Neuropsychological assessment has been extensively
used in the presurgical evaluation of temporal lobe epilepsy
(TLE) patients to assist in determining lateralization
of seizure onset. Very few studies have examined the accuracy
with which commonly used neuropsychological instruments
provide this information in the individual patient. In
81 patients (49 right-, 32 left-TLE) without space-occupying
lesions in whom correct seizure lateralization was inferred
on the basis of postsurgical seizure-free status, we compared
the frequency with which discrepancies between the Wechsler
Memory Scale–Revised (WMS–R; Wechsler, 1987)
Verbal and Visual Memory Indices, Warrington Recognition
Memory Test (WRMT; Warrington, 1984) Words and Faces scaled
scores, and Intracarotid Amobarbital Procedure (IAP) hemispheric
memory scores correctly predicted seizure lateralization
in the individual patient. Using both clinical analysis
and discriminant function analyses (DFA), the IAP was found
to be a clearly superior predictor of seizure laterality
to the neuropsychological measures, whether used individually
or in combination with one another. Using clinical analysis
the WRMT was found to be a superior predictor to the WMS–R,
which frequently gave false lateralizing information. Using
all 3 measures in combination with one another, 87.1% of
patients were correctly lateralized using DFA. Correctly
lateralized patients were older and had longer durations
of seizure disorder. (JINS, 1997, 3,
159–168.)