Lara Jehi, MD: Weighing Cognitive Risks in Epilepsy Surgery

February 12, 2020

The professor of neurology and epilepsy specialist at the Cleveland Clinic Lerner College of Medicine discussed the difficult treatment decisions faced when undergoing epilepsy surgery.

“The unexpected finding, which I think is very valuable for us as we try to make these decisions, is that even when the hippocampus was not removed, patients had a significant loss in their memory.”

While epilepsy surgery can reduce and sometimes eliminate seizures in patients with intractable epilepsy, the decision to fully or partially resect the epileptic focus can be a difficult one. This is especially relevant for patients with temporal lobe epilepsy who must decide whether or not to resect the hippocampus.

Lara Jehi, MD, professor of neurology and epilepsy specialist at the Cleveland Clinic Lerner College of Medicine, sat down with NeurologyLive at the 73rd annual meeting of the American Epilepsy Society (AES), December 6-10, 2019, in Baltimore, Maryland, to discuss the findings of her study on seizure and cognitive outcomes in patients who undergo epilepsy surgery that either spares or removes an MRI-normal hippocampus.

In the study, Jehi and colleagues found that, although not statistically significant, those who chose to spare the hippocampus experienced an increased risk of early seizure recurrence compared with patients who underwent resection, with similar long-term outcomes observed. Notably, Jehi pointed out that the post-op cognitive differences between the 2 groups were very minor, suggesting that the thought that sparing the hippocampus to preserve memory function may not translate to clinically meaningful advantages.

In an interview with NeurologyLive, Jehi discussed the nomogram she has developed to help facilitate the clinical counseling for epilepsy surgery and the nuances of these serious treatment decisions.

For more coverage of AES 2019, click here.

REFERENCE

Morita-Sherman ME, Louis S, Vegh D, et al. Seizure and cognitive outcomes following temporal lobe resections that spare versus remove an MRI-normal hippocampus. Presented at: 2019 American Epilepsy Society Annual Meeting. December 6-10, 2019; Baltimore, MD. Abstract 1.336.