Neuropsychological Characteristics of the Syndrome of Mesial Temporal Lobe Epilepsy

Hermann, Bruce P.; Seidenberg, Michael; Schoenfeld, Jen; Davies, Keith G.

doi:10.1001/archneur.1997.00550160019010

Cited by 422 publications

(312 citation statements)

References 40 publications

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“…The clinical relevance of these findings, at this point, can only be speculative. Nevertheless, it is widely known that patients with L‐MTLE have worse cognitive performance than R‐MTLE [Alessio et al, 2006; Hermann et al, 1997]. As also suggested by intracranial EEG studies, the abnormal connectivity in the hemisphere contralateral to the epileptogenic zone in L‐MTLE could be an attempt to compensate the functional deficit, as the performance of working memory scores have been correlated to this increased contralateral connectivity [Bettus et al, 2009].…”

Section: Discussionmentioning

confidence: 99%

Large‐scale brain networks are distinctly affected in right and left mesial temporal lobe epilepsy

Campos

Coan

Yasuda

et al. 2016

Human Brain Mapping

108

102

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Mesial temporal lobe epilepsy (MTLE) with hippocampus sclerosis (HS) is associated with functional and structural alterations extending beyond the temporal regions and abnormal pattern of brain resting state networks (RSNs) connectivity. We hypothesized that the interaction of large‐scale RSNs is differently affected in patients with right‐ and left‐MTLE with HS compared to controls. We aimed to determine and characterize these alterations through the analysis of 12 RSNs, functionally parceled in 70 regions of interest (ROIs), from resting‐state functional‐MRIs of 99 subjects (52 controls, 26 right‐ and 21 left‐MTLE patients with HS). Image preprocessing and statistical analysis were performed using UF2C‐toolbox, which provided ROI‐wise results for intranetwork and internetwork connectivity. Intranetwork abnormalities were observed in the dorsal default mode network (DMN) in both groups of patients and in the posterior salience network in right‐MTLE. Both groups showed abnormal correlation between the dorsal‐DMN and the posterior salience, as well as between the dorsal‐DMN and the executive‐control network. Patients with left‐MTLE also showed reduced correlation between the dorsal‐DMN and visuospatial network and increased correlation between bilateral thalamus and the posterior salience network. The ipsilateral hippocampus stood out as a central area of abnormalities. Alterations on left‐MTLE expressed a low cluster coefficient, whereas the altered connections on right‐MTLE showed low cluster coefficient in the DMN but high in the posterior salience regions. Both right‐ and left‐MTLE patients with HS have widespread abnormal interactions of large‐scale brain networks; however, all parameters evaluated indicate that left‐MTLE has a more intricate bihemispheric dysfunction compared to right‐MTLE. Hum Brain Mapp 37:3137–3152, 2016. © 2016 The Authors Human Brain Mapping Published by Wiley Periodicals, Inc.

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Section: Discussionmentioning

confidence: 99%

Large‐scale brain networks are distinctly affected in right and left mesial temporal lobe epilepsy

Campos

Coan

Yasuda

et al. 2016

Human Brain Mapping

108

102

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“…FSIQ has not previously been shown to be a significant predictor of memory outcome after ATL. Because lower preoperative FSIQ score is associated with earlier age at onset and the presence of HS (20,48), lower FSIQ may be expected to predict memory stability after ATL. The finding of a positive predictive relationship between preoperative FSIQ and postoperative memory score therefore seems unusual.…”

Section: Discussionmentioning

confidence: 99%

Prediction of Verbal Memory Loss in Individuals After Anterior Temporal Lobectomy

et al. 1998

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Summary:Purpose: Decreased memory function represents the area of greatest neuropsychological morbidity after anterior temporal lobectomy (ATL), particularly for left ATL candidates. We wished to identify easily derived demographic and neuropsychological predictors of risk of pre-to postoperative memory decline using only information available preoperatively.Methods: We assessed decline in memory as measured by the California Verbal Learning Test (CVLT) by deriving multiple regression equations using the following measures as independent variables: age at onset, chronological age at time of surgery, sex, Full Scale IQ (FSIQ), level of education, and preoperative memory scores. In all, 203 patients (93 males, 110 females), undergoing ATL (107 left, 96 right) with preoperative and 6-month postoperative testing, were examined.Results: The combination of age, FSIQ, sex, side of surgery and preoperative score was highly predictive (p-values < 0.0001) of postoperative memory scores. Higher postoperative scores were associated with higher preoperative score, younger chronological age, higher FSIQ, female sex, and right side of resection. Reliable change index (RCI) values were used to estimate meaningful decline on the total score across five trials. Logistic regression analysis showed preoperative score and age to be predictors of RCI decline for left-sided resections. Sensitivity of decline (290th centile RCI) prediction was 56%, and specificity was 95%. Validation in 30 patients from a separate population of patients undergoing left ATL produced similar figures. Conclusions:The derived regression equations can accurately predict verbal memory decline on a list-learning task in -50% of individual patients undergoing ATL, and falsepositive prediction errors are very rare. Key Words: Epilepsy-Memory-Surgery-Temporal lobectomy.Decreased memory function represents the greatest potential neuropsychological morbidity after performance of anterior temporal lobectomy (ATL), particularly for verbal memory measures in patients undergoing left-sided resection (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Right-sided resections pose less consistent risk of memory impairment, possibly reflecting the absence of currently available adequate measures of nonverbal memory. Verbal memory deficit in association with right temporal lobe epilepsy (RTLE) is relatively rare and may be due to the presence of concomitant left mesial temporal abnormality, as demonstrated by magnetic resonance imaging (MRI) spectroscopy (21). Identified risk factors for postoperative memory decline after left ATL are older age at time of surgery, later age at onset of unprovoked seizures, and better preoperative memory performance (1)(2)(3)11,22 Males have been shown to be at greater risk than females in some series (23,24). Better preoperative memory performance is also a risk factor for post-ATL decline for right-sided resections ( I 1). For left-sided resections, the principal risk factor is the absence of hippocampal sclerosis (HS...

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“…It is generally acknowledged that memory functioning is the primary cognitive morbidity in TLE and is related to the functional adequacy of the hippocampus. Nevertheless, it is also evident that there is a more diffuse disruption of cognition in unilateral TLE (Glosser et al, 1997;Helmstaedter et al, 2003;Hermann et al, 1997) and that there is considerable heterogeneity in cognitive dysfunction among patients with unilateral TLE (Oyegbile et al, 2004). We have previously suggested that abnormalities outside the affected hippocampus and temporal lobe may contribute to nonmemory cognitive impairment (Hermann et al, 2003).…”

Section: Cognitive Functioningmentioning

confidence: 99%

“…Affected brain structures include temporal lobe structures adjacent and closely linked to the hippocampus such as the amygdala and entorhinal cortex (Bernasconi et al, 2005;Moran et al, 2001), as well as extratemporal lobe structures such as the thalamus and basal ganglia (Bonilha et al, 2005;Dreifuss et al, 2001;Natsume et al, 2003). Cognitive impairment in TLE has also been shown to encompass domains other than episodic memory, including intellectual functioning, language, executive functioning, visual perceptual functions, and motor abilities (Glosser et al, 1997;Hermann et al, 1997;Marques et al, 2007;Martin et al, 2000;Oyegbile et al, 2004). These findings raise the possibility that the broader pattern of cognitive impairment in TLE is associated with brain abnormalities in regions outside the temporal lobe.…”

Section: Introductionmentioning

confidence: 99%

Thalamic atrophy and cognition in unilateral temporal lobe epilepsy

Seidenberg

Hermann

Pulsipher

et al. 2008

J Inter Neuropsych Soc

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This study examined quantitative magnetic resonance volumes of the thalamus and hippocampus and determined their relationship with cognitive function and clinical seizure characteristics in a sample of 46 unilateral temporal lobe epilepsy (TLE) subjects (20 left and 26 right) and 29 controls. The hippocampus and thalamus exhibited different patterns of volume abnormality, different associations with clinical seizure characteristics, and different patterns of relationship with cognitive measures. Hippocampal volume reduction was primarily ipsilateral to the seizure focus, and thalamic volume reduction was bilateral. Ipsilateral hippocampal volume was significantly correlated with both early neurodevelopmental features (age of seizure onset) and disease characteristics (duration of epilepsy), whereas thalamus integrity was related only to disease variables. Hippocampal volume showed a selective association with verbal memory performance. In contrast, both left and right thalamic volumes were significantly correlated with performance on both memory and nonmemory cognitive domains. These findings underscore the importance of thalamic atrophy in chronic TLE and its potential implications for cognition. (JINS, 2008, 14, 384-393.)

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Neuropsychological Characteristics of the Syndrome of Mesial Temporal Lobe Epilepsy

Abstract: Distinct neuropsychological features of spared, compromised, and laterality-specific cognitive impairments characterize the syndrome of MTLE. This information needs to be incorporated into formal syndrome criteria.

Cited by 422 publications

References 40 publications

Large‐scale brain networks are distinctly affected in right and left mesial temporal lobe epilepsy

Large‐scale brain networks are distinctly affected in right and left mesial temporal lobe epilepsy

Prediction of Verbal Memory Loss in Individuals After Anterior Temporal Lobectomy

Thalamic atrophy and cognition in unilateral temporal lobe epilepsy

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