NEUROPSYCHOLOGICAL OUTCOME 1 YEAR FOLLOWING GAMMA KNIFE RADIOSURGERY FOR MESIAL TEMPORAL LOBE EPILEPSY: PRELIMINARY FINDINGS
Abstract number :
2.444
Submission category :
Year :
2003
Submission ID :
4030
Source :
www.aesnet.org
Presentation date :
12/6/2003 12:00:00 AM
Published date :
Dec 1, 2003, 06:00 AM
Authors :
Mark Quigg, Nicholas Barbaro, Mariann Ward, Kenneth D. Laxer, Epilepsy Radiosurgery Study Group Department of Neurology, University of Virginia, Charlottesville, VA; Department of Neurological Surgery, University of California [ndash] San Francisco, San F
Complications after standard anterior temporal lobectomy (ATL) for medically-intractable mesial temporal lobe epilepsy (MTLE) include transient, but sometimes more persistent ([gt]1year), postoperative mood and cognitive disorders. Gamma knife radiosurgery (GK) for MTLE differs from ATL in that seizures gradually attenuate over a 2 year course. We report the neuropsychological course of patients s/p GK treatment for MTLE to determine if GK and ATL differ in associated changes in mood at 1 year postoperatively.
Patients with MTLE were treated with GK as part of an ongoing, multicenter, NIH-sponsored protocol. Neuropsychological markers were assessed preoperatively and at 1 year following GK treatment. Neuropsychological status was assessed with the QOLIE-10, a subset of quality-of-life measures, the Beck Depression Inventory (BDI), and verbal IQs (VIQ) via Kaufman Brief Intelligence Test. Seizure rates during the 3 months preceding each assessment were obtained through diaries. Postoperative BDI and QOLIE-10 scores were modeled with regression techniques, and individual variables were analyzed with paired t-tests.
8 patients attained f/u duration [gt] 1 year. One patient reported cessation of seizures for 3 months at 1 year. Seizure rate / 3 month block declined from 26[plusmn]7 to 8[plusmn]2 (mean [plusmn] standard error, p = 0.05). Two patients required inpatient evaluation for acute mood disorders: 1 arising without clear cause, and another associated with steroid treatment. Neither QOLIE-10 total score (25[plusmn]2 vs 24[plusmn]3, p=0.81), BDI (7[plusmn]2 vs 8[plusmn]2, p = 0.52), nor VIQ (91[plusmn]4 vs 93[plusmn]6, p=0.52) changed significantly. Neither postoperative BDI nor QOLIE-10 scores were predicted by models that included preoperative scores and change in seizure counts. Psychiatric admission was not predicted by pre-operative BDI or QOLIE-10 scores by logistic regression.
In contrast to reports following ATL, neuropsychological outcomes do not significantly change 1 year after GK treatment for MTLE. Transient mood alterations, however, still occur. Repeat testing will be done to determine time course of neuropsychological changes as the radiosurgical lesion develops. Further follow-up and comparison to an ATL cohort is necessary.
[Supported by: NIH, Elekta Co (Stockhom, Sweden).]