Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Epilepsia. 2024 Oct;65(10):3052-3063. doi: 10.1111/epi.18096. Epub 2024 Aug 20.
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).
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.
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.
HGM language mapping should be used as an adjunct to ESM in clinical practice and may help counsel patients/families about postsurgical cognitive deficits.
在视觉命名任务中，评估皮质部位高伽马功率调制（HGM）显著变化后认知领域的变化，尽管这些部位在标准护理电刺激图（ESM）上被发现为语言阴性。
在接受立体脑电图（SEEG）后进行切除/消融的耐药性癫痫患者中，我们从一系列术前和术后 1 年神经心理学评估中计算了可靠变化指数（RCIs）。我们将 RCIs 建模为一个函数，该函数与病变有关，包括病变一个 HGM 语言部位、病变的 HGM 语言部位数量以及命名相关 HGM 的幅度。这些分析针对术后 1 年无癫痫发作、手术半球和手术病变体积进行了调整。
在 37 名患者的 4455 个 SEEG 电极触点（右半球 1839 个，左半球 2616 个）中，没有 ESM 语言部位被病变。即使病变一个 HGM 语言部位，患者的 Peabody 图片词汇测验（PPVT）、工作记忆和言语学习即时（VLI）得分也明显较低。在 PPVT（斜率[β]=-.10）、工作记忆（β=-.10）、VLI（β=-.14）和字母词识别（LWI；β=-.14）中，随着病变的 HGM 语言部位数量的增加，RCI 下降。在病变 HGM 语言部位后，没有神经心理学领域得到改善。在病变部位的 HGM 幅度上有显著的影响在工作记忆（β=-.31）、故事记忆即时（β=-.27）、言语学习识别（β=-.18）、LWI（β=-.16）、拼写（β=-.49）和段落理解（β=-.33）。由于工作记忆在所有三个分析中都受到显著影响，因此对术后记忆下降最大的患者进行了事后检查，结果发现所有这些患者的 HGM 命名部位均位于病变半球的后象限。
HGM 语言映射应作为临床实践中 ESM 的辅助手段，并有助于向患者/家属告知术后认知缺陷。
