Neuropsychological assessment in temporal lobe epilepsy surgery

Anterior temporal lobectomy (ATL) is an effective treatment for drug-resistant temporal lobe epilepsy, but it is not without risk. Declines in verbal memory and naming abilities following dominant hemisphere ATL are well documented, and declines in visual memory following non-dominant ATL are also reported, although less reliably so. Stereotactic laser interstitial thermal therapy (LITT) is an alternative to surgical resection and is thought to reduce collateral damage to temporal neocortical tissue and in doing so preserve language functions. Assessing risk and identifying those patients at greatest risk for cognitive decline following these interventions are important, and neuropsychological assessment during the pre-surgical stage can provide valuable information toward this goal. Higher preoperative memory and language performance, later age at seizure onset, language dominance in the surgical hemisphere, and larger extent of surgical resection have been found to be strong predictors of cognitive decline following ATL. Although the aim of LITT is to minimize cognitive decline, cognitive outcomes following LITT are not well studied.