title: Neuropsychological outcome after epilepsy surgery in patients with bilateral Ammon's horn sclerosis.
abstract: OBJECTIVE
  The purpose of this study was to retrospectively assess the objective and subjective neuropsychological outcome after epilepsy surgery in patients with bilateral Ammon's horn sclerosis (AHS).
  
  
  METHODS
  Memory and executive functions were evaluated at baseline and at follow-up in 11 surgically treated patients and compared with 8 pharmacologically treated patients with temporal lobe epilepsy and bilateral AHS. The median follow-up duration was 16 months in the surgically treated patients and 80.5 months in the pharmacologically treated group. Subjective outcome was evaluated by questionnaires and included mood, quality of life, subjective memory, and activities of daily living.
  
  
  RESULTS
  At the follow-up assessment, 82% of the surgically treated patients as opposed to 0% of the nonsurgery patients were seizure free. In the surgical group, nonverbal memory performance did not change significantly in any patient after surgery, but there was a floor effect in 55% of the surgical patients. Regarding verbal memory, 9% of the surgical patients improved while 73% declined, despite severe impairments already evident at baseline. In the nonsurgery control group, 13% of the patients declined in nonverbal memory (floor effect in 63%) and 25% declined in verbal memory (floor effect in 25%) at follow-up. None of the controls improved at follow-up. Executive functions remained unchanged on an impaired level in both groups. At follow-up, the patient groups did not differ significantly with respect to mood, quality of life, subjective memory, or activities of daily living. However, in most aspects, surgically treated patients reported a slightly better subjective outcome than pharmacologically treated patients and a significantly improved quality of life.
  
  
  CONCLUSIONS
  These results suggest that beyond benefits concerning seizure control, surgically treated patients with bilateral AHS, despite already poor baseline performance, are still at risk for severe postoperative decline in memory. In the light of predominantly minor benefits on a subjective level, the findings put the overall outcome of epilepsy surgery in bilateral AHS patients into perspective.
authors.affiliation: Departments of Epileptology and.
authors.forename: Viola L
authors.initials: VL
authors.lastname: Vogt
authors.forename: Juri-Alexander
authors.initials: JA
authors.lastname: Witt
authors.forename: Michael P
authors.initials: MP
authors.lastname: Malter
authors.forename: Jan-Christoph
authors.initials: JC
authors.lastname: Schoene-Bake
authors.forename: Marec
authors.initials: M
authors.lastname: von Lehe
authors.forename: Christian E
authors.initials: CE
authors.lastname: Elger
authors.forename: Christoph
authors.initials: C
authors.lastname: Helmstaedter
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D003863:Depression / Q000209:etiology; D004651:Employment / Q000706:statistics & numerical data; D004827:Epilepsy / Q000209:etiology / Q000523:psychology* / Q000601:surgery*; D056344:Executive Function; D005260:Female; D005500:Follow-Up Studies; D006624:Hippocampus / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011788:Quality of Life; D012189:Retrospective Studies; D012598:Sclerosis; D012640:Seizures / Q000601:surgery
keywords: AHS = Ammon's horn sclerosis; BDI = Beck Depression Inventory; QOLIE = Quality of Life in Epilepsy Inventory; RCI = reliable change index; TLE = temporal lobe epilepsy; VLMT = Verbaler Lern- und Merkfähigkeitstest; bilateral Ammon's horn sclerosis; memory; neuropsychological outcome; temporal lobe epilepsy surgery