title: Risk to verbal memory following anterior temporal lobectomy in patients with severe left-sided hippocampal sclerosis.
abstract: BACKGROUND
  Previous investigations indicate low risk for memory loss following anterior temporal lobectomy (ATL) in patients with severe hippocampal sclerosis (HS) compared with patients with mild HS. However, these conclusions have been established primarily with group-level analyses.
  
  
  OBJECTIVE
  To investigate individual base rate risk for verbal memory loss following ATL in patients who have pathologically verified mild, moderate, or severe HS.
  
  
  METHODS
  One hundred fifteen patients with unilateral temporal lobe epilepsy (68 with left-sided and 47 with right-sided epilepsy) were included. Acquisition, retrieval, and recognition components of verbal memory, as measured by the California Verbal Learning Test, were assessed before and after ATL. Postoperatively, the degree of neuronal loss and reactive gliosis of the hippocampus was assessed via a 3-tiered rating system establishing mild, moderate, and severe pathologic features. Patients with preoperative magnetic resonance imaging-based evidence of lesions outside the mesial temporal area (side of surgical resection) were excluded.
  
  
  RESULTS
  Neither seizure laterality nor severity of HS was associated with preoperative verbal memory performance. Postoperatively, the left-sided ATL group demonstrated significant decline across the acquisition (P<.01), retrival (P<.001), and recognition (P<.001) verbal memory components compared with the right-sided ATL group. Patients who underwent left-sided ATL and had mild HS displayed the largest magnitude and percentage proportion of postoperative decline across all verbal memory components. However, 28 (48%) of the 58 patients who underwent left-sided ATL and who had moderate and severe HS displayed statistically reliable declines on retrieval aspects of verbal memory. Most patients undergoing right-sided ATL, regardless of the extent of hippocampal pathologic features, displayed no postoperative memory change.
  
  
  CONCLUSIONS
  Substantial individual heterogeneity of memory outcome exists across groups of patients undergoing ATL, with various degrees of pathologically verified HS. Patients undergoing left-sided ATL who have mild HS seem at greatest risk for broad-spectrum verbal memory decline. However, when examining outcome on a patient-by-patient basis, many patients undergoing left-sided ATL who have moderate to severe HS were also vulnerable to verbal memory loss. This risk seems selective to a retrieval-based aspect of verbal memory.
authors.affiliation: Department of Neurology, UAB Epilepsy Center, Birmingham, AL 35294, USA. rmartin@uab.edu
authors.forename: Roy C
authors.initials: RC
authors.lastname: Martin
authors.forename: Tracy
authors.initials: T
authors.lastname: Kretzmer
authors.forename: Cheryl
authors.initials: C
authors.lastname: Palmer
authors.forename: Stephen
authors.initials: S
authors.lastname: Sawrie
authors.forename: Robert
authors.initials: R
authors.lastname: Knowlton
authors.forename: Edward
authors.initials: E
authors.lastname: Faught
authors.forename: Richard
authors.initials: R
authors.lastname: Morawetz
authors.forename: Ruben
authors.initials: R
authors.lastname: Kuzniecky
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D038481:Anterior Temporal Lobectomy / Q000009:adverse effects* / Q000706:statistics & numerical data; D016001:Confidence Intervals; D004833:Epilepsy, Temporal Lobe / Q000473:pathology / Q000601:surgery; D007839:Functional Laterality / Q000502:physiology; D006624:Hippocampus / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008568:Memory / Q000502:physiology; D008875:Middle Aged; D012044:Regression Analysis; D012307:Risk Factors; D012598:Sclerosis; D012720:Severity of Illness Index; D014706:Verbal Learning / Q000502:physiology