Memory impairment in children with temporal lobe epilepsy: a review
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paper_title: Memory function in childhood epilepsy syndromes

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OBJECTIVE ::: Children with epilepsy are at risk of specific cognitive deficits. We aimed to compare and characterize the memory function of children with childhood absence epilepsy (CAE), frontal lobe epilepsy (FLE) and temporal lobe epilepsy (TLE). ::: ::: ::: METHODS ::: Epilepsy syndrome was identified by clinical data, seizure semiology, interictal and ictal electroencephalogram (EEG). Seventy children aged 6-18 years with CAE, FLE or TLE had neuropsychological assessment including memory function. After adjusting for epilepsy variables, neuropsychological results of the syndrome groups and normative data were compared. ::: ::: ::: RESULTS ::: Children from all three syndrome groups were at risk of memory difficulties. The duration of epilepsy correlated negatively with memory function. Children with TLE had the worst memory function, significantly lower in verbal memory tasks than children with CAE (P = 0.02) and children with FLE (P = 0.01). The performance of children with TLE was significantly below the normed mean across all verbal and most visual tasks. Compared to the normed means, children with FLE had results that were statistically lower in some verbal and visual tasks, and children with CAE were lower in two visual tasks only. ::: ::: ::: CONCLUSIONS ::: This study demonstrates memory dysfunction in three common childhood epilepsy syndromes. Children with TLE had the greatest impairment, children with FLE had memory difficulties not previously reported, and children with CAE had subtle memory deficits. Qualitative differences were also evident. Longer duration of intractable epilepsy was associated with reduced memory ability. Memory function and its potential impact on academic achievement are vital considerations when managing children with epilepsy.
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paper_title: Differences in memory performance and other clinical characteristics in patients with mesial temporal lobe epilepsy with and without hippocampal atrophy

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Abstract Mesial temporal lobe epilepsy (MTLE) is usually accompanied by memory deficits due to damage to the hippocampal system. In most studies, however, the influence of hippocampal atrophy (HA) is confounded with other variables, such as: type of initial precipitating injury and pathological substrate, effect of lesion (HA) lateralization, history of febrile seizures, status epilepticus, age of seizure onset, duration of epilepsy, seizure frequency, and antiepileptic drugs (AEDs). To investigate the relationship between memory deficits and these variables, we studied 20 patients with MTLE and signs of HA on MRI and 15 MTLE patients with normal high-resolution MRI. The findings indicated that (1) HA, earlier onset of seizures, longer duration of epilepsy, higher seizure frequency, and AEDs (polytherapy) are associated with memory deficits; and (2) there is a close relationship between deficits of verbal memory and left HA, but not between visual memory and right HA.
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paper_title: Pre- and postoperative verbal memory in pediatric patients with temporal lobe epilepsy

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Abstract Outcome studies concerning memory after pediatric temporal lobe surgery in the treatment of epilepsy are rare and have not yielded consistent results. In the present study, 55 children and adolescents with temporal lobe epilepsy (TLE; 26 left, 29 right, 6–17 years) performed a verbal memory test before and 3 as well as 12 months after different types of temporal lobe resections (anterior lobectomy, amygdalo-hippocampectomy (AH), lesionectomy (LX)). Groups did not significantly differ before surgery. Three months after surgery, the left resected group showed a decline in learning and delayed recall, and performed significantly lower than the right resected group. Recoveries were evident 1 year after surgery. The postoperative memory declines were associated with a left-sided resection and a higher preoperative performance. Comparisons on the different resection types suggest a special risk in patients undergoing a left-sided AH. In summary, our results indicate a functional association of verbal memory functions with the left temporal lobe similar to findings in adult patients. Declines after left-sided temporal resections seem to be reversible at least for part of the children, perhaps due to the greater plasticity of the immature brain.
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paper_title: Localization of lesions by neuropsychological testing.

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Neuropsychological evaluation differs from other methods used to localize cerebral lesions in that it analyzes cognitive function. Tests sample widely among cognitive abilities, contrasting language proficiency with visuospatial skills. A thorough assessment of memory is crucial in the investigation because of the prominence of the temporal lobes in epileptogenesis and their importance in memory. Different aspects of learning and memory are tested, and measures sensitive to hippocampal function should be included. Patients who will undergo elective surgery may also undergo intracarotid sodium amobarbital tests, which provide additional information about the integrity of each hippocampal region. Appraisal of frontal-lobe function is another important part of neuropsychological evaluation. A growing number and variety of neuropsychological tests have proven to be sensitive to lesions in this large and complex cortical area. Frontal-lobe function could be expected to vary according to the function of subregions within the frontal lobes, and some tests appear to be sensitive to specific regions.
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paper_title: Clinical, electrophysiological and neuropsychological findings of twenty-two children with mesial temporal sclerosis.

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Twenty-two patients, followed with the diagnosis of epilepsy between the ages of 8.5 and 19 years who were found to have mesial temporal sclerosis (MTS) on brain magnetic resonance imaging (MRI) were evaluated according to their clinical, electrophysiological and neuropsychological characteristics, and assessed for the significance of neuropsychological tests on lateralization. In both MTS groups, a remarkable number of patients had their intial seizure before one year of age (45.5% in the right MTS group, and 36.4% in the left MTS group). Half of the patients were seizure-free for a period of two months-9.5 years (average 3.9 years). The duration between the febrile seizure and first non-febrile seizure was 6.2 years. Eleven patients had MTS on the left temporal lobe. Interictal EEG was normal in five (22.5%) patients; 10 (45.5%) had temporal spike on the corresponding side with MTS. Six (27.3%) patients had paroxysmal activity and voltage asymmetry on cortical areas other than temporal region. The Wechsler Memory Scale (WMS), Visual Reproduction Subtest and Auditory Verbal Learning Test (AVLT) Delayed Recall and Retrieval Subtest performances were poor in the right MTS group.
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paper_title: Selective memory improvement and impairment in temporal lobectomy for epilepsy

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Reexamination of 23 patients 1 year after elective anterior temporal lobectomy for intractable complex partial (psychomotor) seizures showed a reduction in certain memory functions combined with an improvement in others. Both improvement and impairment in selective memory functions were related to the degree of postoperative seizure reduction as well as to the side of the remaining temporal lobe. The results imply that uncontrolled seizures interfered with the memory functions of the temporal lobe contralateral to the epileptogenic focus.
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paper_title: Cognition and behavior after temporal lobectomy in pediatric patients with intractable epilepsy.

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The increased use of surgical intervention for intractable epilepsy during childhood has resulted in a critical need for information concerning possible cognitive and behavioral changes in pediatric patients after surgery. In this pilot study, comprehensive neuropsychologic evaluations were completed on nine children who had a temporal lobectomy for intractable epilepsy before 16 years of age. Performances before and after surgery were compared using cognitive and behavioral measures. Repeated measures analysis of variance did not indicate differences in performance on the basis of laterality of surgery, although the number of left (n = 5) vs right (n = 4) temporal resections was small. Paired comparison t tests, which included all patients, did not suggest marked changes in cognitive functioning after surgery, although decreases in delayed verbal memory were evident. Positive effects on quality of life during the first year after surgical intervention were suggested by reduced internalizing symptoms and increased social interaction. Replication of this study is recommended with a larger number of patients and multicenter collaboration.
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paper_title: Object naming and semantic knowledge in temporal lobe epilepsy

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Object-naming impairment is common among temporal lobe epilepsy (TLE) patients, but other aspects of semantic memory have received limited attention in this population. This study examined object-naming ability and depth of semantic knowledge in healthy controls (n = 29) and patients with early onset TLE (n = 21). After administration of the Boston Naming Test (BNT), the authors asked participants to provide detailed definitions of 6 BNT objects. The TLE group demonstrated a significant deficit relative to controls in both object-naming ability and semantic knowledge for the target objects, even after controlling for IQ. In a multiple regression analysis that included other neuropsychological test scores as independent variables, the semantic knowledge score was the only significant predictor of patients' object-naming performance. Thus, at the group level, early onset TLE patients have a semantic knowledge deficit that contributes to dysnomia.
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paper_title: Neuropsychological Characteristics of the Syndrome of Mesial Temporal Lobe Epilepsy

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Objective: To identify the neuropsychological features of the syndrome of mesial temporal lobe epilepsy (MTLE), a surgically remediable epileptic syndrome defined by the presence of hippocampal sclerosis, using a broad and comprehensive neuropsychological test battery. Setting: Epilepsy surgery center. Patients: After scalp and invasive electroencephalographic monitoring, a consecutive series of 107 adults were found to have intractable complex partial seizures of unilateral left (n=62) or right (n=45) temporal lobe origin. Patients were included if they were not retarded and had left hemisphere dominance for speech but no magnetic resonance imaging abnormalities other than hippocampal sclerosis. Histopathological analyses of resected hippocamppi showed that 66 patients had hippocampal sclerosis (MTLE+), and 41 did not have evidence of significant hippocampal sclerosis (MTLE−). Interventions: None. Main Dependent Measures: A comprehensive battery of neuropsychological tests that included measures of intelligence, academic achievement, language, visuoperceptual or visuospatial function, memory and learning, attention, and problem-solving abilities. Results: The syndrome of MTLE was associated with considerable generalized cognitive impairment (in intelligence, academic achievement, language, and visuospatial functions), but not related to adequacy of performances in other selected cognitive domains (attention or concentration, executive functions). Materialspecific memory effects were obtained—primarily for verbal memory in association with left-sided MTLE. Conclusions: Distinct neuropsychological features of spared, compromised, and laterality-specific cognitive impairments characterize the syndrome of MTLE. This information needs to be incorporated into formal syndrome criteria.
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paper_title: Short-term and long-term memory in early temporal lobe dysfunction

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Following medial temporal damage, mature humans are impaired in retaining new information over long delays but not short delays. The question of whether a similar dissociation occurs in children was addressed by testing children (ages 7-16) with unilateral temporal lobe epilepsy (TLE) and controls on short- and long-term memory tasks, including a spatial delayed response task (SDR). Early-onset TLE did not affect performance on short delays on SDR, but it did impair performance at the longest delay (60 s), similar to adults with unilateral medial temporal damage. In addition, early-onset TLE affected performance on pattern recall, spatial span, and verbal span with rehearsal interference. No differences were found on story recall or on a response inhibition task.
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paper_title: Comparison of cognitive ability, personality profile, and school success in epileptic children with pure right versus left temporal lobe eeg foci

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By reviewing electroencephalographic reports compiled over five years and checking clinical details, we identified and studied 27 children with apparently pure left or pure right temporal lobe epilepsy. The children underwent neurological examination and neuropsychological testing (Halstead-Reitan Battery, Wechsler Intelligence Scale for Children [WISC] and Wide Range Achievement Test), and parents completed the Personality Inventory for Children (PIC). Of 15 boys and 12 girls with a mean age of 12.7 years, 14 had right and 13 left temporal lobe epilepsy. Seizure control was excellent in 17. Five (2 with left, 3 with right temporal lobe epilepsy) had received professional emotional help, 6 (3 with left, 3 with right focus) received special help at school, and 5 (3 with left, 2 with right focus) had failed a grade in school. No significant left–right differences were seen in WISC full scale, verbal, or performance IQ scores, neuropsychological test battery findings, or clinical scale scores on the PIC. Most of the children with unilateral temporal lobe epilepsy had no measurable cognitive or emotional difficulties. Cognitive, personality, and school problems were equally distributed between left and right temporal lobe epilepsy groups. When the two groups were combined, however, 10 patients (5 with left, 5 with right focus) were identified by the PIC as maladjusted, and as a group showed significantly lower neuropsychological test functioning than did the normally adjusted children.
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paper_title: Auditory/verbal and visual/spatial memory in children with complex partial epilepsy of temporal lobe origin

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Two groups of epileptic children and a normal control group were administered a Comprehensive Children's Memory Scale (Experimental Edition) which is presently being developed by this author. The first experimental group consisted of 12 children having complex partial seizures of right temporal lobe origin based upon clinical description and EEG/neuroimaging verification
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paper_title: Visual Spatial Learning Test.

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The Visual Spatial Learning Test (VSLT) is a visuospatial memory measure requiring little fine motor dexterity. A series of studies accessed the validity of the VSLT
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paper_title: Selective intellectual deficits in children with temporal lobe or centrencephalic epilepsy

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Abstract Specific patterns of intellectual impairment were observed in children with unilateral temporal lobe or centrencephalic epilepsy. The left temporal patients showed learning and memory deficits on verbal tasks while their performance on nonverbal tasks was unaffected. The converse was true for children with right temporal involvement. In contrast to the two temporal groups, the centrencephalic patients were without significant memory defect; instead, they showed lower scores on a test of sustained attention. The results are similar to those obtained in studies of adults with comparable cerebral dysfunction. The findings suggest that cerebral differentiation of intellectual processes is established in childhood.
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paper_title: Neuropsychological and behavioral status of children with complex partial seizures

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Neuropsychological and behavioral status were examined in 57 children aged 7 to 16 years with complex partial seizures (CPS) and compared with 27 sibling control children of the same age. Epilepsy had a significant effect on both cognitive and behavioral adjustment measures. Children with CPS had significant impairment across all seven cognitive domains assessed, reflective of a profile of relatively diffuse and generalized cognitive dysfunction. Age at onset of recurrent seizures was the strongest and most consistent predictor of adequacy of cognitive functioning; earlier age at onset was associated with poorer cognitive status. Children with CPS also had more problems compared with sibling control children on measures of social and school competence and internalizing behavior problems, but not externalizing behaviors. Further, frequency of seizure activity in the past year, rather than age at seizure onset, emerged as the strongest predictor of these behavioral difficulties. These findings are discussed in the context of understanding the impact of CPS on cognition and behavioral adjustment, and identifying the contribution of various aspects of the neurodevelopmental course of CPS to these issues.
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paper_title: Diagnosis and management of epilepsy.

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This article concisely describes the more common epilepsy conditions and will enable physicians to efficiently evaluate and manage these disorders. Salient aspects of the history and examination, together with electroencephalography, will usually determine the epilepsy syndrome (category), forming the basis for any further investigation and possible antiepileptic therapy. Imaging may be required in some circumstances.
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paper_title: Pre- and postoperative verbal memory in pediatric patients with temporal lobe epilepsy

paper_content:

Abstract Outcome studies concerning memory after pediatric temporal lobe surgery in the treatment of epilepsy are rare and have not yielded consistent results. In the present study, 55 children and adolescents with temporal lobe epilepsy (TLE; 26 left, 29 right, 6–17 years) performed a verbal memory test before and 3 as well as 12 months after different types of temporal lobe resections (anterior lobectomy, amygdalo-hippocampectomy (AH), lesionectomy (LX)). Groups did not significantly differ before surgery. Three months after surgery, the left resected group showed a decline in learning and delayed recall, and performed significantly lower than the right resected group. Recoveries were evident 1 year after surgery. The postoperative memory declines were associated with a left-sided resection and a higher preoperative performance. Comparisons on the different resection types suggest a special risk in patients undergoing a left-sided AH. In summary, our results indicate a functional association of verbal memory functions with the left temporal lobe similar to findings in adult patients. Declines after left-sided temporal resections seem to be reversible at least for part of the children, perhaps due to the greater plasticity of the immature brain.
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paper_title: Memory for faces in epileptic children before and after brain surgery

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Abstract Memory for pairs of unfamiliar children's faces was investigated in 29 children and adolescents suffering from left (LTLE) or right (RTLE) temporal-lobe epilepsy, before and after temporal-lobe surgery. Both immediate and delayed memory were tested. Before surgery, RTLE subjects performed worse than either LTLE subjects or normal children. After surgery, RTLE subjects improved significantly. Overall (after surgery), there was no significant LTLE-RTLE difference, but on delayed memory, the RTLE group was worse than the LTLE group. The results suggest specialization for facial memory in the right hemisphere of young patients, as in adults, despite early brain damage.
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paper_title: Cognition and behavior after temporal lobectomy in pediatric patients with intractable epilepsy.

paper_content:

The increased use of surgical intervention for intractable epilepsy during childhood has resulted in a critical need for information concerning possible cognitive and behavioral changes in pediatric patients after surgery. In this pilot study, comprehensive neuropsychologic evaluations were completed on nine children who had a temporal lobectomy for intractable epilepsy before 16 years of age. Performances before and after surgery were compared using cognitive and behavioral measures. Repeated measures analysis of variance did not indicate differences in performance on the basis of laterality of surgery, although the number of left (n = 5) vs right (n = 4) temporal resections was small. Paired comparison t tests, which included all patients, did not suggest marked changes in cognitive functioning after surgery, although decreases in delayed verbal memory were evident. Positive effects on quality of life during the first year after surgical intervention were suggested by reduced internalizing symptoms and increased social interaction. Replication of this study is recommended with a larger number of patients and multicenter collaboration.
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paper_title: Are there changes in intelligence and memory functioning following surgery for the treatment of refractory epilepsy in childhood?

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Materials and methods:A retrospective review of the neuropsy- chological and medical variables of 26 children who underwent a cortical resection as part of the management of their medically refractory epilepsy was conducted. Neuropsychological variables included pre- and postoper- ative measures of intelligence (Wechsler Scales) and memory func- tioning (Wide Range Assessment of Memory and Learning). Medical variables included age at onset of seizures, age at surgery, site of resec- tion, and degree of seizure control postoperatively. Results: Twenty patients had temporal resections (13 left-sided). Six had extratempo- ral resections. In this series, cortical resection as treatment of epilepsy in children did not result in a signifi- cant change in performance on mea- sures of intelligence or memory functioning. No significant correla- tion was found between the medical variables and the neuropsychological outcome.
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paper_title: Verbal Memory and IQ in Children Who Undergo Focal Resection for Intractable Epilepsy: A Clinical Review

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Previous studies have indicated an increased likelihood of intellectual and memory impairments in children with epilepsy. It has been argued that early surgical intervention in children with intractable seizures might be advantageous to their development. We conducted a retrospective review of pre- and postoperative IQ and verbal memory scores in 16 paediatric patients who underwent temporal (N = 10) or extra-temporal (N = 6) focal surgery for epilepsy. Patients with an extratemporal seizure focus performed significantly worse than patients with a temporal lobe seizure focus on Full Scale IQ and Verbal IQ before surgery. Postoperatively a statistically significant decline in verbal memory, but not in any of the IQ indices was noticed in the extratemporal group. Individual outcome analyses revealed a significant decline in verbal memory in 22% of temporal lobectomy and 60% of extratemporal cases. Our review suggests that verbal memory but not IQ is vulnerable to postoperative decline in children who undergo focal extratemporal surgery for intractable epilepsy. The findings raise the possibility that extratemporal regions play a role in anterograde memory in children. Given the small number of subjects in this study, further investigations into the cognitive effects of paediatric surgical intervention are recommended.
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paper_title: Greater functional recovery after temporal lobe epilepsy surgery in children

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The purpose of our study is to evaluate whether children recover better than adults from memory deficits as a consequence of temporal lobe surgery. We compared 3 and 12 month outcomes obtained in children and adults with medically refractory epilepsy. Each candidate underwent temporal lobe resection for seizure control and children were matched with regard to pathology, onset of epilepsy, side of surgery and type of surgery with adults (N = 30 for each group, mean age at surgery 13 versus 30 years). Three months after surgery, both left-resected groups displayed a significant decline in verbal learning capacity. During the following 9 months, only the children recovered and were able to reach their preoperative level 1 year after surgery. The left-resected adults remained, for the most part, on their low level and one year after surgery, they were still significantly worse than at the time of their preoperative examination. The right-resected adults experienced a deterioration in visual memory 1 year after surgery relative to the results of the short-term follow-up; the children improved. The children also had a better outcome with regard to attentional functions and, as a trend, a better seizure outcome (Engel Outcome I--1 year after surgery: 63% adults, 80% paediatric patients). Our neuropsychological data provide evidence of greater plasticity and compensational capacity in childhood. The results can be taken as a strong argument for early surgical intervention.
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paper_title: Neuropsychological Effect of Temporal Lobe Resection in Preadolescent Children with Epilepsy

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PURPOSE ::: Numerous studies have demonstrated changes in cognitive, memory, and language functioning in adults and adolescents after temporal lobectomy, yet little information is available regarding neuropsychological outcome in preadolescent children. ::: ::: ::: METHODS ::: We studied pre- and postoperative neuropsychological test results from 14 children who underwent temporal lobe resection for intractable epilepsy at age 7-12 years (mean 9.4 years). ::: ::: ::: RESULTS ::: Thirteen patients (93%) had no seizures or less than one seizure a year at follow-up 23-48 months (mean 34 months) after operation. Postoperative neuropsychological testing was performed 6-9 months (mean 7 months) after surgery in 13 patients and 36 months after the first operation in 1 patient who underwent two-stage resection of a tumor. Verbal, Performance, and Full Scale IQ were initially in the low-average range, with no significant change across the pre- and postoperative evaluations. Immediate verbal memory performance decreased significantly in children who initially performed above the median preoperatively and tended to decrease in children who had left rather than right temporal lobe resection. Significant postoperative decreases in delayed memory scores were independent of preoperative ability or side of resection. ::: ::: ::: CONCLUSIONS ::: Our small study suggests vulnerability to postoperative decline in immediate verbal memory scores in preadolescent children who have higher baseline immediate memory function or undergo left rather than right temporal lobe resection, similar to that observed in adolescents in adults. The entire group exhibited a statistically significant decrease in delayed verbal memory. Study of larger series of patients will be important to clarify further the short- and long-term risks and benefits of temporal lobe resection in childhood.
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paper_title: Outcome of Temporal Lobectomy in Adolescents

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We performed temporal lobectomy in 23 young patients with intractable complex partial seizures (CPS) at an average age of 14.5 years. At a mean follow-up interval of 4.8 years, we reevaluated the patients to assess the surgical outcome; 74% were seizure-free. Cognitive testing showed slight improvement in Full-scale I.Q. scores and in some subtest scores. Wechsler Memory Scales had not changed significantly from the preoperative scores. Both pre- and postoperative Minnesota Multiphasic Personality Inventories 168 (MMPIs) were obtained in nine patients; and only postoperative MMPIs were obtained in 18. Pre- and postoperative social function, reported by the patients in a structured interview with a clinical psychologist (H.S.S.), was scored by a rating scale. All patients reported postoperative improvement in social function, although of variable degree. Patients were divided into a well-adjusted and a poorly adjusted group based on their postoperative social function. As compared with the well-adjusted group, the poorly adjusted group reported more preoperative social problems, had lower preoperative and postoperative I.Q. scores, had poorer postoperative seizure control, and had higher postoperative MMPI scores.
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paper_title: Transparahippocampal selective amygdalohippocampectomy in children and adolescents: Efficacy of the procedure and cognitive morbidity in patients

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Object. Unilateral resection of the hippocampus and amygdala can be used to treat medically intractable mesial temporal lobe seizures. To date seizure outcome and the extent of cognitive morbidity have been unknown in children following the transparahippocampal variation of selective amygdalohippocampectomy (TSA), which prompted the present prospective study. Methods. Preoperative examinations and outcomes in 22 consecutive children and adolescents who underwent TSA were studied. Cognitive and psychological morbidity were assessed using standard neuropsychological instruments. The authors evaluated relationships between seizure control and cognitive morbidity and 13 and nine clinical variables, respectively. Seizure control was achieved in 11 (65%) of 17 patients (> 2 years follow up). Among 13 clinical variables, the only preoperative finding that had a significant bearing on seizure control was the presence of unilateral hypometabolism, which could be observed on [18F]fluorodeoxyglucose—positron emissio...
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paper_title: Temporal lobectomy in children with epilepsy

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The results of temporal lobectomy for medically refractory seizures are analyzed in 29 boys and 21 girls with a mean age of 15.8 years. The average age at onset of seizures was 7.5 years, and the time between onset and surgery averaged 8.3 years. Postoperatively, 27 patients (54%) were seizure-free, 12 patients (24%) had only occasional auras without loss of consciousness, five patients (10%) had fewer seizures, and six (12%) were unchanged. Therefore, 78% were essentially seizure-free and 88% benefited significantly from the operation. There was no significant change in the Wechsler Intelligence Scale scores before and after surgery; however, the shorter the time between seizure onset and surgery, the greater the likelihood of improvement in verbal and perceptual intelligence quotient. Social outcome was significantly improved, and a large percentage of patients were either in school or actively employed. Early consideration of temporal lobectomy in children with medically refractory seizures is recommended.
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Title: Memory Impairment in Children with Temporal Lobe Epilepsy: A Review

Section 1: Introduction
Description 1: Provide background on temporal lobe epilepsy (TLE) and its impact on memory, highlighting differences between adults and children.

Section 2: Neuropsychological Deficits in Adults with TLE
Description 2: Discuss the specific cognitive impairments, particularly memory deficits, in adult patients with TLE and the relationship with hippocampal damage.

Section 3: Neuropsychological Features in Children with TLE
Description 3: Review the diverse clinical, electroencephalographic, and etiological presentation in children with TLE and the limited studies available on neuropsychological deficits.

Section 4: Memory Impairment and Lateralization of Lesion
Description 4: Examine the correlation between memory impairment and the lateralization of lesions in children, comparing findings with those in adults.

Section 5: Effect of Epilepsy Duration and Other Variables
Description 5: Discuss the impact of seizure frequency, neuropathology, seizure onset, and duration of epilepsy on neuropsychological functions in children.

Section 6: Post-Surgical Studies
Description 6: Analyze memory impairment in children after surgery, comparing outcomes with adults and discussing the varying results reported in the literature.

Section 7: Conclusion
Description 7: Summarize the findings, emphasizing the controversial data, and call for more studies to better understand the neuropsychological deficits in children with TLE and their implications for quality of life.