Cavaleri Jonathon M, Chiang Jenna A, Wishart Danielle M, Kang Keiko M, Ng Patrick R, Mendoza Leanne, Hartline Kenneth, Van Hirtum-Das Michele, Agurs Latanya D, Kahan Madeline, Jordan Brittany, Liu Charles Y, Lee Brian, Chiarelli Peter A, Chu Jason K
Department of Neurological Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States.
Division of Neurological Surgery, Children's Hospital of Los Angeles, Los Angeles, CA, United States.
Epilepsy Behav Rep. 2024 Oct 29;28:100723. doi: 10.1016/j.ebr.2024.100723. eCollection 2024.
Surgical treatment of medication-resistant mesial temporal lobe epilepsy (MTLE) is associated with cognitive deficits. Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) for MTLE has been shown to result in superior cognitive outcomes in adults when compared to open surgical resection. However, data regarding postoperative cognitive outcomes in adolescent and pediatric patients is limited. We retrospectively reviewed sequential cases of pediatric patients who underwent MRgLITT for MTLE between 2017 and 2023. Patients who had complete preoperative and 12 month postoperative neuropsychological evaluation were analyzed for changes in the neuropsychological domains of cognition, memory, executive functioning, visual scanning, graphomotor speed, and fine motor speed/dexterity. Six adolescent patients who underwent MRgLITT for MTLE (x̄ age = 19.0 years, = 1.2) and had complete preoperative and postoperative neuropsychological evaluations were included in the analysis. There were no statistically significant changes across neuropsychological domains when comparing pre- and postoperative cognitive evaluations, including verbal memory scores. Clinically significant changes in phonemic fluency were observed when examining side-specific effects and improved for patients who received right-sided MRgLITT but declined for patients who received left-sided MRgLITT. 50 % of patients achieved Engel I outcome at last follow-up. Our preliminary results suggest minimal adverse neuropsychologic effects following MRgLITT for adolescent MTLE, including preservation of verbal memory. Clinical outcomes were similar with those reported in the literature.
药物难治性内侧颞叶癫痫（MTLE）的手术治疗与认知缺陷有关。与开放性手术切除相比，磁共振引导激光间质热疗（MRgLITT）治疗MTLE已被证明在成人中能带来更好的认知结果。然而，关于青少年和儿童患者术后认知结果的数据有限。我们回顾性分析了2017年至2023年间接受MRgLITT治疗MTLE的儿童患者的连续病例。对术前和术后12个月进行了完整神经心理学评估的患者，分析其认知、记忆、执行功能、视觉扫描、书写运动速度和精细运动速度/灵活性等神经心理学领域的变化。分析纳入了6例接受MRgLITT治疗MTLE的青少年患者（平均年龄 = 19.0岁，标准差 = 1.2），这些患者术前和术后均进行了完整的神经心理学评估。比较术前和术后认知评估时，包括言语记忆分数在内的各神经心理学领域均无统计学显著变化。在检查侧别特异性效应时，观察到音素流畅性有临床显著变化，接受右侧MRgLITT的患者有所改善，而接受左侧MRgLITT的患者则有所下降。50%的患者在最后一次随访时达到Engel I级结果。我们的初步结果表明，MRgLITT治疗青少年MTLE后神经心理学不良影响最小，包括言语记忆的保留。临床结果与文献报道相似。
