Hipocamp

Amigdala
• Memory outcome after selective amygdalohippocampectomy: a study in 140 patients with
temporal lobe epilepsy.
• PURPOSE:
• The technique of selective amygdalohippocampectomy (SAH) was originally developed in
epilepsy surgery to spare unaffected brain tissue from surgery, thus minimizing the cognitive
consequences of temporal lobe surgery. The results of previous studies, however, are
equivocal in this regard. This study evaluated memory after SAH in a large sample of patients
with mesial temporal lobe epilepsy.
• METHODS:
• The 140 patients received material-specific memory tests before and 3 months after
unilateral SAH.
• RESULTS:
• Significant declines in all aspects of verbal learning and memory were found particularly for
the left resected group. With reliability-of-change indices, a high number of patients showed
postoperative verbal memory declines, < or = 51% in left SAH and < or = 32% in right SAH. For
left SAH, a higher preoperative verbal memory performance, a lower preoperative nonverbal
memory score, an older age at surgery, and a later onset of epilepsy predicted a stronger
decline in verbal memory. After right SAH, the risk for a verbal memory decline was slightly
increased when patients had surgical complications or a presurgical evaluation with bilateral
intrahippocampal depth electrodes. Results concerning nonverbal memory were less clear.
• CONCLUSIONS:
• The results clearly indicate, that particularly left SAH can lead to a significant decline in
memory functions. Predictors of postoperative verbal memory were similar to those
reported for temporal lobectomy. Postoperative deteriorations were broader and stronger in
our study than in previous studies. We discuss methodologic differences (sample size, retest
interval, extent of resection) and other factors as possible reasons.
• BNST neurocircuitry in humans.
• Abstract
• Anxiety and addiction disorders are two of the most common mental disorders in
the United States, and are typically chronic, disabling, and comorbid. Emerging
evidence suggests the bed nucleus of the stria terminalis (BNST) mediates both
anxiety and addiction through connections with other brain regions, including the
amygdala and nucleus accumbens. Although BNST structural connections have
been identified in rodents and a limited number of structural connections have
been verified in non-human primates, BNST connections have yet to be described
in humans. Neuroimaging is a powerful tool for identifying structural and
functional circuits in vivo. In this study, we examined BNST structural and
functional connectivity in a large sample of humans. The BNST showed structural
and functional connections with multiple subcortical regions, including limbic,
thalamic, and basal ganglia structures, confirming structural findings in rodents.
We describe two novel connections in the human brain that have not been
previously reported in rodents or non-human primates, including a structural
connection with the temporal pole, and a functional connection with the
paracingulate gyrus. The findings of this study provide a map of the BNST's
structural and functional connectivity across the brain in healthy humans. In large
part, the BNST neurocircuitry in humans is similar to the findings from rodents and
non-human primates; however, several connections are unique to humans. Future
explorations of BNST neurocircuitry in anxiety and addiction disorders have the
potential to reveal novel mechanisms underlying these disabling psychiatric
illnesses.
• The amygdala and basal forebrain as a pathway for motivationally
guided attention.
• Visual stimuli associated with rewards attract spatial attention.
Neurophysiological mechanisms that mediate this process must register
both the motivational significance and location of visual stimuli. Recent
neurophysiological evidence indicates that the amygdala encodes
information about both of these parameters. Furthermore, the firing rate
of amygdala neurons predicts the allocation of spatial attention. One
neural pathway through which the amygdala might influence attention
involves the intimate and bidirectional connections between the
amygdala and basal forebrain (BF), a brain area long implicated in
attention. Neurons in the rhesus monkey amygdala and BF were therefore
recorded simultaneously while subjects performed a detection task in
which the stimulus-reward associations of visual stimuli modulated spatial
attention. Neurons in BF were spatially selective for reward-predictive
stimuli, much like the amygdala. The onset of reward-predictive signals in
each brain area suggested different routes of processing for reward-
predictive stimuli appearing in the ipsilateral and contralateral fields.
Moreover, neurons in the amygdala, but not BF, tracked trial-to-trial
fluctuations in spatial attention. These results suggest that the amygdala
and BF could play distinct yet inter-related roles in influencing attention
elicited by reward-predictive stimuli.
• Top-down control of visual responses to fear by the amygdala.
• Abstract
• The visual cortex is sensitive to emotional stimuli. This sensitivity is
typically assumed to arise when amygdala modulates visual cortex via
backwards connections. Using human fMRI, we compared dynamic causal
connectivity models of sensitivity with fearful faces. This model
comparison tested whether amygdala modulates distinct cortical areas,
depending on dynamic or static face presentation. The ventral temporal
fusiform face area showed sensitivity to fearful expressions in static faces.
However, for dynamic faces, we found fear sensitivity in dorsal motion-
sensitive areas within hMT+/V5 and superior temporal sulcus. The model
with the greatest evidence included connections modulated by dynamic
and static fear from amygdala to dorsal and ventral temporal areas,
respectively. According to this functional architecture, amygdala could
enhance encoding of fearful expression movements from video and the
form of fearful expressions from static images. The amygdala may
therefore optimize visual encoding of socially charged and salient
information.
• PURPOSE:
• The purpose of this study was to assess axis-I DSM-IV psychiatric disorders in patients at
baseline and 3 months after surgery for medically refractory temporal lobe epilepsy.
• METHOD:
• The Mini International Neuropsychiatric Interview (MINI) and Quality of Life in Epilepsy
Inventory-10 (QOLIE-10) were evaluated before and 3 months after surgery in 50 consecutive
patients (21 females, 29 males) with medically refractory temporal lobe epilepsy (persistent
seizures>2/month, despite treatment with ≥2 appropriate drugs in adequate doses for ≥2
years) who underwent surgery [anterior temporal lobectomy with amygdalo-
hippocampectomy (for mesial temporal sclerosis in 40), electrocorticography-guided
lesionectomy (for other lesions in 10)].
• RESULTS:
• Twenty-six patients (52%) had an axis-I psychiatric disorder [26% depressive disorder, 28%
anxiety disorder] at baseline, while 30 (60%) patients had an axis-I psychiatric disorder [28%
depressive disorder, 28% anxiety disorder] at 3 months after surgery. Twenty percent
developed a new psychiatric disorder, while 12% showed improvement postsurgery. Mean
QOLIE-10 scores improved from 23.78 to 17.80 [24 (48%) patients showed ≥5-point
improvement]. Thirty-four (68%) patients had no seizure, 6 (12%) had non-disabling seizures,
while 2 (4%) had disabling seizures after surgery. High frequency of seizures prior to surgery
(p<0.038) and seizure occurrence after surgery (p<0.055) predicted the presence of
psychiatric disorders after surgery. No clinical characteristic could predict development of
new psychiatric disorder after surgery.
• CONCLUSION:
• Psychiatric dysfunction in the early postsurgery period is seen in nearly half of patients
undergoing surgery for temporal lobe epilepsy, is mild in nature, and does not adversely
affect quality of life but may cause significant clinical problems when it arises de novo
postsurgery
• http://www.ncbi.nlm.nih.gov/pubmed/24463306
• OBJECTIVE:
• In temporal lobe epilepsy surgery, there is a trend towards becoming more selective in order
to achieve seizure control with an optimal neuropsychological outcome. The present study
evaluated whether mesial resection length matters for memory outcome after selective
amygdalo-hippocampectomy (SAH). Therefore, a sub-analysis of the larger SFB/TR3/A1
multicentre randomised trial on seizure outcome and mesial resection length in temporal
lobe surgery was performed.
• METHODS:
• A homogeneous group of 67 selectively operated patients with hippocampal sclerosis as the
sole pathology were allocated to a short (2.5 cm, n=34) or a long (3.5 cm, n=33) mesial
resection. Repeated memory assessment and three-dimensional MRI data sets served as
dependent within group variables, and intraoperatively determined resection lengths
(short/long), resected hippocampal volumes (small/large) and side of surgery were
independent between group variables.
• RESULTS:
• Resection length did not have a significant effect on seizure or on memory outcome. The
resected hippocampal volume also did not affect seizure outcome but it did make a
difference with regard to memory outcome. Outcome in verbal learning and memory was
poorer after resection of larger left hippocampal volumes. Figural memory outcome was
poorer with larger resected volumes on either side.
• INTERPRETATION:
• The data indicate that in SAH, mesial resection length and resected volumes have no
differential effect on seizure outcome. The findings on memory outcome are best explained
by suggesting that hippocampal volumes take the degree of preoperative pathology into
account whereas resection length does not. This suggests resection of non-pathological
functional tissues as the basis for memory outcome after SAH.
• http://www.ncbi.nlm.nih.gov/pubmed/21653207