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Long-term effects of temporal lobectomy on intelligence

From the Departments of Neuropsychology, Epilepsy Centre "SEIN" (Dr. Alpherts, J. Vermeulen), Heemstede, Epilepsy Centre "Hans Berger Kliniek" (M.P.H. Hendriks), Breda, and Epilepsy Centre "Kempenhaeghe" (M.L.O. Franken), Heeze, Department of Functional Neurosurgery (Dr. van Rijen), University Hospital of Utrecht, Rudolf Magnus Institute for Neurosciences (Dr. van Veelen), University of Utrecht, and Institute of Neurobiology (Dr. Lopes da Silva), University of Amsterdam, the Netherlands.

Address correspondence and reprint requests to Dr. W.C.J. Alpherts, Department of Neuropsychology, Stichting Epilepsie Instellingen Nederland, Meer & Bosch/De Cruquiushoeve, Achterweg 5, 2103 SW Heemstede, the Netherlands; e-mail: fepsy{at}euronet.nl

Objective: To characterize the long-term effects of anterior temporal resection on intelligence.

Methods: Twenty-eight left temporal lobectomy (LTL) and 43 right temporal lobectomy (RTL) patients were followed at standard time points for at least 6 years after surgery.

Results: The average gain 6 years after operation was 3.6 Verbal IQ (VIQ) points and 10.3 Performance IQ (PIQ) points in LTL patients and 2.9 VIQ points and 7.7 PIQ points in RTL patients. A seizure-free outcome did not influence the increase in IQ, nor was the extent of resection related to IQ scores at the 6-year follow-up. Patients with exclusively mesial temporal sclerosis did not perform as well as patients with other pathologies, both before and after surgery. Major predictors of improved performance at 6 years were initial higher level of performance and lower age at surgery. Much of the observed improvement may be related to retest effects.

Conclusions: The effects of epilepsy surgery on intelligence in the long term are limited. The largest gain in VIQ is seen from 2 to 6 years after surgery.

Received December 24, 2002. Accepted in final form October 15, 2003.

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