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The neuropsychology of temporal lobectomy: Preoperative correlations and postoperative predictions

Baxendale, Sallie Ann; (1998) The neuropsychology of temporal lobectomy: Preoperative correlations and postoperative predictions. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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Abstract

Neuropsychological assessment has long been associated with epilepsy surgery and continues to play an important role in the presurgical evaluation of candidates for temporal lobectomy. However, material specific memory deficits are not invariably found in pre- or postoperative surgical candidates. The literature suggests that a number of factors may interact with the side of seizure focus and/or surgery in shaping the nature of the associated neuropsychological deficit. The heterogeneity in temporal lobe epilepsy (TLE) cases is clearly demonstrated by the findings from Magnetic Resonance Imaging (MRI) studies that enable the in vivo identification and quantification of a number of pathologies associated with TLE. The aim of the research presented in this thesis was to explore the factors associated with variable memory test performance in pre- and postoperative TLE patients with the ultimate aim of improving clinical neuropsychological practise both in terms of presurgical localisation and the prediction of postoperative memory decline. Five studies form the main body of the thesis. In the first the development of a new test of non verbal memory is described. The findings suggest that the test may be a useful clinical tool in the presurgical assessment of TLE patients. The second study employed a multivariate approach to examine the relationship between the extent and laterality of hippocampal pathology and memory dysfunction. The results suggest that chronological age and age of onset of habitual epilepsy interact with the laterality and extent of pathology in patients with hippocampal sclerosis in determining the nature and the extent of the associated memory deficits. The third study explored these relationships further by examining the correlations between quantitative MRI measures of hippocampal pathology and functional measures from the intracarotid amobarbital procedure (IAP). MRI measures of structural asymmetry were significantly correlated with the IAP measure of functional asymmetry supporting the role of the IAP in lateralising temporal lobe dysfunction. The fourth study examined the relationship between quantitative histology and pre- and postoperative memory function. Postoperative decline in verbal recall was associated with the excision of a relatively intact left hippocampus. The excision of a relatively intact right hippocampus was associated with a postoperative decline in non verbal recall. The final study examined the power of preoperative MRI measures, neuropsychological test profiles and demographic and epilepsy related variables in predicting postoperative memory decline. Approximately one third of the patients demonstrated a significant postoperative decline on each memory task. Different patients deteriorated on each task and the decline was task specific for many of them. A high level of preoperative function was a significant risk factor for every task. The underlying pathology, side of surgery and epilepsy and demographic factors were also associated with decline on many of the indices. The clinical and theoretical implications of these findings are discussed.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: The neuropsychology of temporal lobectomy: Preoperative correlations and postoperative predictions
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Thesis digitised by ProQuest.
Keywords: Biological sciences; Epliepsy
URI: https://discovery.ucl.ac.uk/id/eprint/10103154
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