Very long-term outcome in resected and non-resected patients with temporal lobe epilepsy with medial temporal lobe sclerosis: A multiple case-study

Abstract

A B S T R A C TPurpose: To investigate the very long-term (i.e., ≥15 years) seizure, cognitive and psycho-social outcomes in resected patients (RP) with TLE compared to control patients not having undergone epilepsy surgery. Methods: We applied a multiple case-study design including three non-resected patients (NRP) who were compared to a group of six RP. The latter were matched to the NRP according to clinical-demographic data. Outcome measures were various seizure, cognitive, and psycho-social variables. Results: Patients were 56-72 years old. Seizure and AED outcome was more favourable among RP. RP reported better self-perceived overall health but higher subjective memory complaints. Upon formal neuropsychological testing, RP presented with lower verbal memory scores. Very long-term memory decline was evident in left-sided RP with good baseline memory scores, while RP with lower baseline performance, right-sided RP and NRP remained stable. Seizure-freedom had remarkable effects on the relationship between objective and subjective outcome: seizure-free patients, in general, subjectively reported the best psychosocial and cognitive outcomeirrespective of neuropsychological test results. Conclusion: Our study suggests positive effects of TLE surgery in the very long-term course of ≥15 years postoperatively. Long-term seizure-freedom appears to have the strongest impact on patients' subjectively perceived psycho-social and cognitive outcome and may even outweigh actual memory disturbances and/or decline. Overall, our data do not support the assumption of a generally accelerated cognitive decline in patients with TLE.

Theory of Mind and Empathy in Adults With Epilepsy: A Meta-Analysis

“…Subsequently, 62 full text papers were reviewed. Thirty-four of the 62 studies were excluded for the following reasons: the sample size was under 10 ( K = 1) ( 70 ), the sample was mixed and included patients with epilepsy and other diseases ( K = 1) ( 71 ); patients with different sites of the epileptogenic focus were grouped together ( K = 1) ( 25 ); the samples overlapped with those of other studies ( K = 4) ( 52 , 72 – 74 ); the study did not include an HC group ( K = 5) ( 75 – 79 ); data were insufficient to calculate the effect sizes and standard errors of ToM or empathy ( K = 6) ( 80 – 85 ); and the study population included children or adolescents ( K = 16) ( 51 , 53 , 55 , 59 , 86 – 97 ). Eventually, 28 studies were included in the meta-analysis ( Table 1 ) ( 54 , 56 – 58 , 98 – 121 ).…”

Epilepsy: Workup and Management in Adults

“…76 Cognition and memory deficits are not contraindications for epilepsy surgery. Verbal and visual memories are known to decline in dominant temporal lobectomies; however, paradoxical gains in verbal and visuospatial 77 Temporal lobe epilepsy that has been poorly controlled for many years also leads to a decline in memory, 78 and delay in surgery can affect the postoperative outcome in terms of lower seizure freedom. 79 A lesion on MRI is not necessary amenable to surgical resection, although outcomes tend to be better in lesional epilepsies.…”

Men with adult-onset epilepsy: Their experiences of health care provider relationship qualities following neurosurgery

“…Health professionals' consultative relationships should ensure that the individual understands all aspects of his health condition, post-surgery care, and support. The sharing of findings is necessary to provide realistic scoping of a patient's short-and long-term health management after surgery, since full adaptation to the surgery's effects and results may not be instant and instead take several years (Coleman et al, 2019;Grewe et al, 2019;Jobst, 2015;Kemp et al, 2016). Communication between rehabilitation team members, including a clinician, psychologist, and social worker, may also assist in focusing on the attainment of practical everyday goals to resume a full social life (Lee & Emanuel, 2013;Pickrell et al, 2015;Wilson et al, 2020).…”