title: Cognitive prognosis in chronic temporal lobe epilepsy.
abstract: 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.
authors.affiliation: Matthews Neuropsychology Lab, Department of Neurology, University of Wisconsin-Madison, 53792, USA. hermann@neurology.wisc.edu
authors.forename: Bruce P
authors.initials: BP
authors.lastname: Hermann
authors.forename: Michael
authors.initials: M
authors.lastname: Seidenberg
authors.forename: Christian
authors.initials: C
authors.lastname: Dow
authors.forename: Jana
authors.initials: J
authors.lastname: Jones
authors.forename: Paul
authors.initials: P
authors.lastname: Rutecki
authors.forename: Abhik
authors.initials: A
authors.lastname: Bhattacharya
authors.forename: Brian
authors.initials: B
authors.lastname: Bell
mesh_terms: 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