title: Long-term seizure, cognitive, and psychiatric outcome following trans-middle temporal gyrus amygdalohippocampectomy and standard temporal lobectomy.
abstract: OBJECTIVE
  Previous comparisons of standard temporal lobectomy (STL) and selective amygdalohippocampectomy (SelAH) have been limited by inadequate long-term follow-up, variable definitions of favorable outcome, and inadequate consideration of psychiatric comorbidities.
  
  
  METHODS
  The authors performed a retrospective analysis of seizure, cognitive, and psychiatric outcomes in a noncontemporaneous cohort of 69 patients with unilateral refractory temporal lobe epilepsy and MRI evidence of mesial temporal sclerosis after either an STL or an SelAH and examined seizure, cognitive, and psychiatric outcomes.
  
  
  RESULTS
  The mean duration of follow-up for STL was 9.7 years (range 1-18 years), and for trans-middle temporal gyrus SelAH (mtg-SelAH) it was 6.85 years (range 1-15 years). There was no significant difference in seizure outcome when "favorable" was defined as time to loss of Engel Class I or II status; better seizure outcome was seen in the STL group when "favorable" was defined as time to loss of Engel Class IA status (p=0.034). Further analysis revealed a higher occurrence of seizures solely during attempted medication withdrawal in the mtg-SelAH group than in the STL group (p=0.016). The authors found no significant difference in the effect of surgery type on any cognitive and most psychiatric variables. Standard temporal lobectomy was associated with significantly higher scores on assessment of postsurgical paranoia (p=0.048).
  
  
  CONCLUSIONS
  Overall, few differences in seizure, cognitive, and psychiatric outcome were found between STL and mtg-SelAH on long-term follow-up. Longer exposure to medication side effects after mtg-SelAH may adversely affect quality of life but is unlikely to cause additional functional impairment. In patients with high levels of presurgical psychiatric disease, mtg-SelAH may be the preferred surgery type.
authors.affiliation: Department of Neurology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA. Krzysztof.A.Bujarski@Dartmouth.edu
authors.forename: Krzysztof A
authors.initials: KA
authors.lastname: Bujarski
authors.forename: Fuyuki
authors.initials: F
authors.lastname: Hirashima
authors.forename: David W
authors.initials: DW
authors.lastname: Roberts
authors.forename: Barbara C
authors.initials: BC
authors.lastname: Jobst
authors.forename: Karen L
authors.initials: KL
authors.lastname: Gilbert
authors.forename: Robert M
authors.initials: RM
authors.lastname: Roth
authors.forename: Laura A
authors.initials: LA
authors.lastname: Flashman
authors.forename: Brenna C
authors.initials: BC
authors.lastname: McDonald
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Saykin
authors.forename: Rod C
authors.initials: RC
authors.lastname: Scott
authors.forename: Eric
authors.initials: E
authors.lastname: Dinnerstein
authors.forename: Julie
authors.initials: J
authors.lastname: Preston
authors.forename: Peter D
authors.initials: PD
authors.lastname: Williamson
authors.forename: Vijay M
authors.initials: VM
authors.lastname: Thadani
mesh_terms: D000293:Adolescent; D000328:Adult; D000679:Amygdala / Q000601:surgery*; D038481:Anterior Temporal Lobectomy / Q000523:psychology / Q000534:rehabilitation*; D000927:Anticonvulsants / Q000627:therapeutic use; D003071:Cognition; D015897:Comorbidity; D004833:Epilepsy, Temporal Lobe / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006624:Hippocampus / Q000601:surgery*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D009483:Neuropsychological Tests; D010259:Paranoid Disorders / Q000453:epidemiology; D011183:Postoperative Complications / Q000188:drug therapy / Q000453:epidemiology*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000927:Anticonvulsants