Abstract
Cognitive impairment, particularly memory disruption, is a major complicating feature of epilepsy. This Review will begin with a focus on the problem of memory impairment in temporal lobe epilepsy (TLE). We present a brief overview of anatomical substrates of memory disorders in TLE, followed by a discussion of how our understanding of these disorders has been improved by studying the outcomes of anterior temporal lobectomy. The clinical efforts made to predict which patients are at greatest risk of experiencing adverse cognitive outcomes following epilepsy surgery are also considered. Finally, we examine the vastly changing view of TLE, including findings demonstrating that anatomical abnormalities extend far outside the temporal lobe, and that cognitive impairments extend beyond memory function. Linkage between these distributed cognitive and anatomical abnormalities point to a new understanding of the anatomical architecture of cognitive impairment in epilepsy. Clarifying the origin of these cognitive and anatomical abnormalities, their progression over time and, most importantly, methods for protecting cognitive and brain health in epilepsy, present a challenge to neurologists.
Key Points
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Episodic memory impairment is a key feature of temporal lobe epilepsy (TLE)
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Examination of patients following epilepsy surgery has contributed substantially to our understanding of the neuroanatomy of human memory
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Wide variability is observed in the effects of anterior temporal lobectomy on postoperative memory function
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Understanding the cause of this variability has improved our ability to identify patients at greatest risk of adverse cognitive outcomes
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Cognitive morbidity in TLE can extend beyond memory function, and anatomical abnormalities can extend far beyond the temporal lobe
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Distributed cognitive abnormalities are being linked to anatomical abnormalities outside the temporal lobe, providing a new neurobiological understanding of the neuropsychology of TLE
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Acknowledgements
We thank Dr David Loring and Dr John Langfitt for their critical review of earlier versions of this manuscript. Preparation of this paper was supported in part by the National Institute of Neurological Disorders and Stroke RO1–44351 (B. Hermann, M. Seidenberg) and K–23 NS060993 (J. J. Lin).
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Bell, B., Lin, J., Seidenberg, M. et al. The neurobiology of cognitive disorders in temporal lobe epilepsy. Nat Rev Neurol 7, 154–164 (2011). https://doi.org/10.1038/nrneurol.2011.3
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DOI: https://doi.org/10.1038/nrneurol.2011.3
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