices (RCIs) from a battery of presurgical and 1-year postsurgical neuropsychological assessments. We modeled RCIs as a function of lesioning even one HGM language site, number of HGM language sites lesioned, and the magnitude of naming-related HGM. The analyses were adjusted for 1-year seizure freedom, operated hemispheres, and the volumes of surgical lesions.

Results

In 37 patients with 4455 SEEG electrode contacts (1839 and 2616 contacts in right and left hemispheres, respectively), no ESM language sites were lesioned. Patients with lesioning of even one HGM language site showed significantly lower RCIs for Peabody Picture Vocabulary Test (PPVT), working memory, and verbal learning immediate (VLI) scores. RCI declines with higher number of HGM language sites lesioned were seen in PPVT (slope [β] = −.10), working memory (β = −.10), VLI (β = −.14), and letter–word identification (LWI; β = −.14). No neuropsychological domains improved after lesioning of HGM language sites. Significant effects of the HGM magnitude at lesioned sites were seen on working memory (β = −.31), story memory immediate (β = −.27), verbal learning recognition (β = −.18), LWI (β = −.16), spelling (β = −.49), and passage comprehension (β = −.33). Because working memory was significantly affected in all three analyses, patients with maximal working memory decline were examined post hoc, revealing that all such patients had HGM naming sites lesioned in the posterior quadrants of either hemisphere.

Significance

HGM language mapping should be used as an adjunct to ESM in clinical practice and may help counsel patients/families about postsurgical cognitive deficits.

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高伽马调制语言图谱与癫痫手术后的认知结果。

目的我们评估了在视觉命名任务中对具有显著高伽马功率调制（HGM）的皮层部位进行神经外科病变后认知领域的变化，尽管这些部位在标准护理电刺激图谱（ESM）中被发现语言阴性：在立体脑电图（SEEG）后接受切除/消融术的耐药性癫痫患者中，我们通过一系列手术前和手术后一年的神经心理学评估计算出了可靠的变化指数（RCIs）。我们将 RCIs 作为甚至一个 HGM 语言部位病变、HGM 语言部位病变数量以及与命名相关的 HGM 程度的函数进行建模。分析对 1 年癫痫发作自由度、手术半球和手术病变体积进行了调整：结果：在 37 名有 4455 个 SEEG 电极接触点的患者中（右半球和左半球的接触点分别为 1839 个和 2616 个），没有任何 ESM 语言点发生病变。哪怕只有一个 HGM 语言位点发生病变的患者，其皮博迪图画词汇测试 (PPVT)、工作记忆和即时言语学习 (VLI) 分数的 RCI 都明显较低。PPVT（斜率 [β] = -.10）、工作记忆（β = -.10）、VLI（β = -.14）和字母-单词识别（LWI；β = -.14）的 RCI 随病变的 HGM 语言位点数量增加而下降。对 HGM 语言位点进行病变后，神经心理领域均无改善。病变部位的 HGM 大小对工作记忆（β = -.31）、即时故事记忆（β = -.27）、言语学习识别（β = -.18）、LWI（β = -.16）、拼写（β = -.49）和段落理解（β = -.33）有显著影响。由于工作记忆在所有三项分析中都受到明显影响，因此对工作记忆衰退程度最大的患者进行了事后研究，结果发现所有这些患者的 HGM 命名部位都在任一大脑半球的后象限：意义：在临床实践中，HGM语言图谱应作为ESM的辅助手段，并可帮助患者/家属了解手术后的认知障碍。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Epilepsia 医学-临床神经学

CiteScore

10.90

自引率

10.70%

发文量

319

审稿时长

2-4 weeks

期刊介绍： Epilepsia is the leading, authoritative source for innovative clinical and basic science research for all aspects of epilepsy and seizures. In addition, Epilepsia publishes critical reviews, opinion pieces, and guidelines that foster understanding and aim to improve the diagnosis and treatment of people with seizures and epilepsy.