Subjective versus objective memory change after temporal lobe epilepsy surgery

Objective: To examine subjective versus objective memory change after anter ior temporal lobectomy (ATL). Methods: A prospective, controlled study. Con trols included 39 unoperated patients with intractable temporal lobe epilep sy (TLE) who were administered a series of cognitive and health-related qua lity of life measures at baseline and at 12-month follow-up intervals. The surgery sample included 65 patients with intractable, focal TLE who had und ergone either a right or left ATL. These patients were tested preoperativel y and at 6-month follow-up intervals. Subjective and objective memory chang e was quantified using a newly developed methodology to control for practic e effect and regression to the mean. Results: Measures of subjective and ob jective memory change were not significantly related in the surgery sample. Prevalence of significant subjective memory decline 1 year after surgery r anged from 3 to 7%, whereas prevalence of significant objective memory decl ine ranged from 26 to 55%. Postoperative levels of emotional distress signi ficantly predicted self-reported memory decline 1 year after ATL. Postopera tive medication side effect and seizure outcome were also related significa ntly to subjective memory change in patients who had undergone left ATL. Co nclusions: Subjective and objective memory change after temporal lobectomy are not related. Complaints of significant memory decline after ATL are inf requent and may serve as a marker for depression or other mood disorder rat her than organically based memory decline.