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Title: Looking beyond lesions for causes of neuropsychological impairment in epilepsy.
Austin Authors: Rayner, Genevieve ;Tailby, Chris ;Jackson, Graeme D ;Wilson, Sarah J
Affiliation: Comprehensive Epilepsy Programme, Austin Health, Heidelberg, Victoria, Australia
Melbourne School of Psychological Sciences, the University of Melbourne, Parkville, Victoria, Australia
Melbourne School of Psychological Sciences, the University of Melbourne, Parkville
The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
Institute for Social Neuroscience, Heidelberg, Australia
Issue Date: 12-Feb-2019 2019-01-11
Publication information: Neurology 2019; 92(7): e680-e689
Abstract: 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. 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. 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. 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.
DOI: 10.1212/WNL.0000000000006905
PubMed URL: 30635484
Type: Journal Article
Appears in Collections:Journal articles

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