title: Neuropsychological performance before and after partial or complete insulectomy in patients with epilepsy.
abstract: Resection of the insular cortex is becoming more frequent as it is increasingly recognized that a nonnegligible proportion of surgical candidates with drug-resistant epilepsy have an epileptogenic zone that involves the insula. In the last decades, however, the insula has been proposed to be involved in several neuropsychological functions, and there is a lack of documentation on whether partial or complete insulectomy results in permanent cognitive impairments in this clinical population. In this study, we conducted standard preoperative and postoperative neuropsychological assessments in 18 patients undergoing epilepsy surgery that included the removal of the insula in the right (n=13) or the left (n=5) hemisphere. Postoperative testing was conducted at least five months after surgery. Cognitive impairments were common and heterogeneous prior to surgery, with language and verbal memory impairments being especially frequent among patients in whom epileptic seizures originated from the left hemisphere. After surgery, declines and improvements occurred on a variety of outcomes, although new deficits were relatively infrequent among patients who had obtained normal performance at baseline. Statistical comparisons between preoperative and postoperative assessments revealed significant deterioration of only one outcome - the color naming condition of the Stroop test - which relies on oro-motor speed and lexical access. These findings suggest that partial or complete resection of the insular cortex in patients with drug-refractory epilepsy can be conducted without major permanent neuropsychological impairments in a vast majority of patients. However, small decrements in specific cognitive functions can be expected, which should also be taken into account when considering the surgical option in this clinical population.
authors.affiliation: Département de psychologie, Université de Montréal, Montréal, QC, Canada.
authors.forename: Olivier
authors.initials: O
authors.lastname: Boucher
authors.affiliation: Centre hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montréal, QC, Canada; Département de psychologie, Université du Québec à Montréal, Montréal, QC, Canada.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Rouleau
authors.affiliation: Département de psychologie, Université du Québec à Montréal, Montréal, QC, Canada.
authors.forename: Frédérique
authors.initials: F
authors.lastname: Escudier
authors.affiliation: Centre hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montréal, QC, Canada.
authors.forename: Annie
authors.initials: A
authors.lastname: Malenfant
authors.affiliation: Centre hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montréal, QC, Canada.
authors.forename: Carole
authors.initials: C
authors.lastname: Denault
authors.affiliation: Centre hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montréal, QC, Canada.
authors.forename: Simon
authors.initials: S
authors.lastname: Charbonneau
authors.affiliation: Centre hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montréal, QC, Canada.
authors.forename: Patrice
authors.initials: P
authors.lastname: Finet
authors.affiliation: Département de psychologie, Université de Montréal, Montréal, QC, Canada.
authors.forename: Maryse
authors.initials: M
authors.lastname: Lassonde
authors.affiliation: Département de psychologie, Université de Montréal, Montréal, QC, Canada.
authors.forename: Franco
authors.initials: F
authors.lastname: Lepore
authors.affiliation: Centre hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montréal, QC, Canada.
authors.forename: Alain
authors.initials: A
authors.lastname: Bouthillier
authors.affiliation: Centre hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montréal, QC, Canada. Electronic address: d.nguyen@umontreal.ca.
authors.forename: Dang K
authors.initials: DK
authors.lastname: Nguyen
mesh_terms: D000328:Adult; D002540:Cerebral Cortex / Q000601:surgery*; D003072:Cognition Disorders / Q000209:etiology / Q000523:psychology; D004351:Drug Resistance; D004827:Epilepsy / Q000523:psychology* / Q000601:surgery*; D005260:Female; D007839:Functional Laterality; D006801:Humans; D007806:Language Disorders / Q000209:etiology / Q000523:psychology; D008297:Male; D008569:Memory Disorders / Q000209:etiology / Q000523:psychology; D008875:Middle Aged; D009483:Neuropsychological Tests; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology / Q000523:psychology; D011597:Psychomotor Performance; D013064:Speech Disorders / Q000209:etiology / Q000523:psychology; D057190:Stroop Test; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cognition; Epilepsy; Insula; Neuropsychology; Neurosurgery; Speech