BACKGROUND AND OBJECTIVES Stereo-EEG-guided radiofrequency thermocoagulation (RFTHC) has been proposed as relatively safe from a cognitive perspective; however, there is a lack of evidence based on neuropsychological assessments supporting this. This study is the first prospective evaluation of neuropsychological outcomes associated with stereo-EEG-guided RFTHC in patients with focal drug-resistant epilepsy. METHODS This cohort study involved prospective recruitment of consecutive patients undergoing stereo-EEG from 2 Australian centers. A comprehensive neuropsychological assessment was administered before implantation and 3 months after RFTHC (M = 104.51 days, SD = 29.25). Outcomes across cognitive domains were assessed at a group level with repeated measures t tests. Factorial repeated measures analyses of variance compared memory and language outcomes according to whether dominant mesial temporal lobe (mTL) structures were coagulated. Reliable change indices (RCIs) were computed to explore psychometrically reliable changes at an individual level. RESULTS The sample comprised 39 patients who underwent stereo-EEG (M = 37.08 ± 9.67 years, range = 17-56 years, 54% female). Nineteen (49%) had a language dominant epileptogenic zone (EZ), 16 (41%) a nondominant EZ, and 4 (10%) a bilateral EZ. All patients underwent RFTHC with a mean of 11.87 (SD = 6.82, range = 2-29) coagulation sites. Ten patients (26%) had RFTHC within the dominant mTL. At a group level, RFTHC was not associated with a significant decline on any neuropsychological measures (all comparisons p > 0.05). Subgroup analyses revealed a decline in delayed verbal recall after RFTHC of dominant mTL structures (F(1,37) = 4.46, p = 0.04, ηp2 = 0.11, 95% CI [0-0.30]; medium to large effect), although it did not remain statistically significant after correction for false discovery rate. No statistically significant group differences were observed on visual memory or language measures post-RFTHC (all comparisons p > 0.05). RCI revealed that after RFTHC within the dominant mTL, 20% of patients experienced a decline in verbal memory and 10% in visual memory. By contrast, 7% declined in verbal memory and 10% in visual memory post-RFTHC outside the dominant mTL. DISCUSSION While these findings support the current view that RFTHC is cognitively benign for most cases, the results raise the question of a verbal memory decline after coagulation of the dominant mTL. Individualized neuropsychological counseling before stereo-EEG is essential to avoid unanticipated deficits.

中文翻译：

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立体脑电图射频热凝后的神经心理学结果。


背景和目标 立体脑电图引导的射频热凝固术 （RFTHC） 被认为从认知角度来看相对安全;然而，缺乏基于神经心理学评估的证据支持这一点。本研究是对局灶性耐药性癫痫患者与立体脑电图引导的 RFTHC 相关的神经心理学结果的首次前瞻性评估。方法 这项队列研究涉及前瞻性招募来自 2 个澳大利亚中心接受立体脑电图的连续患者。在植入前和 RFTHC 后 3 个月进行全面的神经心理学评估 （M = 104.51 天，SD = 29.25）。通过重复测量 t 检验在组水平评估跨认知领域的结果。析因重复测量方差分析根据优势近中颞叶 （mTL） 结构是否凝固来比较记忆和语言结局。计算可靠变化指数 （RCI） 以探索个体水平的心理测量可靠变化。结果 样本包括 39 例接受立体脑电图的患者 （M = 37.08 ± 9.67 岁，范围 = 17-56 岁，54% 为女性）。19 例 （49%） 有语言显性致痫区 （EZ），16 例 （41%） 为非显性 EZ，4 例 （10%） 为双侧 EZ。所有患者均接受了 RFTHC，平均凝血部位为 11.87 （SD = 6.82，范围 = 2-29）。10 例患者 （26%） 在显性 mTL 内有 RFTHC。在组水平上，RFTHC 与任何神经心理学指标的显着下降无关（所有比较 p > 0.05）。亚组分析显示，RFTHC 后主要 mTL 结构的延迟语言回忆下降 （F（1,37） = 4.46，p = 0.04，ηp2 = 0.11,95% CI [0-0.30];中到大效应），尽管在校正错误发现率后没有统计学意义。在 RFTHC 后视觉记忆或语言测量上未观察到统计学上显着的组差异 （所有比较 p > 0.05）。RCI 显示，在占主导地位的 mTL 内进行 RFTHC 后，20% 的患者出现语言记忆下降，10% 的患者出现视觉记忆下降。相比之下，在占主导地位的 mTL 之外，RFTHC 后语言记忆下降了 7%，视觉记忆下降了 10%。讨论 虽然这些发现支持目前的观点，即 RFTHC 在大多数情况下在认知上是良性的，但结果提出了显性 mTL 凝固后语言记忆下降的问题。在立体脑电图之前进行个体化神经心理学咨询对于避免意外的缺陷至关重要。