Abstracts

Rationale: Does the resection of the temporal mesial structures run a risk of very long term accelerated memory deficit? To answer this question we studied the long-term cognitive performances of a cohort of patients successfully operated for a temporal lobe epilepsy (TLE) in the University hospital of Rennes, France.

Methods: We selected patients with a post-surgical follow-up of more than 10 years, operated for drug-resistant TLE. The inclusion criteria are:_x000D_ - Neuropsychological assessment with the same protocol before and after surgery (6 months after and at 2 years after for those operated in the dominant hemisphere for the language)_x000D_ - Complete seizure freedom_x000D_ - Patients gave their informed consent for this study_x000D_
The tests used are: Weshler Memory Scale revised, IQ Weschler Adult Intelligence Scale (R then III after 1998), visual memory “test de la ruche” (A. Violon 1984), Denomination of 100 pictures, naming celebrities, learning new names and surnames._x000D_
We also demanded the patient a subjective evaluation on their memory and language performances.

Results: A total of 57 patients were successfully operated on for a TLE. Sixteen patients were lost of view, 3 declined to be evaluated, 8 lived abroad. A total of 30 patients (18 women/12 men) accepted to have this additional neuropsychological assessment 10 to 24 years after surgery (mean, 16.3 years). The mean age at the last evaluation was 51.8 years old (34-60). Seventeen patients were operated in the dominant hemisphere._x000D_
Patient subjective evaluation: _x000D_ - In the dominant hemisphere, surgery a language deficit that moderately affects daily life was reported by 2 patients , mild for 5 patients (focused for these 8 patients on new names learning), and a very light impairment for 3. 7/17 had no cognitive complaints. _x000D_ - In the language nondominant hemisphere surgery: moderate impairment was reported by 3 patients, mild in 4. Six of 13 had no complaints. _x000D_
Among the patients who complain of troublesome deficit, 5 affirm that the deficit began 6 months to 2 years before the recent testing and not after the surgery. _x000D_
Comparing the pre-surgery and the long-term assessments results: _x000D_ - Shows long term stability both in term of memory and language in the patients operated in the non dominant hemisphere surgery_x000D_ - In the patients operated in the dominant hemisphere, there is a mild decrease in language performances, especially learning new first and last names (83.54p before and 71.67p after the surgery out of 100 maximum). _x000D_ - There is almost no difference between the results at 6 months and >10 years after surgery. Remarkably no significant difference between the scores at 2 years and those after 10 years was found._x000D_
The details of the results will be presented on the poster.

Conclusions: A unilateral resection including the temporal-mesial structure to cure focal TLE does not seem to cause long-term unacceptable memory deficit. In the dominant hemisphere, we confirm a moderate language deficit that seems quite stable at long-term evaluation. It thus appears that the temporal-mesial resection does not lead to an accelerated decline in long-term cognitive performances.

Funding: None