Career Center AES Connect

Abstracts

Neuropsychological Outcomes Following Surgical Ablation for Periventricular Nodular Heterotopia

Abstract number : 1.346
Submission category : 11. Behavior/Neuropsychology/Language / 11A. Adult
Year : 2023
Submission ID : 156
Source : www.aesnet.org
Presentation date : 12/2/2023 12:00:00 AM
Published date :

Authors :
Presenting Author: Yosefa Modiano, PhD – Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston, Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston

Oscar Woolnough, PhD – Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston, Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston; Ryan McCormack, MD – Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston, Memorial Hermann Hospital, Texas Medical Center; Nitin Tandon, MD – Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston, Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, Memorial Hermann Hospital, Texas Medical Center

Rationale: Periventricular nodular heterotopia (PVNH) is a malformation of cortical development (MCD) with high rates of epilepsy. Abnormal connectivity between nodules and overlying cortical structures is purported to underlie epileptogenicity, which suggests that nodules may participate in normal cerebral functions in addition to pathological processes. Surgical ablation of epileptogenic PVNH via Magnetic Resonance guided LITT can inform us about functional indispensability of cortical matter. We assessed the functional utility of surgically ablated epileptogenic PVNH tissue via comprehensive neuropsychological testing.

Methods: Sample included patients with PVNH who completed pre-surgical neuropsychological evaluation (n = 28, 68% female) and a subset who underwent LITT of nodule(s) and repeat post-surgical neuropsychological testing (n = 15, 87% female). Patients were classified into diagnostic categories in keeping with the IC-CODE1. Post-operative changes were assessed at domain level and across individual tests using reliable change indices. Spatial distribution of nodules and hemisphere of surgery were considered as potential modifiers of post-operative change.


1 McDonald, C. R. et al. Development and application of the International Classification of Cognitive Disorders in Epilepsy (IC-CoDE): Initial results from a multi-center study of adults with temporal lobe epilepsy. Neuropsychology (2022)



Results: We did not observe a significant difference between the distribution of pre-surgical diagnostic categories from that of a previously published temporal lobe epilepsy population1 (X2(3,1437) = 0.307, p = 0.959, ln(BF) = -10.4). Post-operatively, eight patients (53%) showed no diagnostic change, five (33%) showed additional deficits, and two (13%) showed amelioration of deficits. No significant declines were observed in any domain level z-scores (p > 0.5, ln(BF) < -1.1). At the level of single tests, we observed at least substantial evidence in favor of the null hypothesis (ln(BF) < -1.1) in 18/21 tests. Substantial evidence of a decline was seen in spatial learning only (p = 0.019, ln(BF) = 1.33). A substantial association with laterality was identified in perceptual reasoning index only (PRI; β = -10.1, p = 0.0086, ln(BF) = 2.33). We found substantial evidence of a post-operative reduction in anxiety (p = 0.012, ln(BF) = 1.1).
Behavior