Gross William L, Swanson Sara J, Helfand Alexander I, Pillay Sara B, Humphries Colin J, Raghavan Manoj, Mueller Wade M, Carlson Chad E, Conant Lisa L, Busch Robyn M, Lowe Mark, Tivarus Madalina E, Drane Daniel L, Jacobs Monica, Morgan Victoria L, Allendorfer Jane B, Szaflarski Jerzy P, Bonilha Leonardo, Bookheimer Susan, Grabowski Thomas, Vannest Jennifer, Binder Jeffrey R
Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, United States; Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, United States.
Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, United States.
Neuroimage Clin. 2025;46:103804. doi: 10.1016/j.nicl.2025.103804. Epub 2025 May 16.
While fMRI language laterality has been used to predict verbal memory after epilepsy surgery, supporting evidence is not yet definitive. The FMRI in Anterior Temporal Epilepsy Surgery (FATES) project was a prospective observational cohort study at 10 US epilepsy centers, performed to determine whether a multivariable model including fMRI language laterality can predict verbal memory outcome 6 months after left temporal lobe epilepsy surgery.
This analysis includes 70 adults who underwent left temporal lobe epilepsy surgeries including hippocampal resection for treatment of epilepsy. Patients completed standard protocols, including preoperative fMRI language mapping with a semantic decision versus tone decision (SDTD) task contrast and preoperative and postoperative verbal memory assessment. Five memory measures, obtained from the Selective Reminding Test, Rey Auditory Verbal Learning Test, and Wechsler Memory Scale, were selected to cover a range of episodic memory tasks including word list learning, delayed list recall, and story recall. Multiple linear regression was performed using the preoperative memory score, duration of epilepsy, age at epilepsy onset, age at surgery, hippocampal sclerosis status, and fMRI SDTD laterality index (LI) as predictor variables for 6-month postoperative verbal memory change.
Across different memory measures, decline (defined using Reliable Change Index) was seen in 8%-28% of patients. Changes on all five memory measures were significantly correlated with preoperative score, epilepsy duration, and fMRI SDTD LI. Variance explained by linear regression models for each test ranged from 34%-41%, with fMRI LI independently accounting for 7%-25% of the total variance (all p < 0.05). Cross-validation accuracy for predicting change scores in independent held-back samples ranged from 0.54-0.75 standard deviations of the preoperative sample.
We demonstrate that models incorporating fMRI language LIs from a semantic decision task trained to predict verbal memory decline after left temporal lobe surgery provide meaningful information to help inform patients of the risk associated with left temporal lobe surgery and are practical to implement in different hospital settings. This confirms previous limited evidence that fMRI-based preoperative language protocols can be used to predict verbal episodic memory outcome after left temporal lobe epilepsy surgery.
虽然功能磁共振成像（fMRI）语言偏侧性已被用于预测癫痫手术后的言语记忆，但支持证据尚不明确。颞叶前部癫痫手术中的功能磁共振成像（FATES）项目是在美国10个癫痫中心进行的一项前瞻性观察队列研究，旨在确定包括fMRI语言偏侧性在内的多变量模型是否能够预测左颞叶癫痫手术后6个月的言语记忆结果。
该分析纳入了70名接受左颞叶癫痫手术（包括海马切除术）治疗癫痫的成年人。患者完成了标准方案，包括术前使用语义决策与语调决策（SDTD）任务对比的fMRI语言映射以及术前和术后的言语记忆评估。从选择性提醒测试、雷伊听觉词语学习测试和韦氏记忆量表中选取了五项记忆指标，以涵盖一系列情景记忆任务，包括单词列表学习、延迟列表回忆和故事回忆。使用术前记忆分数、癫痫持续时间、癫痫发作年龄、手术年龄、海马硬化状态以及fMRI SDTD偏侧性指数（LI）作为预测变量，对术后6个月的言语记忆变化进行多元线性回归分析。
在不同的记忆指标中，8%-28%的患者出现了下降（使用可靠变化指数定义）。所有五项记忆指标的变化均与术前分数、癫痫持续时间和fMRI SDTD LI显著相关。每个测试的线性回归模型解释的方差范围为34%-41%，fMRI LI独立占总方差的7%-25%（所有p<0.05）。在独立保留样本中预测变化分数的交叉验证准确率范围为术前样本标准差的0.54-0.75。
我们证明，纳入来自语义决策任务的fMRI语言LI的模型，经训练可预测左颞叶手术后的言语记忆下降，能提供有意义的信息，以帮助告知患者左颞叶手术相关风险，且在不同医院环境中易于实施。这证实了先前有限的证据，即基于fMRI的术前语言方案可用于预测左颞叶癫痫手术后的言语情景记忆结果。
