Pre- and post-operative Wisconsin card sorting test performance in patients with temporal lobe epilepsy due to hippocampal sclerosis

• Main Authors: Luciana Tisser, Andre Palmini, Eliseu Paglioli, Mirna Portuguez, Ney Azambuja, Jaderson Costa da Costa, Eduardo Paglioli, Carolina Torres, Jose Victor Martinez
• Format: Article
• Language: English
• Published: Associação Neurologia Cognitiva e do Comportamento
• Series: Dementia & Neuropsychologia
• Subjects: epilepsia do lobo temporal; escleroses hipocampal; disfunção executiva; Wisconsin card sorting test; cirurgia da epilepsia.
• Online Access: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1980-57642007000200173&lng=en&tlng=en

Abstract Patients with temporal lobe epilepsy due to hippocampal sclerosis (TLE/HS) have a distinct neuropsychological profile, but there is still debate on whether executive dysfunction is part of this profile and also whether temporal lobe surgery can modify this dysfunction. Objective: To study the presence and reversibility of executive dysfunction in patients with unilateral TLE/HS. Methods: Twenty-five patients with refractory seizures due to TLE/HS underwent presurgical evaluation which included the application of the Wiconsin Card Sorting Test (WCST). Nineteen were re-evaluated in follow up, at least 6 months after selective amygdalo-hippocampectomy (SAH). Twenty-two control subjects matched for age and education also performed the WCST. Results: Sixteen of the 25 patients (64%) completed fewer than four categories in the WCST whereas only 4 of the 22 controls (18%) did not complete at least four categories (p<0.005). In addition, the performance of the patients involved significantly more perseverative responses and errors compared to controls. The patient group demonstrated significant post-operative improvement in many measures of the WCST following SAH. Conclusions: These findings support the presence of executive dysfunction in patients with TLE/HS and suggest that such dysfunction can be partially reversed by selective resection of epileptogenic mesial temporal structures.