# Impact of gender and side of surgery on cognition, affectivity, and quality of life in patients undergoing temporal lobe epilepsy surgery: a prospective cohort study

## TL;DR

This study examines how gender and the side of brain surgery affect cognitive functions, mood, and quality of life in epilepsy patients, finding gender-specific differences.

## Contribution

The study reveals how gender and surgery side interact to influence cognitive and emotional outcomes in TLE patients.

## Key findings

- Men with right-sided surgery had poorer executive function and memory than women.
- Women with right-sided surgery had better memory than those with left-sided surgery.
- Quality of life improved after surgery, influenced by the side of surgery.

## Abstract

To examine the impact of gender and its interaction with the side of surgery on cognition, affectivity, and quality of life (QOL) in drug-resistant epilepsy, as well as postsurgical changes in these domains.

In this prospective cohort study, 86 adults with TLE (46 women and 40 men) underwent a neuropsychological evaluation before and one year after surgery, including attention, executive function, language, verbal and visual memory, anxiety, depression, and QOL outcomes.

After surgery, 84.1% of patients were seizure-free. In the group with right-sided surgery, men had poorer executive functioning (p = 0.05) and memory than women (for all, p < 0.05), independently of the time point (i.e., before or after surgery). Men with right-side surgery showed poorer executive function than those with left-side surgery (for all, p < 0.04), and a postsurgical anxiety decrease (p < 0.001). Women with right-side surgery had a better memory than those with left-side surgery, independently of the time point (for all, p < 0.001). Both genders showed postsurgical QOL improvements modulated by surgery side (p = 0.037). Regardless of the surgery side, women had poorer semantic fluency (p = 0.03) and QOL (p = 0.05) than men and postsurgical semantic fluency declines (p = 0.024), whereas men had postsurgical executive function declines (p = 0.05).

These findings underscore the importance of accounting for both gender and the side of surgery in understanding cognitive, affective, and QOL outcomes in patients with TLE, and could be useful for designing targeted neuropsychological interventions.

Temporal lobe epilepsy (TLE) is a condition that involves seizures and other challenges. Surgery is often used to help control seizures and improve the quality of life, but it can also affect cognitive functions. Women with TLE might experience different changes compared to men, and these changes may depend on which side of the brain is operated on. This study looked at how surgery affects the brain and overall well-being in 86 adults (46 women and 40 men) with TLE. We focused on how gender and the side of the surgery (left or right) influenced cognitive functions, affectivity, and quality of life. The patients were tested before surgery and again one year later. The results showed that most patients (84%) were seizure-free after surgery. Women who had surgery on the right side of their brain performed better on memory and executive functions compared to men. Also, women who had right-sided surgery had better memory than those who had left-sided surgery. Men with right-side surgery had poorer executive function than those with left-side surgery, and showed a decrease in anxiety after surgery. Both men and women showed improvements in quality of life after surgery, which were influenced by which side of the brain was operated on. Independently of the side of the surgery, women experienced a decline in word fluency, while men showed declines in executive function. These findings suggest that understanding how gender and the side of surgery interact can help healthcare professionals better plan treatments for patients with TLE.

In the right-sided surgery group, men had poorer executive function and memory than women.

Men with right-side surgery showed poorer executive function than those with left-side surgery.

Men with right-side surgery had a postsurgical anxiety decrease.

Women with right-side surgery had a better memory than those with left-side surgery.

Quality of life improved after surgery in both genders, modulated by surgery side.