Abstracts

RATIONALE: Behavioral abnormalities including affective difficulties (BA) are common in patients with right temporal lobe epilepsy (RTE). This study examines the preoperative incidence of and the postoperative effect of surgery on these complaints. METHODS: We performed retrospective chart reviews of 40 adult patients with RTE who underwent lobectomy (RTL) between 1991-2000. All complaints of mood or behavioral difficulties (e.g., depression, anxiety, explosive disorder) were tabulated. Intracranial electrodes were utilized in 18 to define epileptic focality unclear from surface recordings. The left hemisphere was dominant in 37. MRI revealed unilateral right mesial temporal sclerosis (MTS) in 22; bilateral MTS in 1; and other right structural lesions in 4. FSIQ was less than 80 in 2 patients. Pathology reported gliosis in 97%. Postoperative (postop) follow-up ranged from 2-100 months. RESULTS: History revealed preoperative (preop) complaints of BA in 28/40. Postop early BA at 1 month showed worsening in 6 (15%), improvement in 9 (22%), and no change in 25 (62%). Of the 6 who initially worsened, 3 improved over the next year. 39 patients had follow-up beyond 12 months. 28 (72%) had no BA or improved BA postop, of whom 19 (68%) had reported prior preop BA; 2 (5%) had worsened from preop status and 18 (46%) had no change. Of the 23 patients with MTS, 16 had preop BA which improved in 11 (69%) and worsened in 1. Of the 15 patients without MTS, 10 had preop BA and 4 of this group improved. Of 4 with structural lesions, 2 improved and 2 had no change in BA. Both patients with low FSIQ had preop BA which improved. Seizure outcome was Engel Class I in 95%. CONCLUSIONS: 70% of our patients with RTE had BA preop. After RTL, 25% had persistant BA despite Class I surgical outcome. Persistent BA did not correlate with FSIQ or structural or pathological findings. The presence of preop BA does not preclude successful surgical outcome or improved behavioral status.