Cognitive outcome 10 years after temporal lobe epilepsy surgery

Objective: To explore late effects of temporal lobe resection (TLR) for epilepsy on general cognitive level and memory. Methods: Fifty-one patients who had undergone TLR (23 in the speech-dominant temporal lobe [DTL] and 28 in the nondominant temporal lobe [NDTL]) were assessed preoperatively and 2 and 10 years postoperatively. Twenty-three healthy controls were assessed at baseline and at corresponding intervals. A battery of standardized tests for assessment of general cognitive level and memory was analyzed using a linear mixed model of between-subjects treatment effect and within-subject time effect. Results: The main result was cognitive stability from 2 to 10 years after TLR. The DTL group had declined in verbal memory at the 10-year follow-up compared to the NDTL group and to the controls. However, this decline was detected already 2 years postoperatively, with no further decline from 2 to 10 years. The memory decline was not related to seizure outcome or AED treatment. The NDTL group showed less improvement in performance IQ (PIQ) at the 10-year follow-up compared to the controls. The most important correlate to inferior PIQ scores was continuing seizures, which was more frequent in the NDTL group. Conclusions: In this study, the main finding was cognitive stability from 2 to 10 years after temporal lobe resection. There was no further decline in verbal memory from 2 to 10 years after surgery, lending no support to the notion of an ongoing progressive decline in verbal memory after temporal lobe resection. The verbal memory course was not dependent on seizure outcome or antiepileptic drug treatment.

[1]  O. Spreen,et al.  A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary , 1991 .

[2]  A. Rey,et al.  Translations of excerpts from Andre Rey"s Psychological examination of traumatic encephalopathy and P. A. Osterrieth"s The Complex Figure Copy Test.. , 1993 .

[3]  E. Passaro,et al.  Early and late cognitive changes following temporal lobe surgery for epilepsy , 2003, Neurology.

[4]  Silke Lux,et al.  Chronic epilepsy and cognition: A longitudinal study in temporal lobe epilepsy , 2003, Annals of neurology.

[5]  J. Matarazzo,et al.  Test-retest reliability and stability Of the wais: A literature review with implications for clinical Practice , 1980 .

[6]  H. Silfvenius,et al.  A compound score for estimating the influence of inattention and somnolence during the intracarotid amobarbital test , 1992, Epilepsy Research.

[7]  K. Malmgren,et al.  Visual field defects after temporal lobectomy – comparing methods and analysing resection size , 2004, Acta neurologica Scandinavica.

[8]  L. Brandt,et al.  Cognition and adjustment after late and early operation for ruptured aneurysm. , 1987, Neurosurgery.

[9]  H. Lüders,et al.  Individual change after epilepsy surgery: Practice effects and base-rate information. , 1993 .

[10]  K. Malmgren,et al.  Pre‐ and postoperative general neurocognitive status and memory in
70 epilepsy surgery patients , 2001, Acta neurologica Scandinavica.

[11]  C. Nordborg,et al.  Surgical treatment of epilepsy ‐ clinical, radiological and histopathological findings in 139 children and adults , 1999, Acta neurologica Scandinavica.

[12]  C. Dodrill.  Long-Term Reliability of the Wonderlic Personnel Test. , 1983 .

[13]  J. Ottosson,et al.  RELIABILITY AND VALIDITY OF A MEMORY TEST BATTERY , 1963, Acta psychiatrica Scandinavica.

[14]  S. Baxendale.  The impact of epilepsy surgery on cognition and behavior , 2008, Epilepsy & Behavior.

[15]  H. Lüders,et al.  Prediction of cognitive change as a function of preoperative ability status among temporal lobectomy patients seen at 6‐month follow‐up , 1991, Neurology.

[16]  W T Blume,et al.  Proposal for a New Classification of Outcome with Respect to Epileptic Seizures Following Epilepsy Surgery , 2001, Epilepsia.

[17]  K. Malmgren,et al.  Non-parametric Evaluation of Memory Changes at Group and Individual Level Following Temporal Lobe Resection for Pharmaco-resistant Partial Epilepsy , 2004, Journal of clinical and experimental neuropsychology.

[18]  A. Wyler,et al.  Wisconsin Card Sorting Test performance in patients with complex partial seizures of temporal-lobe origin. , 1988, Journal of clinical and experimental neuropsychology.

[19]  M. Lezak.  Neuropsychological assessment, 3rd ed. , 1995 .

[20]  P. V. van Rijen,et al.  Verbal memory decline after temporal epilepsy surgery? , 2006, Neurology.

[21]  K. Malmgren,et al.  Verbal cognition and attention deficits do not explain the verbal memory decline associated with pharmacoresistant partial epilepsy , 2007, Epilepsy & Behavior.

[22]  Klaus Lehnertz,et al.  Limbic ERPs predict verbal memory after left‐sided hippocampectomy , 1998, Neuroreport.

[23]  K. Malmgren,et al.  Serial cognitive change patterns across time after temporal lobe resection for epilepsy , 2006, Epilepsy & Behavior.

[24]  John P.A. Ioannidis,et al.  Comparison of evidence on harms of medical interventions in randomized and nonrandomized studies , 2006, Canadian Medical Association Journal.

[25]  R. Flink,et al.  Seizure outcome after resective epilepsy surgery in patients with low IQ. , 2008, Brain : a journal of neurology.

[26]  H. Lüders,et al.  Empirical methods for assessing meaningful neuropsychological change following epilepsy surgery , 1996, Journal of the International Neuropsychological Society.