title: Effect of invasive EEG monitoring on cognitive outcome after left temporal lobe epilepsy surgery.
abstract: OBJECTIVE
  The objective of this cohort study was to compare neuropsychological outcomes following left temporal lobe resection (TLR) in patients with epilepsy who had or had not undergone prior invasive monitoring.
  
  
  METHODS
  Data were obtained from an institutional review board-approved, neuropsychology registry for patients who underwent epilepsy surgery at Cleveland Clinic between 1997 and 2013. A total of 176 patients (45 with and 131 without invasive EEG) met inclusion criteria. Primary outcome measures were verbal memory and language scores. Other cognitive outcomes were also examined. Outcomes were assessed using difference in scores from before to after surgery and by presence/absence of clinically meaningful decline using reliable change indices (RCIs). Effect of invasive EEG on cognitive outcomes was estimated using weighting and propensity score adjustment to account for differences in baseline characteristics. Linear and logistic regression models compared surgical groups on all cognitive outcomes.
  
  
  RESULTS
  Patients with invasive monitoring showed greater declines in confrontation naming; however, when RCIs were used to assess clinically meaningful change, there was no significant treatment effect on naming performance. No difference in verbal memory was observed, regardless of how the outcome was measured. In secondary outcomes, patients with invasive monitoring showed greater declines in working memory, which were no longer apparent using RCIs to define change. There were no outcome differences on other cognitive measures.
  
  
  CONCLUSIONS
  Results suggest that invasive EEG monitoring conducted prior to left TLR is not associated with greater cognitive morbidity than left TLR alone. This information is important when counseling patients regarding cognitive risks associated with this elective surgery.
authors.affiliation: From the Epilepsy Center (R.M.B., L.E.J., R.Y., I.N., W.B., J.G.-M.) and Department of Psychiatry and Psychology (R.M.B, L.F.), Neurological Institute, Cleveland Clinic; Departments of Medicine (T.E.L.) and Epidemiology and Biostatistics (T.E.L.), Center for Health Care Research and Policy at MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH. buschr@ccf.org.
authors.forename: Robyn M
authors.initials: RM
authors.lastname: Busch
authors.affiliation: From the Epilepsy Center (R.M.B., L.E.J., R.Y., I.N., W.B., J.G.-M.) and Department of Psychiatry and Psychology (R.M.B, L.F.), Neurological Institute, Cleveland Clinic; Departments of Medicine (T.E.L.) and Epidemiology and Biostatistics (T.E.L.), Center for Health Care Research and Policy at MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Love
authors.affiliation: From the Epilepsy Center (R.M.B., L.E.J., R.Y., I.N., W.B., J.G.-M.) and Department of Psychiatry and Psychology (R.M.B, L.F.), Neurological Institute, Cleveland Clinic; Departments of Medicine (T.E.L.) and Epidemiology and Biostatistics (T.E.L.), Center for Health Care Research and Policy at MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH.
authors.forename: Lara E
authors.initials: LE
authors.lastname: Jehi
authors.affiliation: From the Epilepsy Center (R.M.B., L.E.J., R.Y., I.N., W.B., J.G.-M.) and Department of Psychiatry and Psychology (R.M.B, L.F.), Neurological Institute, Cleveland Clinic; Departments of Medicine (T.E.L.) and Epidemiology and Biostatistics (T.E.L.), Center for Health Care Research and Policy at MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH.
authors.forename: Lisa
authors.initials: L
authors.lastname: Ferguson
authors.affiliation: From the Epilepsy Center (R.M.B., L.E.J., R.Y., I.N., W.B., J.G.-M.) and Department of Psychiatry and Psychology (R.M.B, L.F.), Neurological Institute, Cleveland Clinic; Departments of Medicine (T.E.L.) and Epidemiology and Biostatistics (T.E.L.), Center for Health Care Research and Policy at MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH.
authors.forename: Ruta
authors.initials: R
authors.lastname: Yardi
authors.affiliation: From the Epilepsy Center (R.M.B., L.E.J., R.Y., I.N., W.B., J.G.-M.) and Department of Psychiatry and Psychology (R.M.B, L.F.), Neurological Institute, Cleveland Clinic; Departments of Medicine (T.E.L.) and Epidemiology and Biostatistics (T.E.L.), Center for Health Care Research and Policy at MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH.
authors.forename: Imad
authors.initials: I
authors.lastname: Najm
authors.affiliation: From the Epilepsy Center (R.M.B., L.E.J., R.Y., I.N., W.B., J.G.-M.) and Department of Psychiatry and Psychology (R.M.B, L.F.), Neurological Institute, Cleveland Clinic; Departments of Medicine (T.E.L.) and Epidemiology and Biostatistics (T.E.L.), Center for Health Care Research and Policy at MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH.
authors.forename: William
authors.initials: W
authors.lastname: Bingaman
authors.affiliation: From the Epilepsy Center (R.M.B., L.E.J., R.Y., I.N., W.B., J.G.-M.) and Department of Psychiatry and Psychology (R.M.B, L.F.), Neurological Institute, Cleveland Clinic; Departments of Medicine (T.E.L.) and Epidemiology and Biostatistics (T.E.L.), Center for Health Care Research and Policy at MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH.
authors.forename: Jorge
authors.initials: J
authors.lastname: Gonzalez-Martinez
mesh_terms: D000328:Adult; D038481:Anterior Temporal Lobectomy / Q000009:adverse effects* / Q000379:methods; D003071:Cognition; D003072:Cognition Disorders / Q000209:etiology*; D015331:Cohort Studies; D000069280:Electrocorticography / Q000379:methods*; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008297:Male; D008568:Memory; D008569:Memory Disorders / Q000209:etiology*; D008875:Middle Aged; D009483:Neuropsychological Tests; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult