Objective:Neuropsychological assessment is an essential part of presurgical evaluation for epilepsy patients with refractory temporal lobe epilepsy. Evaluations assist in localizing and lateralizing epileptogenic focal points and identifying possible risks for cognitive decline following surgery. Researchers and clinicians consistently find that verbal memory dysfunction is an accurate indicator of left temporal lobe epilepsy (TLE) through verbal measures such as the CVLT-II. Although visual memory structures are assumed to be in the right (nondominant) hemisphere, visual memory assessments have not been reliable in identifying right TLE. It is hypothesized that assessments to test visual memory are confounded by verbal cueing to assist in visual learning. To account for this, researchers have identified that comparing verbal and visual score asymmetries does accurately differentiate left and right TLE patients. This study aimed to determine if verbalvisual asymmetry using the CVLT-II and BVMT-R accurately identifies left and right TLE relative weaknesses potentially associated with epileptogenic regions.Participants and Methods:As part of a pre-surgical neuropsychological evaluation, 37 well-characterized medically refractory TLE patients (18 right TLE; 19 left TLE) were administered the Brief Visuospatial Memory Test-Revised to evaluate visuospatial memory and the CVLT-II to evaluate verbal memory. A multivariate analysis of variance was used to compare RTLE and LTLE group performances on BVMT-R delay recall subscales, using T-scores. Then memory asymmetry scores were calculated by converting CVLT-II verbal delay memory scores to T-scores and subtracting BVMT-R delayed recall T-score from the verbal memory T-score. An independent samples t-test was used to compare asymmetry scores between the groups.Results:There were no significant differences between patients with RTLE and LTLE for BVMT-R Delay [F(2,34) = 0.11, p = .895]. There was not a significant difference when accounting for verbal-visual asymmetry (t (35) = 0.422, p = 0.675, d = 12.566) between left (M = -2.42, SD = 13.82) and right side (M = -4.17, SD = 11.09).Conclusions:The BVMT-R did not identify nondominant hemisphere dysfunction in this sample of 18 right TLE patients. Because visual memory performance did not inform lateralization, we investigated the usefulness of memory asymmetry. Inconsistent with our hypothesis, verbal-visual memory asymmetry scores did not differentiate RTLE from LTLE in this sample. These findings add to existing findings that the BVMT-R may not be able to identify visuospatial memory dysfunction in epilepsy. Additionally, these data indicate the inability to assess for visuospatial memory even when accounting for verbal abilities in epilepsy patients. Future research should consider alternate visuospatial measures for the evaluation of epilepsy patients.

中文翻译：

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TLE 患者视觉记忆功能偏侧化的 28 个挑战

目的：神经心理评估是难治性颞叶癫痫患者术前评估的重要组成部分。评估有助于定位和侧化致癫痫焦点，并识别手术后认知能力下降的可能风险。研究人员和临床医生一致发现，通过 CVLT-II 等言语测量，言语记忆功能障碍是左颞叶癫痫 (TLE) 的准确指标。尽管视觉记忆结构被认为位于右半球（非优势半球），但视觉记忆评估在识别右 TLE 方面并不可靠。据推测，测试视觉记忆的评估会被有助于视觉学习的言语暗示所混淆。考虑到这一点，研究人员发现，比较语言和视觉评分的不对称性确实可以准确地区分左右 TLE 患者。本研究旨在确定使用 CVLT-II 和 BVMT-R 的言语视觉不对称是否能够准确识别与致癫痫区域可能相关的左右 TLE 相对弱点。 参与者和方法：作为术前神经心理学评估的一部分，37 名具有良好医学特征的患者难治性 TLE 患者（18 名右侧 TLE；19 名左侧 TLE）接受修订版简短视觉空间记忆测试以评估视觉空间记忆，并接受 CVLT-II 评估言语记忆。多变量方差分析用于比较 RTLE 和 LTLE 组在 BVMT-R 延迟回忆分量表上的表现，并使用 T 分数。然后通过将 CVLT-II 言语延迟记忆评分转换为 T 评分并从言语记忆 T 评分中减去 BVMT-R 延迟回忆 T 评分来计算记忆不对称评分。使用独立样本 t 检验来比较各组之间的不对称评分。结果：RTLE 和 LTLE 患者之间的 BVMT-R 延迟没有显着差异 [F(2,34) = 0.11, p = .895]。考虑到言语视觉不对称性（t (35) = 0.422，p = 0.675，d = 12.566），左侧（M = -2.42，SD = 13.82）和右侧（M = -4.17， SD = 11.09)。结论：BVMT-R 并未在 18 名右侧 TLE 患者样本中发现非优势半球功能障碍。由于视觉记忆表现并不影响偏侧化，因此我们研究了记忆不对称的有用性。与我们的假设不一致的是，在此样本中，言语-视觉记忆不对称得分并未区分 RTLE 和 LTLE。这些发现补充了现有的发现，即 BVMT-R 可能无法识别癫痫患者的视觉空间记忆功能障碍。此外，这些数据表明，即使考虑到癫痫患者的言语能力，也无法评估视觉空间记忆。未来的研究应考虑使用替代的视觉空间测量方法来评估癫痫患者。