Pre- and post-operative Wisconsin card sorting test performance in patients with temporal lobe epilepsy due to hippocampal sclerosis

Patients with temporal lobe epilepsy due to hippocampal sclerosis (TLE/HS) have a distinct neu- ropsychological profi le, but there is still debate on whether executive dysfunction is part of this profi le and also whether temporal lobe surgery can modify this dysfunction. Objective: To study the presence and reversibility of executive dysfunction in patients with unilateral TLE/HS. Methods: Twenty-fi ve patients with refractory sei- zures due to TLE/HS underwent presurgical evaluation which included the application of the Wiconsin Card Sorting Test (WCST). Nineteen were re-evaluated in follow up, at least 6 months after selective amygdalo-hip- pocampectomy (SAH). Twenty-two control subjects matched for age and education also performed the WCST. Results: Sixteen of the 25 patients (64%) completed fewer than four categories in the WCST whereas only 4 of the 22 controls (18%) did not complete at least four categories (p<0.005). In addition, the performance of the patients involved signifi cantly more perseverative responses and errors compared to controls. The patient group demonstrated signifi cant post-operative improvement in many measures of the WCST following SAH. Conclu- sions: These fi ndings support the presence of executive dysfunction in patients with TLE/HS and suggest that