CONTRIBUTION OF NEUROPSYCHOLOGICAL DATA TO THE PREDICTION OF TEMPORAL-LOBE EPILEPSY SURGERY OUTCOME

Purpose: We empirically examined the contribution of neuropsychologica l data to the prediction of postoperative seizure control relative to base rate information in an existing series of patients undergoing ant erior temporal lobectomy (ATL). Methods: A discriminant function predi cting surgery out come (seizure-free vs, non-seizure-free) was compute d separately for samples of patients with left (n = 79) and right (n = 62) temporal lobectomy (LATL, RATL). Predictor variables included 14 measures tapping five neurocognitive domains. The predicted base rates were compared with the actual base rates in the two samples. Finally, overall predictive accuracy was examined in optimal versus suboptimal ATL patients. Results: The base rate of seizure freedom in the LATL g roup was 74.70%; that in the RATL group was 66.10%. The predictive fun ction for the LATL group achieved a hit rate of 80.00% and a positive predictive power of 92.11%. The function for the RATL group achieved a hit rate of 83.33% and a positive predictive power (PPP) of 89.66%. T he overall predictive accuracy for the optimal group was only 55%, but that in the suboptimal group was 72%. Conclusions: Neuropsychological data used in a multivariate statistical fashion may be able to offer an incremental increase in the prediction of postoperative seizure fre edom relative to existing base rates of surgery success in patients wi th ATL epilepsy. The use of neuropsychological data may be of greatest predictive value in a population of ATL candidates with suboptimal fi ndings with a lower base rate of postoperative seizure freedom, but ma y actually reduce predictive accuracy in a group of ATL candidates fro m an optimal population with an already high base rate of surgical suc cess.