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Module 7 > Memory & TLE > Flashcards

Memory & TLE Flashcards

1
Q

Underlying pathology of TLE

A

> Hippocampal sclerosis – 22%
Developmental tumours – 40%
Cortical Dysplasia – 30%
Tuberous Sclerosis – 2%

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2
Q

TLE & medication

A

Often medication resistant

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3
Q

Epilepsy surgery in TLE

A

23% of cases

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4
Q

What is hippocampal sclerosis

A

Neuronal loss

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5
Q

Left Temporal lobe associated with _ memory

A

Verbal Memory

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6
Q

Right Temporal lobe associated with _ memory

A

Visual Memory

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7
Q

Anterior Temporal lobe associated with _ memory

A

Semantic memory

  • General knowledge of objects
  • No reference to time/space
  • Shared across human cultues

The ATL is a hub where all information gets stored and consolidated
e.g. semantic dementia starts in ATL

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8
Q

Hippocampus associated with _ memory

A

Episodic Memory

  • unique to time & place
  • Specific to that individual
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9
Q

Hierarchical organisation of memory is…

A

Mischkin Hierarchical organisation

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10
Q

According to MHO ventral visual stream feeds into…

A

Perirhinal Cortex

‘What’

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11
Q

According to MHO Dorsal visual stream feeds into…

A

Parahippocampal Cortex

‘where’

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12
Q

Part of the MHO that interfaces the hippocampus & neocortex

A

Entorhinal cortex

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13
Q

IQ in epilepsy is correlated with

A

age of onset

Cormack et al. 2007

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14
Q

Hippocampal Scleorsis & dysembryoplastic neuroepithelial tumours has no impact on which type of memory?

A

STM memory - Digit Span

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15
Q

How is semantic memory impacted

A

lower in Left HS

but general reduction for all

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16
Q

Impact of TLE on regions connected to atrophic hippocampues

A

focal grey matter reductions controlatterally

Therefore there is a global impact

In adults - there was limbic system atrophy - all the parts that connect to the Hippocampus

17
Q

What impacts degree of hippocampal atrophy?

A

Duration of TLE negatively impacted hippocampal volume
+
increase seizures

Cormack (2005)
Duzel (2006)

18
Q

Decline in hippocampal volume correlates with:

A

decline in episodic memory

Skirrow et al. ICE abstracts (2014)

19
Q

Wilson 2012 developmental statistics

A

52% - normal
37% altered
11% delayed

20
Q

Predictors of developmental impact

A
  • FSIQ
  • Seizure Freedom
  • Surgical intervention
  • Male
21
Q

What is the ‘release effect’?

A

release of skills as a result of seizure freedom

- they go closer to their pre-epilepsy developmental path

22
Q

Seizure freedom after epilepsy surgery

A

87%

23
Q

Cognitive outcomes after Epilepsy Surgery

A 
More educational attainments
Less diability
Independent living
improved QoL
Employment (N.S.)
24
Q

IQ increase of >15

A

in 26% of patients

25
Q

IQ decrease od >10

A

2%

26
Q

When were the greatest IQ gains seen?

A

6 years post op

- related to AED withdrawal

27
Q

IMP note for neurosurgeons

A

the higher the brain volume the better the increase in IQ
- take out least possible

Semantic memory = extent of L. TL resection
-Verbal Episodic Memory extent of hippocampal resection (more left = lower score)

28
Q

Difference in PIQ and VIQ improvements

A

PIQ improved in both

VIQ improved in left side surgery
- despite tissue loss
= release effect - due to seizure freedom

29
Q

Release effect & Left resection

A

Verbal memory returns to pre-operative level

  • but dips initially after surgery
  • semantic memory was linked to extent of L.TL resection

Visual Memory: increases and follows a +ve developmental trajectory

30
Q

Right Resection & release effect

A

Visual memory: returns to pre-op level -

Verbal memory: increases

31
Q

Interesting finding… resection & release effect

A

improvement on the ‘contra-lateral memory’

32
Q

Outcomes of epilepsy surgery impacted by:

A

Seizure Freedom - release effect
AED discontinuation
Follow-up time

Maybe:
duration of epilepsy
Seizure Frequency
Seizure type/severity

Module 7 (13 decks)

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