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Dominant TLE Surgery – Verbal Memory Risk — SCE Neurology MCQ

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HardEpilepsy & Seizure DisordersDominant TLE Surgery – Verbal Memory RiskSCE Neurology

A 40-year-old woman with drug-resistant focal epilepsy is discussed at the epilepsy surgery MDT. Her seizures arise from the left mesial temporal lobe. She is left-hemisphere dominant for language. Her neuropsychologist is concerned about post-operative verbal memory decline. What is the approximate risk of verbal memory decline after dominant temporal lobectomy?

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Correct answer: A — Approximately 30–40% of patients have measurable verbal memory decline after dominant (left) temporal lobectomy — this is because the hippocampus being resected contributes to verbal memory encoding

Dominant (usually left) temporal lobectomy removes the hippocampus and parahippocampal structures that are involved in verbal memory encoding. Approximately 30–40% of patients have measurable verbal memory decline on formal neuropsychological testing, though the clinical impact varies. Risk factors for worse verbal memory outcome include: high preoperative verbal memory performance (high functional adequacy of the surgical hippocampus), intact MRI hippocampus (suggesting preserved function), and older age. Non-dominant (right) temporal lobectomy carries lower verbal memory risk but may affect visual/spatial memory. A: Much higher risk. C: Memory can be affected. D: Not inevitable. E: Both sides have different memory risks.

Reference: NICE NG217; ILAE Commission; Baxendale Memory Outcomes