Abnormally slow processing of language may be a factor contributing to the poor verbal memory seen in many patients with lesions of the anterior temporal region in the left hemisphere. This possibility was examined by comparing the performance of 12 patients with left temporal-lobe resections (LT), 10 patients with similar lesions in the right hemisphere (RT) and 13 normal control (NC) subjects on a lexical-decision task, a sentence-plausibility-judgement task, and a story-recall task. Stimuli were presented aurally, and, in the latter two tasks, at 5 different speech rates ranging from 125 words per minute (wpm) to 325 wpm. Recall of stories by LT subjects was not abnormally sensitive to the effect of increasing rate, although it was inferior to that by NC subjects at all speeds. LT patients presented aurally but not visually (Frisk and Milner, 1991), suggesting that the left anterior temporal region plays a special role in the processing of speech sounds.

Defining language lateralisation is important to minimise morbidity in patients treated surgically for temporal lobe epilepsy (TLE). Functional magnetic resonance imaging (fMRI) offers a promising, non-invasive, alternative strategy to the Wada test. Here, fMRI has been used to study healthy controls and patients with TLE in order (i) to define language-related activation patterns and their reproducibility; (ii) to compare lateralisation determined by fMRI with that from the Wada test; and (iii) to explore the usefulness of multiple fMRI language paradigms. 18 healthy controls (12 right-handed and 6 left-handed) and 24 pre-operative TLE patients (19 right-handed: 12 left-TLE, 7 right-TLE; 5 left-handed: 2 right-TLE, 3 left-TLE) were studied using fMRI. Four fMRI language paradigms used: phonetic and semantic fluency, and the naming of living and non-living things. The data for all 4 tasks were acquired during a single scanning session on two occasions. All patients also underwent Wada testing. In patients and controls, phonetic and semantic fluency tasks were robustly activating and strongly lateralising. Quantified language-related lateralisation from fMRI verbal fluency data was highly reproducible and concordant with the lateralisation of the Wada test. Both fluency tasks identified patients with atypical language lateralisation, including 4/12 right-handed patients with left-TLE and 4/5 left-handed TLE patients, regardless of the side of epileptic focus. In comparison, the two confrontational naming tasks were not strongly lateralising and did not reliably agree with Wada lateralisation in either 12 right-handed controls or 19 right-handed patients with TLE. However, there was a difference in the pattern of fMRI activation in right-handed pat ients with left-TLE. Left-TLE patients had a more right lateralised network of activation when naming living things relative to non-living things, suggesting that some patients may be at risk of a category specific naming decline for non-living things after left anterior temporal lobectomy. These results demonstrate that non-invasive fMRI measures of languagerelated lateralisation may provide a practical and reliable alternative to invasive testing for pre-surgical language lateralisation in patients with TLE. The high proportion of TLE patients showing atypical language lateralisation suggests considerable plasticity of language representation in the brains of patients with intractable TLE.

Defining language lateralisation is important to minimise morbidity in patients treated surgically for temporal lobe epilepsy (TLE). Functional magnetic resonance imaging (fMRI) offers a promising, non-invasive, alternative strategy to the Wada test. Here, fMRI has been used to study healthy controls and patients with TLE in order (i) to define language-related activation patterns and their reproducibility; (ii) to compare lateralisation determined by fMRI with that from the Wada test; and (iii) to explore the usefulness of multiple fMRI language paradigms. 18 healthy controls (12 right-handed and 6 left-handed) and 24 pre-operative TLE patients (19 right-handed: 12 left-TLE, 7 right-TLE; 5 left-handed: 2 right-TLE, 3 left-TLE) were studied using fMRI. Four fMRI language paradigms used: phonetic and semantic fluency, and the naming of living and non-living things. The data for all 4 tasks were acquired during a single scanning session on two occasions. All patients also underwent Wada testing. In patients and controls, phonetic and semantic fluency tasks were robustly activating and strongly lateralising. Quantified language-related lateralisation from fMRI verbal fluency data was highly reproducible and concordant with the lateralisation of the Wada test. Both fluency tasks identified patients with atypical language lateralisation, including 4/12 right-handed patients with left-TLE and 4/5 left-handed TLE patients, regardless of the side of epileptic focus. In comparison, the two confrontational naming tasks were not strongly lateralising and did not reliably agree with Wada lateralisation in either 12 right-handed controls or 19 right-handed patients with TLE. However, there was a difference in the pattern of fMRI activation in right-handed pat ients with left-TLE. Left-TLE patients had a more right lateralised network of activation when naming living things relative to non-living things, suggesting that some patients may be at risk of a category specific naming decline for non-living things after left anterior temporal lobectomy. These results demonstrate that non-invasive fMRI measures of languagerelated lateralisation may provide a practical and reliable alternative to invasive testing for pre-surgical language lateralisation in patients with TLE. The high proportion of TLE patients showing atypical language lateralisation suggests considerable plasticity of language representation in the brains of patients with intractable TLE.

Orientadores: Fernando Cendes, Íscia Lopes-Cendes / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-18T00:02:21Z (GMT). No. of bitstreams: 1 Bilevicius_Elizabeth_D.pdf: 3815616 bytes, checksum: 984636c562a41b059889857b7a8b2037 (MD5) Previous issue date: 2011 / Resumo: O objetivo foi realizar uma análise multifatorial dos aspectos clínicos e de ressonância magnética (quantitativos e qualitativos) relacionados à resistência ao tratamento com drogas anti-epilépticas (DAES) em pacientes com epilepsia de lobo temporal mesial e melhor caracterizar o grupo de resposta intermediário a DAES, aqui denominado remitente-recorrente. Foram incluídos 165 pacientes e divididos em 3 grupos de acordo com a resposta medicamentosa: 50 respondedores (31 mulheres) , 87 não respondedores ao uso de DAES (53 mulheres) e 28 remitentes-recorrentes (17 mulheres) . Estes foram avaliados quanto à idade, freqüência de crises e idade no início destas, presença de crises febris, presença e lateralidade da atrofia hipocampal à análise visual, fatores precipitantes e DAES utilizadas. A quantificação dos volumes hipocampais foi realizada através de volumetria manual pelo software DISPLAY e as comparações dos volumes médios de ambos os hipocampos foi realizada entre os 3 grupos e 30 controles sadios por ANOVA. As imagens de ressonância magnética também foram avaliadas através da técnica de Morfometria Baseada em Voxel (VBM) com o software SPM 5 (Statistical Parametric Mapping)/MATLAB 7.7.0, comparando os três grupos com 75 indivíduos normais e entre si através de Teste -T. Observamos que idade de início das crises foi menor (p=0,005) e a freqüência das crises ao início foi maior (p=0,018) em farmacorresistentes quando comparado aos outros 2 grupos. As DAES mais utilizadas foram a carbamazepina e o clobazam (em associação) em todos os grupos. As doses de carbamazepina utilizadas foram maiores em farmacorresistentes (p<0,001) e remitentes-recorrentes (p=0,02) em comparação aos responsivos. Em relação ao clobazam, observamos dose significativamente maior somente nos farmacorresistentes em comparação aos outros dois grupos (p=0,017). A comparação da média dos volumes hipocampais entre os 3 grupos e controle evidenciou diferenças somente entre farmacorresistentes e controles bilateralmente (esquerda ,p = 0,004; direita, p=0,02). A análise por VBM evidenciou atrofia de substância cinzenta em todos os grupos. No grupo farmacorresponsivo tal atrofia foi mais restrita a áreas ipsilaterais ao foco epileptigênico, ao passo que nos grupos farmacorresistente e remitente-recorrente esta atrofia apresentou-se mais difusa. A comparação entre os grupos evidenciou as seguintes áreas com maior redução de substância cinzenta nos grupos farmacorresistente e remitenterecorrente quando comparados aos farmacorresponsivos: frontal periorbital bilateral (p<0,01), cíngulo (p<0,05) e temporal contralateral ao foco epileptogênico (p<0,05). Desta forma, observamos que embora as características clínicas demonstrassem mais similaridades entre os grupos respondedor e remitente-recorrente, a análise de VBM mostrou redução de substância cinzenta mais difusa em farmacorresistentes e remitentesrecorrentes. Assim pudemos observar que as variáveis clínicas relacionadas ao pior prognóstico foram idade e freqüência de início de crises. Em relação às variáveis estruturais, embora a atrofia de substância cinzenta (SC) se apresentasse mais difusamente em pacientes de pior resposta medicamentosa, também ocorre em áreas extra-hipocampais e mesmo extratemporais em pacientes considerados farmacorresponsivos mesmo que ipsilateralmente ao foco epileptogênico. Por último, conseguimos caracterizar clínica e estruturalmente o grupo remitente-recorrente, observado na prática clínica, porém até então muito pouco reconhecido na literatura / Abstract: The objective of the present work was to investigate the relationship between brain MRI and clinical characteristics and patterns of antiepileptic drug (AED) response in patients with mesial temporal lobe epilepsy (MTLE).In order to do that,one hundred sixty five MTLE patients were divided into seizure-free with AED (50 AEDresponders, 31 women), 87 pharmacoresistants (53 women), and 28 remitting-relapsing seizure control group (17 women). All groups were evaluated regarding age, frequency of seizures and age at epilepsy onset, duration of epilepsy, febrile seizures (FS), presence and side of hippocampal atrophy on visual inspection (HA), initial precipitating injuries (IPIs), type and quantity of AEDS used. The right and left hipoccampi from 99 patients belonging to all three groups (43 pharmacoresistants, 31 pharmacoresponsive and 25 remitting-relapsing subjects). were submitted to manual morphometry by DISPLAY software (Brain Imaging Centre, Montreal, Canada) as well as hipoccampi selected from 30 healthy controls. The calculated mean from those hipoccampi were compared within subjects and with controls. For gray matter (GM) MRI voxel-based morphometry (VBM) we selected only patients with unilateral HA on visual MRI analysis (n=100). Comparisons were made between all groups and 75 healthy controls. Age at epilepsy onset was lower (p=0,005) and initial frequency of seizures was higher in pharmacoresistants compared with the other two groups (p=0,018). The most used AEDS were carbamazepine and clobazam (always in association). The highest carbamazepine dose was observed in pharmacorresistants (p<0,001) and remitting-relapsing group (p=0,02). The highest dose of clobazam occurred only in pharmacoresistant group (p=0,017). The comparison between the mean hippocampi volumes from three groups and controls showed differences only on the pharmacoresistants left (p=0,004) and right(p=0,02) hippocampus comparing to controls. All groups showed GM atrophy compared to controls in ipsilateral hippocampus, bilateral parahippocampal gyri, frontal, occipital, parietal and cerebellar areas. In the AED-responders group such findings were more restricted to areas ipsilateral to the epileptic focus and more widespread in pharmacoresistants and remitting-relapsing groups. VBM pairwise comparisons showed areas with GM volume reduction in pharmacoresistants and remitting-relapsing compared with AED-responders in bilateral periorbital frontal (p< 0,01), cingulum (p<0,05), and temporal lobe contralateral to the epileptic focus (p< 0,05). We may conclude that, pharmacoresistants and remittingrelapsing patients presented a similar pattern of GM atrophy which was more widespread compared with AED-responders on VBM. We could also observe that age at epilepsy onset was lower (p=0,005) and initial seizure frequency was higher in pharmacoresistants / Doutorado / Neurociencias / Doutor em Ciências

Orientador: Fernando Cendes / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-13T01:46:44Z (GMT). No. of bitstreams: 1 Campos_BrunoAugustoGoulart_M.pdf: 774663 bytes, checksum: ef708c3035e1e8aaca7bef6613de3b28 (MD5) Previous issue date: 2009 / Resumo: Objetivos: Comparar as medidas relativas de N-Acetil Aspartato (NAA) em pacientes com epilepsia do lobo temporal (ELT) entre aqueles com resposta adequada a primeira droga anti-epiléptica (DAE) com aqueles que não responderam a primeira DAE, requerendo outra monoterapia ou politerapia. Métodos: Nós estudamos 27 indivíduos no grupo-controle, 25 pacientes com ELT com resposta a primeira DAE (grupo-resposta) e 21 que não responderam a primeira DAE (grupo-falência) e que eram regularmente acompanhadas no nosso serviço de epilepsia. Todos foram submetidos a estudo por imagem e espectroscopia pela RNM e a razão NAA/Creatina foi calculada. Resultados: A razão NAA/Creatina foi testada por análise de variância (ANOVA) entre os grupos, mostrando uma significativa redução tanto no hipocampo ipsilateral quanto no contralateral relacionado ao EEG (p<0,001 e p=0,021 respectivamente). A análise post hoc não mostrou diferença significativa entre o grupo-resposta e o grupo-controle, mas com diferença entre o grupo-falência e os outros grupos. A análise individual mostrou uma redução maior que dois desvios-padrão abaixo da média dos controles em nove dos 21 (42,8%) pacientes no grupo-falência, mas em nenhum dos pacientes no grupo-resposta. Discussão: Nosso trabalho mostrou uma redução significativa na razão NAA/Cre no grupo com falência à primeira DAE, mas não no grupo com que apresentou resposta à primeira DAE comparado aos indivíduos do grupo controle. Estes resultados indicam que pacientes com ELT com resposta à primeira DAE têm menos evidência de dano ou disfunção neuronal/axonal comparado a aqueles refratários a primeira DAE. / Abstract: Purpose: To compare relative N-acetylaspartate (NAA) measurements in temporal lobe epilepsy (TLE) patients with good response to the first trial of AED (an important prognostic factor) to TLE patients who failed the first AED trial and required further AED trials with monotherapy or polytherapy. Methods: We studied 27 individuals in control-group, 25 TLE patients who responded to the first AED (response-group) and 21 who did not (failure-group) that were regularly seen at our Epilepsy Service. They were submitted to both MRI and proton spectroscopy, and NAA/Creatine ratio calculated. Results: ANOVA of NAA/Cre demonstrated significant reduction in both ipsilateral and contralateral hippocampus related to EEG focus (p<0.001 and p=0.021), and post hoc analysis of ipsilateral and contralateral hippocampus did not reach statistic significance between response-group and control-group, but we found difference between failuregroup and the others groups. Individual analysis showed NAA/Cre ratios lower than 2 SD below the mean of controls in nine of 21 (42.8%) patients in the first AED failure group (six with unilateral and three with bilateral NAA/Cre reduction) but in none of patients who responded to first AED. Discussion: Our study demonstrated observed in refractory and mild TLE patients with HA. These results indicates that patients with TLE who respond well to first AED have significantly less evidence of neuronal and axonal damage/dysfunction compared to those who are refractory to first AED. / Mestrado / Neurociencias / Mestre em Fisiopatologia Médica

No description available.

The research of my thesis focused on the use of transcriptomic open discovery approaches to interrogate the molecular basis of two distinct yet related neurological disorders that are both associated with cognitive decline, Temporal Lobe Epilepsy and Alzheimer’s Disease. Interestingly, a potential role for compromised synaptogenesis early in disease was common to both, as was the direct role that neurons may play in brain inflammatory processes involving glia. Temporal lobe epilepsy (TLE) is a progressive disorder mediated by pathological changes in molecular cascades and hippocampal neural circuit remodeling that results in spontaneous seizures and cognitive dysfunction. Targeting these cascades may provide disease-modifying treatments for TLE patients. Janus Kinase/Signal Transducer and Activator of Transcription (JAK/STAT) inhibitors have emerged as potential disease-modifying therapies; however, a more detailed understanding of the contribution of JAK/STAT signaling to epileptogenesis is required to increase the potential therapeutic efficacy and reduce adverse effects associated with un-targeted JAK/STAT inhibition. With our collaborators, my lab developed a mouse line in which tamoxifen treatment conditionally abolishes STAT3 signaling from forebrain excitatory neurons (nSTAT3KO). Seizure frequency (continuous in vivo electroencephalography) and memory (contextual fear conditioning and motor learning) were analyzed in wildtype (Wt) and nSTAT3KO mice after intrahippocampal kainate (IHKA) injection as a model of TLE. Selective STAT3 KO in excitatory neurons reduced seizure progression and hippocampal memory deficits without reducing the extent of cell death or mossy fiber sprouting induced by IHKA injection. In my thesis, RNA was extracted from harvested hippocampi 24 h after IHKA and libraries were prepared for bulk RNA-sequencing (70–80 million reads/sample) using the NextSeq 500 Illumina system. 3190 genes were differentially expressed in Wt mice injected with KA vs saline (fold change |1.5|, FDR=<0.05). Ingenuity Pathway Analysis (IPA) revealed significant enrichment in 2 overarching sets of pathways: 1) those related to synaptic signaling and 2) those related to inflammation. As expected, many of the IHKA-induced genes were previously associated with epilepsy or seizure disorders (260 for Seizure Disorder, 267 for Epilepsy or Neurodevelopmental Disorder), and Seizure Disorder had the highest activation score in Neurological Disease based on gene expression patterns. Interestingly, a closer analysis of the IHKA-induced gene set revealed an enrichment of STAT3-associated genes (216), most of which were upregulated by IHKA. Compared to the 3190 Differentially Expressed Genes (DEGs) between IHKA and saline-injected Wt mice 24 hours after SE, more than half of these DEGs (1609) were rescued when comparing IHKA-injected nSTAT3KO mice and saline-injected Wt mice, indicating a significant rescue of gene expression when nSTAT3 is absent in excitatory neurons. While nSTAT3 KO influences the expression of genes in many different pathways, including the reversal of genes whose expression was inhibited in pathways of learning and memory by IHKA, the greatest surprise came from the predicted regulatory control over microglial function. nSTAT3KO mice displayed the greatest number of rescued DEGs compared to IHKA-injected WT mice in pathways that regulate inflammation and ion transport, and while inflammation was an expected response to IHKA, we were surprised to find evidence for its rescue in nSTAT3 KO mice. We also interrogated the expression of the Alzheimer’s disease genome as modeled using a rat model (TgF344-AD ) of familial AD that allows for behavioral and molecular characterization of AD, and expresses an endogenous pathogenic form of tau in addition to Abeta oligomers and plaques. AD is a neuropsychiatric disorder characterized initially by short term memory loss and disorientation, followed by declining cognitive functioning, and eventually, death. Widespread failure of 99% of AD drugs that make it to clinical trials has led to renewed interest in early signatures of disease in hopes of altering disease trajectory through early intervention. Key to such efforts is capturing a molecular window into AD at its earliest stages. The TgF344-AD rat shows overt pathology (including Aβ plaques, frank neuronal loss, and endogenous tau pathology) at 16 and 26 mo, but only to a very limited extent at 6 mo (Towne, 2013). Thus, in my thesis research, we set out to uncover any cell-type specific transcriptomic alterations that may be present in advance of major behavioral deficits or appearance of pathology, given that a strong body of literature suggests a long pre-symptomatic stage of illness in which subtle abnormalities may be present. 10x Genomics’ v3 gene expression assays were used to perform snRNA-seq on freshly dissected hippocampi from 6 mos, 9 mos and 19 mos littermate pairs of Tg and Wt rats (n=16 for 6 months and 9 months, with 8 for 19 months). ~2000 cells/subject were collected, and cDNA libraries were sequenced to a depth of ~120k reads/nuclei. Interestingly, data analysis revealed wide-scale gene changes in dentate granule cells (DGCs) and non-DGC excitatory neurons (Excit Ns) at 6 mos, suggestive of a significant decrease in synaptogenesis in Tg vs their Wt littermates, as well as small increases in cholesterol biosynthesis in the Tg rats in these cell types. By 9 months, some differentially expressed genes were observed across genotype in classes of glial cells, but the strongest impact on gene expression could still be seen in Excit Ns and DGCs, which continued to display evidence of decreased synaptogenesis, though to a lesser extent than at 6 mos. Interestingly, 9 mos Tg rats displayed an even stronger upregulation in genes related to cholesterol biosynthesis than 6 mos for both DGCs and Excit Ns. At 19 months, cholesterol and steroid biosynthesis were amongst the top biological pathways enriched for in Excit Ns and Inhibitory neurons of the Tg, to an even greater extent than changes in synaptogenesis. Altogether, our results suggest the transcriptional basis for a profound suppression of synapse formation or maintenance during early stages of illness in the TgF344-AD rat model, as well as abnormalities in neuronal cholesterol biosynthesis. Given that cholesterol is a key component of plasma membranes and lipid rafts, structures needed for the generation of new synapses and the stability of their receptor populations, it may be that deficiencies in the available cholesterol of Tg neuronal cells is leading to the impaired synaptogenesis in these cell types. Future work will focus on identifying whether these transcriptional alterations can be detected at even earlier time points, whether they are prescient for changes at the membrane in vivo that are correlated with memory impairment, and whether they are related to the alterations in the genome seen in our acquired epilepsy models, suggesting a common theme for the brain’s genomic response to injury of the hippocampus. / 2025-02-12T00:00:00Z

No description available.

A epilepsia do lobo temporal mesial (ELTM) é uma síndrome epiléptica de alta prevalência e de difícil controle medicamentoso. Cerca de 80% das cirurgias realizadas em centros de epilepsia são para tratamento desta síndrome. Do ponto de vista neuropsicológico, os pacientes portadores da ELTM podem apresentar prejuízos no processamento de memória declarativa, sejam elas de caráter verbal e/ou não-verbal, além de outras esferas da cognição. Normalmente, associam-se às queixas de memória, dificuldade de adaptação psicossocial e, consequentemente, piora na qualidade de vida. A reabilitação neuropsicológica tem demonstrado efeitos positivos como forma de tratamento para pacientes com lesões cerebrais de etiologias diversas. O presente estudo investigou os efeitos da reabilitação neuropsicológica no desempenho cognitivo, nas queixas de memória e sintomas de humor de 26 pacientes com ELTM clínica ou cirurgicamente tratados comparados a 14 indivíduos sem queixas neurológicas. De maneira geral, a reabilitação mostrou-se viável para pacientes com epilepsia independente do momento do tratamento: houve melhora na memória episódica auditivo-verbal, na aprendizagem, na fluência nominal, na intensidade das queixas de memória e nos sintomas depressivos. Mudanças semelhantes também foram observadas no grupo sem queixas neurológicas. Adicionalmente pode-se observar que a melhor resposta cognitiva após intervenção ocorreu no grupo com epilepsia cirurgicamente tratado, com melhora na maioria das variáveis cognitivas. / Temporal lobe epilepsy (TLE) is a high prevalence and drug resistant epileptic syndrome. Around 80% of surgeries performed at epilepsy centers aim this syndrome treatment. From the neuropsychological point of view, the patients with the TLE show declarative memory impairment, neither verbal and / or nonverbal processing and other cognitive failures. Usually, they are associated with memory complaints, difficulty in psychosocial adaptation and, consequently, worsening in quality of life. Neuropsychological rehabilitation has demonstrated positive effects as one of the treatments for patients with diverse brain injuries. The present study investigated the effects of neuropsychological rehabilitation on cognitive performance, memory complaints and mood symptoms of 26 TLE patients clinically or surgically treated compared to 14 individuals without neurological symptoms. Overall, rehabilitation proved to be feasible for patients with epilepsy regardless treatment timing: there was improvement in verbal episodic memory, learning, verbal fluency, memory complaints and depressive symptoms. Similar changes were also found in the group without neurological conditions. Additionally, the best cognitive response after intervention occurred in the group surgically treated, with improvement in most of the cognitive variables.

A avaliação neuropsicológica é instrumento auxiliar para lateralização em epilepsia temporal (ET). Desempenho comprometido em memória verbal (MV) e não verbal (MNV) sugeririam, respectivamente, disfunção no sistema de memória do hemisfério dominante e não dominante. Não há consenso sobre a capacidade lateralizatória da avaliação de memória em pacientes com epilepsia. Estudou-se o poder lateralizatório da avaliação neuropsicológica em testes de memória verbal e não verbal em ET secundária a esclerose mesial temporal (EMT) unilateral. Comparamos o desempenho em memória verbal (RAVLT e o Memória Lógica) e não verbal (RVDLT e a figura complexa de Rey) em 87 pacientes destros com EMT (44 direita, 43 esquerda) e 42 controles. Pacientes e controles tinham escolaridade>8 anos, QI>70, sem comorbidades. Pacientes com EMTE tiveram desempenho rebaixado comparado a controles e EMTD em evocação livre e tardia do RAVLT. EMTE e EMTD tiveram desempenho rebaixado em relação a controles em evocação livre e tardia em Memória Lógica. EMTD tiveram desempenho rebaixado em relação a controles em evocação tardia da figura complexa de Rey. Observou-se baixa prevalência de dificuldade em ambos tipos de memória em ambos os grupos. Quando considerado acometimento de específico de MV observou-se associação com EMTE, com baixa sensibilidade, médio valor preditivo positivo (VPP) e alta especificidade. Quando considerado acometimento específico de MNV observou-se associação com EMTD, com baixa sensibilidade e altos valor preditivo positivo (VPP) e especificidade. O poder lateralizatório da testagem neuropsicológica de memória em EMT é observado, em apenas uma parcela de pacientes com EMT unilateral / Neuropsychological testing is a standard tool in the evaluation of patients with epilepsy. It allows assessment of performance in various cognitive domains, and is used as a lateralizing tool for seizure focus localization. Poor performance in verbal memory (VM) test is believed to indicate a dominant hemisphere focus. Poor performance in nonverbal memory (NVM) tests would localize the focus to the nondominant hemisphere. There still is a paucity of evidence of the ability of neuropsychological testing to predict seizure focus lateralization. We studied the lateralizing ability of neuropsychological testing of VM and NVM in a sample of 87 right handed patients with epilepsy secondary to unilateral mesial sclerosis (MTS) (44 right R, 43 left - L) and 42 controls (C), with an IQ>70, eight or more years of schooling, without comorbidities. LMTS patients performed significantly worse than controls in free and delayed recall of RAVLT items. L and RMTS performed worse than controls in immediate and delayed recall of the Logical Memory stories. RMTS performed worse than controls in delayed recall of the Complex Rey Figure. Our findings showed a low prevalence of VM and NVM impairment in both groups, an association between specific VM deficit and LMTS, with fair PPV and good specificity, and low sensibility. Selective NVM impairment was associated with RMTS, with good PPV and specificity for RMTS, and low sensibility. The lateralizing power of neuropsychological testing is noted only in a minority of patients with specific selective patterns of VM and NVM impairment