Lateralising value of neuropsychological protocols for presurgical assessment of temporal lobe epilepsy.
OBJECTIVE
To estimate the value of neuropsychological measurements in determining the side of seizure onset for presurgical assessment in patients with temporal lobe epilepsy. The lateralising value of neuropsychological protocols was evaluated for all patients and in subpopulations depending on surgical outcome with regard to seizure control, speech dominance, neuropathology, and need for intracranial EEG recordings.


METHODS
A battery of neuropsychological procedures was carried out preoperatively in 125 patients who underwent left (n = 66) or right (n = 59) temporal lobectomies. Binary logistic regression analysis was performed to find sets of variables that allowed the best prediction of the side of seizure onset (assumed to be the operated-on side).


RESULTS
Combinations of noninvasive neuropsychological tests and Wada subscores showed the highest lateralising values: 80.8% for all patients, 79.4% in seizure-free patients, 86.0% in patients not rendered seizure free, 85.7% in left speech patients, 77.8% in non-left speech patients, 89.3% in patients with mesial temporal sclerosis (MTS), 78.1% in non-MTS patients, 80.3% in patients who underwent intracranial EEG recordings, and 77.3% in those who did not.


CONCLUSIONS
The lateralising value (80-90%) of neuropsychological protocols appears similar to that of other tests widely accepted for lateralisation (ictal and interictal scalp EEG and neuroimaging). Attention should be paid to neuropsychological results, particularly from the Wada test, during presurgical assessment of temporal lobe epilepsy, as they can provide strong support for findings from other lateralising tests, particularly in patients with presumed MTS or in left-speech patients.
Akanuma
Nozomi
N
Division of Neuroscience, Guy's, King's, and St Thomas' School of Medicine, King's College London, London, England.
Alarcón
Gonzalo
G
Lum
Francis
F
Kissani
Najib
N
Koutroumanidis
Michael
M
Adachi
Naoto
N
Binnie
Colin D
CD
Polkey
Charles E
CE
Morris
Robin G
RG
D000328:Adult; D000654:Amobarbital; D001931:Brain Mapping / Q000379:methods; D003072:Cognition Disorders / Q000175:diagnosis; D004567:Electrodes, Implanted; D004569:Electroencephalography / Q000379:methods; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D007839:Functional Laterality / Q000187:drug effects / Q000502:physiology; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D011300:Preoperative Care / Q000379:methods*; D013060:Speech / Q000502:physiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014743:Videotape Recording
D000654:Amobarbital