Cognitive prognosis in chronic temporal lobe epilepsy.
OBJECTIVE
First, to determine whether patients with chronic temporal lobe epilepsy have a different cognitive trajectory compared to control subjects over a prospective 4-year interval; second, to determine the proportion of patients who exhibit abnormal cognitive change and their profile of demographic, clinical epilepsy, and baseline quantitative magnetic resonance imaging characteristics; and third, to determine the most vulnerable cognitive domains.


METHODS
Participants with chronic temporal lobe epilepsy (n = 46) attending a tertiary referral clinic and healthy control subjects (n = 65) underwent neuropsychological assessment and reevaluation 4 years later. Analysis of test-retest patterns identified individual patients with adverse cognition outcomes.


RESULTS
The prospective cognitive trajectory of patients with chronic temporal lobe epilepsy differs from age- and sex-matched healthy control subjects. Lack of practice effects is common, but frank adverse cognitive outcomes are observed in a subset of patients (20-25%), particularly in vulnerable cognitive domains that include memory. Cognitive declines are associated with a profile of abnormalities in baseline quantitative magnetic resonance volumetrics, lower baseline intellectual capacity, as well as longer duration of epilepsy and older chronological age.


CONCLUSIONS
Cognitive prognosis is poor for a subset of patients characterized by chronicity of epilepsy, older age, lower intellectual ability, and more baseline abnormalities in quantitative magnetic resonance volumetrics.
Hermann
Bruce P
BP
Matthews Neuropsychology Lab, Department of Neurology, University of Wisconsin-Madison, 53792, USA. hermann@neurology.wisc.edu
Seidenberg
Michael
M
Dow
Christian
C
Jones
Jana
J
Rutecki
Paul
P
Bhattacharya
Abhik
A
Bell
Brian
B
D000293:Adolescent; D000328:Adult; D002908:Chronic Disease; D003072:Cognition Disorders / Q000209:etiology* / Q000473:pathology* / Q000503:physiopathology; D004833:Epilepsy, Temporal Lobe / Q000150:complications* / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D011379:Prognosis