Long-Term Neuropsychological Outcomes Following Temporal Lobe Epilepsy Surgery: An Update of the Literature
Abstract
:1. Introduction
2. Methods
2.1. Data Sources
2.2. Study Selection and Classification
- Reports of >20 patients with a medical history of drug-resistant temporal lobe epilepsy (TLE), undergoing resective surgery;
- Patients older than 16 years old;
- A mean/median >5 years post-surgery follow-up;
- Outcomes explored included long-term postoperative neuropsychological data and possible associated predictive factors (Figure 1).
3. Results
4. Discussion
Models of Cognitive and Memory Prognosis Following Surgery
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Conflicts of Interest
References
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Scheme | Mean Follow-Up Years | Type of Surgery and N Sample Used | Population and Type of Study | Controlled Study | Neuropsychological Outcome |
---|---|---|---|---|---|
Helmstaedter, 2003 | 5 | Temporal (N 147) Medical (N 102) | Adults prospective | Yes medical versus surgery | This was greater after a left temporal lobectomy or if seizures continued postoperatively. Seizure-free surgical patients showed a recovery of memory function. Intelligence: No significant changes were seen in either group |
Rausch, 2003 | 12.8 | Temporal (N 44) Medical (N 8) | Adults prospective | Yes medical versus surgery | Memory: Patients with LTL surgery showed selective early decreases in verbal memory. At the long-term follow-up, further decreases in verbal memory and visual memory scores were seen for all patient groups. The nonmemory scores remained stable over time. |
Alpherts, 2004 | 6 | Temporal (N 71) | Adults prospective | No | Intelligence: Right or left surgery did not affect intelligence |
Paglioli, 2004 | 5.4 | Temporal (N 65) | Adults prospective | No | Memory: Left side surgery: Of 38 patients, worsening occurred in logical memory in 5 (13%) and in verbal learning in 10 (26%). Right side surgery: Of 27 patients, worsening occurred in logical memory in one (4%), in verbal learning in three (11%), and in visual memory in 6 (22%). |
Alpherts, 2006 | 6 | Temporal (N 85) | Adults prospective | No | Memory: LTL patients showed an ongoing memory decline for consolidation and acquisition of verbal material for up to 2 years after surgery. RTL patients at first showed a gain in both memory acquisition and consolidation, which vanished in the long term. The group with pure MTS showed an overall lower verbal memory performance than the group without pure MTS (mesiotemporal sclerosis). A dynamic decline of verbal memory functions up to 2 years after left temporal lobectomy, which then levels off. |
Engman, 2006 | 9.8 | Temporal (N 25) Control group (N 25) | Adults prospective | Yes control group versus surgery | Memory: No signs of accelerated cognitive aging after 10 years in a majority of the patients. Those who were seizure-free at long-term follow-up had a significantly higher intelligence score than patients who were still having seizures |
Andersson-Roswall, 2010 | 10 | Temporal (N 51) | Adults prospective | No | Memory: Decline was detected already 2 years postoperatively, with no further decline from 2 to 10 years. The memory decline was not related to seizure outcome or AED treatment. |
Baxendale, 2012 | 9.1 | Temporal (N 71) | Adults prospective | No | Intelligence: No difference on intellectual function after surgery. Memory: Verbal learning LTL (Left temporal lobe) performed more poorly than the RTL (rlght temporal lobe). Visual learning: Patients who were seizure free at T4 demonstrated a significant improvement in visual learning. Patients who were not seizure free at the long term follow up had experienced a decline in visual learning. Those who were not stable both in verbal and visual memory had more post-operative seizures. Significant role of poor postoperative seizure control in progressive memory impairment suggesting cumulative effect of seizures on memory |
Salvato, 2016 | 5 | Temporal (N 151) | Adults retrospective | No | Memory: Patients with LTLE worsened in the immediate postsurgical period, their performance progressively improved, and at 5 years after surgery, it returned to be equal to the baseline. Shorter duration of epilepsy, younger age, and withdrawal of AED would predict a better memory outcome |
Manton, 2017 | 8.7 | Temporal (N 389) | Adults prospective | No | Worsening of cognitive function: Histology ILAE type 2/Preoperative verbal memory deficit/Surgical approach: ATL/Preoperative high seizure frequency/Advanced age at surgery/Surgery on left side/Postoperative major complications/Postoperative depression. |
Helmstaedter, 2018 | Temporal (N 161) Medical (N 208) | Adults retrospective | Yes surgery group versus medical group | Memory: In the operated group about 9% demonstrated significant losses in verbal memory, figural memory, or executive functions over the T2-T3 interval. In the nonoperated group 10%, 17%, and 6% showed a decline in verbal memory, figural memory, or executive functions between T1 and T3. 5–22 years after surgery, and compared to baseline, only 17% of those who had undergone left and 10% of those who had right temporal lobe surgery showed losses in verbal memory when they were seizure free, as compared to 37% of patients after left and 20% after right temporal lobe surgery if their seizures continued. |
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Alexandratou, I.; Patrikelis, P.; Messinis, L.; Alexoudi, A.; Verentzioti, A.; Stefanatou, M.; Nasios, G.; Panagiotopoulos, V.; Gatzonis, S. Long-Term Neuropsychological Outcomes Following Temporal Lobe Epilepsy Surgery: An Update of the Literature. Healthcare 2021, 9, 1156. https://doi.org/10.3390/healthcare9091156
Alexandratou I, Patrikelis P, Messinis L, Alexoudi A, Verentzioti A, Stefanatou M, Nasios G, Panagiotopoulos V, Gatzonis S. Long-Term Neuropsychological Outcomes Following Temporal Lobe Epilepsy Surgery: An Update of the Literature. Healthcare. 2021; 9(9):1156. https://doi.org/10.3390/healthcare9091156
Chicago/Turabian StyleAlexandratou, Ioanna, Panayiotis Patrikelis, Lambros Messinis, Athanasia Alexoudi, Anastasia Verentzioti, Maria Stefanatou, Grigorios Nasios, Vasileios Panagiotopoulos, and Stylianos Gatzonis. 2021. "Long-Term Neuropsychological Outcomes Following Temporal Lobe Epilepsy Surgery: An Update of the Literature" Healthcare 9, no. 9: 1156. https://doi.org/10.3390/healthcare9091156