From the Cleveland Clinic Lerner College of Medicine (N.K., A.S.N., R.M.B.), Case Western Reserve University; Quantitative Health Sciences (A.S.N.), Lerner Research Institute, Cleveland Clinic; Epilepsy Center (D.K.L., W.B., R.M.B.), Neurological Institute, Cleveland Clinic, OH; Division of Pediatric Neuropsychology (M.M.B.), Childrens National Medical Center, Washington, DC; Department of Neurology (M.J.H.), Columbia University Medical Center, New York, NY; and Department of Psychiatry & Psychology (P.K., R.M.B.), and Department of Neurology (P.K., R.M.B.), Neurological Institute, Cleveland Clinic, OH.
Neurology. 2023 May 2;100(18):e1878-e1886. doi: 10.1212/WNL.0000000000207143. Epub 2023 Mar 16.
The aim of this study was to characterize short-term outcomes in episodic memory, as assessed by the Children's Memory Scale (CMS), after temporal lobe resection in children with epilepsy using empirical methods for assessing cognitive change (i.e., reliable change indices [RCI] and standardized regression-based change scores [SRB]) and develop and internally validate clinically applicable models to predict postoperative memory decline.
This retrospective cohort study included children aged 6-16 years who underwent resective epilepsy surgery that included the temporal lobe (temporal only: "temporal" and multilobar: "temporal plus") and who completed preoperative and postoperative neuropsychological assessments including the CMS. Change scores on the CMS delayed memory subtests (Faces, Stories, and Word Pairs) were classified as decline, no change, or improvement using epilepsy-specific RCI and SRB. Logistic regression models for predicting postoperative memory decline were developed and internally validated with bootstrapping.
Of the 126 children included, most of them demonstrated either no significant change (54%-69%) or improvement (8%-14%) in memory performance using RCI on individual measures at a median of 7 months after surgery. A subset of children (23%-33%) showed postoperative declines. Change distributions obtained using RCI and SRB were not statistically significantly different from each other. Preoperative memory test score, surgery side, surgery extent, and preoperative full-scale IQ were predictors of memory decline. Prediction models for memory decline included subsets of these variables with bias-corrected concordance statistics ranging from 0.70 to 0.75. The models were well calibrated although slightly overestimated the probability of verbal memory decline in high-risk patients.
This study used empiric methodology to characterize memory outcome in children after temporal lobe resection. Provided online calculator and nomograms may be used by clinicians to estimate the risk of postoperative memory decline for individual patients before surgery.
本研究旨在采用评估认知变化的经验方法（即可靠变化指数[RCI]和基于标准化回归的变化分数[SRB]），描述儿童癫痫手术后情景记忆的短期结局，并开发和内部验证可用于预测术后记忆下降的临床适用模型。方法：本回顾性队列研究纳入了 6-16 岁接受颞叶切除术（单纯颞叶：“颞叶”和多叶：“颞叶加”）且完成术前和术后神经心理学评估（包括儿童记忆量表[CMS]）的癫痫患者。使用特定于癫痫的 RCI 和 SRB 将 CMS 延迟记忆子测验（面孔、故事和单词对）的变化分数分类为下降、无变化或改善。采用 bootstrap 法开发并内部验证预测术后记忆下降的逻辑回归模型。结果：在 126 名纳入的儿童中，大多数儿童在术后中位数为 7 个月时，使用 RCI 对个体测试进行测量，记忆表现要么没有显著变化（54%-69%），要么改善（8%-14%）。一小部分儿童（23%-33%）术后出现下降。使用 RCI 和 SRB 获得的变化分布在统计学上无显著差异。术前记忆测试评分、手术侧、手术范围和术前全量表智商是记忆下降的预测因子。记忆下降预测模型包括这些变量的子集，校正偏倚后的一致性统计量范围为 0.70 至 0.75。模型具有良好的校准能力，尽管对高危患者的言语记忆下降概率略有高估。讨论：本研究采用经验方法描述了儿童颞叶切除术后的记忆结局。提供的在线计算器和列线图可由临床医生在手术前用于估计个别患者术后记忆下降的风险。
