Precision medicine in pediatric temporal epilepsy surgery: optimization of outcomes through functional MRI memory tasks and tailored surgeries.

Autor:	Goldstein HE; 1Neurosciences Center, Seattle Children's Hospital, Seattle.; 2Department of Neurological Surgery, University of Washington School of Medicine, Seattle.; 3Division of Neurosurgery, Seattle Children's Hospital, Seattle.; 9Center for Integrated Brain Research, Seattle Children's Hospital, Seattle, Washington; and., Poliakov A; 1Neurosciences Center, Seattle Children's Hospital, Seattle.; 3Division of Neurosurgery, Seattle Children's Hospital, Seattle.; 4Department of Radiology, Seattle Children's Hospital, Seattle., Shaw DW; 4Department of Radiology, Seattle Children's Hospital, Seattle.; 5Department of Radiology, University of Washington School of Medicine, Seattle., Barry D; 6Clinical Analytics, Seattle Children's Hospital, Seattle., Tran K; 2Department of Neurological Surgery, University of Washington School of Medicine, Seattle.; 3Division of Neurosurgery, Seattle Children's Hospital, Seattle., Novotny EJ; 1Neurosciences Center, Seattle Children's Hospital, Seattle.; 7Division of Pediatric Neurology, Seattle Children's Hospital, Seattle.; 8Department of Neurology, University of Washington School of Medicine, Seattle.; 9Center for Integrated Brain Research, Seattle Children's Hospital, Seattle, Washington; and., Saneto RP; 1Neurosciences Center, Seattle Children's Hospital, Seattle.; 7Division of Pediatric Neurology, Seattle Children's Hospital, Seattle.; 8Department of Neurology, University of Washington School of Medicine, Seattle.; 9Center for Integrated Brain Research, Seattle Children's Hospital, Seattle, Washington; and., Marashly A; 10Epilepsy Center, Department of Neurology, The Johns Hopkins University Medical Center, Baltimore, Maryland., Warner MH; 1Neurosciences Center, Seattle Children's Hospital, Seattle.; 7Division of Pediatric Neurology, Seattle Children's Hospital, Seattle.; 9Center for Integrated Brain Research, Seattle Children's Hospital, Seattle, Washington; and., Wright JN; 4Department of Radiology, Seattle Children's Hospital, Seattle.; 5Department of Radiology, University of Washington School of Medicine, Seattle., Hauptman JS; 1Neurosciences Center, Seattle Children's Hospital, Seattle.; 2Department of Neurological Surgery, University of Washington School of Medicine, Seattle.; 3Division of Neurosurgery, Seattle Children's Hospital, Seattle.; 9Center for Integrated Brain Research, Seattle Children's Hospital, Seattle, Washington; and., Ojemann JG; 1Neurosciences Center, Seattle Children's Hospital, Seattle.; 2Department of Neurological Surgery, University of Washington School of Medicine, Seattle.; 3Division of Neurosurgery, Seattle Children's Hospital, Seattle.; 5Department of Radiology, University of Washington School of Medicine, Seattle.; 9Center for Integrated Brain Research, Seattle Children's Hospital, Seattle, Washington; and., Shurtleff HA; 1Neurosciences Center, Seattle Children's Hospital, Seattle.; 7Division of Pediatric Neurology, Seattle Children's Hospital, Seattle.; 9Center for Integrated Brain Research, Seattle Children's Hospital, Seattle, Washington; and.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgery. Pediatrics [J Neurosurg Pediatr] 2022 Jul 01; Vol. 30 (3), pp. 272-283. Date of Electronic Publication: 2022 Jul 01 (Print Publication: 2022).
DOI:	10.3171/2022.5.PEDS22148
Abstrakt:	Objective: The goal of epilepsy surgery is both seizure cessation and maximal preservation of function. In temporal lobe (TL) cases, the lack of functional MRI (fMRI) tasks that effectively activate mesial temporal structures hampers preoperative memory risk assessment, especially in children. This study evaluated pediatric TL surgery outcome optimization associated with tailored resection informed by an fMRI memory task. Methods: The authors identified focal onset TL epilepsy patients with 1) TL resections; 2) viable fMRI memory scans; and 3) pre- and postoperative neuropsychological (NP) evaluations. They retrospectively evaluated preoperative fMRI memory scans, available Wada tests, pre- and postoperative NP scores, postoperative MRI scans, and postoperative Engel class outcomes. To assess fMRI memory task outcome prediction, the authors 1) overlaid preoperative fMRI activation onto postoperative structural images; 2) classified patients as having "overlap" or "no overlap" of activation and resection cavities; and 3) compared these findings with memory improvement, stability, or decline, based on Reliable Change Index calculations. Results: Twenty patients met the inclusion criteria. At a median of 2.1 postoperative years, 16 patients had Engel class IA outcomes and 1 each had Engel class IB, ID, IIA, and IID outcomes. Functional MRI activation was linked to NP memory outcome in 19 of 20 cases (95%). Otherwise, heterogeneity characterized the cohort. Conclusions: Functional MRI memory task activation effectively predicted individual NP outcomes in the context of tailored TL resections. Patients had excellent seizure and overall good NP outcomes. This small study adds to extant literature indicating that pediatric TL epilepsy does not represent a single clinical syndrome. Findings support individualized surgical intervention using fMRI memory activation to help guide this precision medicine approach.
Databáze:	MEDLINE
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