Preoperative white matter network organization and memory decline after epilepsy surgery

Author:

Stasenko Alena12,Kaestner Erik12,Arienzo Donatello12,Schadler Adam J.12,Helm Jonathan L.3,Shih Jerry J.4,Ben-Haim Sharona5,McDonald Carrie R.126

Affiliation:

1. Center for Multimodal Imaging and Genetics, University of California, San Diego, California;

2. Departments of Psychiatry,

3. Department of Psychology, San Diego State University, San Diego, California

4. Neurosciences,

5. Neurosurgery, and

6. Radiation Medicine & Applied Sciences, University of California, San Diego, California; and

Abstract

OBJECTIVE Risk for memory decline is a common concern for individuals with temporal lobe epilepsy (TLE) undergoing surgery. Global and local network abnormalities are well documented in TLE. However, it is less known whether network abnormalities predict postsurgical memory decline. The authors examined the role of preoperative global and local white matter network organization and risk of postoperative memory decline in TLE. METHODS One hundred one individuals with TLE (n = 51 with left TLE and 50 with right TLE) underwent preoperative T1-weighted MRI, diffusion MRI, and neuropsychological memory testing in a prospective longitudinal study. Fifty-six age- and sex-matched controls completed the same protocol. Forty-four patients (22 with left TLE and 22 with right TLE) subsequently underwent temporal lobe surgery and postoperative memory testing. Preoperative structural connectomes were generated via diffusion tractography and analyzed using measures of global and local (i.e., medial temporal lobe [MTL]) network organization. Global metrics measured network integration and specialization. The local metric was calculated as an asymmetry of the mean local efficiency between the ipsilateral and contralateral MTLs (i.e., MTL network asymmetry). RESULTS Higher preoperative global network integration and specialization were associated with higher preoperative verbal memory function in patients with left TLE. Higher preoperative global network integration and specialization, as well as greater leftward MTL network asymmetry, predicted greater postoperative verbal memory decline for patients with left TLE. No significant effects were observed in right TLE. Accounting for preoperative memory score and hippocampal volume asymmetry, MTL network asymmetry uniquely explained 25%–33% of the variance in verbal memory decline for left TLE and outperformed hippocampal volume asymmetry and global network metrics. MTL network asymmetry alone produced good diagnostic classification of memory decline in left TLE (i.e., an area under the receiver operating characteristic curve of 0.80–0.84 and correct classification of 65%–76% of cases with cross-validation). CONCLUSIONS These preliminary data suggest that global white matter network disruption contributes to verbal memory impairment preoperatively and predicts postsurgical verbal memory outcomes in left TLE. However, a leftward asymmetry of MTL white matter network organization may confer the highest risk for verbal memory decline. Although this requires replication in a larger sample, the authors demonstrate the importance of characterizing preoperative local white matter network properties within the to-be-operated hemisphere and the reserve capacity of the contralateral MTL network, which may eventually be useful in presurgical planning.

Publisher

Journal of Neurosurgery Publishing Group (JNSPG)

Subject

Genetics,Animal Science and Zoology

Reference47 articles.

1. Neuropsychological outcomes after epilepsy surgery: systematic review and pooled estimates;Sherman EMS,2011

2. Nomograms to predict verbal memory decline after temporal lobe resection in adults with epilepsy;Busch RM,2021

3. Cognitive phenotypes in temporal lobe epilepsy are associated with distinct patterns of white matter network abnormalities;Reyes A,2019

4. Critical area for memory decline after mesial temporal resection in epilepsy patients;Kim D,2020

5. Hippocampal shape is associated with memory deficits in temporal lobe epilepsy;Postma TS,2020

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