Lesionectomy versus electrophysiologically guided resection for temporal lobe tumors manifesting with complex partial seizures

Complex partial seizures associated with tumors and other mass lesions are readily diagnosed by modern imaging techniques but their optimum surgical treatment remains unresolved. Lesionectomy has been reported to produce seizure outcomes equal to outcomes after resection that ablates the epileptogenic cortex with the lesion. However, some evidence suggests that when the lesion is in the temporal lobe, simple excision of the tumor or lesion more often fails to control seizures. After retrospectively reviewing the records of 30 patients with complex partial seizures and temporal lobe tumors who underwent surgical treatment at the University of Cincinnati hospitals (1985-1992), the authors divided them into two groups: Group A (16 patients) underwent lesionectomy only and Group B (14 patients) received surgical treatment for seizures with electroencephalographic delineation of the epileptogenic zone and resection of the lesion. Seizure control was best achieved in Group B patients with 13 (92.8%) seizure free at follow up (mean 52 months). Only three (18.8%) of the Group A patients became seizure free after lesionectomy at follow up (mean 33 months). In eight Group A patients, who underwent temporal lobectomy as a second procedure after lesionectomy failed to control seizures, five (62.5%) became seizure free. Group B patients had a longer duration of seizures and were more likely to have lesions smaller than 2.5 cm compared with Group A. Analysis of covariance demonstrated that the differences in outcome between the groups remained significant even with adjustment for the variation in duration of seizures (p = 0.0006) and size of tumor (p = 0.0001). Based on this study, the authors found that the probable relief from seizures caused by a temporal lobe lesion is greater if the region of epileptogenicity, usually the amygdalohippocampal complex, is resected along with the tumor in a temporal lobectomy

Severity of Depressive Symptoms, Hippocampal Sclerosis, Auditory Memory, and Side of Seizure Focus in Temporal Lobe Epilepsy

The relationship between severity of depressive symptoms and performance on three Wechsler Memory Scale-III auditory memory and learning subtests was examined in 84 inpatients diagnosed with medically intractable seizures of left (n=46, LTLE) or right (n=38, RTLE) temporal lobe origin. Depressive symptom severity was associated with auditory recall test performance in individuals with LTLE, but not RTLE. Multiple regression analyses indicated that severity of depressive symptoms, hippocampal sclerosis, and naming ability were significant predictors of auditory memory test performance in LTLE; however, hippocampal sclerosis was the only significant predictor of auditory memory in RTLE. Results demonstrate the importance of hippocampal sclerosis, greater self-report of depressive symptoms, and poor naming ability as independent predictors of poor auditory memory and learning abilities. Results suggest that a complex relationship exists among multiple risk factors that combine to influence performance on auditory memory tests as a function of side of seizure focus

Confrontation Naming in Individuals with Temporal Lobe Epilepsy: A Quantitative Analysis of Paraphasic Error Subtypes

Although confrontation naming deficits have been observed in dominant temporal lobe epilepsy (DTLE), the relative contribution of impoverished phonologic word retrieval and/or semantic knowledge remains unclear. Analysis of verbal-semantic, phonemic-literal, and combination paraphasias produced during confrontation naming by participants with seizure disorders (52 DTLE; 47 nondominant temporal lobe epilepsy [NDTLE]; 54 psychogenic nonepileptic seizures [PNES]) indicated that the frequency of: (a) verbal-semantic paraphasias was similar across groups, (b) phonemic-literal paraphasias was highest in DTLE, and (c) combination paraphasias was lowest in PNES. Confrontation naming ability was most strongly related to phonemic-literal paraphasia frequency in DTLE and to verbal IQ in both NDTLE and PNES. Greater confrontation naming deficits in DTLE may be attributed to impairments in phonological processing

The Prevalence of Seizure Types Among Individuals Referred for Phase I Neuropsychological Assessment: Demographic and Neuropsychological Characteristics

The prevalence of seizure types among the subpopulation of patients referred for phase I neuropsychological assessment likely differs from the prevalence of specific seizure types within the general seizure population. Understanding the prevalence of clinical diagnoses is critical to maximizing the predictive value of any assessment or diagnostic technique, clinical neuropsychological assessment of patients with seizures being no exception. Data from a series of 835 patients referred for phase I neuropsychological evaluation are used to report the prevalence of specific seizure types, as well as neuropsychological and demographic characteristics. Considerations for clinical neuropsychological research and practice are briefly discussed

Accuracy of Clinical Neuropsychological Versus Statistical Prediction in the Classification of Seizure Types

Many studies have reported on the pattern of neuropsychological test performance across varied seizure diagnosis populations. Far fewer studies have evaluated the accuracy of the clinical neuropsychologist in formulating an impression of the seizure diagnosis based on results of neuropsychological assessment, or compared the accuracy of clinical neuropsychological judgment to results of statistical prediction. Accuracy of clinical neuropsychological versus statistical prediction was investigated in four seizure classification scenarios. While both methods outperformed chance, accuracy of clinical neuropsychological classification was either equivalent or superior to statistical prediction. Results support the utility and validity of clinical neuropsychological judgment in epilepsy treatment settings

What Does the Family Pictures Subtest of the Wechsler Memory Scale-III Measure? Insight Gained from Patients Evaluated for Epilepsy Surgery

The Family Pictures (FP) task is a new subtest of the Wechsler Memory Scale Version III (WMS-III) used to assess visual memory and learning. This study assessed the extent to which different cognitive abilities contribute to performance on the FP task in 125 patients evaluated for epilepsy surgery. Results indicated that the FP task relies heavily on auditory-verbal based cognitive abilities, as well as visual memory, and may better represent a general measure of memory performance. These results raise questions about the appropriateness of including FP task performance in the calculations of the WMS-III Visual Index scores

The Use of Self-Generation Procedures Facilitates Verbal Memory in Individuals with Seizure Disorders

The efficacy of a self-generation encoding procedure in facilitating the encoding and retrieval of verbal memories was compared with the didactic presentation of information in individuals with seizure disorders. Through a within-subject design, 87 patients (25 left temporal seizure onset, 29 right temporal, 8 frontal, and 25 psychogenic nonepileptic seizures) received a self-generation learning condition and a didactic learning condition and were subsequently tested for verbal paired associate free recall, cued recall, and recognition memory. All patient groups benefited from the use of the self-generation condition relative to the didactic condition. Better performance occurred with the self-generation procedure for cued recall and recognition memory test performance, but not free recall. Individuals with a left temporal seizure onset (patients with the poorest memory performance on the didactic condition) benefited the most from the self-generation condition. A memory encoding strategy that actively involves patient participation enhances memory performance

Accuracy of Self-Reported Neuropsychological Functioning in Individuals with Epileptic or Psychogenic Non-Epileptic Seizures

The aim of this study was to determine the degree to which subjective ratings of neurocognitive ability accurately reflect objectively measured neuropsychological functioning in patients diagnosed with epileptic (ES, n=45) or psychogenic nonepileptic (PNES; n=37) seizures. Patients received a battery of neuropsychological tests, measures of current mood state, and the Quality of Life In Epilepsy—89 questionnaire. Results indicated that subjective ratings of neuropsychological functioning were only partially accurate within each group. Patients with ES accurately rated their memory function, but overestimated language and attention abilities. Patients with PNES accurately rated attention, but underestimated memory and overestimated language. In both groups, poorer self-reported neurocognitive functioning was strongly related to poorer mood state; however, mood state did not predict objectively measured neurocognitive abilities. Given the inaccuracies that exist in patient self-report, results highlight the importance of a comprehensive neuropsychological assessment when evaluating the neurocognitive status of individuals with seizures