Cognitive decline in temporal lobe epilepsy due to unilateral hippocampal sclerosis.
OBJECTIVE
We assessed the cognitive performance of patients with temporal lobe epilepsy (TLE) caused by unilateral hippocampal sclerosis (HS), in comparison with that of matched, healthy controls. We report the relationship between cognitive measures and duration of epilepsy, correlating with hippocampal volumes, and the impact of educational level on cognitive decline.


METHODS
This study involved 61 outpatients (40 with < or = 8 years and 21 with >8 years of formal education) with unilateral HS and 61 controls. Volumetric MRI was performed on all patients and 10 controls. The results (mean, SD) of the neuropsychological tests of healthy subjects and patients were compared using the Student t and Mann-Whitney tests.


RESULTS
Patients performed worse than controls in the neuropsychological evaluation. When adjusted z scores were used to calculate the impairment index, patients had a greater percentage of abnormal tests compared with controls. The cognitive decline, assessed through the impairment index, correlated with duration of epilepsy. Higher level of education did not protect against this decline, thus not supporting the hypothesis of cerebral reserve in this population. A significant correlation between hippocampal volumetric measures and duration of epilepsy was observed only in patients with left HS.


CONCLUSIONS
Patients with TLE caused by HS present with cognitive morbidity that extends beyond memory deficits. Cognitive decline is associated with duration of epilepsy, and in patients with left-sided HS, duration may correlate with volumetric hippocampal loss.
Marques
Carolina Mattos
CM
Department of Neurology, Escola Paulista de Medicina/UNIFESP, São Paulo, Brazil.
Caboclo
Luís Otávio Sales Ferreira
LO
da Silva
Tatiana Indelicato
TI
Noffs
Maria Helena da Silva
MH
Carrete
Henrique
H
Lin
Katia
K
Lin
Jaime
J
Sakamoto
Américo Ceiki
AC
Yacubian
Elza Márcia Targas
EM
D000328:Adult; D000368:Aged; D003072:Cognition Disorders / Q000209:etiology* / Q000473:pathology; D018450:Disease Progression; D004833:Epilepsy, Temporal Lobe / Q000150:complications* / Q000473:pathology; D005260:Female; D006624:Hippocampus / Q000473:pathology*; D006801:Humans; D007297:Inpatients; D008182:Luria-Nebraska Neuropsychological Battery / Q000706:statistics & numerical data; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012598:Sclerosis / Q000150:complications* / Q000473:pathology; D018709:Statistics, Nonparametric