Cognitive and behavioral outcome of stereotactic laser amydalohippocampotomy in a pediatric setting

• Published in: Epilepsy & behavior reports Vol. 14; p. 100370
• Main Authors: Ono, Kim E., Bearden, Donald J., Adams, Elizabeth, Doescher, Jason, Koh, Sookyong, Eksioglu, Yaman, Gross, Robert E., Drane, Daniel L.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2020; Elsevier
• Subjects: Cognitive outcome; Laser interstitial thermal therapy; Medial temporal lobe epilepsy; Pediatric; Socio-emotional deficits; Stereotactic laser ablation; Stereotactic laser ablation; Cognitive outcome; Socio-emotional deficits; Medial temporal lobe epilepsy; Pediatric; Laser interstitial thermal therapy
• ISSN: 2589-9864; 2589-9864
• DOI: 10.1016/j.ebr.2020.100370

We present neuropsychological and functional outcome data in a teenager undergoing stereotactic laser amygdalohippocampotomy (SLAH) who had drug-resistant mesial temporal lobe epilepsy due to left hippocampal sclerosis. Given strong baseline cognitive performance, there was concern for post-operative declines in language and verbal memory were this patient to undergo open resection. She was evaluated pre- and post-ablation with clinical and experimental neuropsychological measures including semantic memory, category-specific object/face recognition and naming, spatial learning, and socio-emotional processing. The patient became seizure-free following SLAH and experienced significant improvements in school performance and social engagement. She experienced improvement in recognition and naming of multiple object categories, memory functions, and verbal fluency. In contrast, the patient declined significantly in her ability to recognize emotional tone from facial expressions, a socio-emotional process that had been normal prior to surgery. We believe this decline was related to surgical disruption of the limbic system, an area highly involved in emotional processing, and suspect such deficits are an under-assessed and unrecognized risk for all surgeries involving the amygdalohippocampal complex and broader limbic system regions. We hope this positive SLAH outcome will serve as impetus for group level research to establish its safety and efficacy in the pediatric setting. •Stereotactic laser ablation can be used successfully in pediatric epilepsy.•At risk cognitive abilities did not decline after focal ablation in this teenager.•Functional improvement was observed that paralleled gains in seizure status and cognition.•Deficits still occurred in select areas related to focal structures ablated.•Socio-emotional deficits can result from surgeries restricted to the amygdalohippocampal complex.