Cognitive impairment in temporal lobe epilepsy: contributions of lesion, localization and lateralization
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ORIGINAL COMMUNICATION
Cognitive impairment in temporal lobe epilepsy: contributions of lesion, localization and lateralization Thanh Ha Phuong1,2 · Marion Houot3,4,5 · Marie Méré6 · Marisa Denos1 · Séverine Samson7 · Sophie Dupont1,6,8,9 Received: 17 July 2020 / Revised: 5 November 2020 / Accepted: 8 November 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Cognitive impairment is an important comorbidity of refractory temporal lobe epilepsy (TLE). We aimed to explore the impact of (i) specific lesions, such as dysembryoplastic neuroepithelial tumor (DNET), dysplasia, or hippocampal sclerosis, (ii) focus localization (medial versus lateral) and (iii) focus lateralization (right versus left) on the neuropsychological profile of refractory TLE adult patients. Methods We examined the neuropsychological characteristics of 312 adults with refractory TLE: 100 patients without hippocampal sclerosis (HS) and 212 with HS. Scores on tests of intelligence (Global IQ, Verbal IQ and Performance IQ), working memory, episodic memory (verbal and visual learning and forgetting), executive functions and language abilities were analyzed. Results Three main factors influenced the neuropsychological profile of refractory TLE patients: (i) the lesion, patients with HS obtaining poorer cognitive performances than patients without HS and specifically DNET patients performing better than patients with HS, (ii) the focus side, that seems only relevant for verbal memory abilities which are affected in left but not right TLE patients and (iii) the localization of seizure focus, patients with medial TLE exhibiting lower memory performances than patients with lateral TLE. Conclusion Lesion, localization and lateralization are major contributors of the cognitive impairment depicted in TLE. Hippocampal sclerosis appears as the main contributor. Keywords Cognitive impairment · Temporal lobe epilepsy · Hippocampal sclerosis · Dysembryoplastic neuroepithelial tumor · Lateralization · Localization
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00415-020-10307-6) contains supplementary material, which is available to authorized users. * Sophie Dupont [email protected] 1
Rehabilitation Unit, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
2
Neurology Unit, Hôpital Bach Mai, Hanoi, Vietnam
3
Clinical Investigation Centre, Institut du Cerveau Et de La Moelle Épinière (ICM), Pitié-Salpêtrière Hospital Paris, Paris, France
4
Department of Neurology, Institute of Memory and Alzheimer’s Disease (IM2A), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
Cognitive impairment, especially episodic memory impairment, has been described as a potential comorbidity of longterm temporal lobe epilepsy (TLE) [1]. Many factors shape the nature and extent of cognitive deficits in TLE patients 5
Centre of Excellence of Neurodegenerative Disease (CoEN), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
6
Epilepsy Unit, AP-HP, Pitié
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