New evidence supports cognitive decline in temporal lobe epilepsy

A Comprehensive Review of Recent Trends in Surgical Approaches for Epilepsy Management

Epilepsy is a neurological disorder that affects millions of people worldwide, with a significant proportion of patients experiencing drug-resistant epilepsy, where seizures remain uncontrolled despite medical treatment. This review evaluates the latest surgical techniques for managing epilepsy, focusing on their effectiveness, safety, and the ongoing challenges that hinder their broader adoption. We explored various databases including PubMed, Google Scholar, and Cochrane Library to look for relevant literature using the following keywords: Epilepsy, Resective Surgery, Corpus Collectumy, and Antiepileptic Drugs. A total of 54 relevant articles were found and thoroughly explored. Recent advancements in surgical interventions include resective procedures such as anterior temporal lobectomy, corpus callosotomy, and hemispherectomy, which have been particularly effective in reducing seizures for specific types of epilepsy. Minimally invasive techniques, including laser interstitial thermal therapy and focused ultrasound, are increasingly being used, offering promising outcomes for certain patient groups. Additionally, neuromodulation methods such as deep brain stimulation, vagus nerve stimulation, and responsive neurostimulation provide alternative treatment options, especially for patients who are not suitable candidates for resective surgery. Despite these advancements, the full potential of epilepsy surgery is often underutilized due to various challenges. Inconsistent referral practices, a lack of standardized surgical protocols, and significant socioeconomic barriers continue to limit access to these procedures. Addressing these issues through improved referral processes, better education for healthcare providers and patients, and ensuring equitable access to advanced surgical treatments is crucial for optimizing patient outcomes. Future research should focus on overcoming these barriers and assessing long-term outcomes to further enhance the care of patients with epilepsy.

[Effects of temporal lobe epilepsy and idiopathic epilepsy on cognitive function and emotion in children]

OBJECTIVE

To investigate the effects of temporal lobe epilepsy and idiopathic epilepsy on cognitive function and emotion in children and the risk factors for cognitive impairment.

METHODS

A retrospective analysis was performed for the clinical data of 38 children with temporal lobe epilepsy and 40 children with idiopathic epilepsy. The controls were 42 healthy children. All subjects received the following neuropsychological tests: Montreal Cognitive Assessment (MoCA) scale, verbal fluency test, digit span test, block design test, Social Anxiety Scale for Children (SASC), and Depression Self-rating Scale for Children (DSRSC).

RESULTS

Compared with the control group, the temporal lobe epilepsy and idiopathic epilepsy groups showed significantly lower scores of MoCA, verbal fluency, digit span, and block design (P<0.05) and significantly higher scores on SASC and DSRSC (P<0.05). Compared with the idiopathic epilepsy group, the temporal lobe epilepsy group showed significantly lower scores of MoCA, verbal fluency, digit span, and block design (P<0.05) and significantly higher scores on SASC and DSRSC (P<0.05). In the temporal lobe epilepsy group, MoCA score was negatively correlated with SASC score, DSRSC score, and seizure frequency (r=-0.571, -0.529, and -0.545 respectively; P<0.01). In the idiopathic epilepsy group, MoCA score was also negatively correlated with SASC score, DSRSC score, and seizure frequency (r=-0.542, -0.487, and -0.555 respectively; P<0.01).

CONCLUSIONS

Children with temporal lobe epilepsy and idiopathic epilepsy show impaired whole cognition, verbal fluency, memory, and executive function and have anxiety and depression, which are more significant in children with temporal lobe epilepsy. High levels of anxiety, depression, and seizure frequency are risk factors for impaired cognitive function.

The relationship between emotional intelligence and task-switching in temporal lobe epilepsy

Objectives:

To examine the role of emotional intelligence (EI) in task-switching performance of patients with temporal lobe epilepsy (TLE).

Methods:

An experimental research design conducted at Sheikh Zayed Hospital, Rahim Yar Khan, Mayo and Services Hospital, Lahore, Pakistan from March 2013 to October 2014. Twenty-five patients with TLE and 25 healthy individuals from local community participated in the study. Participants completed measures of intelligence, EI, depression, anxiety, stress, and task-switching experiment.

Results:

Patients and controls showed an average intelligence quotient, and normal levels of depression, anxiety, and stress. In contrast to controls, patients showed lower EI and impaired task-switching abilities. This result can be seen in the context of disintegrated white matter and cerebral connectivity in patients with TLE. Emotional intelligence was found to be a significant predictor of task-switching performance.

Conclusion:

Emotional intelligence is a potential marker of higher order cognitive functioning in patients with TLE.

Cognitive-behavioral therapy for depression in patients with temporal lobe epilepsy: a pilot study

Depression has a high prevalence among patients with temporal lobe epilepsy (TLE). A pilot study was carried out to evaluate group cognitive-behavioral therapy (CBT) as a treatment for depression in patients with TLE. Twenty-three outpatients with TLE and major depressive disorder, according to DSM-IV criteria, were enrolled and divided into two groups to receive 16 weekly sessions of CBT. The primary outcome measures were depression severity (assessed with the Beck Depression Inventory) and quality of life (measured with the Quality of Life in Epilepsy-31). Sixteen patients (70%) completed at least 80% of the sessions. From week 8, CBT had a significant positive effect on severity of depression that lasted until the end of treatment. A significant improvement in quality of life was also observed. CBT seems to be a useful intervention for treating depression and improving quality of life in patients with TLE.

Two-dimensional movement control using electrocorticographic signals in humans

We show here that a brain-computer interface (BCI) using electrocorticographic activity (ECoG) and imagined or overt motor tasks enables humans to control a computer cursor in two dimensions. Over a brief training period of 12-36 min, each of five human subjects acquired substantial control of particular ECoG features recorded from several locations over the same hemisphere, and achieved average success rates of 53-73% in a two-dimensional four-target center-out task in which chance accuracy was 25%. Our results support the expectation that ECoG-based BCIs can combine high performance with technical and clinical practicality, and also indicate promising directions for further research.

It's about Time: Long-term Memory Outcome following Temporal Lobectomy

Verbal Memory Decline after Temporal Epilepsy Surgery?: A 6-Year Multiple Assessments Follow-up Study. Alpherts WC, Vermeulen J, van Rijen PC, da Silva FH, van Veelen CW; Dutch Collaborative Epilepsy Surgery Program. Neurology 2006;67:626–631.

Objective

To assess the long-term effects of temporal lobe epilepsy surgery on verbal memory.

Methods

We assessed verbal memory performance as measured by a verbal learning test (“15 Words Test,” a Dutch adaptation of Rey's Auditory Verbal Learning Test) before surgery and at three specific times after surgery: 6 months, 2 years, and 6 years in 85 patients (34 left temporal lobe [LTL] vs. 51 right temporal lobe [RTL]). An amygdalo-hippocampectomy and a neocortical temporal resection between 2.5 and 8 cm were carried out in all patients.

Results

LTL patients showed an ongoing memory decline for consolidation and acquisition of verbal material (both 2/3 SDs) for up to 2 years after surgery. RTL patients at first showed a gain in both memory acquisition and consolidation, which vanished in the long term. Breaking the group up into a mesiotemporal (MTS) group and a non-MTS group showed clear differences. The group with pure MTS showed an overall lower verbal memory performance than the group without pure MTS, in the LTL group more pronounced than in the RTL group. After surgery, both pathology groups showed an ongoing decline for up to 2 years, but the degree of decline was greater for the LTL patients with MTS compared with the non-MTS group. Becoming and remaining seizure-free after surgery does not result in a better performance in the long term. Predictors of postoperative verbal memory performance at 6 years after surgery were side of surgery, preoperative memory score, and age.

Conclusions

The results provide evidence for a dynamic decline of verbal memory functions up to 2 years after left temporal lobectomy, which then levels off.