Günay Gül1, Demet Yandim Kuşcu2, Mesude Özerden1, Melek Kandemir3, Fulya Eren1, Bekir Tuğcu4, Cahit Keskinkiliç5, Nalan Kayrak6, Dursun Kirbaş7. 1. Clinic of 3 Neurology, Bakırköy Psychiatric and Neurological Diseases Training and Research Hospital, İstanbul, Turkey. 2. Department of Neurology, MedAmerican Policlinics, İstanbul, Turkey. 3. Clinic of of Neurology, Bayındır Hospital, İstanbul, Turkey. 4. Clinic of Neurosurgery, Bakırköy Psychiatric and Neurological Diseases Training and Research Hospital, İstanbul, Turkey. 5. Neuropsychology Laboratory, Bakırköy Psychiatric and Neurological Diseases Training and Research Hospital, İstanbul, Turkey. 6. Department of Neurology, Private Practice, İstanbul, Turkey. 7. Department of Neurology, İstanbul University Institute of Forensic Medicine, İstanbul, Turkey.
Abstract
INTRODUCTION: The aim of the present study was to evaluate the neuropsychological outcomes of patients with medically intractable unilateral mesial temporal lobe epilepsy (MTLE) due to hippocampal sclerosis (HS) treated either by anterior temporal lobectomy (ATL) or selective amygdalohippocampectomy (SAH). METHODS: This was a retrospective study where 67 patients who had undergone surgery for MTLE were evaluated. Thirty-two patients underwent ATL and 35 underwent SAH. All patients underwent a detailed neuropsychological evaluation before and 1 year after surgery. RESULTS: The verbal memory outcome was unchanged after left-sided surgery, whereas learning capacity increased after right-sided surgery (p=0.038). The visual memory outcome improved after right-sided surgery. Improvement of executive functions, particularly in the resistance of interference pattern in the Stroop Test, shortened 5th card time (p=0.000), and decreased corrections (p=0.003), after right-sided surgery and increased attention (p=0.027) after left-sided surgery were observed. After both surgery types, although statistically insignificant, there was a marked decrease in incorrect answers in the Stroop Test, which also showed an improvement in the resistance of interference pattern. Moreover, there was a significant decrease in switching errors with word pairs in the Verbal Fluency Test (p=0.008) after right-sided surgery. When the two sides were compared, we observed that the recall phase of the verbal memory worsened (p=0.018); however, the recognition phase improved (p=0.015) after left-sided surgery. Additionally, the short-term visual memory was better for both sides (p=0.035). CONCLUSION: Our results showed that patients with left MTLE were not worsened in verbal memory, but despite improved recognition, they have some problems in recalling information and only a minor improvement in attention. Patients with right MTLE improved in their verbal learning capacity, visual memory, and resistance of interference pattern 1 year after surgery. It was thus shown that while epilepsy surgery is associated with some negative cognitive changes, it may also improve some cognitive functions.
INTRODUCTION: The aim of the present study was to evaluate the neuropsychological outcomes of patients with medically intractable unilateral mesial temporal lobe epilepsy (MTLE) due to hippocampal sclerosis (HS) treated either by anterior temporal lobectomy (ATL) or selective amygdalohippocampectomy (SAH). METHODS: This was a retrospective study where 67 patients who had undergone surgery for MTLE were evaluated. Thirty-two patients underwent ATL and 35 underwent SAH. All patients underwent a detailed neuropsychological evaluation before and 1 year after surgery. RESULTS: The verbal memory outcome was unchanged after left-sided surgery, whereas learning capacity increased after right-sided surgery (p=0.038). The visual memory outcome improved after right-sided surgery. Improvement of executive functions, particularly in the resistance of interference pattern in the Stroop Test, shortened 5th card time (p=0.000), and decreased corrections (p=0.003), after right-sided surgery and increased attention (p=0.027) after left-sided surgery were observed. After both surgery types, although statistically insignificant, there was a marked decrease in incorrect answers in the Stroop Test, which also showed an improvement in the resistance of interference pattern. Moreover, there was a significant decrease in switching errors with word pairs in the Verbal Fluency Test (p=0.008) after right-sided surgery. When the two sides were compared, we observed that the recall phase of the verbal memory worsened (p=0.018); however, the recognition phase improved (p=0.015) after left-sided surgery. Additionally, the short-term visual memory was better for both sides (p=0.035). CONCLUSION: Our results showed that patients with left MTLE were not worsened in verbal memory, but despite improved recognition, they have some problems in recalling information and only a minor improvement in attention. Patients with right MTLE improved in their verbal learning capacity, visual memory, and resistance of interference pattern 1 year after surgery. It was thus shown that while epilepsy surgery is associated with some negative cognitive changes, it may also improve some cognitive functions.
Authors: R C Martin; S M Sawrie; R Edwards; D L Roth; E Faught; R I Kuzniecky; R B Morawetz; F G Gilliam Journal: Neuropsychology Date: 2000-10 Impact factor: 3.295
Authors: Silvia B Bonelli; Robert H W Powell; Mahinda Yogarajah; Rebecca S Samson; Mark R Symms; Pamela J Thompson; Matthias J Koepp; John S Duncan Journal: Brain Date: 2010-02-15 Impact factor: 13.501
Authors: Jerome Engel; Samuel Wiebe; Jacqueline French; Michael Sperling; Peter Williamson; Dennis Spencer; Robert Gumnit; Catherine Zahn; Edward Westbrook; Bruce Enos Journal: Epilepsia Date: 2003-06 Impact factor: 5.864