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Randomised controlled trial of naming outcomes in anterior temporal lobectomy versus selective amygdalohippocampectomy
  1. Victoria Ives-Deliperi1,
  2. James Thomas Butler2,3
  1. 1Neuroscience Institute, University of Cape Town, Rondebosch, Western Cape, South Africa
  2. 2Neurology, University of Cape Town, Rondebosch, Western Cape, South Africa
  3. 3Neurology, University of Stellenbosch, Stellenbosch, Western Cape, South Africa
  1. Correspondence to Dr Victoria Ives-Deliperi, Neuroscience Institute, University of Cape Town, Rondebosch 7701, Western Cape, South Africa; vickideliperi{at}icloud.com

https://doi.org/10.1136/jnnp-2020-324531

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    Introduction

    Surgery for medically refractory temporal lobe epilepsy (TLE) is well established, with favourable outcomes in seizure control, patient quality of life (QOL) and treatment costs.1 2 However, postoperative cognitive decline is a concern. Dysnomia is reported in 25%–60% of patients following anterior temporal lobectomy (ATL) in the dominant hemisphere.3 Selective amygdalohippocampectomy (SAH) is an alternative procedure in which temporal neocortex is spared to reduce functional impairment. No controlled studies have been conducted to demonstrate superior outcomes of either procedure. There is an imperative to establish whether SAH better preserves neuropsychological functioning without foregoing the seizure benefits of a more extensive resection. This study aimed to identify differential naming outcomes of SAH and ATL using a randomised controlled trial (RCT) design.

    Methods

    A parallel-group, single-centre RCT was conducted at a tertiary healthcare facility between 2012 and 2018. The trial was discontinued due to a diminishing recruitment rate. No interim analyses were conducted.

    All right-handed patients aged between 18 and 60 years diagnosed with medically refractory left mesial TLE and deemed suitable candidates for surgery were given an opportunity to take part in the trial. Visual naming was the prespecified primary outcome and measured using the Boston Naming Test (BNT).4 The instrument is the most frequently used assessment of naming in patients with epilepsy and has been shown to reliably detect postoperative dysnomia.5 An intention-to-treat analysis was planned and a sample size of 48 was calculated based on 80% power of detecting a five-point difference between the groups on the BNT, which …

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    Footnotes

    • Correction notice This article has been corrected since it first published. The provenance and peer review statement has been included.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.