Wood, Stephen J.; (1998) Memory Dysfunction and Pathology in Children with Temporal Lobe Epilepsy. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Temporal lobe epilepsy is known to affect cognitive functions in both adults and children, with memory being particularly seriously affected. Traditionally, clinical and neurophysiological data have provided information regarding seizure lateralization and this has been related to memory deficits. This technique, which has demonstrated the material-specificity of temporal lobe function, is unable to control for the high degree of bilateral temporal lobe pathology that is often seen in patients with temporal lobe epilepsy. Modem imaging technology has enabled the non-invasive investigation of the brain and the quantification of temporal lobe pathology. In this thesis, three quantitative magnetic resonance techniques were used to evaluate the degree of temporal lobe damage in children with temporal lobe epilepsy. These were hippocampal volumetry, T2 relaxometry and proton magnetic resonance spectroscopy. The first two techniques both measure pathology in the hippocampus, but in different ways. Specifically, volumetry assesses how much tissue has been lost, whilst T2 assesses the integrity of the remaining tissue. Spectroscopy, by contrast, investigates the biochemistry of the medial temporal lobe, providing information that is not available from standard magnetic resonance imaging. This information about medial temporal lobe pathology was related to memory performance. Measures of left temporal, and particularly left hippocampal, pathology were found to be associated with scores on a number of verbal memory tests. However, measures of right temporal pathology were not associated with any test of memory, even those thought to be dependent on the right temporal lobe. The response of the epileptic brain to surgery was investigated using the magnetic resonance techniques and neuropsychological measures. The results suggested that outcome differed depending on the type of surgical procedure. In particular, the contralateral hippocampus appeared to show a volume increase following a temporal lobectomy, but an increase in T2 relaxation time following a temporal lesionectomy. Spectroscopic data showed a trend towards more normal biochemistry in both groups. Immediate memory function was found to improve in patients who had a lesionectomy, but worsen following temporal lobectomy. The relationship between these findings is discussed. This thesis demonstrates the use of quantitative magnetic resonance techniques in the investigation of temporal lobe epilepsy of the relationship between temporal lobe epilepsy and memory dysfunction.

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