Cognitive Outcomes in Patients with Chronic Temporal Lobe Epilepsy

Abstract

Cognitive impairment is frequent in temporal lobe epilepsy (TLE). In particular, specific deficits in temporal lobe related functions occur, but deficits in extratemporal lobe functions and global intelligence are also found. The degree and type of the impairment are first determined by structural damage and functionally dynamic factors. Most cognitive problems in TLE are already detectable at, or even before, the onset of the epilepsy. Accumulation of damage during the course of chronic epilepsy may add to this. This additional damage may be caused directly by severe seizures, head trauma, intoxication etc., or indirectly by interference of the epilepsy with mental development. Surgical treatment of TLE may also affect the cognitive outcome of patients with chronic TLE, with a risk of additional impairments on the one hand and functional recovery due to seizure control on the other hand. With regard to patient-associated factors, better baseline performance, younger age, cerebral plasticity, and good mental reserve capacities are associated with a better outcome. With regard to treatment-associated factors, prevention of additional brain dysfunction/damage and successful seizure control are important.

Altered Phase Precession and Compression of Temporal Sequences by Place Cells in Epileptic Rats

“…As in our rat model, MTLE is often precipitated by SE (Cossart et al, 2001). Although cognitive impairment may be progressive in some patients with MTLE that have poorly controlled epilepsy (Hermann et al, 2006), much of the cognitive impairment is a result of the initial insult (Elger et al, 2004;Helmstaedter and Kockelmann, 2006). Similar to the impairment found in the rats in spatial memory in the water maze, humans with medial temporal lobe epilepsy demonstrate impairment in navigation in a virtual reality maze (Weniger and Irle, 2006).…”

Impact of epilepsy surgery on development of preschool children: identification of a cohort likely to benefit from early intervention

“…This finding is consistent with the literature that shows that ongoing refractory seizures are associated with poorer cognitive outcome. 5,9,24 In contrast, the patients with short duration of seizures prior to resection had better outcomes, with more postsurgical improvement. These findings argue for earlier resection in the context of lesion-associated seizures to preserve cognitive functions.…”

Equal but Different? MRI-Guided Stereotactic Laser Amygdalohippocampectomy and Traditional Temporal Lobe Surgery

“…It took many studies and patients to demonstrate that a larger resection is likely associated with a slightly better outcome but is also accompanied by greater neuropsychological and psychiatric risk (10). The discussion is ongoing, and reported differences were certainly not as striking as reported in the Drane et al study (11).…”

“…The discussion is ongoing, and reported differences were certainly not as striking as reported in the Drane et al study (11). Individualized approaches and procedures have been suggested (10). Magnetic resonance imaging-guided SLAH could be one of the individualized approaches.…”

“…The discussion about improved neuropsychological outcomes with similar seizure outcomes is reminiscent of past discussions on whether a selective amygdalohippocampectomy is more advantageous than a complete temporal lobectomy (10). It took many studies and patients to demonstrate that a larger resection is likely associated with a slightly better outcome but is also accompanied by greater neuropsychological and psychiatric risk (10).…”