RT Journal Article
SR Electronic
T1 Looking beyond lesions for causes of neuropsychological impairment in epilepsy
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP e680
OP e689
DO 10.1212/WNL.0000000000006905
VO 92
IS 7
A1 Genevieve Rayner
A1 Chris Tailby
A1 Graeme Jackson
A1 Sarah Wilson
YR 2019
UL http://n.neurology.org/content/92/7/e680.abstract
AB Objective Patients with temporal lobe epilepsy (TLE) are similar in their epileptology regardless of whether they have a lesion evident on MRI; this study aims to prospectively clarify whether they are also similar in their neuropsychological profiles.Methods Participants comprised 152 adults: 79 patients with TLE and 73 healthy controls. Patients and controls did not differ in age, sex, or education (p > 0.05). Sixty-two percent of patients had an MRI-resolvable lesion (39% with presumed hippocampal sclerosis [HS-TLE], 61% with a lesion other than HS [MRI-positive TLE]); the remaining 38% of patients were lesion-negative. Psychometric measures well established in epilepsy were used.Results Relative to controls, all 3 patient subgroups showed significantly impaired autobiographical, verbal, and visual memory (p < 0.05–0.001) and significantly more depression and anxiety (p < 0.05–0.01). Yet, contrary to expectations, the 3 TLE subgroups did not differ in their severity of memory or mood impairment (p > 0.05). Lower Full-Scale IQ predicted memory impairments across all TLE subtypes, with early age at seizure onset a predictor unique to MRI-negative TLE.Conclusions MRI-negative TLE is associated with memory and mood dysfunction equivalent to that seen in patients with hippocampal sclerosis and other MRI-resolvable pathologies. As such, neuropsychological impairments in TLE are not contingent on a macroscopic lesion and might be an intrinsic property of the underlying network disease.AMI=Autobiographical Memory Interview; ANCOVA=analysis of covariance; CI=confidence interval; DSM-IV=Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition); ES=effect size; FSIQ=Full-Scale IQ; HS=hippocampal sclerosis; HS-TLE=temporal lobe epilepsy with hippocampal sclerosis; MRI-neg TLE=MRI-negative temporal lobe epilepsy; MRI-pos TLE=MRI-positive temporal lobe epilepsy; NDDI-E=Neurological Disorders Depression Inventory for Epilepsy; PHQ-GAD-7=Patient Health Questionnaire–Generalized Anxiety Disorder 7-item; ROCF=Rey-Osterrieth Complex Figure; SCID=Structured Clinical Interview for DSM-IV Axis I Disorders; TLE=temporal lobe epilepsy; VPA=Verbal Paired Associates