Abstracts

There is evidence that adults with temporal lobe epilepsy (TLE) present frontal lobe dysfunction (FLD), characterized by attentional and executive deficits. Through literature, there are two hypothesis that can explain this dysfunction: 1) the direct influence of the lesionated mesial structure ; 2) the epileptogenic neocortex influence, through its connections with the frontal lobe.
Nevertheless, it is controversial if children with TLE present FLD and if children with mesial lesion have greater FLD than those with neocortical lesions. The purpose of this study was to evaluate the presence of FLD in children with mesial or neocortical TLE and verify if one of these clinical entities is responsable for greater seriousness in childhood. For this purpose were evaluated 13 children with mesial TLE, 8 children with neocortical TLE and 21 healthy children (without neurological or psychiatric diagnosis). A comprehensive neuropsychological battery was applied in order to evaluate the attentional and executive functions composed by the Wisconsin Card Sorting Test (WCST), the Matching Familiar Figures Test (MFFT), Verbal fluency for animals and food and the subtests Digits (WISC-III) and Finger Windows (WRAML). [WX1] The results were compared through non parametric analysis (Mann-Whitney). The mesial TLE group was older and had higher education (p[lt]0,01) compared to the others groups. Both patient groups presented lower IQ compared to the control group (p[lt]0,05). The neocortical TLE patients showed worse performance in tests of recruiting and sustaining attention to audio verbal and visual stimulus, (p [lt]0,05), verbal fluency under delimitated conditions (p[lt]0,05), inhibitory control and concept formation (p [lt]0,05), besides showing a tendency to perseveration (p = 0,06 ) than the control group .Between the two patient groups, the neocortical TLE patients showed worse performance in working memory evaluation tests and for recruiting and sustaining attention for visual stimulus, (p[lt]0,05). The difference of age and years of school education between groups was not a limiting factor for data analysis, since it was expected that the control individuals (in average younger than the others) would show a worse performance, which did not happend. These findings reveal the presence of FLD in children with TLE and even worse impairment in those with neocortical lesions. Our study corroborates the hypothesis that neocortical temporal lobe epileptogenical activity affects the extratemporal regions which mediate attentional and executive functions. (Supported by FAPESP: Fundacao de Amparo a Pesquisa de Sao Paulo.)