Changes in neuropsychological functioning following temporal lobectomy in patients with temporal lobe epilepsy

Shin, Min-Sup; Lee, Sang-Kun; Seol, S. C.; Lim, Young-Jin; Park, Eun-Hee; Sergeant, Joseph A.; Chung, Chun Kee

doi:10.1179/174313209x389848

Cited by 22 publications

(18 citation statements)

References 23 publications

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“…As functional inadequacy of the brain to be resected is crucial to good cognitive outcome, 6) the presence of HS suggests that the ipsilateral temporal lobe was adequately dysfunctional so that the removal do not carry significant and specific risks for post-operative deterioration. 23) Patients who had undergone Lt anterior temporal lobectomy without significant sclerosis in the resected hippocampus had greater risk of deterioration in verbal memory, because the resected hippocampus had reasonably good function. 24) Therefore, our findings suggest that patients with TLE and unilateral HS have low risk for post-operative impairment in memory indices regardless of the side of surgery.…”

Section: Discussionmentioning

confidence: 99%

Verbal Dominant Memory Impairment and Low Risk for Post-operative Memory Worsening in Both Left and Right Temporal Lobe Epilepsy Associated with Hippocampal Sclerosis

Khalil

Iwasaki

Nishio³

et al. 2016

Neurol. Med. Chir.(Tokyo)

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Post-operative memory changes after temporal lobe surgery have been established mainly by group analysis of cognitive outcome. This study investigated individual patient-based memory outcome in surgically-treated patients with mesial temporal lobe epilepsy (TLE). This study included 84 consecutive patients with intractable TLE caused by unilateral hippocampal sclerosis (HS) who underwent epilepsy surgery (47 females, 41 left [Lt] TLE). Memory functions were evaluated with the Wechsler Memory Scale-Revised before and at 1 year after surgery. Pre-operative memory function was classified into three patterns: verbal dominant memory impairment (Verb-D), visual dominant impairment (Vis-D), and no material-specific impairment. Post-operative changes in verbal and visual memory indices were classified into meaningful improvement, worsening, or no significant changes. Pre-operative patterns and post-operative changes in verbal and visual memory function were compared between the Lt and right (Rt) TLE groups. Pre-operatively, Verb-D was the most common type of impairment in both the Lt and Rt TLE groups (65.9 and 48.8%), and verbal memory indices were lower than visual memory indices, especially in the Lt compared with Rt TLE group. Vis-D was observed only in 11.6% of Rt and 7.3% of Lt TLE patients. Post-operatively, meaningful improvement of memory indices was observed in 23.3–36.6% of the patients, and the memory improvement was equivalent between Lt and Rt TLE groups and between verbal and visual materials. In conclusion, Verb-D is most commonly observed in patients with both the Lt and Rt TLE associated with HS. Hippocampectomy can improve memory indices in such patients regardless of the side of surgery and the function impaired.

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Section: Discussionmentioning

confidence: 99%

Verbal Dominant Memory Impairment and Low Risk for Post-operative Memory Worsening in Both Left and Right Temporal Lobe Epilepsy Associated with Hippocampal Sclerosis

Khalil

Iwasaki

Nishio³

et al. 2016

Neurol. Med. Chir.(Tokyo)

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“…Studies in patients with non tumor-related intractable epilepsy showed cognitive improvement (e.g., memory or verbal fluency) with adequate seizure control after temporal resections [10–16]. Less extensive resection of the mesiotemporal structures seems to correlate with better memory outcome compared with more extensive temporal lobectomy according to some groups [17–19], whereas others have reported conflicting observations [20–22].…”

Section: Introductionmentioning

confidence: 99%

Cognition and resective surgery for diffuse infiltrative glioma: an overview

2012

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Compared to classical oncological outcome measures such as time to progression and survival, the importance of cognitive functioning in patients with diffuse infiltrative brain tumors has only recently been recognized. Apart from the relatively low incidence and the invariably fatal outcome of gliomas, the general assumption that cognitive assessment is time-consuming and burdensome contributes to this notion. Our understanding of the effects of brain surgery on cognition, for instance, is largely based on studies in surgical patients with refractory epilepsy, with only a limited number of studies in surgical patients with gliomas. The impact of other factors affecting cognition in glioma patients such as direct tumor effects, radiotherapy and chemotherapy, and medical treatment, including anti-epileptic drugs and steroids, have been studied more extensively. The purpose of this paper is to provide an overview of cognition in patients with diffuse infiltrative gliomas and the impact of resective surgery as well as other tumor and treatment-related factors.

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“…For patients with medically intractable focal epilepsy, the best option for achieving seizure control is often surgical resection . However, the benefit of epilepsy surgery must be weighed against the risk of cognitive decline, which is commonly observed in the domains of language and long‐term memory . Conversely, postsurgical gains in executive domains such as attention and working memory can be observed .…”

mentioning

confidence: 99%

“…1 However, the benefit of epilepsy surgery must be weighed against the risk of cognitive decline, which is commonly observed in the domains of language and longterm memory. 2,3 Conversely, postsurgical gains in executive domains such as attention and working memory can be observed. 4 Clinical (e.g., epilepsy duration, presurgical cognitive level) and demographic (e.g., age) factors predict postsurgical cognitive outcomes.…”

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confidence: 99%

The corpus callosum and recovery of working memory after epilepsy surgery

et al. 2015

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SUMMARYObjective: For patients with medically intractable focal epilepsy, the benefit of epilepsy surgery must be weighed against the risk of cognitive decline. Clinical factors such as age and presurgical cognitive level partially predict cognitive outcome; yet, little is known about the role of cross-hemispheric white matter pathways in supporting postsurgical recovery of cognitive function. The purpose of this study is to determine whether the presurgical corpus callosum (CC) midsagittal area is associated with pre-to postsurgical change following epilepsy surgery. Methods: In this observational study, we retrospectively identified 24 adult patients from an epilepsy resection series who completed preoperative high-resolution T 1 -weighted magnetic resonance imaging (MRI) scans, as well as pre-and postsurgical neuropsychological testing. The total area and seven subregional areas of the CC were measured on the midsagittal MRI slice using an automated method. Standardized indices of auditory-verbal working memory and delayed memory were used to probe cognitive change from pre-to postsurgery. CC total and subregional areas were regressed on memory-change scores, after controlling for overall brain volume, age, presurgical memory scores, and duration of epilepsy. Results: Patients had significantly reduced CC area relative to healthy controls. We found a positive relationship between CC area and change in working memory, but not delayed memory; specifically, the larger the CC, the greater the postsurgical improvement in working memory (b = 0.523; p = 0.009). Effects were strongest in posterior CC subregions. There was no relationship between CC area and presurgical memory scores. Significance: Findings indicate that larger CC area, measured presurgically, is related to improvement in working memory abilities following epilepsy surgery. This suggests that transcallosal pathways may play an important, yet little understood, role in postsurgical recovery of cognitive functions.

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Changes in neuropsychological functioning following temporal lobectomy in patients with temporal lobe epilepsy

Cited by 22 publications

References 23 publications

Verbal Dominant Memory Impairment and Low Risk for Post-operative Memory Worsening in Both Left and Right Temporal Lobe Epilepsy Associated with Hippocampal Sclerosis

Verbal Dominant Memory Impairment and Low Risk for Post-operative Memory Worsening in Both Left and Right Temporal Lobe Epilepsy Associated with Hippocampal Sclerosis

Cognition and resective surgery for diffuse infiltrative glioma: an overview

The corpus callosum and recovery of working memory after epilepsy surgery

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