Dados do Trabalho

Título

Clinical aspects associated with cognitive impairment in Temporal Lobe Epilepsy: an investigation of episodic memory performance and executive function in adult patients

Introdução

Cognitive impairments in Temporal Lobe Epilepsy (TLE) have been associated with lower academic performance, loss of functionality, and greater dependence on daily living tasks. Thus, the relationship between clinical variables and possible deficits refines the evaluation and assists in the choice of interventions.

Objetivo

In this sense, this study investigated the degree of association between clinical variables (lesion lateralization, age at first seizure, and type of lesion) and performance on verbal episodic memory and executive function tasks (lexical access) in patients with pharmacoresistant TLE.

Método

In this sample, 23 right-handed adult patients (16 [69.6%] male, age 21 ± 60 years) with a diagnosis of TLE associated with brain lesions (14 [60.9%] mesial temporal sclerosis, 9 [39.1%] tumors; 8 [34.8%]), being 15 (65.2%) on the right, were included. Patients with IQ lesser than 80 were excluded from this analysis. For the assessment of verbal episodic memory, The Free and Cued Selective Reminding Test [TESLIP, by Paz Fonseca, Zimmermann and Delaere, 2019 in Portuguese] was used, and for the executive function related to lexical access, the Semantic and Phonological Verbal Fluency test (SPVFT) was used. Statistical analyses were performed in SPSS 20.

Resultados

Among the clinical variables, median age at first seizure was different between lesion type groups: 54 (range, 1–55 ) for mesial temporal sclerosis and 47 (range, 10–57 ) for tumor patients (P=0,018). with the former having greater impairments related to a younger age. Furthermore, using a multivariate generalized linear models, we investigated the relationship between clinical variables (seizure onset age, lesion type, and lesion side) and cognitive performance (TESLIP and SPVFT), with effective models for mnestic (P=0.015) and executive (P=0.002) performance.

Conclusão

In these models, it was shown that the earlier the first epileptic seizure, the worse the ability to evoke long-term information (delayed free evocation – TESLIP) (P=0.044), and to access words in the lexicon via the phonological route (Phonological Verbal Fluency) (P=0.019). Thus, our findings shed light on the association between structural lesions in early temporal epilepsy and emphasize the importance of identifying primary and secondary impairments in the cognitive assessment during follow-up in this clinical population.

Palavras-chave

cognitive impairments; temporal lobe epilepsy; episodic memory; verbal fluency; neuropsychology