title: Neurocognitive outcome following stereotactic laser ablation in two patients with MRI-/PET+ mTLE.
abstract: The most effective treatment for drug-resistant seizures associated with mesial temporal lobe epilepsy (mTLE) is surgical resection. Neurocognitive sequelae may occur and are especially likely to occur after left temporal lobectomy. Smaller resections observed with selective amygdalohippocampectomy have resulted in a more favorable neurocognitive outcome in some cases when compared to standard anterior temporal lobectomy. Specifically, MRI-guided interstitial laser thermal ablation (MRgLITT) uses a superselective stereotactic amygdalohippocampotomy that has been reported to preserve object recognition and naming abilities compared with standard temporal lobe resection. We report two patients with drug-resistant mTLE and a normal high-resolution 3-T brain MRI who underwent neuropsychological assessment pre- and postleft temporal MRgLITT. Both patients demonstrated preserved visual naming ability following surgery. Semantic verbal fluency declined after surgery, but the magnitude of decline did not reach the statistical threshold for reliable change. Both patients demonstrated statistically significant and clinically meaningful declines in memory, but abilities across other nonmemory neurocognitive domains (i.e., visuospatial ability, attention) were preserved.
authors.affiliation: Department of Neurology, Mayo Clinic, Jacksonville, FL 32224, USA.
authors.forename: Brynn K
authors.initials: BK
authors.lastname: Dredla
authors.affiliation: Department of Psychology, Mayo Clinic, Jacksonville, FL 32224, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Lucas
authors.affiliation: Department of Neurosurgery, Mayo Clinic, Jacksonville, FL 32224, USA.
authors.forename: Rober E
authors.initials: RE
authors.lastname: Wharen
authors.affiliation: Department of Neurology, Mayo Clinic, Jacksonville, FL 32224, USA. Electronic address: Tatum.william@mayo.edu.
authors.forename: William O
authors.initials: WO
authors.lastname: Tatum
mesh_terms: D000328:Adult; D000679:Amygdala / Q000601:surgery; D038481:Anterior Temporal Lobectomy / Q000379:methods*; D003072:Cognition Disorders / Q000209:etiology* / Q000523:psychology*; D000069279:Drug Resistant Epilepsy / Q000601:surgery; D004833:Epilepsy, Temporal Lobe / Q000473:pathology / Q000523:psychology* / Q000601:surgery*; D006624:Hippocampus / Q000601:surgery; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D008569:Memory Disorders / Q000209:etiology / Q000523:psychology; D008875:Middle Aged; D009483:Neuropsychological Tests; D019635:Neurosurgical Procedures / Q000379:methods*; D049268:Positron-Emission Tomography; D013238:Stereotaxic Techniques; D016896:Treatment Outcome
keywords: Anterior temporal lobectomy; MRI−, PET+; Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT); Neurocognitive; Temporal lobe epilepsy