Abstract Details

Title Individual Prediction of Postoperative Verbal Memory in Temporal Lobe Epilepsy: the Contribution of Postictal Memory Testing

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) S48 - Epilepsy/Clinical Neurophysiology (EEG) III (1:33 PM-1:44 PM)

Poster/Presentation
Number 004

Objective We measured the prognostic value of postictal memory testing in predicting the postoperative verbal memory.

Background The prediction of verbal memory decline after temporal lobe epilepsy surgery remains difficult at individual level. We analyzed consecutive patients undergoing anterior temporal lobectomy (ATL).

Design/Methods Sixty-three consecutive patients were included who underwent temporal lobe epilepsy (TLE) surgery in our center with pre-operative interictal/postictal and postoperative memory testing. Verbal memory was evaluated using 15-item Rey’s auditory-verbal learning task. We used reliable change indices with the 90% confidence interval (RCI90) to evaluate a significant postoperative memory decline. The Sensitivity (Sn), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), area under the curve (AUC), and accuracy (ACC) was calculated. The analysis was performed for all TLE patients and for the subgroup with hippocampal sclerosis (HS).

Results The median age was 31.3 years (range 12-56) with median duration of epilepsy of 18.8 years (range 2-53). L-TLE patients (n=31) had lower verbal memory scores than R-TLE at 3 months (57 vs. 78%) and 12 months (53 vs. 78%) after surgery. The RCI90 was 4 out of 15 items decline. In HS patients, the postictal verbal memory predicted the postoperative VDR decline (p=0.03, AUC=0.694, CI [0.493-0.895]). The 40% postictal decline had a Sn 50%, Sp 88%, PPV 50%, NPV 88%, AUC 0.689, and ACC 80% to predict a postoperative memory decline in patients with HS (n=41) and Sn 42%, Sp 84%, PPV 39%, NPV 86%, AUC 0.630, and ACC 76% in the whole group.

Conclusions The postictal memory is a non-invasive bedside test that can help predict the postoperative verbal memory decline in patients with HS with an overall accuracy of 80%. It is valuable in identifying patients at risk of postoperative verbal memory decline and can serve as an addition to the standard pre-surgical work-up.

Authors/Disclosures
Lukas Sveikata (University of Geneva) PRESENTER	No disclosure on file
	No disclosure on file
	No disclosure on file
Margitta Seeck, MD, PhD	No disclosure on file
	No disclosure on file
	No disclosure on file
Serge Vulliemoz	No disclosure on file

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