Neuropsychological Changes After Surgical Treatment for Temporal Lobe Epilepsy

Abstract

Summary: Purpose: The effect of unilateral temporal lobectomy on seizure frequency is well recognized, but little is known about the neuropsychological changes that occur after surgical treatment. We assessed neuropsychological status in 26 patients with an average age of 35 years before and after unilateral temporal lobectomy for medically intractable TLE. Methods: Neuropsychological examination to assess cognitive function, memory, attention, visuospatial analysis, language, and emotional functions was performed preoperatively and at 1 month and 1 year after the surgery. Results: At both 1 month and 1 year after the surgery, the patients had improved scores, compared with the preoperative scores, on the Wechsler Adult Intelligence Scale–Revised (WAIS‐R: verbal IQ, performance IQ, and full‐scale IQ), Wechsler Memory Scale–Revised (WMS‐R: verbal, general, and delayed paired associates memory), and Raven Colored Progressive Matrices. In the Minnesota Multiphasic Personality Inventory (MMPI), significant decreases were observed at 1 year after the surgery in the scores for infrequency, hypochondriasis, psychasthenia, and schizophrenia. Patients in whom the seizures had been relieved postoperatively also had improved scores on the WAIS‐R, WMS‐R, and Raven Colored Progressive Matrices. Conclusions: These data suggest that neuropsychological improvement postoperatively is influenced by the reduction in the frequency of seizures after surgery.

Subtemporal Hippocampectomy Preserving the Basal Temporal Language Area for Intractable Mesial Temporal Lobe Epilepsy: Preliminary Results

“…A comparative trial that examines the outcomes of anterior temporal lobectomy against selective temporal resections for both epilepsy and nonepilepsy patients should be considered. As some patients have postoperative improvements in cognitive function after surgeries using the lateral approach or transsylvian approach (23,31), other factors besides the BTLA contribute to postoperative improvement in verbal memory. Preservation of part of the amygdaloid body and fiber tract, such as the anterior temporal stem, as well as trajectories of cholinergic pathways from the nucleus basalis of Meynert and uncal fiber, may also lead to better neuropsychological outcomes.…”

“…It is controversial whether seizure control is correlated with postoperative verbal memory (31) or not (22). Sparing the BTLA preserves this memory function but does not improve it.…”

“…Because no parallel versions of the WMS‐R exist, retest effects on the results also should be a concern. One report describes improvement of verbal memory scores in WMS‐R after anterior temporal lobectomy without preserving the BTLA (31), although patients included individuals operated on by both left‐ and right‐sided anterior temporal lobectomy and a temporolateral lesionectomy. Others (2,35) have reported a decline of verbal memory after left temporal lobectomy.…”

Neuropsychology of the temporal lobe: Luria's and contemporary conceptions

“…According to Luria's theories, after a cortical lesion in the brain, the brain can compensate by distributing the specific function to other areas,1 , 2 particularly in children,11 as observed elsewhere 42. Potentially corroborating data may be, for example, which type of surgery for temporal lobe epilepsy improves neuropsychological test scores for the same patients, particularly those experiencing a reduction in seizures 51…”

Effect of Long-Term Treatment with Vagus Nerve Stimulation on Mood and Quality of Life in Korean Patients with Drug-Resistant Epilepsy

“… 12 In contrast, other VNS studies found no significant changes in depression, whereas significant improvements were observed on anxiety scales or QOL after VNS implantation. 13 14 While many studies have investigated the QOL in epilepsy patients who underwent resective surgery, 15 16 17 18 only a few studies have evaluated QOL changes in patients receiving VNS treatment. 14 19 20 21 Two studies found significant improvements in QOL at follow-ups after 12 months in 19 patients 20 and 3–12 months in 56 patients.…”