Pre- and post-operative Wisconsin card sorting test performance in patients with temporal lobe epilepsy due to hippocampal sclerosis

Abstract

Patients with temporal lobe epilepsy due to hippocampal sclerosis (TLE/HS) have a distinct neuropsychological profile, but there is still debate on whether executive dysfunction is part of this profile and also whether temporal lobe surgery can modify this dysfunction.ObjectiveTo study the presence and reversibility of executive dysfunction in patients with unilateral TLE/HS.MethodsTwenty-five patients with refractory seizures due to TLE/HS underwent presurgical evaluation which included the application of the Wiconsin Card Sorting Test (WCST). Nineteen were re-evaluated in follow up, at least 6 months after selective amygdalo-hippocampectomy (SAH). Twenty-two control subjects matched for age and education also performed the WCST.ResultsSixteen of the 25 patients (64%) completed fewer than four categories in the WCST whereas only 4 of the 22 controls (18%) did not complete at least four categories (p<0.005). In addition, the performance of the patients involved significantly more perseverative responses and errors compared to controls. The patient group demonstrated significant post-operative improvement in many measures of the WCST following SAH.ConclusionsThese findings support the presence of executive dysfunction in patients with TLE/HS and suggest that such dysfunction can be partially reversed by selective resection of epileptogenic mesial temporal structures.

Cognitive, Affective, and Feedback-Based Flexibility – Disentangling Shared and Different Aspects of Three Facets of Psychological Flexibility

“…Unlike the instructed task switches discussed so far, the flexible adaptation of behavior in naturalistic situations often requires the processing of dynamically changing feedback from the environment – an ability that is disturbed in many psychiatric (e.g., Tchanturia et al, 2012 ) and neurological (e.g., Tisser et al, 2007 ) populations. These problems in flexible behavioral adaptation are also often referred to as impairments in cognitive flexibility (e.g., Lange et al, 2016 ), and are in clinical populations commonly assessed with tasks like the Wisconsin Card Sorting Test (WCST; Heaton, 1981 ).…”

Memory and executive functioning outcomes of selective amygdalohippocampectomy in patients with hippocampal sclerosis: A preliminary study in a developing country

“…[4] e improved postoperative executive functioning of our SA cases in set-shifting and their stability in other aspects of executive functioning is not unprecedented. Several other previous studies have also reported enhanced [35,39,40,42] or stable [2,23] executive functioning following selective/ nonselective temporal lobe surgery. e executive dysfunction in MTLE has been attributed to the impaired function of the hippocampus and amygdala in memory retrieval and emotional processing, but also to the dynamic epileptiform abnormalities in temporofrontal networks, which may be regularized following temporal lobe surgery and lead to restored executive functioning.…”

“…e executive dysfunction in MTLE has been attributed to the impaired function of the hippocampus and amygdala in memory retrieval and emotional processing, but also to the dynamic epileptiform abnormalities in temporofrontal networks, which may be regularized following temporal lobe surgery and lead to restored executive functioning. [39] Although investigating this hypothesis requires further investigation, aberrant effective connectivity of epileptogenic zone with the executive control network has been observed in a functional imaging study on MTLE. [15] Improved executive functioning following temporal lobe surgery may also result from a decreased rate of seizures.…”

“…[15] Improved executive functioning following temporal lobe surgery may also result from a decreased rate of seizures. [39] For instance, in a study on patients undergoing anterior temporal lobectomy, postoperative executive functioning was significantly better in seizure-free patients. [23] Similarly, a study on patients undergoing SA showed that seizure outcome for patients with improved intelligence quotient is generally favorable.…”

Systematic Review of Cognitive Function in Euthymic Bipolar Disorder and Pre-Surgical Temporal Lobe Epilepsy

“…The number of studies where any executive function instrument was administered in TLE was only 4 (2 WCST, 2 COWAT) of 29 compared to 21 of 27 in BD-I. One study compared RTL, LTL and HC and showed that all patients were impaired on the WCST relative to HC ( 87 ). The number of studies where any verbal memory instrument was administered was 26 of 29 in TLE compared to 14 of 27 in BD-I.…”