The integrity of the neuronal networks underlying relational memory as a predictor of post-surgical memory outcome in patients with mesial temporal lobe epilepsy: a multimodal neuroimaging approach

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Mesial temporal lobe epilepsy (mTLE) is a common neurological disorder characterized by recurrent seizures originating in the mesial temporal lobe (MTL). One third of mTLE patients are resistant to pharmacotherapy and benefit from surgical removal of the MTL. However, the MTL plays a key role in relational memory, a form of memory responsible for our ability to remember association-rich information. Post-surgical memory decline is a major problem following MTL removal, and reliable predictors of memory outcome after surgery are missing. Current techniques for assessing post-surgical outcome focus exclusively on the MTL, which is insufficient as they do not consider important neuronal network interactions with non-MTL brain structures.The main goal of this project is the development of reliable post-surgical predictors that explicitly consider large-scale neuronal network interactions beyond the MTL. To unravel the spatiotemporal characteristics of the brain-wide relational memory network in healthy controls and how mTLE affects this network, we will combine complementary state-of-the-art brain imaging techniques (i.e. fMRI, DTI, T2 relaxometry, EEG and intracranial EEG). We will then examine how the integrity level of this complex network predicts post-surgical memory outcome. We expect that patients with normal distributed relational memory networks are at greater risk of post-surgical memory decline than patients who have developed compensatory mechanisms to process relational information.In sum, the applied aim of this project is to help clinicians predict the risk of memory decline after MTL resection. Moreover, I emphasize that the proposed project will offer new insights into both the fundamental understanding of memory processes, and the question of how the underlying neuronal network changes when a key structure, the MTL, is damaged. This is important not only for mTLE but for many other neurological and psychiatric diseases in which the MTL is affected.