Epileptology Unit, Reference Center for Rare Epilepsies, Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris, France; Neurology Unit, AP-HP, Lariboisière Hospital, Paris, France.
Univ. Lille, ULR 4072 - PSITEC - Psychologie: Interactions Temps Émotions Cognition, Lille F-59000, France.
Epilepsy Res. 2024 Sep;205:107405. doi: 10.1016/j.eplepsyres.2024.107405. Epub 2024 Jul 4.
In medial temporal lobe epilepsy (MTLE), the benefits of surgery must be balanced against the risk of post-operative memory decline. Prediction of postoperative outcomes based on functional magnetic resonance imaging (fMRI) tasks is increasingly common but remains uncertain. The aim of this retrospective study was to determine whether hippocampal activations elicited by fMRI language tasks could enhance or refine memory fMRI in MTLE patients candidates to surgery. Forty-six patients were included: 30 right and 16 left MTLE, mostly with hippocampal sclerosis. Preoperative assessment included neuropsychological tests and fMRI with language (syntactic verbal fluency) and memory tasks (encoding, delayed, and immediate recognition of images of objects). Thirty patients underwent surgery and had neuropsychological evaluations one year after surgery. Worsening was defined as a degradation of more than 10 % in postoperative forgetting scores compared to preoperative scores in verbal, non-verbal and global memory. Memory fMRI had the best sensitivity with hippocampal activations obtained in 95 % of patients, versus 65 % with language fMRI. Considering the patients who elicited an hippocampal activation, language fMRI led to 80 %, 65 % and 85 % of correct predictions for respectively global, verbal and non verbal memory (versus 71 %, 64 % and 68 % with memory fMRI). Memory and language fMRI predictions outperformed those made by neuropsychological tests. In summary, language fMRI was less sensitive than memory fMRI to elicit hippocampal activations but when it did, the proportion of correct memory predictions was better. Moreover, it proved to be an independent predictive factor regardless of the side of the epileptic focus. Given the ease of setting up a language task in fMRI, we recommend the systematic combination of memory and language tasks to predict the post-operative memory outcome of MTLE patients undergoing epilepsy surgery.
在颞叶内侧癫痫（MTLE）中，手术的益处必须与术后记忆减退的风险相平衡。基于功能磁共振成像（fMRI）任务预测手术结果的方法越来越普遍，但仍不确定。本回顾性研究的目的是确定 fMRI 语言任务引起的海马激活是否可以增强或改善 MTLE 患者手术候选者的记忆 fMRI。共纳入 46 例患者：30 例右侧 MTLE 和 16 例左侧 MTLE，主要为海马硬化。术前评估包括神经心理学测试和 fMRI，包括语言（语法言语流畅性）和记忆任务（物体图像的编码、延迟和即时识别）。30 例患者接受了手术，并在术后一年进行了神经心理学评估。恶化定义为言语、非言语和总体记忆的术后遗忘评分与术前评分相比下降超过 10%。与语言 fMRI 相比，具有海马激活的记忆 fMRI 的敏感性最好，95%的患者获得了海马激活，而语言 fMRI 为 65%。考虑到引起海马激活的患者，语言 fMRI 分别对应于总体、言语和非言语记忆的正确预测率为 80%、65%和 85%（而记忆 fMRI 为 71%、64%和 68%）。记忆和语言 fMRI 的预测结果优于神经心理学测试。总之，语言 fMRI 比记忆 fMRI 更不敏感，无法引起海马激活，但当它引起激活时，记忆预测的正确率更高。此外，它被证明是一个独立的预测因素，与癫痫灶的侧别无关。鉴于在 fMRI 中设置语言任务相对容易，我们建议系统地结合记忆和语言任务，以预测接受癫痫手术的 MTLE 患者的术后记忆结果。
