Verbal learning and memory outcome in selective amygdalohippocampectomy versus temporal lobe resection in patients with hippocampal sclerosis
Abstract number :
2.334
Submission category :
9. Surgery / 9A. Adult
Year :
2017
Submission ID :
349489
Source :
www.aesnet.org
Presentation date :
12/3/2017 3:07:12 PM
Published date :
Nov 20, 2017, 11:02 AM
Authors :
Olaf B. Paulson, Rigshospitalet and University of Copenhagen; Mette T. Foged, Rigshospitalet and University of Copenhagen; Kirsten Vinter, Rigshospitalet; Louise Kristensen, Danish Epilepsy Centre, Dianalund; Troels W. Kjær, Zealand University Hospital, R
Rationale: To investigate the influence of the epilepsy surgery approach on cognition and seizure outcome in patients with temporal lobe epilepsy and histopathological verified hippocampal sclerosis (HS). It is controversial whether selective amygdalohippocampectomy (SAH) has a better neuropsychological outcome compared to nonselective temporal lobe resection (TLR). Methods: We identified 108 adults (>16 years) with HS, operated between 1995-2009 in Denmark. Exclusion criteria: Intelligence below normal range, right hemisphere dominance, other native language, dual pathology, missing follow-up data. Among the patients 56 fulfill these criteria and were analyzed. The patients were allocated to SAH (n=22) or TLR (n=34) based on intraoperative electrocorticography. Verbal learning, verbal memory and semantic fluency were tested pre- and postsurgery (Danish version of 15 Verbal Paired Associated words, containing 7 semantically related/ easy pairs and 8 unrelated/ hard pairs). Results: Altogether 73% were seizure-free one-year and 64% seven-years after surgery. Seizure outcome did not differ between patients operated using the SAH versus the TLR at one-year (p=0.951). At seven-years, an unadjusted model showed no difference (p=0.177) while adjusting for age and duration of epilepsy revealed that right-sided TLR were more likely to be seizure-free than right-sided SAH patients (p=0.048).Verbal learning was more affected in patients resected in the left hemisphere than in the right (p=0.002). In patients with left-sided TLR, a worsening in verbal memory performance was found (p=0.011). Conclusions: There was no difference in seizure outcome between the TLR and SAH approaches after one year. At seven year follow up we would consider the slightly better result for right sided operations to be a coincidence. Verbal learning was worse in patients operated in the left hemisphere. TLR in the left hemisphere was associated with a worse outcome in verbal memory. Funding: Supported by a grant from the Lundbeck Foundation. Grant number: R118-A11263.
Surgery