Structural versus functional prediction of memory change following anterior temporal lobectomy.
Decline in recent memory function is a significant risk for patients undergoing anterior temporal lobectomy. We report a patient with a febrile seizure history, complex partial seizures arising from the left anterior temporal lobe, and MRI evidence suggesting left hippocampal sclerosis, all of which indicate a low likelihood of significant postoperative memory decline. However, high normal verbal memory on neuropsychological testing and bilaterally normal Wada memory scores indicated increased risk for postoperative memory decline. Following left anterior temporal lobectomy, the patient displayed a significant decline in verbal recent memory that affected school performance. Despite the worsening in memory, the patient reported a significant improvement in his self-reported quality-of-life perception, demonstrating that factors other than change in cognitive performance are related to whether a patient considers epilepsy surgery worthwhile. In the present case, behavioral measures were superior to structural measures in predicting cognitive change following surgery.
Loring
David W
DW
Department of Neurology, Georgetown University Medical Center, Building D, Suite 207, 4000 Reservoir Road, NW, Washington, DC 22057, USA. dwl7@georgetown.edu
Meador
Kimford J
KJ
Lee
Gregory P
GP
Smith
Joseph R
JR
D000328:Adult; D000654:Amobarbital; D038481:Anterior Temporal Lobectomy; D004292:Dominance, Cerebral / Q000502:physiology; D004833:Epilepsy, Temporal Lobe / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005500:Follow-Up Studies; D006624:Hippocampus / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008569:Memory Disorders / Q000175:diagnosis* / Q000503:physiopathology; D008570:Memory, Short-Term / Q000502:physiology; D009483:Neuropsychological Tests; D011183:Postoperative Complications / Q000175:diagnosis* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011788:Quality of Life; D018570:Risk Assessment; D012598:Sclerosis; D014706:Verbal Learning / Q000502:physiology
D000654:Amobarbital