38 Language and memory outcome after frontal or temporal resection for epilepsy

Abstract

Objective:

The purpose of this investigation was to examine neuropsychological functioning after frontal (FL) or temporal lobectomy (ATL) in patients with localization related epilepsy. Few studies have compared cognitive changes following FL and ATL. Past research found improvement on measures of verbal and visual memory along with confrontation naming after FL (Busch et al., 2017). In contrast, a number of studies have reported verbal memory and naming decline in those undergoing left ATL. The current study examined post-operative cognitive changes in epilepsy patients who underwent either a left or right FL or ATL.

Participants and Methods:

Subjects include 430 patients (204 men, 225 women, 1 gender not specified), who underwent surgical resection; Right FL = 25, Left FL = 26, Right ATL = 211, Left ATL = 168. Patients had a mean FSIQ = 90, ages ranging from 18 to 71 (mean age = 37 years), right (n=359), left (n=50), or mixed (n=18) handedness, and education ranging from 3 to 22 years (mean = 12.9 years of education). Change from pre- to post FL and ATL was examined in the following domains: learning and memory [Long Term Storage for Selective Reminding Tests (SRT), Wechsler’s Memory Scale (WMS): Logical Memory Delayed Recall (LM) and Visual Reproduction Delayed Recall (VR)], and language [Boston Naming Test (BNT)].

Results:

A one-way ANOVA was used to examine changes in language and memory. Our findings revealed statistically significant differences between resection groups for LM, SRT, and BNT. There were significant declines (p<.001) for left ATL when compared to right ATL for LM, SRT, and BNT. There were significant declines for left ATL, when compared to the gains in both left (p<.001; p=.002) and right (p=.018; p=.008) FL for LM and BNT. Left ATL also had significant declines when compared to gains in SRT (p<.001) for right FL. There were significant declines for left FL when compared to right ATL for SRT (p=.007). Lastly, there were significant gains for right FL when compared to left FL for SRT (p=.020).

Conclusions:

The pre- to post-surgical neuropsychological change in learning, memory, and language is understudied in frontal lobe epilepsy (FLE); although several investigators reported some learning and memory impairments in FLE at either pre- or post-surgical time points (Johnson-Markve et al., 2011; Incisa Della Rocchetta et al., 1993). The current study suggests that resections of the frontal lobes are associated with better outcomes for naming and verbal memory (LM) when compared to left ATLs. Interestingly, verbal list learning declined more in left than right FL and right ATL patients suggesting a possible language based executive functioning component to this memory measure. As expected, our study further supports that left ATLs are associated with material specific memory declines. This pattern was not seen for those undergoing a right ATL (i.e., nonverbal memory did not decline in patients with right ATL).