4.4 Article

Consequences of mesial temporal sparing temporal lobe surgery in medically refractory epilepsy

Journal

EPILEPSY & BEHAVIOR
Volume 115, Issue -, Pages -

Publisher

ACADEMIC PRESS INC ELSEVIER SCIENCE
DOI: 10.1016/j.yebeh.2020.107642

Keywords

Hippocampal sparing anterior temporal lobectomy; Verbal memory; Employment; Disability

Funding

  1. NINDS NIH HHS [R01 NS112816] Funding Source: Medline

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This study compared long-term seizure, neuropsychological, and occupational outcomes of anterior temporal lobectomy (ATL) with and without sparing of mesial structures. Sparing mesial structures did not reduce the chance of stopping seizures but mitigated postoperative verbal memory impairment. Both surgical approaches showed similar occupational outcomes.
Objective: We compared long-term seizure outcome, neuropsychological outcome, and occupational outcome of anterior temporal lobectomy (ATL) with and without sparing of mesial structures to determine whether mesial sparing temporal lobectomy prevents memory decline and thus disability, with acceptable seizure outcome. Methods: We studied patients (n = 21) and controls (n = 21) with no evidence of mesial temporal sclerosis (MTS) on MRI who had surgery to treat drug-resistant epilepsy. Demographic and pre- and postsurgical clinical characteristics were compared. Patients had neuropsychological assessment before and after surgery. Neuropsychological analyses were limited to patients with left-sided surgery and available data (n = 14 in each group) as they were at risk of verbal memory impairment. The California Verbal Learning Test II (CVLT-II) (sum of trials 1-5, delayed free recall) and the Logical Memory subtest of the Wechsler Memory Scale III or IV (WMS-III or WMS-IV) (learning and delayed recall of prose passages) were used to assess verbal episodic learning and memory. Seizure and occupational outcomes were assessed. Results: The chance of attaining seizure freedom was similar in the two groups, so sparing mesial temporal structures did not lessen the chance of stopping seizures. Sparing mesial temporal structures mitigated the extent of postoperative verbal memory impairment, though some of these individuals suffered decline as a consequence of surgery. Occupational outcome was similar in both groups. Significance: Mesial temporal sparing resections provide a similar seizure outcome as ATL, while producing a better memory outcome. Anterior temporal lobectomy including mesial structure resection did not increase the risk of postoperative disability. Published by Elsevier Inc.

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