Five-Year Neuropsychological Outcome after Stereotactic Radiofrequency Amygdalohippocampectomy for Mesial Temporal Lobe Epilepsy: Longitudinal Study

Abstract

Purpose: To assess the neuropsychological performance recoded over a period of 5 years after stereotactic radiofrequency amygdalohippocampectomy (SAHE) in the treatment of mesial temporal lobe epilepsy. Material and Methods: Thirty patients (mean age 38 years, 14 females/16 males) were included in this study. Twenty-one patients were treated on the left side, 9 on the right. Patients underwent neuropsychological evaluation by the Wechsler Adult Intelligence Scale-Revised and the Wechsler Memory Scale-Revised preoperatively and 5 years after SAHE. Results: Twenty-three (77%) patients were classified as Engel class I. At the group level, we found significant increases in all intelligence domains (Global, Visual, and Performance) by 19.1 (7.4), 15.8 (6.1), and 19.1 (7.9) points, respectively. Significant improvements were also detected in all memory measures (Global, Verbal, Visual, Attention/Concentration, Delayed Recall) by 19.4 (14.2), 16.9 (13.3), 19.0 (14.7), 15.3 (15.0), and 24.6 (13.4), respectively. Patients with left-sided surgery improved significantly more in Attention/Concentration. Otherwise, there were no statistically significant differences in memory function improvements between subgroups according to the operated side. Conclusion: After SAHE, we found favorable long-term neuropsychological outcomes. These results could be caused by incomplete destruction of target structures and minimization of collateral damage that possibly enables adaptive postoperative neuronal reorganization.

Comparison between simultaneously acquired arterial spin labeling and 18F-FDG PET in mesial temporal lobe epilepsy assisted by a PET/MR system and SEEG

“…In our 12 patients, SEEG was used not only for better localization of SOZ in patients with MTLE, but also for the RFTC approach as a further treatment for epilepsy. We found that seizures were mostly well controlled after RFTC (Engel I: 75% of patients), which was similar to the findings of previous studies ( Kramska et al, 2017 ; Malikova et al, 2014 ). The invasive EEG results and middle-term surgical outcomes were used as the gold standards to confirm the diagnosis and localization of MTLE.…”

Alterations Functional Connectivity in Temporal Lobe Epilepsy and Their Relationships With Cognitive Function: A Longitudinal Resting-State fMRI Study

“…In agreement with other results, a study of TLE patients over a 13 year period also showed no significant change in cognitive function ( 36 ). In addition, Helmstaedter and Elger ( 37 ) and Krámská et al ( 38 ) revealed, based on their longitudinal-sectional study of declarative cognitive functioning in chronic refractory partial epilepsy, that there was no deterioration in neuropsychological performance after a long period of epilepsy. The ANT scores are remarkably stable, with only a decline the orientation effect over time in our results.…”

A Systematic Review of Minimally Invasive Procedures for Mesial Temporal Lobe Epilepsy: Too Minimal, Too Fast?

“…24,26,28,47,48,57 Improved neurocognitive outcomes, however, could be offset by reductions in seizure freedom; thus, further evaluation of surgical targets is needed to optimize seizure and neuropsychological outcomes. 19,47,48,59 Future studies should consider more comprehensive testing, standardized metrics, and longer follow-up periods paired with QoL assessments to observe potential long-term impacts of cognitive impairment on individuals' lives.…”