Keywords
cognitive outcomes - anterior temporal lobectomy - long-term outcomes - epilepsy surgery
- processing speed - attention - memory - seizure freedom - antiseizure medications
Cognitive issues are ubiquitous with epilepsy and ongoing seizures, and anti-epileptic
medications (ASMs) are known to impact processing speed and attention. Most studies
have focused on memory outcomes 1-year post-ATL surgery. There is sparse literature
to understand long-term outcomes in other cognitive domains.
Aim: Our study assesses postsurgery cognitive shifts in processing speed, attention, memory,
and language.
Method: Retrospective data analysis of patients who underwent ATL and fulfilled inclusion
criteria of (1) test data for three time points: preoperative (T0), 1-year postoperative
(T1), and long-term 5-year postoperative (T2); (2) seizure freedom, Engel's classification
I and discontinuation of all antiseizure medications (ASMs) at the long term, (3)
no psychiatric comorbidity, (4) normal intelligence. A repeated measures ANOVA analysis
was performed.
Results: The data analysis of 43 patients who fulfilled the inclusion criteria revealed significant
group main effects (p < 0.05) for attention and processing speed. Post hoc analysis showed a significant
improvement in processing speed between T0–T1 and T0–T2, while a significant improvement
in focused attention was observed only between T0–T2 when, with seizure freedom, there
was the discontinuation of ASMs.
Conclusions: There is differential improvement in the cognitive domains in the short and long term.
Processing speed improves with seizure freedom at one-year, but improvements in attention
occur only on stoppage of ASMs in the long term. Improvements in attention may indirectly
benefit memory. The long-term benefits of seizure freedom and discontinuation of ASMs
are important findings for counseling and planning the rehabilitation of patients
who undergo ATL.
