Abstract Details

Title Limited resection preserved verbal memory outcome in drug-resistant dominant temporal lobe epilepsy due to temporal encephaloceles

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) S24 - Epilepsy/Clinical Neurophysiology (EEG): Clinical Epilepsy (3:42 PM-3:54 PM)

Poster/Presentation
Number 002

Background TE are a recognized cause of DR-TLE. There is no consensus on whether TE should be treated with limited resection vs. ATLAH. Patients are at risk of verbal memory deficits following left ATLAH. We hypothesized that limited resection would be associated with lower decline in verbal memory in patients with epilepsy due to left TE.

Objective To compare verbal learning outcomes for limited resection vs. anterior temporal lobectomy with amygdalohippocampectomy (ATLAH) in dominant hemisphere drug-resistant temporal lobe epilepsy (DR-TLE) related to temporal encephaloceles (TE).

Design/Methods Patients with dominant DR-TLE due to TE, ≥12 months post-operative seizure outcome, and both pre- and post-operative neuropsychological testing were identified. A favorable seizure outcome was defined as Engel I or II outcome. Results from a pre- and post-operative neuropsychological test of verbal learning and memory (Wechsler Memory Scale Logical Memory subtest) were compared for each patient. Definite change was defined by improvement or decline of at least one standard deviation from baseline.

Results Thirteen patients were identified (9 women; median age at surgery 27 years; 9 limited TE resections and 4 ATLAH). Seizure outcome was favorable in 9 (64%), including 5 (36%) who were seizure free after a median follow-up of 20 months (12-73). In the test of verbal learning and memory, 3/4 patients who underwent ATLAH demonstrated a definite post-operative decline, compared to 0/9 patients with limited TE repair (p-value 0.014). There was no association between verbal memory decline and seizure outcome. Favorable seizure outcome was similar between the two surgical approaches (ATLAH 2/4 vs limited 7/9, p-value 0.53).

Conclusions Verbal memory decline was less likely after limited resection compared to ATLAH in patients with dominant hemisphere DR-TLE due to TE, and there was no significant difference in rate of favorable seizure outcome. Limited resection should be considered in these patients.

Authors/Disclosures
Kelsey M. Smith, MD (Mayo Clinic) PRESENTER	The institution of Dr. Smith has received research support from CURE Epilepsy. The institution of Dr. Smith has received research support from UCB Pharmaceuticals.
	No disclosure on file
Kiran M. Kanth, MD (UC Davis Medical Center Department of Neurology)	Dr. Kanth has nothing to disclose.
Karl Krecke	Karl Krecke has nothing to disclose.
	No disclosure on file
Jamie J. Van Gompel, MD	Jamie J. Van Gompel, MD has received stock or an ownership interest from Neuroone.
Elson L. So, MD, FAAN (Mayo Clinic)	Dr. So has nothing to disclose.
Jeffrey W. Britton, MD, FAAN (Mayo Graduate School of Medicine)	Dr. Britton has received personal compensation in the range of $0-$499 for serving as a Online course with American Clinical Neurophysiology Society.
Gregory D. Cascino, MD, FAAN (Mayo Clinic)	Dr. Cascino has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for International League Against Epilepsy . Dr. Cascino has received intellectual property interests from a discovery or technology relating to health care. Dr. Cascino has received publishing royalties from a publication relating to health care. Dr. Cascino has received publishing royalties from a publication relating to health care.
Lily Wong-Kisiel, MD, FAAN (Mayo Clinic)	Dr. Wong-Kisiel has nothing to disclose.