Intraindividual relative deficits in visual memory to lateralize seizure onset in temporal lobe epilepsy

It is well established that presurgical neuropsychological assessment can assist in lateralizing and localizing focal epileptogenic regions. However, unlike verbal memory impairment, which is a robust and reliable finding in patients with left temporal lobe epilepsy (LTLE), nonverbal memory deficits are less consistently found among patients with right TLE (RTLE). This study aimed to determine whether memory assessment for spatial location in addition to visual content would differentiate patients with RTLE and LTLE. We compared performances between patients with 25 RTLE and 37 patients with LTLE on the Wechsler Advanced Clinical Solutions-Faces (ACS-F) subscales (Faces I, Faces II, Content, and Spatial), verbal–visual memory asymmetry scores, and intelligence quotient (IQ)–visual memory difference scores. Results revealed no significant differences between patients with RTLE and LTLE for any ACS-F memory score. By contrast, groups demonstrated significant differences in memory asymmetry scores (p =.007) and IQ difference scores (p =.006). Thus, visual memory scores in isolation failed to differentiate groups with RTLE and LTLE; however, within-patient differences between visual memory and other cognitive abilities successfully differentiated the groups. These results highlight the importance of using an intraindividual model of neuropsychological assessment to identify relative weaknesses potentially associated with the epileptogenic region.