Carla Pauli1, Maria Emilia Rodrigues de Oliveira Thais2, Ricardo Guarnieri3, Marcelo Liborio Schwarzbold4, Alexandre Paim Diaz3, Juliana Ben5, Marcelo Neves Linhares6, Hans Joachim Markowitsch7, Peter Wolf8, Samuel Wiebe9, Katia Lin10, Roger Walz11. 1. Serviço de Neurocirurgia, Hospital Governador Celso Ramos, Florianópolis, SC, Brazil; Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil. 2. Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil. 3. Serviço de Neurocirurgia, Hospital Governador Celso Ramos, Florianópolis, SC, Brazil; Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Serviço de Psiquiatria, Departamento de Clínica Médica, HU-UFSC, Florianópolis, SC, Brazil. 4. Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Serviço de Psiquiatria, Departamento de Clínica Médica, HU-UFSC, Florianópolis, SC, Brazil. 5. Serviço de Neurocirurgia, Hospital Governador Celso Ramos, Florianópolis, SC, Brazil. 6. Serviço de Neurocirurgia, Hospital Governador Celso Ramos, Florianópolis, SC, Brazil; Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Departamento de Cirurgia, Serviço de Neurocirurgia, HU-UFSC, Florianópolis, SC, Brazil; Centro de Epilepsia de Santa Catarina (CEPESC), HU-UFSC, Florianópolis, SC, Brazil. 7. Physiological Psychology, University of Bielefeld, Bielefeld, Germany. 8. Serviço de Neurologia, Departamento de Clínica Médica, HU-UFSC, Florianópolis, SC, Brazil; Centro de Epilepsia de Santa Catarina (CEPESC), HU-UFSC, Florianópolis, SC, Brazil; Danish Epilepsy Centre, Dianalund, Denmark. 9. Department of Clinical Neurosciences, University of Calgary, Canada. 10. Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Serviço de Neurologia, Departamento de Clínica Médica, HU-UFSC, Florianópolis, SC, Brazil; Centro de Epilepsia de Santa Catarina (CEPESC), HU-UFSC, Florianópolis, SC, Brazil. 11. Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Serviço de Neurologia, Departamento de Clínica Médica, HU-UFSC, Florianópolis, SC, Brazil; Centro de Epilepsia de Santa Catarina (CEPESC), HU-UFSC, Florianópolis, SC, Brazil. Electronic address: rogerwalz@hotmail.com.
Abstract
PURPOSE: The purpose of this study was to investigate the following: i) the objective impairment in neuropsychological tests that were associated with the subjective perception of cognitive function decline in Brazilian patients who underwent mesial temporal lobe epilepsy (MTLE) surgery and ii) the predictive variables for those impaired objective neuropsychological tests. METHODS: Forty-eight adults with MTLE (27 right HS and 23 male) were divided according to their perception of changes (Decline or No-decline) of cognitive function domain of the QOLIE-31 questionnaire applied before and 1year after the ATL. The mean (SD) of changes in the raw score difference of the neuropsychological tests before and after the ATL was compared between Decline and No-decline groups. Receiver Operating Characteristic curves, sensitivity, specificity, and predictive values were used to assess the optimum cutoff points of neuropsychological test score changes to predict patient-reported subjective cognitive decline. KEY FINDINGS: Six (12.5%) patients reported a perception of cognitive function decline after ATL. Among the 25 cognitive tests analyzed, only changes in the Boston Naming Test (BNT) were associated with subjective cognitive decline reported by patients. A reduction of ≥8 points in the raw score of BNT after surgery had 91% of sensitivity and 45% specificity for predicting subjective perception of cognitive function decline by the patient. Left side surgery and age older than 40years were more associated with an important BNT reduction with overall accuracy of 91.7%, 95% predictive ability for no impairment, and 75% for impairment of cognitive function. SIGNIFICANCE: Impairment in word-finding seems to be the objective cognitive finding most relevant to Brazilian patients after mesial temporal lobe epilepsy surgery. Similar to American patients, the side of surgery and age are good predictors for no decline in the BNT, but shows a lower accuracy to predict its decline. If replicated in other populations, the results may have wider implications for the surgical management of patients with drug-resistant MTLE.
PURPOSE: The purpose of this study was to investigate the following: i) the objective impairment in neuropsychological tests that were associated with the subjective perception of cognitive function decline in Brazilian patients who underwent mesial temporal lobe epilepsy (MTLE) surgery and ii) the predictive variables for those impaired objective neuropsychological tests. METHODS: Forty-eight adults with MTLE (27 right HS and 23 male) were divided according to their perception of changes (Decline or No-decline) of cognitive function domain of the QOLIE-31 questionnaire applied before and 1year after the ATL. The mean (SD) of changes in the raw score difference of the neuropsychological tests before and after the ATL was compared between Decline and No-decline groups. Receiver Operating Characteristic curves, sensitivity, specificity, and predictive values were used to assess the optimum cutoff points of neuropsychological test score changes to predict patient-reported subjective cognitive decline. KEY FINDINGS: Six (12.5%) patients reported a perception of cognitive function decline after ATL. Among the 25 cognitive tests analyzed, only changes in the Boston Naming Test (BNT) were associated with subjective cognitive decline reported by patients. A reduction of ≥8 points in the raw score of BNT after surgery had 91% of sensitivity and 45% specificity for predicting subjective perception of cognitive function decline by the patient. Left side surgery and age older than 40years were more associated with an important BNT reduction with overall accuracy of 91.7%, 95% predictive ability for no impairment, and 75% for impairment of cognitive function. SIGNIFICANCE: Impairment in word-finding seems to be the objective cognitive finding most relevant to Brazilian patients after mesial temporal lobe epilepsy surgery. Similar to American patients, the side of surgery and age are good predictors for no decline in the BNT, but shows a lower accuracy to predict its decline. If replicated in other populations, the results may have wider implications for the surgical management of patients with drug-resistant MTLE.
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