Mismatch Between Functional and Neuropsychological Outcome After Epilepsy Surgery Suggests Key Memory Constructs Are Not Being Assessed
Abstract number :
3.437
Submission category :
9. Surgery / 9A. Adult
Year :
2022
Submission ID :
2232945
Source :
www.aesnet.org
Presentation date :
12/5/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:28 AM
Authors :
Daniel Drane, PhD – Emory University School of Medicine; Nigel Pedersen, MD – Neurology, Neurology, UC Davis; Anne Cleary, PhD – Colorado State University; Noah Okada, undergrad – undergraduate student, Arts and Sciences, Emory University; Kelsey Hewitt, PsyD – Emory University School of Medicine; Charles Epstein, MD – Emory University School of Medicine; Joseph Neisser, PhD – Grinnell University; Aastha Bansal, undergrad – undergraduate student, Arts and Sciences, Emory University School of Medicine; Cady Block, PhD – Emory University School of Medicine; Ekaterina Staikova, PhD – Emory University School of Medicine; Deqiang Qiu, PhD – Emory University School of Medicine; Adam Dickey, MD – Emory University School of Medicine; Abed Alwaki, MD – Emory University School of Medicine; Ezequiel Gleichgerrcht, MD – Medical University of South Carolina; Jon Willie, MD, PhD – Washington University St. Louis; David Loring, PhD – Emory University School of Medicine; Ammar Kheder, MD – Emory University School of Medicine; Leonardo Bonilha, MD – Emory University School of Medicine; Robert Gross, MD, PhD – Emory University School of Medicine
This is a Late Breaking abstract
Rationale: Studies have reported a mismatch between patient self-report of cognitive function and actual neuropsychological (NP) scores. We have noted better NP scores with minimally invasive surgery as compared to open resection procedures, yet have observed that family members of some of our best NP outcomes still report functional decline (even total incapacity in rare cases). We explored the rate of mismatches and interviewed patients and family members to determine the nature of possible missed deficits.
Methods: We compared NP performance to functional ratings of outcome based on work/school performance and activities of daily living in 40 post-surgical temporal lobe epilepsy (TLE) patients, including an equal number of left and right cases. We predicted the correlation between NP performance and functional outcome would be weak but significant. We also decided to explore whether the proportion of mismatched cases (i.e., inconsistency between NP performance and function) differed by side of surgery. All subjects exhibited left hemisphere cerebral language dominance, valid NP data, and did not differ on psychiatric variables. Family members and patients were interviewed to assess their perceptions of cognitive and emotional function, and to determine if changes occurred in various sub-levels of function (e.g., changes in job duties, grades, life skills).
Results: NP results and functional outcome were not significantly related in our sample (r=.32, ns), yet we found that left and right TLE patients differed in the nature of outcome mismatches. When mismatches occurred in the left TLE group, it always reflected poor NP outcome despite a normal functional status (positive mismatch: n=4). In contrast, when mismatches occurred in the right TLE sample, it always reflected a good NP outcome (often reflecting outstanding memory scores) with a family report of significant functional decline (negative mismatch: n=5). This outcome was highly significant (Fishers Exact Test, p=0.0079). Family members of negative mismatches reported patient memory problems with disordered temporal and spatial context (e.g., not knowing when or where information/events were encountered), not distinguishing between the importance of recall elements (often lacking any emotional contribution to learning), and a loss of information over time. Moreover, positive mismatches, all left TLE cases, appeared to use these same skills to compensate for verbal memory deficits.
Conclusions: Mismatches between NP performance and functional outcome occurred in nearly 25% of TLE surgery patients, and differed between the left and right groups. Mismatches were more likely to reflect intact NP but poor functioning in right TLE patients and the opposite pattern among left TLE patients. It appears mismatched outcomes may result from a deficient assessment of memory functions in epilepsy surgery patients, rather than past attributions to possible psychiatric factors.
Funding: This project was supported by grants received by Dr. Drane from the National Institute of Neurological Disorders and Stroke (NINDS) of the National Institutes of Health (NIH) [K23 NSO49100, K02NS070960, L30 NS080215, R01NS088748] and Medtronic, Inc. [A1225797BFN:1056035].
Surgery