Quantitative MRI of the prefrontal cortex and executive function in patients with temporal lobe epilepsy.

We investigated the relationship between prefrontal cortex (PFC) and hippocampal volume and executive functioning in patients with temporal lobe epilepsy (TLE). Prefrontal volume and hippocampal volume were studied using stereology in conjunction with point counting and voxel-based morphometry on MR images. Executive functioning was assessed using tests routinely incorporated into presurgical neuropsychological evaluation. Relative to 30 healthy controls, 43 patients (26 left, 17 right) with TLE had volume atrophy of the ipsilateral hippocampus and bilateral dorsal PFC. Performance on the working memory index of the Wechsler Memory Scale was positively correlated with the volume of all prefrontal regions, and the Controlled Oral Word Association Test with the left dorsal PFC, whole left PFC, and left hippocampus. Stroop Color-Word Interference performance was not related to volume of dorsal PFC. The "extratemporal neuropsychological profile" frequently observed in patients with TLE may be due to extended damage to brain regions remote from the epileptogenic focus. In particular, volume atrophy of the dorsal PFC may account for deficits in executive functioning.