Frontal Lobe Dysfunction in Children With Temporal Lobe Epilepsy Patrícia Rzezak, BSc*, Daniel Fuentes, PhD*, Catarina A. Guimarães, PhD † , Sigride Thome-Souza, MD ‡§ , Evelyn Kuczynski, MD, PhD § , Li M. Li, MD, PhD † , Renata C. Franzon, MD, PhD † , Claudia C. Leite, MD, PhD ¶ , Marilisa Guerreiro, MD, PhD † , and Kette D. Valente, MD, PhD ‡§ There is evidence that adults with temporal lobe epilepsy present executive impairments. However, there is limited information in children, especially when using a comprehensive neuropsychologic bat- tery. We aimed to: 1) investigate the presence and severity of executive dysfunctions in children with temporal lobe epilepsy, and 2) determine the impli- cations of clinical variables (including etiology) in the occurrence and severity of executive dysfunction, using eight paradigms. Thirty-one children with temporal lobe epilepsy were evaluated and com- pared with 21 age-matched controls. Patients with temporal lobe epilepsy had significantly worse per- formance than controls. Intragroup analysis indi- cated that patients with symptomatic epilepsy were more impaired than those with cryptogenic epilepsy. In the former group, patients with mesial lesions performed worse than those with lateral lesions. Regarding the severity of executive dysfunction, 83.87% manifested severe to moderate executive impairment. Early age of onset, longer duration of epilepsy, and use of polytherapy were correlated with worse executive dysfunction. These findings indicated the presence of frontal lobe dysfunction in children with temporal lobe epilepsy, with worse performance in those with mesial temporal lobe epilepsy, early onset, longer duration of disease, and use of polythe- rapy. Our study corroborates the hypothesis that tem- poral lobe epileptogenic activity affects the extratem- poral regions that mediate attentional and executive functions. © 2007 by Elsevier Inc. All rights reserved. Rzezak P, Fuentes D, Guimarães CA, Thome-Souza S, Kuczynski E, Li LM, Franzon RC, Leite CC, Guerreiro M, Valente KD. Frontal lobe dysfunction in children with temporal lobe epilepsy. Pediatr Neurol 2007;37:176-185. Introduction In temporal lobe epilepsy, the presence of specific cognitive deficits, such as learning and memory impair- ments (functions known to be associated with the temporal lobes), are fully recognized as part of the typical clinical picture [1-3]. In addition, some studies demonstrated the occurrence of frontal lobe dysfunction, characterized by executive malfunctioning, in adults with temporal lobe epilepsy. These patients show perseverative responding and impair- ments in abstraction and problem-solving abilities [4-7]. Two hypotheses were postulated to explain this execu- tive dysfunction in patients with temporal lobe epilepsy. According to Corcoran and Upton [8], perseverative re- sponding could be explained by an impairment of working memory, determined by the involvement of the hippocam- pus per se. In their study, patients with hippocampal sclerosis performed poorly in a modified version of the Wisconsin Card Sorting Test compared with patients with either temporal neocortical lesions or frontal lobe lesions. On the other hand, Hermann and Seidenberg [5] proposed that temporal lobe epileptogenic activity might disrupt the extratemporal lobe connections responsible for executive From the *Psychology and Neuropsychology Unit, Institute of Psychiatry, Clinical Hospital, Medical School, University of São Paulo, São Paulo, Brazil; † Department of Neurology, University of Campinas, Campinas, Brazil; and ‡ Laboratory of Clinical Neurophysiology, Institute of Psychiatry and Department of Psychiatry, § Project for the Study of Psychiatric Disorders in Children and Adolescents with Epilepsy, Institute of Psychiatry, and ¶ Institute and Department of Radiology, Clinical Hospital, Medical School, University of São Paulo, São Paulo, Brazil. Communications should be addressed to: Dr. Valente; Rua Jesuíno Arruda 901/51; São Paulo, 04532-082 São Paulo, Brazil. E-mail: kettevalente@msn.com Received July 31, 2006; accepted May 25, 2007. 176 PEDIATRIC NEUROLOGY Vol. 37 No. 3 © 2007 by Elsevier Inc. All rights reserved. doi:10.1016/j.pediatrneurol.2007.05.009 ● 0887-8994/07/$—see front matter