Cognitive prognosis in chronic temporal lobe epilepsy

Ann Neurol. 2006 Jul;60(1):80-7. doi: 10.1002/ana.20872.

Abstract

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.

Publication types

  • Controlled Clinical Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Chronic Disease
  • Cognition Disorders / etiology*
  • Cognition Disorders / pathology*
  • Cognition Disorders / physiopathology
  • Epilepsy, Temporal Lobe / complications*
  • Epilepsy, Temporal Lobe / pathology*
  • Epilepsy, Temporal Lobe / physiopathology
  • Female
  • Humans
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Neuropsychological Tests
  • Predictive Value of Tests
  • Prognosis