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The neurobiology of cognitive disorders in temporal lobe epilepsy

Nature Reviews Neurology volume 7, pages 154–164 (2011)Cite this article

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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

  • Episodic memory impairment is a key feature of temporal lobe epilepsy (TLE)

  • Examination of patients following epilepsy surgery has contributed substantially to our understanding of the neuroanatomy of human memory

  • Wide variability is observed in the effects of anterior temporal lobectomy on postoperative memory function

  • Understanding the cause of this variability has improved our ability to identify patients at greatest risk of adverse cognitive outcomes

  • Cognitive morbidity in TLE can extend beyond memory function, and anatomical abnormalities can extend far beyond the temporal lobe

  • 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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Figure 1: Variability in verbal memory change following left and right anterior temporal lobectomy.
Figure 2: Verbal memory change following left anterior temporal lobectomy in relation to hippocampal pathology.
Figure 3: Change in the serial position curve following left anterior temporal lobectomy as a function of left hippocampal pathology.
Figure 4: Reduced gray matter thickness and white matter integrity in left MTLE.

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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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Authors and Affiliations

  1. Department of Neurology, Matthews Neuropsychology Section, University of Wisconsin School of Medicine and Public Health, 600 North Highland Avenue, Madison, 53792, WI, USA

    Brian Bell & Bruce Hermann

  2. Department of Neurology, University of California—Irvine, 105 Irvine Hall, Irvine, 92697–4275, CA, USA

    Jack J. Lin

  3. Department of Psychology Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, 60064, IL, USA

    Michael Seidenberg

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All authors contributed equally to the researching the data and writing the article, provided substantial contributions to discussion of the content and reviewing and editing of the manuscript.

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Correspondence to Bruce Hermann.

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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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