Cognitive function fifty-six years after surgical treatment of temporal lobe epilepsy: A case study☆

We report a long-term follow-up investigation of a patient who was operated in 1954 to relieve intractable temporal lobe seizures characterized by automatism and amnesia. Neuropsychological review at 16 months after surgery showed a slight residual impairment of verbal comprehension and verbal recall and good nonverbal skills. Seizure-free since the operation except for two attacks in the early postoperative years, the patient has been off medication for 25 years and has pursued a successful career as an artist. Our investigation at 56 postoperative years focused on cognitive skills, with some emphasis on learning and memory; a clinical examination was also performed, and the anatomical extent of the resection was determined on 3-Tesla magnetic resonance imaging. Four age- and IQ-appropriate women were tested as healthy control subjects. The patient showed material-specific impairments in language and verbal memory compared with the control subjects and also compared with her own earlier performance, but her performance on other cognitive tasks did not differ from that of the control subjects. Thus, her specific deficits had worsened over time, and she was also impaired compared with healthy individuals of her age, but her deficits remained confined to the verbal sphere, consistent with her temporal lobe seizure focus and surgery.