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• Quality of life improved following epilepsy surgery. • Quality of life improved regardless of seizure outcome or side of surgery. • Post-operative cognitive decline was associated with less improvement in quality of life. The objectives of this study were to examine the association between cognitive decline and quality of life (QoL) change in a large sample of individuals with drug-resistant epilepsy who underwent resective surgery and to examine whether the association between cognitive decline and QoL is differentially affected by seizure classification outcome (Engel Class 1 vs. 2–4) or side of surgery (left vs. right hemisphere). The sample comprised 224 adults (ages ≥ 18) with drug-resistant focal epilepsy treated with resective surgery who underwent comprehensive pre-operative and post-operative evaluations including neuropsychological testing and the Quality of Life in Epilepsy Inventory - 31 between 1991 and 2020. Linear mixed-effects models were fit to examine subject-specific trajectories and assess the effects of time (pre- to post-operative), cognitive decline (number of measures that meaningfully declined), and the interaction between time and cognitive decline on pre- to post-operative change in QoL. Increases in QoL following resection were observed (B = −10.72 [SE = 1.22], p <.001; mean difference between time point 1 and time point 2 QoL rating = 8.11). There was also a main effect of cognitive decline on QoL (B = −.85 [SE =.27], p =.002). Follow-up analyses showed that the number of cognitive measures that declined was significantly associated with post-surgical QoL, (r = −.20 p =.003), but not pre-surgical QoL, (r = −.04 p =.594), and with pre-to post-surgery raw change in QoL score, (r = −.18 p =.009). A cognitive decline by time point interaction was observed, such that those who had greater cognitive decline had less improvement in overall QoL following resection (B =.72 [SE =.27], p =.009). Similar results were observed within the Engel Class 1 outcome subgroup. However, within the Engel Class 2–4 outcome subgroup, QoL improved following resection, but there was no main effect of cognitive decline or interaction between cognitive decline and time point on QoL change. There was no main effect of resection hemisphere on overall QoL, nor were there interactions with hemisphere by time, hemisphere by cognitive decline, or hemisphere by time by cognitive decline. Quality of life improves following epilepsy surgery. Participants who had cognitive decline across a greater number of measures experienced less improvement in QoL post-operatively overall, but there was no clear pattern of domain-specific cognitive decline associated with change in QoL. Our results indicate that cognitive decline in a diffuse set of cognitive domains negatively influences post-operative QoL, particularly for those who experience good seizure outcomes (i.e., seizure freedom), regardless of the site or side of resection. [ABSTRACT FROM AUTHOR]

Abstract: Objective: This study aimed to examine language outcome after left or right anterior temporal lobectomy (ATL) in patients with epilepsy with bilateral language representation on intracarotid sodium amobarbital (Wada) testing. Methods: Twenty-two patients with epilepsy with bilateral language (Wada laterality index between −50 and 50) underwent right ATL (RATL, n=10) or left ATL (LATL, n=12). All the patients were administered the Boston Naming Test preoperatively and six months postoperatively. Results: Left anterior temporal lobectomy patients showed greater postoperative naming decline than RATL patients. Group differences were also observed on subtests of the Wada test. Performance on the Wada naming and comprehension subtests was better in the nonsurgical hemisphere than in the surgical hemisphere in the RATL group, but there was no difference between the nonsurgical and the surgical hemisphere naming and comprehension performance in the LATL group. Conclusions: Left anterior temporal lobectomy patients with bilateral language are at greater risk for naming decline than RATL patients with bilateral language. This difference may be due to relatively better naming and comprehension abilities in the nonsurgical hemisphere in the RATL group. [Copyright &y& Elsevier]

Abstract: Objective: Investigations of the validity of fMRI as an alternative to Wada language testing have yielded Wada/fMRI discordance rates of approximately 15%, but almost nothing is known regarding the relative accuracy of Wada and fMRI in discordant cases. The objective of this study was to determine which of the two (the Wada test or the language fMRI) is more predictive of postoperative naming outcome following left anterior temporal lobectomy in discordant cases. Methods: Among 229 patients with epilepsy who prospectively underwent Wada and fMRI language testing, ten had discordant language lateralization results, underwent left anterior temporal lobectomy, and returned for postoperative language testing. The relative accuracy of Wada and fMRI for predicting language outcome was examined in these cases. Results: Functional magnetic resonance imaging provided a more accurate prediction of language outcome in seven patients, Wada was more accurate in two patients, and the two tests were equally accurate in one patient. Conclusions: In cases of discordance, fMRI predicted postsurgical naming outcome with relatively better accuracy compared to the Wada test. [Copyright &y& Elsevier]

• The International Classification of Cognitive Disorders in Epilepsy (IC-CoDE) produced largely stable frontal lobe epilepsy (FLE) phenotypes across centers. • Patients with FLE reported language predominant cognitive impairment. • FLE resulted in more severe cognitive impairment compared with temporal lobe epilepsy. The International Classification of Cognitive Disorders in Epilepsy (IC-CoDE) was recently introduced as a consensus-based, empirically-driven taxonomy of cognitive disorders in epilepsy and has been effectively applied to patients with temporal lobe epilepsy (TLE). The purpose of this study was to apply the IC-CoDE to patients with frontal lobe epilepsy (FLE) using national multicenter data. Neuropsychological data of 455 patients with FLE aged 16 years or older were available across four US-based sites. First, we examined test-specific impairment rates across sites using two impairment thresholds (1.0 and 1.5 standard deviations below the normative mean). Following the proposed IC-CoDE guidelines, patterns of domain impairment were determined based on commonly used tests within five cognitive domains (language, memory, executive functioning, attention/processing speed, and visuospatial ability) to construct phenotypes. Impairment rates and distributions across phenotypes were then compared with those found in patients with TLE for which the IC-CoDE classification was initially validated. The highest rates of impairment were found among tests of naming, verbal fluency, speeded sequencing and set-shifting, and complex figure copy. The following IC-CoDE phenotype distributions were observed using the two different threshold cutoffs: 23–40% cognitively intact , 24–29% single domain impairment , 13–20% bi-domain impairment , and 18–33% generalized impairment. Language was the most common single domain impairment (68% for both thresholds) followed by attention and processing speed (15–18%). Overall, patients with FLE reported higher rates of cognitive impairment compared with patients with TLE. These results demonstrate the applicability of the IC-CoDE to epilepsy syndromes outside of TLE. Findings indicated generally stable and reproducible phenotypes across multiple epilepsy centers in the U.S. with diverse sample characteristics and varied neuropsychological test batteries. Findings also highlight opportunities for further refinement of the IC-CoDE guidelines as the application expands. [ABSTRACT FROM AUTHOR]

• The Selective Reminding Test is used in pre-surgical evaluations for people with epilepsy. • Verbal memory decline after left ATL resection is a consistent finding across studies. • Reliable Change Indices are useful for predicting risk for decline after left ATL surgeries. The Selective Reminding Test (SRT) is widely used in pre-surgical evaluations for people with epilepsy; however, important characteristics such as reliability and stability over time within an epilepsy-specific control cohort are unclear. In this study, we document test–retest reliabilities, practice effects, and Reliable Change Indices (RCI) for this test in a sample of right temporal lobe epilepsy patients who are left hemisphere dominant for language and underwent surgical resection on the right temporal lobe. A sample of 101 adults with a right temporal lobe seizure focus (mean age = 38.5) was administered the SRT pre- and post-right temporal lobe surgery. Test-retest reliabilities were modest (r = 0.44–0.59). Practice effects were minimal (0.25–2.04). Reliable Change Indices were calculated and ranged from 4 to 26 depending on the SRT index. The RCI's indicate that relatively moderate to large changes on the SRT are needed for a change score to be considered a significant change in an individual's performance. The RCIs can be used to detect a reliable change in patients undergoing left temporal lobe epilepsy surgery who are at significant risk for verbal memory decline. [ABSTRACT FROM AUTHOR]