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Cognitive prognosis in chronic temporal lobe epilepsy
Author(s) -
Hermann Bruce P.,
Seidenberg Michael,
Dow Christian,
Jones Jana,
Rutecki Paul,
Bhattacharya Abhik,
Bell Brian
Publication year - 2006
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.20872
Subject(s) - epilepsy , temporal lobe , cognition , neuropsychology , magnetic resonance imaging , psychology , prospective cohort study , cognitive decline , frontal lobe , effects of sleep deprivation on cognitive performance , audiology , medicine , pediatrics , psychiatry , radiology , dementia , disease
Objective First, to determine whether patients with chronic temporal lobe epilepsy have a different cognitive trajectory compared to control subjects over a prospective 4‐year interval; second, to determine the proportion of patients who exhibit abnormal cognitive change and their profile of demographic, clinical epilepsy, and baseline quantitative magnetic resonance imaging characteristics; and third, to determine the most vulnerable cognitive domains. Methods Participants with chronic temporal lobe epilepsy (n = 46) attending a tertiary referral clinic and healthy control subjects (n = 65) underwent neuropsychological assessment and reevaluation 4 years later. Analysis of test–retest patterns identified individual patients with adverse cognition outcomes. Results The prospective cognitive trajectory of patients with chronic temporal lobe epilepsy differs from age‐ and sex‐matched healthy control subjects. Lack of practice effects is common, but frank adverse cognitive outcomes are observed in a subset of patients (20–25%), particularly in vulnerable cognitive domains that include memory. Cognitive declines are associated with a profile of abnormalities in baseline quantitative magnetic resonance volumetrics, lower baseline intellectual capacity, as well as longer duration of epilepsy and older chronological age. Interpretation Cognitive prognosis is poor for a subset of patients characterized by chronicity of epilepsy, older age, lower intellectual ability, and more baseline abnormalities in quantitative magnetic resonance volumetrics. Ann Neurol 2006;60:80–87