Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.