The Neuropsychological Outcomes of Surgery for Drug-Resistant Temporal Lobe Epilepsy and Underlying Pathologies
Objective: With the ongoing debate on the superiority of either anterior temporal lobec- tomy or selective amygdalohippocampectomy, this study aims at making recommen- dations in terms of neuropsychological- and quality of life outcomes. Furthermore, it intends to add to pre-surgical risk-benefit ev...
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|Objective: With the ongoing debate on the superiority of either anterior temporal lobec- tomy or selective amygdalohippocampectomy, this study aims at making recommen- dations in terms of neuropsychological- and quality of life outcomes. Furthermore, it intends to add to pre-surgical risk-benefit evaluations by analyzing the underlying epileptogenic pathologies.
Methods: One hundred and seventy-four patients from the Epilepsy Center Hessen, who were seen between 2001 and 2018, were retrospectively included in this study. One hundred and fourteen of them were part of the cohort comparing the types of surgery; 160 were diagnosed with hippocampal sclerosis or other temporal pathologies. Neu- ropsychological testing was performed pre-surgically as well as six months, one year, two years, and five years after surgery. The parameters considered were verbal me- mory and fluency for surgery in the dominant hemisphere and figural memory and visuospatial functioning for resection on the non-dominant side. Mood and quality of life were analyzed without differentiation of sides.
Results: Patients showed better performance changes after selective amygdalohippo- campectomy than after anterior temporal lobectomy on the dominant side. The diffe- rences were, however, often just observed in descriptive statistics and not always si- gnificant. Neither surgery was superior concerning the properties of the non-domi- nant temporal lobe or in terms of mood and quality of life. Patients with hippocampal sclerosis showed a greater profit from dominant-sided resections than individuals with other pathologies. Pre-surgically, hippocampal sclerosis led to a significantly worse verbal memory, in particular, if patients were older. In the non-dominant hemi- sphere, neither pathology benefited significantly from surgery. Mood improved more among patients with hippocampal sclerosis than those with other pathologies.
Conclusion: While the extent and location of lesions, as well as seizure outcome, must also always be considered, in respect of neuropsychological outcomes, selective amygdalohippocampectomy should be the surgery of choice for patients with mesial temporal lobe epilepsy in the speech-dominant hemisphere. Patients with hippocam- pal sclerosis in this hemisphere can expect a greater profit from surgery than those with other pathologies. On the side opposite to speech dominance, neither type of surgery or seizure etiology is superior regarding neuropsychological outcomes.