Neuropsychological outcomes in epilepsy surgery patients with unilateral hippocampal sclerosis and good preoperative...

We examined postoperative changes in the memory function of 68 people with unilateral hippocampal sclerosis (HS) who underwent epilepsy surgery and had no previous clinical memory impairments. One in four with right HS (RHS) and one in five with left HS (LHS) in our sample of 323 people with unilateral HS performed within normal limits on memory tests that are sensitive to hippocampal pathology in group studies. People with intact memory function prior to surgery were significantly younger and had higher IQs than those with memory impairments. The majority of those with intact memory functions prior to surgery had significant postoperative declines on the memory measures at the 1-year follow-up and no longer functioned within the average range. People with RHS and left LHS were equally at risk of a postoperative decline. Postoperative deterioration was not related to seizure outcome. A higher IQ appears to protect against postoperative memory decline in this group. This finding does not support the notion that intact memory function in people with unilateral HS represents a migration of memory function to the contralateral structures, and thus protection from surgical insult. People with good preoperative memory function in the context of unilateral HS should therefore be counseled regarding the likelihood of a significant postoperative decline in memory function following a temporal lobe resection.