Background:
Patients with refractory complex partial seizures (CPS) are
at a higher risk for mental and cognitive impairments. Objective:
To evaluate the cognitive decline in patients with
refractory CPS of temporal lobe origin. Methods:
This study was carried out on 57 epileptic patients with
temporal CPS. They were grouped into the refractory group (32 patients),
subdivided into right (17 patients) and left (15 patients) subgroups, and the
control group (25 patients) with controlled CPS. All patients were subjected to
history taking, clinical neurological examination, electroencephalography
(EEG), magnetic resonance imaging (MRI) of the brain, and neuropsychological
assessment using: Wechsler adult
intelligence scale-revised (WAIS-R), Trail making test for assessment of
attention, Digit span subtest of WAIS for assessment of immediate retention,
and Bender Gestalt test for assessment of visual memory. Results:
The digit span, Bender Gestalt and WAIS-R tests showed
significantly lowered scores in the refractory group when compared to the
control group (p<0.05). The mean score of the Trail making test showed a
significantly longer time among patients with refractory than that of the
control group (p<0.05). The WAIS-R has an inverse correlation with each of
the duration of illness and the frequency of seizures. Hippocampal sclerosis
ranked the first MRI abnormality. The EEG was concordant to MRI findings in
hippocampal sclerosis. Conclusion: Patients
with refractory CPS of temporal lobe origin are at higher risk for mental and
cognitive impairments. Negative MRI studies in refractory CPS are still a
challenge. [Egypt J Neurol Psychiat
Neurosurg. 2012; 49(2): 149-156]
Key words: complex partial seizures, cognitive impairment, refractory
seizures.
Correspondence to Ashraf A. Aboelsafa, Department of
Neurology, Tanta University; Egypt. Tel:+20106622792. E-mail:
draboelsafa@hotmail.com