Relação entre volume hipocampal e volume de ressecção cirúrgica com controle de crises e desempenho de memória em pacientes com epilepsia de lobo temporal mesial submetidos a tratamento cirúrgico / Relationship between hippocampal volume and surgical resection volume with seizure control and memory performance in patients with mesial temporal lobe epilepsy undergoig surgical treatment

Daniela Alves Fernandes

Epilepsy is the second most frequent neurological disease and temporal lobe epilepsy is the most common form of focal epilepsy and is more frequently associated to refractoriness and memory decline. The epileptogenic lesion can be studied through magnetic resonance imaging, EEG and other tests, facilitating the indication of surgery that aims to reduce seizure frequencies, however cognitive function may be affected. We proposed to evaluate the effectiveness of surgery on the management of seizures, memory performance and compare the results of neuropsychological assessments pre/post-operative and the frequency of seizures, surgical approach and volume of hippocampi and amount of resection. We analyzed 55 patients who underwent epilepsy surgery and 29 healthy control subjects. All patients underwent imaging in a 2T MR scanner in two steps with intervals of 4.4 ± 2.8 years. The volumetry of the hippocampus and surgery gap was done with the software display, using the protocol described by Bonilha et al, 2004. Patients were evaluated according to the postoperative classification of Engel Jr., 1997 and neuropsychological evaluation that included the subtests, Wechsler Memory Scale-Revised, Wechsler Adult Intelligence Scale-Revised and Rey Auditory Verbal Learning Test, performed with an average interval 8.2 years after surgery. For data analysis, pre/post-operative we used the Student t test, Wilcoxon or Man-Whitney, Pearson and Spearman correlation test according to the characteristics of variables. We observed significant differences in neuropsychological evaluations, when we compared the groups pre/post-operative and the groups according to the Engel Scale and side of surgery, with worsening of cognitive performance in the postoperative period. There was a relative improvement in memory performance in those who were classified as Engel IA compared to individuals who continued to have seizures. The comparisons between the groups of selective amygdalohippocampectomy and anterior temporal lobe resection showed no significant differences in memory performance. The level of education had a negative influence on the outcome of neuropsychological evaluations. Our results showed that 80% were classified as Engel I, 18.2% in Engel II and 1.8% in Engel III. The volumetry of the left and right hippocampi ipsilateral to the surgery showed lower values than controls. The left and right hippocampus pre/post-operative contralateral to the side of surgery did not show significant differences when compared to controls. There was a correlation between hipocampal volumes and memory performance. Our results showed that after surgical resection there is a decline in memory performance, but the frequency of seizures in these patients decreased significantly and that the types of surgical approaches do not differ in terms of post-operative nor the total volume of the surgical lacunae.

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