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Consequences of mesial temporal sparing temporal lobe surgery in medically refractory epilepsy
Journal article   Open access   Peer reviewed

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

Lilach Goldstein, Mitra Dehghan Harati, Kathryn Devlin, Joseph Tracy, Maromi Nei, Christopher Skidmore, Caio M. Matias, Ashwini D. Sharan, Chengyuan Wu, Scott Mintzer, …
Epilepsy & behavior, v 115, 107642
01 Feb 2021
DOI: https://doi.org/10.1016/j.yebeh.2020.107642
PMID: 33360404
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9940265View
Accepted (AM)Open Access (License Unspecified),  Open

Abstract

Disability Employment Hippocampal sparing anterior temporal lobectomy Verbal memory
•Anterior temporal lobectomy (ATL) was compared to mesial temporal sparing resection.•Long term seizure freedom rates were similar.•Verbal memory declined less following mesial temporal sparing resection.•Loss of employment after surgery was comparable in the two groups.•The greater decline in memory did not confer a greater risk of becoming disabled. 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. 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. 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. 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.

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Web of Science research areas
Behavioral Sciences
Clinical Neurology
Psychiatry
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